7 Question Guide to Decide on In-Person or Online Therapy

Online therapy experienced a sudden boom that was prompted by the spread of COVID-19 in 2020. Mental health became a nearly unavoidable topic of conversation as people were faced with unprecedented uncertainty on a global scale and experienced new levels of social isolation. Online therapy provided access to a confidential and therapeutic space to share these experiences and feel supported along the way. Since then, online therapy has stuck around, as many discovered the benefits of accessible, convenient, and effective therapy from the comfort of their own home.

At a Glance

• Pros and Cons of In-Person vs. Online Therapy
• Is Online Therapy as Effective as In-Person Therapy?
• Seven Question Guide to Help You Decide

Pros and Cons of In-Person vs. Online Therapy

In-person therapy and video therapy both offer merit to their customers. If you’re having a hard time deciding on what might be best for you, read on!

In-person therapy offers a neutral and [hopefully] comforting space that is likely to be quiet, private, and free from distraction. It is often recommended for people struggling with more severe mental health concerns that could benefit from a stable environment, crisis intervention, and in-person interaction that allows for a better sense of non-verbal communication.

Hybrid therapy models amongst clinicians have taken off since online therapy was popularized in 2020. A consequence of this trend is that many therapists offer in-person services part-time and work online the remainder of the time. For people seeking services, this can result in longer wait times for in-person therapy and fewer [desirable] options within your radius.

Online therapy has stuck around even after in-person restrictions surrounding COVID-19 were lifted in 2022. The spike of online therapy inspired research to evaluate the effectiveness compared to in-person care. The results speak for themselves, as we head into 2025 with online therapy being a preference for many.

Online therapy offers increased accessibility to a wider variety of therapists, convenience, reducing barriers to attendance (i.e., parking fees, traffic, commute time), ease and comfort if you are lucky enough to have a private and safe space in your home.

Unfortunately, issues with technology and Internet connectivity can be particularly frustrating when you’re already in a vulnerable state and time is limited. Some of those who opt for in-person over virtual options report doing so because it is close to where they live, they lack privacy or a calming space at home, they feel more connected to their therapist in-person (perhaps due to the richness of non-verbal communication), or they don’t want to sit in front of a screen for another hour of their day.

Moreover, if you are feeling especially distraught or in need of crisis intervention, support from a therapist in-person can feel more comforting and helpful than online.

Is Online Therapy as Effective as In-Person Therapy?

Yes, and…

The short answer is, yes, meta-analytic research has found virtual therapy as efficacious as in-person delivered therapy (Fernandez et al., 2021). A patient satisfaction study conducted in 2022 found that online therapy was the preferred format for therapy, particularly as exposure to telehealth increased (Waite, Diab, & Adefisoye, 2022). The results showed the majority of patients preferring virtual (60%), followed by no preference (26.7%), and then in-person (13.3%). It was suggested that positive therapy outcomes was partially associated with the higher attendance rates, completion rates, and number of treatment visits of virtual therapy.

While virtual therapy is an option for effective and accessible mental health care, it is important to consider personal preferences and individual differences in living circumstances. Luckily, many therapists offer hybrid options, such that clients can choose to flexibly schedule appointments online and in-person.

Seven-Question Guide to Help You Decide

The following questions can help you clarify your direction:

1. Do I have an intuitive preference for in-person or virtual therapy?
2. Are there desirable therapists available for in-person therapy in proximity to me?
3. Is travelling for appointments going to serve as a barrier or contribute as an unnecessary stressor given my schedule?
4. Are the pros of virtual therapy more important to me than the cons? Am I willing to deal with the cons of virtual therapy?
5. Are the pros of in-person therapy more important to me than the cons? Am I willing to deal with the cons of in-person therapy?
6. Is the option for hybrid therapy available to me?
7. Is there anything I can do to optimize my environment at home for virtual therapy?

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References:

1. Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., & Aboujaoude, E. (2021). Live psychotherapy by video versus in‐person: A meta‐analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy, 28(6), 1535-1549.
2. Ko, N. J. (2024, April 10). Virtual therapy vs. in-person therapy. Psychology.org. Retrieved from: https://www.psychology.org/resources/virtual-therapy-vs-in-person/
3. Waite, M. R., Diab, S., & Adefisoye, J. (2022). Virtual behavioral health treatment satisfaction and outcomes across time. Journal of Patient-Centered Research and Reviews, 9(3), 158.
4. Ward, A. (2024, March 19). Remote therapy just as good as in-person care, researchers find. McMaster University. Retrieved from: https://brighterworld.mcmaster.ca/articles/remote-therapy-as-good-as-in-person-mcmaster-research/