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Online Therapy vs. In-Person Therapy: What are the pros and cons?

According to a recent scientific brief released by the World Health Organization, the prevalence of anxiety and depression worldwide increased significantly by 25% from the Covid-19 pandemic. This has resulted in an increased demand for therapy and other mental health services.

During the COVID-19 pandemic, because in-person therapy was no longer a viable option, online therapy, also known as virtual or tele-therapy, started to gain popularity. Since then, tele-therapy remains a very popular option of mental health care because of it's convenience for individuals and mental health professionals alike to access and provide mental health treatment from home. In contrast, a therapist's office provides a space for some clients to focus more due to eliminated work and home distractions. There are also times when teletherapy is used to complement in-person sessions or vice versa.

Each has unique benefits. Whether you're considering online therapy services yourself or have yet to start your therapy search, here's what you need to know about the differences between online therapy and in-person therapy and what their pros and cons are.

1. Communication method

The method of communication is one key distinction between teletherapy and in-person therapy.

Traditional therapy sessions take place in a therapist's office at a specified time. This allows you to have a real-time discussion with a licensed therapist while promoting holistic mental health assessment by allowing your therapist to pick up on your non-verbal cues such as body language and tone of voice.

On the other hand, online therapy sessions are done via texting on an app, audio calls or video chat. While it may appear that non-verbal cues are lost during online therapy sessions, this may not necessarily be the case in practice. For example, during video sessions, seeing a client's environment can offer additional nonverbal insights that are not available during in-person psychotherapy.

Additionally, because you are at home for online therapy sessions, you can quickly obtain objects that assist you in emotionally regulating or coping during difficult conversations. This is a luxury not found in traditional therapy methods.

Comfort is a key consideration in your choice here. While some people may feel confident connecting with a therapist in-person, others may feel anxious and more comfortable talking about their feelings and emotions behind a screen or without a face camera. Similarly, you may feel more comfortable to chat in your own room than being in a new environment, while others may welcome a change in scenery.

Ultimately, it comes down to your preferences and your therapist's technological capabilities.

2. Accessibility

Online therapy is undeniably more convenient than face-to-face therapy. Most online therapists offer more flexible scheduling, as not needing an office space allows them more availability for clients. Moreover, it saves you the hassle and time of commuting to your therapist's office. As such, online therapy allows busy individuals to schedule a therapy session into their hectic schedules easier.

The growing trend of online therapy also removes some logistical barriers, particularly for people who find it challenging to access in-person treatment for whatever reason. It could be a lack of transportation, a long commute, a disability, inability to take time off from work, anxiety, or childcare issues. These people can now receive the psychological assistance they require through online therapy with just access to a computer.

In a similar vein, traditional therapy methods may be the better option for you if there are logistical barriers to teletherapy. If your home is not a safe space for you, or if you do not have a private place to communicate at home, you may find yourself benefitting more from in-person therapy. Online therapy is also heavily reliant on an internet connection. Frozen videos and choppy conversations may make it hard to communicate and cause frustration for both sides. As such, a reliable internet connection can be a factor when deciding if online therapy is right for you.

3. Cost

Depending on where you live, the price of a traditional in office therapy session can run upwards of $200 per session. Some providers can charge less or more. Part of the reason why in-person therapy is more expensive is because therapists have to rent office space, which adds to their monthly expenses.

With online therapy, therapists can treat clients from home, and pass savings on to their clients. As such, tele-therapy can be a cheaper price option to traditional therapy.

Another financial consideration when making this choice is the external costs of in-person sessions. For example, the cost of commuting to and from your therapist every week is something you should take into account for as well.

4. Therapeutic alliance

The therapeutic alliance is an essential component of the therapist-client relationship. It contributes to the success of treatment.

According to Bordin, a therapeutic alliance consists of three parts: (1) the bond between the client and the therapist, (2) agreement on tasks aimed at improving the client, and (3) agreement on therapeutic goals.

Several studies have found a consistent relationship between the quality of the therapeutic alliance and the outcomes of in-person therapy. Which begs the question, "Is therapeutic alliance possible in online therapy?"

The answer is yes. Recent studies found that the delivery method of therapy (be it in-person, telephone or videoconferencing) did not significantly affect therapeutic alliance of mental health professionals.

Lastly, worth considering is the fact that individuals have a wider pool of therapists to choose from for virtual therapy versus traditional therapy. This is because instead of just the therapists that are close in proximity to you, you can choose to work with any therapist that is licensed in your state. Because of this, it may be easier to search for a therapist with a strong therapeutic alliance when pursuing tele-therapy.

5. Effectiveness

There is no doubt that face-to-face or traditional therapy is an effective treatment for mental health concerns, as demonstrated by numerous studies spanning over a century.

With the prevalence of online therapy, a lot of research has been done on it's effectiveness since the pandemic. A review of 17 studies show that it can be just as effective for clients as in-person psychotherapy for various mental health conditions. Specifically, a systematic review found that cognitive-behavioral therapy delivered online effectively treats depression, panic, and anxiety disorders in clients.

Additionally, many studies reported that clients find themselves "less conscious" and have a greater sense of control with virtual therapy. They were able to express their complex feelings and disclose difficult experiences to online therapists easier than face-to-face therapy. This is attributed to the feeling of being "safe at a distance."

Which is a better option?

As effectiveness and therapeutic alliance is similar for both in-person and tele-therapy sessions, there is no "better" option. There are pros and cons to both in office therapy and therapy online and it all comes down to personal preferences. The best way to start your therapy search is to engage in a treatment model that you feel most comfortable with. Then, you have the freedom to switch or explore other options if you think that one is better suitable for addressing your mental health concerns.

Remember that having a therapist to address your mental health concerns and improve your quality of life is better than not having one to talk to, even if it is not your preferred therapy method. It is also important to pick the method that will be easiest to motivate you to go to therapy every week. That said, research your options, read reviews, and find the right therapist for you, whether online or in-person.

Are you considering online or in-person therapy?

You might find it helpful to answer these questions before your search for a therapist. While this list of questions is not exhaustive, it can help you decide which mode of therapy is best for you.

  • Do I feel more comfortable talking face-to-face or virtually?

  • Do I have a space at home where I can talk privately with my therapist?

  • Can I limit distractions at home when it's time for my session?

  • Do I have access to a reliable internet connection?

  • Am I able to travel to my therapist's office?

  • Do I have time in my schedule to commute to my therapist's office?

  • Can I afford the extra cost associated with in-person sessions?

  • Are there many therapists in my area that are able to help me?

  • Would I be able to find a better fit with a therapist that is not near me?


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