In-Person vs Online Therapy: Is Online Therapy Effective?
A question we are frequently asked, both by existing clients and potential new clients is “Is Online Therapy Effective?”
At The Gaia Center, we offer in-person therapy at our office in West Nashville, as well as online therapy throughout the state of Tennessee. Both are great options, however, it’s a very personal decision that comes down to your unique needs.
When looking at your therapy options, there are so many factors to consider – and choosing whether you want to pursue online therapy vs. in person therapy is a great place to start.
Advantages of Online Therapy
Convenience
When engaging in online therapy, you don’t have to worry about driving to a physical office. This can be especially beneficial for folks who live in more rural areas who want to work with a specific therapist but the drive is too far. This can also be helpful for folks who can’t drive or don’t have access to a car. In addition, people who are physically disabled and find it challenging to leave home or those who experience chronic pain that is worsened by travel may prefer online therapy. Folks with busy schedules may also find it convenient to not have the “time cost” of commuting to our office. So long as you’re not in a moving vehicle and are physically located in Tennessee, we don’t care where you sign in for our virtual sessions!
Expanded Access to Specialized Care
In some areas, it can be challenging to find a therapist who specializes in your particular concerns or who offers a particular therapeutic modality that you’re interested in engaging in. We’ve seen this across a variety of presenting concerns, especially for eating disorders, trauma, and sex therapy. Given the time and financial investments that are put into therapy, it’s important to seek care that is specialized to your concerns. Our therapists at The Gaia Center offer most modalities both in person and online, allowing folks to receive specialized, individualized care anywhere in the state of Tennessee.
Flexibility
Some of our therapists offer additional time slots that are only available virtually – so if you’re open to online sessions, you may have more opportunities to work with a particular clinician than if you were only open to in-person therapy. In addition, some of our virtual clients choose to do their sessions on their lunch break due to not having another time to fit therapy into their schedule, which would be challenging to make work with an in-person session.
Continuity of Care
Maybe you are located in Nashville currently but are moving to another part of Tennessee – you can switch to online therapy and continue with your current therapist! This is also great for college students who go to school in Nashville but live in another part of the state on school breaks. In times of transition, it can be helpful to know you have the stability of having already built rapport with your therapist vs. having to start over with a new one.
Comfort and Privacy
While our office has super cozy vibes and privacy is of utmost importance to us, some folks feel more comfortable in therapy when doing it from their own home. In addition, some folks don’t feel comfortable with the possibility of running into someone they know in the waiting room (or if someone is a celebrity/public figure, the possibility of a fan recognizing them), so choosing to do therapy remotely provides the opportunity to know you won’t be seen in our office.
Safety For Those Who Are Immunocompromised
While we have protocols and policies that prevent our clinicians and clients from being present in the office while experiencing contagious illness, we know that some folks have health conditions that lead to a severely compromised immune system and can’t leave their house often. In cases like this, online therapy can make therapy accessible for when someone cannot leave their home due to health concerns.
Disadvantages of Online Therapy
Technology Challenges
For folks who have a poor internet connection or those who don’t have a computer, tablet, or smartphone, online therapy can prove to be a challenge (or, in some cases, impossible). While the platforms we use for online therapy at The Gaia Center for Embodied Healing are pretty user friendly, some folks do find that technology makes it too challenging. In addition, there is the risk of having a session stop abruptly if either you or your therapist loses power or internet connection. We have protocols/back up plans in place for our therapists (such as always having a second device available + also having phone sessions as a back up), but they aren’t fail proof.
Privacy and Confidentiality Concerns
For folks who live with others, if someone else is home, there is always the possibility of them overhearing your sessions. Our therapists are always in a confidential, private location, but we know that this isn’t always possible for our clients. If you don’t want to risk having any chance of having someone else present in your home hear you during your sessions, you may want to choose in-person therapy over online therapy.
Distractions
Due to the nature of online therapy, it is often much easier for clients to get distracted than during in-person sessions. Whether it’s the temptation of scrolling on your phone, your partner or children interrupting you, or your boss barging in on your break, there are times where distractions like these get in the way of therapy being effective. We’ve also seen that some (but not all!) adolescents struggle with getting distracted/remaining present during online sessions.
Difficulty Reading Nonverbal Cues
While our therapists are trained in ways to observe nonverbal communication/behaviors both during in-person sessions and virtual sessions, there is a difference between your therapist being able to see your full body vs. just your shoulders up (or however much of your body is visible on your screen). Some clients also report that there is a difference between being able to read your therapist’s energy/vibe in person vs. online, which can sometimes lead to struggles in building rapport.
Lack of Separation Between Home and Therapy
For some folks, having the symbolic transition of being in and leaving their therapist’s office is beneficial for their therapeutic process, especially if home isn’t a safe (emotionally, physically, or both) place for them. While many clients have other ways to have a sense of transition and closure (which we’re happy to help you create!), for some, the only way to have that feeling is by doing therapy in-person.
Situations Where Online Therapy Is Not Clinically Appropriate
Clients experiencing intense, acute suicidal ideation
In situations where there is a concern for a client’s safety, online therapy is typically not clinically appropriate. For client’s experiencing recurrent, intense suicidal ideation (especially when there has been any planning involved), online therapy is not a safe option due to the client not being physically in their therapist’s presence due to the risk of not being able to intervene in an emergency situation.
Clients who frequently experience severe dissociation
While our therapists have worked virtually with many folks experiencing dissociation, there are times where folks have dissociation so severe that it’s not possible to do trauma work or anything that can potentially create emotional dysregulation virtually due to the client not being able to physically ground themselves.
Clients who want to attend a virtual therapy group but don’t have a private, confidential space
While for individual sessions, it’s almost up to the client’s level of comfort in terms of if they’re okay with not being in a 100% private space, it is required for those attending therapy groups to have a completely private space where there is no possibility of someone walking in, for confidentiality reasons. For example, if a college student has a roommate and the therapy group is during a time where they only have access to their dorm room and their roommate is also present in the room, that would not be appropriate.
Research On The Effectiveness of Online Therapy
Loucas et al. (2014) - Efficacy of Internet-Based Interventions for Eating Disorders
This meta-analysis of 10 studies found that internet-based therapy for eating disorders was effective for reducing eating disorder symptoms, especially for bulimia nervosa and binge eating disorder. It noted significant decreases in frequency of binge eating episodes + improvements in eating disorder thoughts. This review also highlighted how online therapy can expand access to treatment for folks with eating disorders.
McGowan et al. (2021) - Online EMDR for PTSD During COVID-19
This study evaluated the efficacy of EMDR therapy delivered via the internet during the COVID-19 pandemic, involving 93 patients. It found that there were statistically significant and clinically meaningful reductions in PTSD symptoms.
Stoll et al. (2020) - Patient Satisfaction with Online Therapy During COVID-19
This study included a diverse range of participants and found that most participants had high levels of satisfaction with online therapy + didn’t report that the development of rapport + therapeutic alliance was compromised.
Turgoose et al. (2018) - Teletherapy for Veterans with PTSD
This study found that for a group of veterans diagnosed with PTSD, results of online EMDR were comparable to those of in-person EMDR.
Donker et al. (2015) - Internet Interventions for Mental Health in Children, Adolescents, and Adults
This review/meta-analysis included 8 studies and showed that online therapy led to a reduction in depression symptoms across age groups.
Wagner et al. (2021) - Internet-Delivered DBT Skills Training for College Students
This study found that participants who participated in online DBT skills training experienced marked improvements in stress, anxiety, depression, and use of emotion regulation skills compared to the control group.
Bradford et al. (2019) - Efficacy of Online Couples Therapy: A Randomized Controlled Trial
This study found that couples engaging in virtual couples therapy experienced significant improvements in relationship satisfaction, communication skills, and overall relationship quality, comparable to those in the in-person therapy group.
Pennant et al. (2015) - Effectiveness of Online Interventions for Adolescent Mental Health: A Systematic Review
This study found that online therapy led to improvements in anxiety and depression symptoms among adolescents. The study also highlighted the expanded access and flexibility that online therapy provides that in-person therapy may not.
McCarthy and Farrington (2020) - Efficacy of Online Sex Therapy for Couples
This study showed that couples assigned to online therapy experienced significant improvements in sexual satisfaction, communication about sexual issues, and overall relationship satisfaction that were comparable to those assigned to in-person therapy.
Buhrman et al. (2013) - Internet-Delivered Acceptance and Commitment Therapy for Chronic Pain
This study showed that participants assigned to the online ACT group experienced significant improvements in pain acceptance, pain-related interference and quality of life compared to the waitlisted control group.
Should I Choose Online Therapy or In-Person Therapy?
Research shows that online therapy can be just as effective as in-person therapy for a wide range of concerns, making both great therapy options. Ultimately, the decision between engaging in online therapy and in-person therapy is unique and individualized.
At The Gaia Center, we also offer a hybrid option where clients sometimes come into the office and sometimes do their sessions virtually. In addition, we always offer the option for clients to shift their sessions to virtual at any point, whether due to illness, inclement weather, or any other reason.
Some reasons why you may want to consider online therapy over in-person therapy:
You are looking for specialized care that you are not able to find in-person local to you or you want to work with a particular therapist who is located in your state but not within reasonable driving distance
You have a disability, chronic pain, injury, or health condition that makes leaving your home unsafe or difficult
Your schedule doesn’t allow you time to come to the office for therapy
You don’t have a car or access to public transportation
You want to work with a particular therapist but the only time slots they have that work with your schedule are only available virtually
You are moving somewhere else within the state your therapist is able to practice in but you don’t want to have to change therapists
You want the comfort and convenience of doing therapy from home vs. in-office
Some reasons why you may want to consider in-person therapy over online therapy:
You don’t have a reliable internet connection or access to a device that is compatible with telehealth platforms
You find yourself getting easily distracted during virtual sessions
You don’t have a private space at home to do therapy sessions
You are seeking therapy for your adolescent who gets distracted or isn’t mentally present when doing virtual meetings (i.e. if they have done virtual school and haven’t been able to remain engaged)
You experience severe dissociation and feel that it is unsafe for you to do deeper work when there isn’t a therapist physically present
You want to have a physical boundary between therapy and home
Summary
Online therapy and in-person therapy are both effective options for mental health support. Research shows that in most cases, the results of online therapy are comparable to the results of in-person therapy. Online therapy provides expanded access to specialized care and specialized therapeutic modalities that may not be accessible to folks living in more rural areas or those who have challenges that preclude them from being able to physically come into an office.
We have found that many of our clients report similar results and satisfaction with both in-person and online therapy and have had the opportunity to gain data on this as a result of some clients having to shift to virtual sessions due to moving or some clients alternating between virtual and in-person sessions.
There are pros and cons to both in-person and virtual therapy, and we are glad to offer both options at The Gaia Center for Embodied Healing.
