Technology has changed the way we live. We can connect with people all over the world in an instant. We are able to manage our calendars, our daily tasks, and even our finances with the click of a button. Technology has also given us new ways to manage our mental health.
If you are considering psychotherapy, virtual therapy is now an option. But is it really better than in-person therapy when it comes to managing your most sensitive issues? What are the pros and cons of in-person vs. virtual therapy?
Virtual vs. In-Person Therapy: The Science
In-person therapy involves face-to-face sessions where you sit together with your therapist to discuss your concerns and receive treatment. In-person therapy is often thought of as traditional therapy. It was the only option for treatment before virtual platforms were created. Today, in-person therapy is still preferred by many. And studies suggest that it might still be the gold standard.
According to research published in the Journal of Frontiers in Psychology, in-person therapy might be more effective than virtual therapy. The 2021 study included 1,257 therapists that had recently switched from in-person to virtual sessions (telehealth). Data was collected as soon as therapists made the switch to telehealth, as well as three months later to measure differences.
The results showed that therapists experienced several challenges with virtual therapy, including difficulties with emotional connection, distractions, privacy, and boundaries. All of these had a negative effect on the relationship between the client and provider, and the quality of therapy. The challenges also increased negative attitudes towards teletherapy itself.
After three months, the rate at which these challenges occurred decreased, except for distractions, which increased.
Scientific studies, like this one, can help us evaluate the upsides and downsides of each therapy method. But the success of treatment also hinges on your comfort level during sessions. Consider each pro and con of virtual and in-person therapy and consider how it might affect your overall experience.
In-Person Therapy: Pros
Face-to-face sessions feel awkward for some but lead to a greater connection with the therapist for others. Consider some of these benefits of in-person therapy.
Stronger Emotional Connection
The in-person nature of face-to-face therapy is able to provide qualities that can help therapists and their clients build a bond of trust and understanding with one another.
For instance, have you ever felt like you have deeper conversations with people when you're with them in person, rather than over the phone? Maybe you make eye contact or feel safer when you are physically close to them. Or, maybe you feel more present and are able to get a better handle on the vibe of the personal exchange.
Sometimes, a face-to-face connection can help people develop in a way that enables them enough to open up and talk about whatever has been weighing on their minds.
In-person sessions also give therapists an opportunity to observe a client's body language during a meeting. The way that you hold your body or move during a conversation can provide insight into how you are feeling. It provides one more avenue to help the therapist prompt more helpful conversations during a session.
Fewer Distractions
The majority of in-person sessions are held at a therapist's office. The office is generally set up to feel warm and inviting and to help you feel at ease when you step into session. Usually, the therapist is able to ensure that the room is quiet and that distractions won't interrupt the work that the two of you will do together.
In addition, when you step into an in-person therapy session, your therapist might ask you to turn your phone on silent or to put it away entirely. Doing so helps ensure that you can give your full attention to your session.
Enhanced Privacy
In-person therapy sessions offer privacy. Sessions are closed to other people that haven't been invited by the therapist or the client themselves. So whatever is said during the session stays between you and your therapist.
In addition, most therapy offices have specific policies that are designed to protect a client's privacy. For example, other people are usually unable to enter the room once the door is closed during session. The closed door can help you feel more at ease and help you feel more comfortable about sharing thoughts and experiences.
No Additional Supplies Required
You don't need access to a smartphone, a laptop, or even Wi-Fi in order to attend an in-person therapy session. All you have to do is show up and do your best to be open and honest.
While the cost of therapy sessions may be significant, in-person sessions don't require that you pay for additional supplies like a laptop or access to the internet. For this reason, in-person therapy might be more accessible than teletherapy, especially for people with fewer resources. There are some programs that provide access to mental health care but don't necessarily provide equipment for virtual care.
In-Person Therapy: Cons
Although there are several benefits that in-person therapy can provide, there are also some negative aspects when you compare it to telehealth. Depending on a person's unique needs and situation, these cons might mean that virtual sessions are a better fit.
Fewer Therapists
One major downside to in-person therapy is that it limits the number of mental health professionals that a person has access to. Access can be a significant issue for people who live in rural or low-income areas.
In these areas - often referred to as "healthcare deserts" - there are a limited number of healthcare professionals in general and even fewer mental health professionals. There may be long waiting lists to see a therapist or you may have to travel several hours away to seek mental health care.
In addition, therapists in these areas might be burned out due to the high demand and may not be able to provide the best care possible. Sometimes the long waiting lists might even discourage people from seeking help since they can't actually access care immediately when they need it.
Commute Time
In-person therapy requires that you add a commute time to your schedule. If your therapist's office is nearby, then the time added might be minimal. However, if your provider is further away, the commute may require you to shift other priorities in order to access care.
This added time commitment might discourage someone to avoid treatment. Or it might lead a client to work with a therapist who is nearby, but not a good fit.
Virtual Therapy: Pros
In a virtual therapy session, the therapist and client don't occupy the same physical room. Instead, they share a virtual online space. This allows both the client and therapist to remain in their own environments.
While the convenience of this setup seems appealing, we don't know yet if it offers any clear advantages. The field of psychology is still gathering more information about teletherapy in order to better understand the practice. Currently, research shows that there is no difference in the drop-outs rates of participants between virtual and in-person therapy. There are several reasons that people might prefer the virtual option.
Increased Access to Therapists
In most cases, virtual therapy can increase your access to mental health care. Virtual sessions allow you to see providers regardless of where they are located - increasing your access to different kinds of therapy and different types of therapists with various backgrounds. For instance, you might be able to find a provider who speaks your native language or who practices a holistic approach that interests you.
Telehealth creates the opportunity to reduce (and hopefully eliminate) the existence of healthcare deserts. And, with more therapists to choose from, it can reduce the time that you spend on a waiting list before receiving care.
No Commute Time
Telehealth is a great option for people that have full schedules or that simply don't want to have to drive to a therapist's office to receive care. It takes the stress of commute time out of the equation and can make it easier for people to incorporate mental health care into their daily routines. Instead of having to travel to and from an appointment, you can access care from almost anywhere.
More Convenient
Another advantage of virtual therapy is flexible scheduling. For example, you can schedule a telehealth session before you start work in the morning, during your lunch break, or immediately after you clock out. Increased convenience might encourage some people to work with a mental health professional and also ease thoughts about not having enough time to accommodate mental health needs.
Virtual Therapy: Cons
Because virtual therapy is new, studies examining long-term care in a virtual setting are lacking. The therapists surveyed in the 2021 Frontiers study had just recently switched to virtual sessions. They were in the middle of learning something new and trying to conduct sessions in a different format than they had traditionally been used to. So the impact of certain barriers may have been more significant.
The study also noted that the majority of these challenges were overcome by therapists within three months. And, that more experienced therapists reported fewer struggles throughout than newer professionals.
However, more than one study has found that virtual therapy can negatively impact treatment quality. Findings from the Journal of Medical Internet Research, show that many psychotherapists believe that virtual therapy can lead to more disadvantages and risks than in-person sessions. In addition, the study found that less experienced therapists held greater negative associations with telehealth than more experienced providers.
Disrupted Emotional Connection
According to the Frontiers study, therapists reported that virtual therapy sessions made it more difficult to establish an emotional connection. Building rapport and establishing a strong client-provider relationship are imperative because they allow clients to feel seen, heard, and understood.
When this connection isn't strong, you might not feel like you can open up. You might avoid talking about the thoughts, behaviors, or life events that brought you to therapy in the first place.
According to the study, virtual therapy sessions also made it more difficult for therapist to read emotions and even more challenging to express or feel empathy during sessions.
More Distractions
The 2021 study also found that telehealth therapy sessions involve more distractions for both therapists and clients. For example, during a session there might be someone knocking on a door, kiddos running in to see what you're doing, or pets crawling up to sit on your lap. Also, your house might be noisy, or unexpected guests could arrive mid-conversation.
There are plenty of interruptions that could draw your attention away from a therapy session. These distractions can make it more difficult to address the thoughts and issues that you want to discuss during your time in therapy.
Technical Difficulties
You don't have to be a tech guru to use virtual therapy. But, some tech-savvy experience might be helpful.
The success of virtual therapy is completely dependent on technology. If Wi-Fi shuts down, a computer freezes, or the telehealth platform doesn't work consistently, your session is affected. These challenges have a strong impact on your overall therapy experience.
In addition, some people may not feel completely comfortable using technology for one reason or another. Or, they might not appreciate the pressure of being on camera, especially if they already experience Zoom fatigue from their work environment.
No Guarantee of Privacy
Finding privacy at home is not always easy. For this reason, virtual therapy sessions can be challenging because a therapist can't guarantee or protect a person's privacy on the other side of the screen.
Some people might not have consistent access to a safe, quiet, and private space where they can feel comfortable holding teletherapy sessions. In these instances, you might fear that other people in the house will walk into the room or overhear your private conversations with their therapist. As a result, you might not share certain aspects of your life that are important for the therapist to understand.
More Difficult to Set Boundaries
According to the 2021 study, therapists reported that they had more challenges setting boundaries with their clients while facilitating virtual therapy sessions.
It may be more difficult for therapists to establish a professional space when working from home. Or, it may be challenging for professionals to keep certain aspects of their own personal lives private due to the possibility of interruptions from loved ones on their side of the screen.
If it is difficult to set and hold boundaries, it may be challenging to establish an appropriate client-therapist relationship, which could compromise the quality of the care.
Requires Additional Supplies
Although telehealth can increase a person's access to available healthcare providers, it can negatively influence accessibility in other ways.
For example, in order to attend virtual therapy sessions, you need to have a computer, a private space, and access to the internet. These might seem like easy fixes for some. However, they can create a greater financial burden and a source of stress for others.
How to Choose the Best Option for You
Many providers offer both virtual and in-person therapy sessions to clients. So it may be possible for you to test out both settings and see which one makes you feel most comfortable. If this is your first time exploring therapy, know that it may take a few sessions before you feel connected to your therapist, so don't be discouraged if both virtual and in-person therapy feel a bit awkward at first.
What's most important is that you're taking care of your mental health. Navigating through the pros and cons of virtual and in-person therapy is just part of the therapeutic process. Consider these factors as you decide which option is best.
Prioritize Your Needs
At the end of the day, you are the only person who knows whether in-person or virtual therapy is best for you. Think about what environment you would feel most comfortable in, and take into account how you feel about using technology.
You can refer to the list of pros and cons above to help you make an informed decision. Then, weigh the pros and cons from your perspective. Some downsides might not have a big influence, and certain upsides might be very impactful. What's important is that you think about your own wants and needs, and then go from there.
Evaluate Your Schedule
For many people, time is a huge barrier to accessing mental health care. So you might find it helpful to reflect on your schedule and the amount of time you can dedicate to therapy sessions.
Does it seem realistic to fit drive time to and from sessions into your schedule? Is there a mental health professional nearby that you could reasonably commute to? Can you make this commitment for the duration of therapy?
Ask yourself these questions and reflect on how your current schedule makes you feel mentally, physically, and emotionally. Then, use those reflections to help you make a decision that best supports your lifestyle.
Explore Your Resources
Another element to take into account when deciding between in-person and virtual therapy is the resources you have. Do you have consistent access to a private, quiet space? Will you have access to a computer and be able to connect to the internet? Do you feel comfortable using technology?
If you answered no to any of these questions, then maybe virtual therapy sessions might not be the best fit for you. In-person sessions may be able to help you avoid these pitfalls.
Consider Insurance
While the cost of therapy can vary, in-person and virtual therapy are usually offered at comparable rates. However, your insurance provider may not cover one or the other. Traditionally, if an insurance provider covered mental health services, it was assumed that those services would be offered face-to-face. But now many insurers have added the option of virtual therapy. But if you want insurance to cover your care, you should contact your provider to get details about what is covered and what is not.
Once you take into account your individual needs, preferences, and resources you should have a better idea about whether virtual or in-person therapy would be a better fit for you. If you decide on one option and it turns out to not be a great fit, you can always try the other. Go easy on yourself, and remember that all of your efforts are an act of self-care.
