Wondering Whether to Start Online Therapy? 5 Pro's and Con's to Help You to Decide
Major Take-Aways:
The coronavirus pandemic has challenged entire industries to move online, and the delivery of psychological services is no exception
While some concern around the efficacy of online therapy is to be expected, its been established as a comparable alternative to in-person therapy for most people, most of the time
This article reviews five pro’s and con’s to therapy in the online environment in order to help you to decide whether online therapy is right for you
A reluctant move online
The coronavirus pandemic has compelled entire industries to go online, and psychological services like therapy have been no exception. Suddenly, a profession that had been resistant to moving online was forced to do so, and entire swaths of psychologists and therapists moved their practices online. While there is some hope that many therapists will return to offering in-person therapy sooner-than-later, the question remains: how did things pan out while working online?
The answer is surprisingly simple: online therapy has worked pretty well!
In fact, this sudden influx of online therapy providers and their clients has led to an explosion of new research on the subject, with a number of studies now detailing the appropriateness of online therapy for meeting the needs of clients and therapists alike. While the study of therapy rarely results in definitive black-or-white findings, what researchers have found is that online therapy is about as effective as in-person therapy for most people, with most concerns, most of the time. While that may not necessarily mean that most people or even most therapists prefer meeting online, it has given many therapists the confidence to provide online therapy with assurance that it meets our ethical obligations to provide quality, best-practice care. And, as you might expect, many therapists will likely continue to provide some combination of in-person and online therapy moving forward, given the latter’s convenience for our clients.
That said, even though online therapy is often as effective as in-person therapy, few would suggest that the two are exactly the same. Naturally, each experience brings its own set of distinct opportunities and potential drawbacks. In this article, I’d like to review just a few that I’ve noticed in the last 18 months of providing online therapy (at the time of this writing), so that you can make a more informed decision as to whether online therapy will meet your needs. As with most therapeutic concerns, if you’re ever unsure whether online therapy is appropriate for you, you should speak with a mental health professional who can collaborate with you on making this important determination.
Pro’s to Online Therapy
Added convenience
One of the main appeals of online therapy is its overall convenience relative to in-person therapy. For most of us, life is a busy intersection of competing concerns: everything from work to school to caregiving to homemaking to socializing to self-care compete for our limited time. We often prefer to maximize the time we do have by eliminating things that feel non-essential; for example, we might shop online rather than in-store to reduce this burden on our time, or we might outsource things like grocery shopping with UberEats or Instacart. Modern life is resplendent with conveniences!
Online therapy offers another opportunity to add convenience to our lives by cutting out the usual commute to a therapist’s office and broadening our options for where to meet with them. Suddenly, instead of having to make a hectic Metro commute 30 minutes both ways, we simply have to walk from the couch to our office desk or other private space. While that hour saved may not make or break our stress levels, it may reduce barriers to treatment for individuals who struggle with the commitment or who suffer from low energy or motivation because of difficulties like depression.
Increased accessibility
While online therapy can certainly make for a more convenient therapeutic experience, it can also mean greater access to therapy overall. For those of us seeking therapy in Washington, DC, accessibility may not be as great an issue as in rural parts of the country, but the landscape can still create unique challenges. For example, it may prove challenging to find a nearby therapist you really like who has availability, as area demand often outpaces the amount of therapists we have. It may also prove challenging to find a therapist who works with your particular niche of concerns. Online therapy helps ease these barriers by making difficult-to-reach therapists more accessible. For example, while your lunch hour in Georgetown may not be enough time to squeeze in an in-person session with someone in Dupont, it could be enough time to meet with them online.
It’s important to note here that most therapists are limited by licensing laws in terms of which clients they are allowed to see, and that most can only see clients who are physically located in the state(s) for which they are licensed. For example, I am licensed in DC, so my clients have to be physically present in DC when meeting with me. There are some exceptions to this however, and many therapists in DC are also licensed in Maryland, Virginia, or both. These rules are also rapidly changing for psychologists in particular as more states adopt PSYPACT, an interstate agreement to allow psychologists to practice across state lines. Nonetheless, it’s important to bear in mind that your therapist will likely still need to be local to you or that you will need to confirm they are licensed to work with you before getting started.
Greater comfort and approachability
Another unique advantage to online therapy is the relative comfortability it offers to clients, particularly those who may struggle to “open up” to someone new. Online therapy, insofar as it doesn’t require actually meeting face-to-face with a therapist, can sometimes feel less intimidating than in-person therapy. For example, some clients have shared that they feel less socially anxious than they would otherwise, and for this reason may be able to acclimate to therapy sooner and meet their goals more quickly without these fears distracting them. Others may simply appreciate the comfort of being in their homes, surrounded by familiar comforts that help them to feel more at ease. Ultimately, you have control over your environment when meeting online, which may just remove one additional anxiety to the process.
That said, while the added comfort is certainly a benefit to online therapy, I would caution you from making this the sole reason you decide to meet with a therapist online. Certainly, online therapy may help you to avoid your social anxiety, but avoidance as a response to anxiety is not always the most effective strategy for anxiety management, and it may even be counterproductive in the long-term. Experiencing anxiety when beginning with a therapist is entirely normal, and working through that anxiety can be an important part of the experience for those who find their anxiety gets in the way of other important day-to-day opportunities.
Enhanced opportunities for sharing
Just as being in your home may carry unique comforts, it may also carry unique opportunities to disclose the intimate details of your life to your therapist. You may find yourself referencing family members while talking with your therapist, for example, and choose to show your therapist a photo of them you keep on your desk. Alternatively, you may reference a significant object that results in a sort of show-and-tell that may otherwise not happen in-person. Some therapists have even reported that a client may share a song or play an instrument in-session— can you imagine lugging a guitar to a therapist’s office to do the same in-person? While I believe this is an altogether positive experience for many clients, it is also worth considering how this may lead to unwanted disclosures (as when a child walks into a room and hops on the call) or may make some clients self-conscious about their living space.
Added privacy
Lastly, seeing a therapist online may come with some added privacy. While online therapy presents unique vulnerabilities to your privacy (more on that in a minute), it also ensures that you can meet with a therapist without having to worry about running into a familiar face in the lobby or when leaving their office. While events like this are uncommon, they can happen, especially if you were referred to your therapist from a friend or loved one. Online therapy, for its part, reduces the risk of these awkward encounters entirely.
Con’s to Online Therapy
Technological hiccups
The majority of us working from home during the pandemic have endured our fair share of technological hiccups: everything from poor connectivity to microphones suddenly not working to embarrassing things said or done while we had believed we were on mute. These hiccups have generated a number of frustrations for many of us (as well as a few schadenfreude-ful viral clips), and many feel entirely unpredictable. Online therapy is notably dependent on a number of technologies on both the client’s and the therapist’s end, and while serious technological issues are generally far and few between, they happen and can feel significantly disruptive when they do.
Limited body language
If therapy were the economy, body language would be its currency.
While we may think that the “talk” of talk therapy is its most essential ingredient, the reality is that so much of what we communicate happens nonverbally. Even when we’re talking, it’s not just what we say, but how we say it that communicates meaning. Some of this nonverbal data can be lost online. For example, if you’re anxious and your leg is bouncing, I likely won’t notice. Subtleties like a quivering lip or trembling chin, even when in frame, may also become imperceptible due to issues of low resolution. Therapists are overall really good at reading these subtleties and using them to understand the nuances of your emotional state; while losing a few of these points of contact is not the end of the world, it can add unwanted complexity to the experience.
Interruptions, distractions, and complicating associations
We’ve all seen it: the co-worker whose children interrupt important meetings; the friend whose cat wants in on the action; or the boss whose spouse crossed the screen in nothing but a towel. The fact is, our homes are often bustling and busy places, and sharing space with others means the potential for interruptions that therapists otherwise work really hard to shield their clients from when working in-person. Even something as simple as an Amazon delivery can come at exactly the wrong time and interrupt you when you just begin crying— speaking from experience here!
In addition to these potential interruptions, clients may find that their homes can be distracting places to meet for therapy. Already, your home and its objects are associated with all kinds of different activities like play, entertainment, sleep, and nourishment. These associations prime us for those activities, so when we catch a glance of our refrigerator we might start thinking about our next meal or when we are in the same room as our beds we may feel sleepy. Even worse, online therapy can begin to muddle these associations; for example, if you meet with your therapist from bed, you may find it begins to affect the quality of your sleep. While having a devoted space and routine for meeting with your therapist online can help with this issue, it may initially disrupt your focus and attention.
Crisis management and severe need
While online therapy is appropriate for most people most of the time, a major exception to this includes individuals who are experiencing or at risk for significant emotional crisis (e.g., a suicidal crisis) or who have significant need. Online therapy may create unique barriers for therapists to ensure your or your loved one’s safety in the event of a crisis, and it is therefore likely not to be appropriate if you are at a significant risk for one. For clients requiring more intensive support, online therapy is likely only appropriate as a supplement to in-person therapy or when in-person is for one reason or another not a possibility. Additionally, certain forms of experiential therapy, like EMDR (Eye Movement Desensitization and Reprocessing) and exposure therapy, may not be appropriate in the online format when the option to meet in-person is a viable and likely superior alternative. If you are concerned that you are in or at risk for a serious crisis, or if you believe your mental health needs are significant enough to require in-person treatment, you should discuss this with a mental health professional when choosing whether online therapy is an appropriate fit to your needs.
Data privacy concerns
At the end of the day, all forms of therapy have their data privacy risks, and even meeting in-person is not free of these. However, meeting online creates a number of unique vulnerabilities that are at least worth considering when choosing to get started. For example, online therapy video streams may be vulnerable to security breaches from hackers or individuals who in some other way are able to acquire access to your online therapy session. These events are significantly unlikely, and most online therapists use platforms that defend against such threats. For example, the video software I use is HIPAA-compliant and integrates end-to-end encryption to protect your privacy, and the link at which we meet is unique to you (rather than a generic link used by all of my clients). Nonetheless, these risks are important to be aware of and to plan to defend against.
In short, online therapy works— and it may just work for you
While it is not without its disadvantages, online therapy has proven to be a stunning alternative to in-person therapy for many people with a range of therapeutic concerns. While it is not quite appropriate for all people and while many may simply prefer the opportunity to meet in-person, online therapy is likely to continue to be offered as a viable option for individuals seeking a convenient alternative to in-person. From my point of view, online therapy is simply here to stay.
Looking for online therapy in Washington, DC? Interested in working together?
I’m flattered! You can learn more about my experience with online therapy here, or check out a bit more of my webpage to learn more about me and my approach to therapy. Or, if you’re ready to jump right in, feel free to check-out my Contact page to get started.
