Is Online Therapy Effective? The Pros and Cons

This article is for informational use only, should not be considered clinical advice, and does not establish a patient-therapist relationship.

Online therapy is a broad term for therapy delivered via video/audio, email, and live chat. In this article, I will focus exclusively on live therapy using video and audio.

Benefits to doing online therapy

Disinhibition effect – If you plan to never meet your online therapist in real life and you live hundreds or even thousand miles away, it’s not unlikely that you’ll be less afraid of judgement. Then add to this the feeling of sitting in the comforts of your own house. The feeling is far different than sitting in a therapist’s professional office.

The online therapy environment can help you put your guard down and reveal information about yourself that you may never reveal or that would take much longer to come out and say in person. In online counseling, we call this the disinhibition effect. And it’s likely to make your therapy richer in many ways.

Extra layer of confidentiality – In online therapy, you don’t need to worry about a friend or family member seeing you or your car at a counseling office. Also, if you don’t live in the same town as your therapist, you don’t have to worry about running into your therapist around town or having mutual acquaintances.

Consistent treatment regardless if you move – If you’re seeing your therapist for in-person sessions, you decide to move out of town, and online therapy isn’t offered, it means you would need to find a new therapist. Online therapy fixes this.

There is one caveat, however. In the U.S., to practice therapy, each state has it’s own license. This means if your therapist is only licensed in one state (and most therapists are) and you move to a different state, your therapist won’t legally be able to see you any longer. If you move out of the country, it will depend on whether or not therapy is regulated.

Access to specialists – If you live in a rural area, you’re no longer limited to the one generalist therapist downtown. This means you can have access to leading specialists. And even if you live in a major city, maybe you came across a therapist’s article or video online that resonated with you deeply. Online therapy allows you to work with that person.

After-hours appointments – With no commuting, therapist are likely to offer a wider range of appointment times than before. This allows you to attend sessions that work better for your schedule.

 Lower cost – Since you won’t be driving to therapy, sitting in traffic, or stopping by a convientant store on the way back from therapy, you’ll spend less money by doing therapy online.

Cons to doing therapy online

Trust – There’s something about walking into a brick and mortar office. It’s easier to trust a therapist you see has an office, a sign, a parking lot, etc. Online is different.

Anyone can throw up a website. Is this person actually a therapist?

Also, there can be questions regarding your therapist’s professionalism online. Do they have actual office space or are they logging in from the same room they sleep in? Maybe your therapist will be less likely to dress in professional clothes online. And if these questions and concerns exist in your mind, it will impact how you view your therapist, the level of trust, and ultimately will impact the quality of treatment you’re getting.

Distractions – Without your full attention, therapy won’t be effective. And online therapy can make focusing a challenge. Distractions can range from electronic distractions (Internet browser, instant chat notifications, automatic software updates) to human distractions (doorbell ringing, roommate interruptions, kids).

And this goes for your therapist to. Your therapist might not be as present for you online as they are in person. You might catch them checking their cell phone or they may ask for a minute to check on their kids or dogs. This is important as it interferes with the therapy.

Personal connection – Some clients report they don’t feel as connected with their therapist online. And given how important the client-therapist relationship is in therapy is, this is an important area for you to consider.

Video/audio quality – Tech is great when it’s working. And when it’s not, it’s extremely irritating. If you have a low quality video/audio exchange with your therapist, the quality of your treatment is going to be negatively impacted.

Also, since you’re paying for sessions by the hour, it’s really important to consider how much of your session time is spent on your therapist addressing tech issues. You’re paying for treatment, not for spending time addressing technical issues.

Easier to cancel or miss sessions – It’s easier to cancel on someone you plan on never meeting in person. If the online world feels far less personal to you and you’re hesitant to go to therapy in the first place, it might really easy to keep putting it off.

Also, it’s easier to lose track of time at home, making it easier to accidently forget an appointment or show late.

More options means harder to make a choice – Since COVID, most therapists are not offering sessions online. This means more choices. And more choices isn’t always a good thing. It might be easier to bounce from therapist to therapist, in attempt to find the perfect one (when in fact the perfect one doesn’t exist). And the endless choices can feel overwhelming. All the therapists start to blend together and it become paralyzing.

It’s not suitable for some issues – Not all issues are appropriate for online therapy and each therapist will have different comfort level, knowledge, and experience for working with certain issues online.

Hard to switch to in-person therapy – If you meet your therapist only online and then decide you want to start seeing that same therapist in-person, you might find it to be extremely awkward. After so many online session, your mind starts to fill in missing information about your therapist: their height, their weight, their general demeanor and body posture. Your mind will also fill in other information: the size of their office, how comfortable their office is, maybe even the smell of the office. Once you meet in-person, none of it will be accurate and clients often report it feeling odd and disappointing.

If you start online with your therapist, it’s probably best to stay that way.

Things to look out for

Is the therapist licensed – If you’re located in the U.S., your therapist needs a license to legally provide mental health services in the state you’re physically located in. And the therapist’s license number should be easy to find on their website. If you don’t see it, ask. And if they can’t provide you with the number, this is a red flag and it’s likely the person is practicing illegally.

Verify the license – Do a Google search for the state their licensed in and the type of license (e.g., Marriage and Family Therapist, Social Worker, Psychologist, etc.). Also, add something like “verify license” to the search query. The search will look like:

“[state] [license type] verify license”

In the results you should see the state’s licensing board. Click on the result, which should bring you to the license verification webpage. If not, you should be able to navigate to it by searching the menu. Then type in the full name of the therapist or their license number.

This will tell you if the license is still valid, how long they’ve been licensed, and if they have any complaints filed against them.

What type of platform is your therapist using – There are many platforms to do videoconferencing. Some of them are secure, others are extremely insecure, which can compromise your privacy. Research the platform your therapist is using and make sure you’re comfortable with it.

If your therapist is using social media platforms like Facebook to exchange messages and videos that are intended to be private and confidential, this is a red flag. If it’s HIPAA compliant, that’s usually a good sign. 

How is your therapist storing your records – Most clients don’t think of it, but your therapist is legally required to keep records of each session. They are also legally required to store and maintain those records for 7 years after your final session. That means your therapist will be maintaining not only your personal information, but detailed records of your intimate, personal conversations for many years.

You should find out how your therapist stores their records. If they store it online, make sure it’s HIPAA compliant and/or stored in a very secure manner. If they keep physical records, ask how they secure them at their office. If you’re not comfortable with how they store your records talk them or find someone else.

Constant trouble with tech – If you find a good portion of your session is your therapist working out technical issues, you need to have a direct conversation about it or leave. In my opinion, a good therapist should be addressing this without the need for the client to bring it up. If their having trouble with tech, they need to get the extra training or equipment to resolve the issue. If they can’t they should refer you to a different therapist.

Of course some things are out of everyone’s control, but if it’s happening on a regular basis, and your therapist continues to struggle or ignore it, it needs to be addressed.

How to decide between online vs in-person therapy

Ultimately, it’s up to you decide if online therapy is best or not. It doesn’t matter what the research shows, and it doesn’t matter if you find the best therapist in the field, if it doesn’t work for you, that’s important.

For most clients, I think they’ll find online vs in person therapy is an even trade.

Very often I hear clients say that online will never work for them. They prefer in person. However, since the COVID crisis, this forced clients and therapists to move to exclusively online. Ancitodetly, I did not notice a significant impact on our work together. I also had many clients  who were initially resistant to the idea of online therapy, after a few online sessions, actually never looked back. They requested to stay online indefinitely.

I recommend trying both and asking yourself some questions:

  • Are you more open in one environment over the other?

How to find a therapist

Word of Mouth

One of the best ways to find an in-person therapist is through word of mouth. Ask a friend, a family member, or a doctor you trust to see if they know of anyone. Some of the best therapists around spread through word of mouth quickly.

Google

Do online searches for what you’re struggling with and dig a little deeper than the first page of Google. By searching for articles, podcasts, books, YouTube videos, you’ll likely uncover a few experts on your issue. This not only helps you find someone who knows what they’re doing, but also helps give you a taste of their style through their writing, video, or audio. If their material resonates with you, it’s probably a good sign.

Another way is through online directories. This can be a little tedious as there are endless pages of therapists who all seem to blend together. But, directories usually have some decent filtering tools to help narrow down your search.

Here are some online directories:

PsychologyToday

GoodTherapy

Associations

Most reputable therapist are members of associations. Therapists join these associations to network and stay informed on the best practices related to their works’ focus.

These associations usually have public resources including directories of therapists. There are general therapist associations (e.g., California Associations of Marriage and Family Therapists) and there are associations around particular issues (e.g., Association of Anxiety and Depression).

Try to find an association around a core issue you’re struggling with. If there is an association, you’ll likely find some of the best therapists here.

How to make the most out of online therapy

Get rid of distractions – If you expect your therapist’s full attention, then you should be prepared to do the same.

  • Make sure others in your house know it’s your alone time
  • Find a quite, confidential location so you can open up completely
  • Make sure you’re sitting in a comfortable spot
  • Log in 5 to 10 minutes before session to make sure your tech is working properly

Pretend like you’re walking into an office – When you go to therapy in person, there’s far more of a process than logging in from a computer. You get ready, you’re mentally planning what time you need to leave, you get in your car and drive. This process gives your brain time to transition away from whatever you were doing, and slowly get prepared for therapy.

I encourage clients to do something similar for online therapy. Have a process for getting your mind ready for therapy. It doesn’t need to be a 20 minute ritual, but it needs to something more than rushing to open your laptop and logging in right at the start of session. Here are some ideas:

  • Take 10 to 15 minutes to set up your laptop or computer and make yourself some coffee or tea before the session begins
  • Take a walk outside for 10 minutes or so before the sessions starts

Pretend like you’re walking out of an office

Test your Internet connection – A stable and fast Internet is key to having a successful session.

 

About the Author

Brian O'Sullivan, M.S., LMFT

Brian O'Sullivan is a Licensed Marriage and Family Therapist dedicated to helping people overcome their social anxiety. Brian uses Cognitive Behavioral Therapy to help clients better understand the role our thoughts, behaviors, and emotions play in either maintaining and calming anxiety.

This article is for informational use only, should not be considered clinical advice, and does not establish a patient-therapist relationship.