Online Therapy vs. In-Person: What You Should Know – CNET [CNET]

Here’s how online services compare to up-close-and-personal talk therapy.

If you are having thoughts of suicide, or someone you know is in immediate danger, you should call 911 (or your country’s local emergency line) or go to an emergency room. Explain that it’s a psychiatric emergency and ask for someone who is trained for these kinds of situations.

More and more people are reaching for therapy services, and in 2024, we have online therapy options as well as in-person services to bridge some of the care gap people may experience when trying to manage their mental health and wellness. While both are great options, whether online therapy is the best choice for you will depend on your preferences and reasons for seeking therapy. 

“Online counseling can bring people to therapy who would otherwise not go,” Mark Pines, a licensed marriage and family therapist in California and the CEO and founder of OpenCounseling, a website that helps connect people to free and affordable counseling, told CNET in 2019. But, he said, “There are times when it should definitely not be used.” 

So when is online therapy appropriate and how does it differ from in-person sessions? Here’s what to consider in terms of services, efficacy, accessibility, cost and confidentiality. 

Services

With traditional psychotherapy, or talk therapy, you typically meet with a counselor at a specified time and place — usually at the therapist’s office — and speak face to face. The benefit of this is that you and the practitioner can have a real-time conversation, where they can pick up on your body language and tone of voice, which can give them insights on what you’re feeling. 

With online therapy, there are more options. Many therapists offer online therapy directly to clients through their private practice (you can search for one here). But there are a number of third-party companies, like Talkspace and BetterHelp, will also remotely connect you with licensed therapists.

The services offered depend on the platform or expert you see, but usually include:

Messaging via text, video or voice: With this option, you’re able to send messages to your therapist anytime through a third-party platform. The therapist will reply as soon as they’re able, though some platforms do guarantee a response within a certain amount of time.

Live text, video, or phone sessions: These are scheduled in advance and are typically conducted through the third-party platform, or with a therapist directly. They give you and your therapist a chance to communicate much as you would during a traditional in-person session. 

Ultimately, the form of communication you use will depend on personal preference — yours and your therapist’s. For instance, text messaging-based therapy is appealing to a generation of young adults who grew up communicating that way.

If you feel like text-message therapy is a good fit for you, check if any online therapy service or individual therapist offers that option.

Efficacy of talk therapy 

The efficacy of traditional talk therapy will vary depending on a few factors, including the type of therapy that’s used — such as cognitive behavioral therapy, psychodynamic psychotherapy, interpersonal therapy — as well as the issue it’s being used to treat. In some cases, talk therapy may be sufficient by itself to improve mental health symptoms, while other cases may require medication in addition to meetings with a therapist. 

But according to the American Psychiatric Association, about 75% of people who enter psychotherapy get some benefit from it, and it’s been linked to positive changes in the brain and body. In fact, research that shows that talk therapy can literally change your brain, strengthening the connection between regions of the brain that can help reduce symptoms and support recovery. 

In-peron vs. online therapy effectiveness 

In one small study, 93% of telepsychiatry patients said that they felt they could present the same information virtually as they could in person, 96% were satisfied with their sessions, and 85% were comfortable in their ability to talk. However, they did feel slightly less supported and encouraged during online therapy compared to in-person therapy. 

By and large, research seems to support online therapy as an effective route for treating conditions such as anxiety, depression and post-traumatic stress disorder. One 2020 study even found that online cognitive behavioral therapy (CBT) was at least as effective as in-person CBT in reducing the severity of depression symptoms.

However, there are some drawbacks to meeting with a therapist online instead of in-person. Notably, therapists may miss out on important details about someone’s body language or actions that may only be noticed in-person and can signal an important piece in someone’s mental health journey. As psychotherapist Sean Grover described in a 2023 article for Psychology Today, people’s “unspoken insecurities, destructive habits and psychical attributions” are often well-hidden on screen. While they may be uncomfortable to discuss, they can offer a mental health professional a more complete view of you for more effective treatment. 

Other caveats to online therapy is that it it may not be as effective for more severe cases of mental health conditions, or complex cases where a therapist may recommend the patient be seen in-office.

Accessibility

There are tons of reasons why someone might find it difficult to get to an in-person therapy appointment: social anxiety, chronic illness, physical disabilities, inability to take time off work, difficulty finding childcare, living far from the doctor and so on. 

With online therapy, individuals can start a session or continue communication with their therapist anytime and anywhere they have an internet connection. The downside of this, of course, is that you and your therapist are both at the mercy of your internet services.

Another disadvantage of working remotely is that it can make it more difficult for a therapist to help you in a crisis situation, which includes experiencing thoughts of suicide or plans for self-harm or other experiences of overwhelm. Because the therapist is not in the same room as the patient, they won’t be able to offer the same level of protection or protocols that help keep a patient safe during a crisis.

Cost

Out-of-pocket expenses for traditional therapy can run anywhere from a few dollars to more than $250 for a session, depending on where you live, whether you have health insurance and what your therapist’s training and reputation is. Without insurance, most sessions cost $100 to $200, according to GoodTherapy and Psychology Today, which maintain searchable databases of mental health professionals.

The cost of online therapy also varies, depending on the service and level of support you choose. For example, Talkspace is a subscription service and prices depend on what type of service you’re seeking (messaging vs. live therapy, for example) and may be a better option for some, but there are a variety of online therapy companies, psychiatry service companies and general telemedicine companies that vary in insurance coverage and pricing.

It’s also worth noting that, should you be prescribed a medication during in-person or virtual therapy, its cost will usually depend on your insurance.

Confidentiality

The first time you go see a new doctor, you’re probably used to filling out a bunch of paperwork. In part, that’s because healthcare providers must follow strict guidelines dictated by federal laws — Health Insurance Portability and Accountability Act (HIPAA) — plus additional state-level rules and regulations designed to keep you safe and protect your privacy. And mental health professionals are no different.

If you’re not getting the same level of care from an online therapy platform, you should demand it. Before you sign up, make sure the platform is compliant with state laws and employs therapists who are licensed in the state where you live. 

During the onboarding process, if you’re only asked to fill out a short, generic consent form that leaves you with more questions than answers, ask the therapist if they’re able to provide you with additional contracts. Some services put the onus on the counselor to customize and/or augment their documentation.

Further, ask about record-keeping practices. Ideally, all data and communication conducted on the platform you’re using will be encrypted to protect against cyber attacks. Both the platform and the therapist you’re seeing should also have policies and procedures in place that adhere to your state’s record-keeping laws and the APA’s record-keeping guidelines. 

So which is better: Online or in-person therapy?

What’s best for you will depend on your needs and which symptoms you’d like to manage. For people who have limited time or access to in-person services, or those who feel uncomfortable seeking therapy in-person, online therapy is an excellent option to try. For more complex cases, or in situations where a person will be most understood when their whole presence is taken into account, in-person services will be the better choice. 

“I think it’s really is up to a person trusting their intuition — knowing what they need in the moment — and then making sure that they pick a [therapist] who feels comfortable to them, whether it’s online or in person,” Adriane Kruer, a licensed clinical psychologist, told CNET in 2019.

Importantly, if you don’t love your experience with one therapist or company, you aren’t tied for life. You have a say in the type of therapy you receive, who you’re receiving it from and how the experience makes you feel.