The ways that therapy takes place have drastically changed since the pandemic, similar to many other aspects of our lives. Telehealth quite literally became a lifeline for many overnight. The ability to provide therapy virtually offered accessibility, convenience, and safety in a very unpredictable time. Prior to March 2020, our office provided telehealth to exactly two clients. Currently, over four years later, 50-60% of our clients remain fully telehealth. However, as life slowly returns to a sense of normalcy, many clients are reconsidering the benefits of in-person therapy. Many ask if returning to in-person sessions has a benefit over telehealth sessions, or if the convenience of telehealth is more important. 

Telehealth as a Lifeline 

Many clients who previously found therapy inaccessible due to transportation issues, work schedules, childcare, or physical disabilities have found telehealth to be a crucial tool. It has especially benefited people in rural areas, providing access to mental health services without requiring long commutes. The flexibility telehealth offers has also allowed those with busy lives to fit therapy into their schedules more easily. Clients and therapists alike have found that they have increased flexibility with scheduling when it comes to telehealth. While telehealth is better than no therapy at all, recent research has noted that it’s best for mild symptoms and clients presenting with fairly straightforward concerns. Meanwhile, in-person therapy may be best for more complex cases and long-term skill retention.

“Big Box” Therapy

It’s important to differentiate between legitimate telehealth therapy and some of the newer, more impersonal “big box” therapy companies. The allure of these companies is the affordability and essentially 24-hour/day accessibility. However, it comes at a steep price. 

While telehealth offers the same quality therapy that clients receive in person, some services that rely on texting or asynchronous messaging do not provide the same level of care. Text-based platforms can be useful for providing short-term support, but they often lack the depth needed for comprehensive therapy. Depending on the company, the treating physician can be paid more or less based on the number of words they use to respond to texts or messages, and won’t be paid if a session lasts too few or too many minutes. Clinicians have reported that because they need to respond to messages within a prescribed time frame in order to get paid, they are often compelled to respond at times that most people would find inappropriate (e.g., at dinner with a group, while in bed after a glass of wine). Clients have reported these types of companies for being unprofessional, as this seeps into the therapeutic relationship. The clinicians are overworked, underpaid, and under constant threat of not being paid at all if they don’t meet unethical and arbitrary markers set forth by the company, none of which are run by licensed mental health professionals. Ultimately, if you prefer virtual sessions, make sure you avoid these types of companies and aim for better care that would be mutually beneficial for both parties.

The Power of In-Person Connection

As we move past the height of the pandemic, many clients are realizing, or experiencing, the unique benefits of in-person therapy. One of our practice clients who had attended therapy in person before the pandemic remained fully remote until about a month ago when they had their first in-person session since 2020. They shared that being in the room with their therapist allowed for deeper conversations and feeling more connected. The client stated that this made the session feel more effective and productive. Their therapist felt this stronger connection as well!

The in-person environment offers somewhat intangible things that telehealth can’t fully capture, such as body language, eye contact, and a sense of presence that video calls just can’t replicate. For many, there is an emotional intimacy and security found in a therapy room that can feel more grounding and safe. Clients who were introduced to therapy via telehealth, have often commented that once they tried in-person therapy they found it more impactful. The subtle nuances of tone, facial expressions, and energy can sometimes be lost through a screen. Additionally, most therapists have designed their therapy rooms to be calming and free of distractions, which isn’t possible for most people dialing in from home, work conference rooms, or their cars. The therapy room also helps with compartmentalization —keeping therapy in its own space.  For example, when you do work in your bed often, it may become hard to later relax or fall asleep in bed because your brain now associates the bed with work. Having a place that’s reserved for therapy alone can help this type of association form in a space that you’d like to keep neutral or positive. 

The Best of Both Worlds: Hybrid Therapy

The convenience and accessibility of telehealth are not lost on us! Telehealth is highly effective for many reasons. There will never be an end to telehealth and there is no reason to try to make everyone return to full in-person. However, there is also a middle ground with hybrid therapy, which may be the best of both worlds. This is when clients come into the office when possible, but use telehealth when life makes it difficult to attend in-person sessions. The hybrid approach allows for the convenience of telehealth, while still offering the major benefits of face-to-face interaction and connection when needed. This approach recognizes that life can get in the way sometimes- whether due to child care, illness, or other barriers- but that shouldn’t stop anyone from accessing therapy. It’s a flexible model that ensures the continuity of care no matter the circumstance. 

Therapy Is Effective, No Matter the Format

Multiple studies confirm that both in-person and telehealth therapy are effective. The effectiveness of therapy is much more dependent on the therapeutic relationship and the techniques used than on the mode in which it is delivered. The best choice is the one that works best for you. Whether you prefer the face-to-face connection of in-person therapy, the flexibility of telehealth, or a balanced hybrid approach, the most important thing is that you are accessing care. If you have found telehealth to be helpful and convenient, don’t feel pressured to change. But, if you are considering trying in-person therapy again, or for the first time, it may offer a new depth to your sessions that could make all the difference. 

If you are considering therapy but are unsure about the format, schedule a consultation to discuss what might work best for you. Whether in-person, online, or a combination of both, you deserve to get the help you need in a way that fits your life.