When I first went to college, I left the therapist I’d been seeing back home and found a new one near school. But I didn’t click with her as much, so I asked my old one if she’d do sessions over the phone. We couldn’t do all the exercises we did in person (like writing negative thoughts on a pillow and then ripping it up), but I still got the sympathy and advice I sought from her. Nowadays, I talk to a life coach who I’ve known for several years over video chat. It’s more important to me to get support from someone I trust and connect with than to find someone geographically close to me.
Sian Ferguson, a 23-year-old writer in South Africa, made a similar decision when she had trouble finding therapists in her town who didn’t make homophobic or victim-blaming comments. When her mom recommended someone from her hometown, she met with that therapist during a visit home and, when they clicked, began meeting with her over Zoom.
“It is nice to be in a different physical space during therapy—I like going to a relaxing office that's intended for therapy,” she says. “But on the other hand, I like the fact that I don't have to travel or even dress up to see my therapist. In terms of the actual therapy, it feels the same. I often feel so submerged in the video chat that it feels like we're talking in person.”
With sites like Talkspace and BetterHelp dedicated to providing online therapists, long-distance therapy is becoming increasingly popular. But does it offer everything that in-person therapy does? Therapists themselves have mixed opinions.
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“For the most part, anything you can do in person you can do online,” says Pennsylvania-based psychoanalyst and psychiatrist Mary Davis, who does both virtual and in-person therapy. However, people may be slower to open up to therapists they’ve never met in person, she adds. “It is enough of an issue that I will no longer work with people online unless I have at least one year of working with them face-to-face, so that we know each other well and know the usual responses.”
Nonverbal communication is also harder when you’re not in the same room. “Because psychotherapy is an interpersonal process, some percentage of in-session communication is strictly through facial expressions and body language,” says Chicago-based clinical psychologist Ryan Hooper. “There is an emotional energy that happens, particularly in big moments of change. It is almost like an electricity in the air. Those same moments certainly do happen through online mediums, but in my experience aren’t quite as powerful.”
Clients may also be more distracted when talking to a therapist from a distance, whether they’re on the phone outside with people around them or on a computer with notifications popping up. “Many of us do other things while we are talking in informal conversations, and if you don’t watch yourself, it is easy to let that habit slip into your online work,” Davis says. Another challenge is that problems with the internet or phone connection can interrupt important moments in a conversation, says David F. Khalili, a marriage and family therapist in Oakland, California.
However, research shows that therapy from a distance can be just as effective as in-person therapy, Hooper says. One study in the Journal of Telemedicine and Telecare, for example, found that telepsychiatry patients reported improved mental health after a month. Telepsychiatry patients also reported similar levels of overall satisfaction and comfort as in-person ones, though they reported “slightly lower levels of satisfaction regarding feeling supported and encouraged than did the in-person clients,” the study authors wrote.
There are circumstances where online therapy may even be the best option. Certain clients may not want to devote the time to traveling to a therapist’s office, and that fact that an hour-long voice or video chat will take no additional time out of their day is appealing. “Some people have difficulty leaving the house because of the mental health issues they face but need professional support, while others have to travel for work or need to stay home for child care,” Khalili says. Others, like me and Sian, want to stick with the person they trust the most, and that might not be someone they can visit in person.
In addition, not all forms of remote therapy are created equal. Miami- and NYC-based psychotherapist Jasmin Terrany prefers video sessions over voice. "[Over video] I can still feel and experience my clients as if we are in the same room,” she explains. “I can feel when [clients are hiding their emotions] or when something isn’t being said. This non-verbal communication is integral in the therapeutic process and can still be completely present in a virtual video conference session. Phone, however, is a bit more difficult, especially with new clients.”
Text therapy requires even less direct interaction, but can work well for those who express themselves most comfortably with written (or typed, rather) words. Kelsey, a 27-year-old social worker in New Orleans who declined to use her last name so that clients won’t learn about her personal life, talked to a therapist solely through email and instant messaging via Talkspace. “Meeting in person makes me really uncomfortable, but I definitely thinks it’s more helpful,” she says. “Sometimes, when you talk about things, that leads to tangents or connections that are made and can show you something about another issue, but online, that almost never happens because you’re not there in real time talking things out. It’s easy to just read and move on, unlike if it were in your face staring at you, pushing you. It’s easier for me to play off and ignore things via internet therapy.”
So, all other things being equal, it’s probably optimal to see a therapist in person—but not if the alternative is to see one who’s not the best match for you or not see one at all. Since the therapist-client relationship is a delicate one that requires trust, online therapy is a valuable way to expand your options. If you talk to a therapist remotely, though, it’s best to make the sessions mimic face-to-face interactions as much as possible.
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