How do online therapy services stack up to their in-person alternatives?

As technology continues to permeate our lives, online therapy has become a popular form of self-help—and in the wake of COVID-19, engagement with services like BetterHelp have skyrocketed.^[]

However, just as with other virtual forms of previously in-person services (such as shopping and education), many have questioned the effectiveness of online therapy.

Can psychiatrists and therapists connect with their patients through a screen as well as they can face-to-face? And if not, how should they proceed with their practice in the digital age?

The ongoing debate

In an exclusive interview, MDLinx medical advisor Kristen Fuller, MD, said there is no “right” way to conduct therapy services. She believed both mediums have their benefits and downsides, and the effectiveness of an online session varies on a case-to-case basis.

“It really depends on what the client is looking for, how severe the disorder is, and the relationship between the client and therapist.” Fuller said. “For example, if someone is dealing with severe acute or chronic trauma, they may find more benefit being treated in person compared to someone who is looking for advice on stress or relationships, which may be reasonably treated via an online platform.”

Potential hurdles

Ultimately, a therapist’s goal is to connect with their patient. To properly treat and diagnose clients, the therapist must have a working knowledge of their habits, mannerisms, and issues.

According to an article published in Psychology Today, patients who favor face-to-face therapy question whether such levels of closeness are feasible when physicians communicate solely through a screen.^[]

There are doubts as to whether integral parts of patient assessment such as body language, demeanor, and overall tone can be accurately perceived through a webcam.

It’s also easier to lie through a screen. In an article published by Scientific Daily, Michael Woodworth, forensic psychologist at UBC Okanagan, stated, “When people are interacting face to face, there is something called the ‘motivational impairment effect,’ where your body will give off some cues as you become more nervous and there’s more at stake with your lie. In a computer-mediated environment, the exact opposite occurs.”^[]

Because of this, patients may be more prone to be dishonest or obscure truths with therapists. In a 2015 study published in Secrets and Lies in Psychotherapy, 93% of participants admitted to lying during therapy at least once.^[] This poll does not even factor in how COVID-19 may have contributed to a possible spike in this number amidst the rise of online mental health services.

Fuller added that not all therapy sessions operate through a webcam—some online therapy programs only offer text messaging services. She felt this could impede an intimate client-therapist relationship, which is key to a productive session.

Potential benefits

One 2014 study published in ScienceDirect reported that online cognitive behavioral therapy was not only effective for treating anxiety disorders, but patient improvement remained high after one year of virtual treatment.^[]

A Forbes review of 17 studies, lasting between 8 and 15 weeks, found that online therapy may even be more effective in treating cognitive behavioral issues than in-person visits.^[]

Fourteen of the studies reviewed found that online therapy resulted in a 50% improvement in symptoms of social and generalized anxiety, obsessive compulsive disorder, panic disorder, depression, and compulsive gambling disorder.

Online sessions can benefit more than just the patient. Conducting sessions virtually can save therapists money, time, and convenience. They can remove commuting hassles and cut costs by eliminating the need for an office rental. Working from home can also help therapists feel more relaxed. Consequently, they can conduct better sessions without these added stressors, according to the Forbes study.