Therapy in-person or online? What suits me?

It wasn’t even a question before 2020. Most things were done sharing an office. However, the advent of the Covid pandemic and lockdown moved virtually everything remote. The IRL concept (in real life) turned into something of the past and Zoom (and other similar programmes) became our friends (and foes, at times), as we had to rely on them to work, study, keep in touch with family… and even for therapy.

Changes felt strange and exciting at the same time. New rituals like asking if the other can hear us. New frustrations… when they cannot or the connection is unsteady. And in the context of therapy, concerns about ‘connecting with’ the therapist, managing overwhelming feelings when physically distant from the therapist, concerns about confidentiality, like potentially being recorded or a third party accessing our conversations.  

And fast-forward to now, where Covid has stopped dictating how we live our lives, it’s time to re-connect with our lives as they were, meeting with others, at work, with friends… and doing therapy in person, as it once was the norm. The issue now is that it may not be all that straightforward. There are positives in getting back to IRL mode, but we shouldn’t forget the ‘good bits’ of online work. And this is something that, if you are considering to start therapy, you may need to consider, to decide one option or the other. And make sure it’s you that decides, as everyone you ask will speak from their experience or opinion, which might not fit yours.

Outcome studies suggest that in general terms that face-to-face and in-person therapy are comparably effective. Some studies focusing on the experience of receiving and offering therapy conclude differing views on the experience of both therapists and clients differ: whilst some advocate the traditional face-to-face, others happily embrace the goodness of the remote option. However, these only reflects individual preferences.

First things first, you need to consider if both options are viable for you. Do you have a reliable internet connection and device which enable good communication? Do you also have a private enough space where you can have your sessions without worrying about the privacy of your conversations? If so, then, remote work would be something you can consider.

Some of the benefits of working remotely are:

-        It provides easier access to therapy for people with mobility problems or when transport can be an issue (poor commuting options). It also enables working internationally.

-        It involves savings -both in time and money- as no transport is involved.

-        Therapy can be offered in a more consistent manner, reducing absences and cancellations due to sickness or poor weather conditions.

-        No need for commuting also means that therapy can be scheduled more frequently when this is deemed clinically appropriate.

-        Following from the point above, clinical progress can be accelerated due to more intense/frequent therapy.

-        Online therapy also means access to specialists not in the geographic location of the person.

-        Online therapy can also help reduce the stigma of receiving therapy.

-        More flexibility due to greater access to more specialists who can offer suitable schedules.

Ways to address some of the challenges of remote working:

-        Most remote therapy platforms support text, video and whiteboard functions, which can be a good replacement (and even an improved version) over face-to-face therapy.

-        Some platforms also offer a transcript option, which can help reviewing our therapy discussions once this has concluded.

-        Different apps and websites offer ways of addressing demands of specific therapy options, e.g., bilateral stimulation in EMDR, drawing of formulation and treatment diagrams in CBT.

-        Exposure work and behavioural experiments can be carried out remotely, e.g., by using a mobile phone camera which enables the therapist to be ‘present’ during the experiment.  

All in all, remote therapy presents as an option not to be disregarded due to its advantages and the relatively simple ways of addressing its weaknesses. If in doubt, feel free to approach therapists, as they may give you a better sense of its suitability to your difficulties.

If, after reading this, you think I may be able to help you with the difficulties that you, your relationship or someone close are experiencing, just let me know and we can discuss it further.  

By Dr Jose Lopez, Clinical psychologist, Accredited CBT and EMDR therapist