Looking to start therapy but wondering if online or in-person is right for you? There's a lot to consider before making the choice: Is one more beneficial than the other? Can your psychotherapist actually get to know you through a screen? Is it useful for serious mental illnesses? It’s a lot to think about! 

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Here are some answers of the most commonly asked questions about online therapy and some ways to determine which is best for you:

 

Is virtual therapy or in-person therapy more effective? ​

Research shows that online therapy can be just as effective as in-person therapy, as long as you’re not in an active crisis or require a high level of care. Generally, the most successful type of therapy is therapy where you're safe, comfortable, and where you have a strong relationship with your therapist. 

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Can therapists effectively help calm emotions in a virtual setting?​​

One important role of a psychotherapist is what’s called co-regulation – the ability to soothe another person's emotions during a distressing situation. When your psychotherapist practices co-regulation, it can look like:

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• Maintaining a warm and calming presence.

• Using a soothing tone of voice.

• Modeling appropriate behaviors.

• Verbally validating distress. 

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While it can be harder to read body language in virtual sessions, psychotherapists are still able to use co-regulation to create a supportive virtual therapeutic environment by:

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• Using active listening by maintaining a non-judgmental perspective and reflecting what you say. 

• Taking visual cues from you through facial expressions and hand gestures which is why it's so important to use cameras in virtual sessions.

• Writing high-quality notes so they follow up on and address distressful threads from session to session.

• Practicing cultural humility by being open-minded, curious, and adaptive enough to learn from clients what aspects of their cultural identity are most important to them.

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Can online therapy treat people with a mental illness?​

Online therapy can be an excellent treatment option for mental illnesses such as mood disorders, depression, eating disorders, obsessive-compulsive disorder, addiction recovery and personality disorders, if the symptoms are being managed effectively. Symptom management can include personal coping skills, psychotherapy, exercise, meditation, good sleep hygeine, nutrition and medication.

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Online therapy is appropriate if the treatment can be done safely. If someone is experiencing an active crisis (a situation that produces significant cognitive or emotional distress) where they are potentially a danger to themself or others, virtual services are not suitable. This can look like delusions, suicidality, hallucinations, or paranoid ideations. Emergency services should be utilized to determine if a higher level of treatment is necessary.

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What about active substance use? ​​

If someone is in active substance use, online therapy would not be appropriate as a treatment. Active substance use often requires the oversight of a medical doctor to monitor potential withdrawal symptoms and other medical complications. In these situations, in-person therapy and/or a higher level of care is required. 

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Online therapy for support after completing an inpatient program or recovery program would be appropriate.

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Which is better for couple's therapy?​

Couples seek therapy for different reasons, improving communication, infertility, pregnancy, parenting challenges, distribution of labor, infidelity, substance use or financial issues. Like individual therapy, research shows that couples therapy can be just as effective in a virtual environment. 

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That doesn't necessarily mean online couple's therapy is right for every couple. Virtual therapy is a good option for couples who:

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• Can join sessions from the same space and computer. Looking at your partner and embracing each other during vulnerable conversations is essential. 

• Feel physically and emotionally safe together.   

• Believe therapy can benefit their relationship, and they are committed to seeing it through.

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If either person feels unsafe in the relationship, is reluctant to attend sessions, or is highly volatile, in-person therapy is likely a better option. 

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So, which is best for you?​​

Here are some questions to determine if online therapy is a good fit: 

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• Do you find it easier to open up to a friend over the phone as opposed to in-person? Some people find that having a vulnerable conversation with a degree of separation (like on a computer or phone) is easier than having the conversation face-to-face. 

• Do you have a comfortable, quiet place to connect virtually with your psychotherapist each week? Is this a place where you feel emotionally, mentally, and physically safe?

• Are facial cues and hand movements enough body language to engage with?

• Is convenience a vital factor for you? Is commuting to a therapist's office a challenge? 

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If you answer yes to these questions, online therapy is an excellent option for you! 

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On the other hand, online therapy is not a good fit for you if:

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• You are actively in crisis. 

• You are struggling with persistent or active suicidal thoughts. 

• You are unable to meet daily responsibilities like going to work or having a hard time taking care of yourself. ​​​​​​​​​​​​​​​​​​​​​​​​​​

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