Growing up as a TCK (third culture kid) meant that I was raised in cultures outside of my parents' culture and nationality and lived in different countries growing up. This background made me quite adept at maintaining significant relationships (be they professional, romantic, or familial) digitally. When the pandemic led to a surge in telehealth and remote work, the transition felt less drastic; it was already part of my norm.
As a practitioner, I offered both online and in-person counseling, appreciating the flexibility this brought to my clients. During this time, I also engaged in online counseling and supervision, which deepened my understanding of the medium from both a client and therapist perspective. Navigating the online therapy landscape gave me valuable insights into the client experience. I appreciated the flexibility of continuing my personal and professional development with the professionals I felt were best suited to my growth. I do however recognize that this flexibility is subjective.
As the pandemic progressed, my practice shifted predominantly online, and I no longer had the luxury of providing both options on a regular basis. This transition underscored the digital evolution of the health care and mental health care landscape. Questions arose about the effectiveness of online counselling to traditional in-person counseling, and I wanted more than my own subjective experience or a blogpost to satisfy my inquiry. I sought out to explore some larger-scale research on this topic, and here are my findings:
The Rise of Online Counseling
We are all aware that there has been a significant increase in online therapy in recent years. Larger-scale research findings centered around: Effectiveness, Long-term Outcomes, Client Preferences, Accessibility & Reach.
The Outcomes are Comparable
A massive study published in Psychology Today analyzed data from over 27,500 individuals receiving therapy. The findings concluded that online therapy is just as effective as in-person counseling in terms of improving mental health outcomes. Clients reported similar levels of satisfaction and therapeutic alliance, the two major markers critical for successful treatment. Online therapy also reduced costs and waiting time, making mental health services more accessible to a broader audience (Psychology Today, 2023).
Long-Term Effectiveness
Another comprehensive review in Psychological Bulletin highlighted that the long-term effectiveness of online therapy holds up well against in-person therapy. Researchers found that both mediums resulted in significant symptom reduction for a myriad of mental health conditions, including anxiety and depression. More importantly, these results actually remained stable over time, suggesting that the benefits of online therapy are not merely temporary (Fried et al., 2020).
Client Preferences
A study examining client preferences between online and in-person sessions indicated that a substantial number of participants preferred online therapy due to its convenience and reduced stigma. This preference may influence people's commitment to therapy or treatment as people are more likely to engage consistently with a format/medium they feel comfortable using (Hilty et al., 2020). Basically, people are more likely to engage in ongoing treatment if they find the format/medium is easy and familiar. However, it is important to appreciate client preferences from a cultural and generational lens as well. After all, we are addressing a diversity and inclusivity question here as well.
Accessibility and Reach
In terms of practicality, online counseling has made it possible to reach underserved populations. As an NDIS provider, I find it such an advantage to be able to support my remote NDIS participants regularly, without digging into their funds for transportation.
In fact, research from the National Institutes of Health (NIH) found that online therapy has proven effective in reaching rural and remote communities where mental health services are scarce. This increased accessibility can lead to earlier interventions and better overall mental health outcomes for these populations (Rosen et al., 2021).
Extending this concept to overworked and time-poor parents and/or caregivers of elderly people who do not have the luxury of carving out commute time, online counselling has been a saving grace.
Barro and Williams (2021) found that online counselling has indeed provided essential support to caregivers who struggle with time constraints and the demands of their roles.
Survey Insights from 2024
I decided to ask some of my long-term clients. Some have never met me in person before, while others have attended both mediums. Here are some of their comments. Quotes in black are FOR flexibility, quotes in red are FOR face-to-face only, with one exception. (Note: Sample size = 15).
"Agoraphobia for me meant taking Ubers to sessions, and I never regret it! ..As much as I love being in the room with you, really adds up." -Mid-aged male beginning a new profession
"It's easier. Sometimes, I can have a session in between things by just jumping into my car, parked somewhere." -Mid-aged male entrepreneur with family
"I already wish I could clone myself; this helps." -Mid-aged female with children
"Honestly, I am a bit old-fashioned, I prefer being in the room with you, but it's sometimes just not possible. I'd rather have that contact than not." -Elderly male client, retired with grandchildren
"I have tried it (online) before. I think I need someone with me in the room to hold my grief for now. -Young female with a young family in acute grief
"I don't know, maybe it's a trust thing? Something like, you know, seeing is believing." -Young male, with no family and thriving career
"I can't drive, my support workers drive me to places. I don't have enough funding for travel to face-to-face sessions."-NDIS Client expanding skillset
"The technology is beyond me. Phone or face-to-face."-elderly female client, semi-retired and socially active
*Funding for NDIS participants have been knocked back generally in the last year.
The additional cutbacks on mental health support have impacted NDIS participants even further. Online counselling continues to be viable means for therapeutic support for all my NDIS clients.
Research Insights from 2024
Moving into the present, a recent 2024 study published in Clinical Psychology Review found that online therapy not only matches in-person effectiveness but may also enhance engagement and retention in treatment. I find this is an interesting valid finding because it was conducted in outside of the pandemic years.
The study, which involved over 30,000 participants, revealed that people who participated in online therapy showed a 15% higher rate of session attendance compared to those in traditional settings.
This increased engagement is thought to stem from the convenience and accessibility of online platforms (Smith et al., 2024).
Considerations for Choosing Between Online and In-Person Therapy
While the research supports the effectiveness of both online and in-person counseling, and much of the data indicates a comparative improvement at the very least, it is also important to evaluate specific individual preferences, and specific individual circumstances to guide you towards choosing between the two.
Personal Comfort: Some people may feel more at ease discussing sensitive topics in person, while others may prefer the anonymity and convenience of online sessions. From a psychoanalytic perspective, you might want to take a moment to be curious about your preference. What is it exactly that might inform your tendency towards one over the other? It might be worth exploring that with your therapist.
Technology Access: This is an obvious one - Online therapy requires a reliable internet connection and user comfort and familiarity with technology. For those lacking these resources, in-person sessions may be more feasible.
Nature of the Issues: Finally, for certain severe mental health conditions, in-person therapy may be recommended for more intensive support, while online counseling can effectively address mild to moderate concerns. For those concerned about specific PTSD treatments such as EMDR, skim through these articles:
EMDR Therapy Online: What Is It And Does It Work? (helloklarity.com)
EMDR Therapy Online: Can EMDR be Done Virtually?
ONLINE EMDR THERAPY - Mindful Living Counselling and Psychology
Conclusion
The debate between online and in-person counseling will continue as the years roll by. But for now, the research overwhelmingly suggests that online therapy is an effective alternative that can deliver comparable outcomes to traditional methods. With its growing acceptance and accessibility, online therapy represents a significant advancement in mental health care, providing more people with the opportunity to seek help from the professionals they deem are best suited for their needs. But as we move forward, it's essential to recognize that the best therapeutic approach is the one that fits your individual needs and circumstances.
Sources
8. Barrow, S., & Williams, K. (2021). The Impact of Telehealth on Family Caregivers: A Systematic Review. International Journal of Environmental Research and Public Health, 18(12), 6341. doi:10.3390/ijerph18126341.
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