Dear Therapist:

What advantages and disadvantages come with receiving therapy in person versus using an online platform? If a therapist offers both options, which should I choose? I would assume that in person would be more effective but sometimes maybe it would be easier to share through a screen? Aside from convenience, are there any other factors that I should be taking into consideration when choosing a venue for psychotherapy?

Response:

You ask about factors aside from convenience. I wonder, however, whether you have considered one of the very advantages of the convenience of teletherapy.

Sometimes therapy can be dynamic, absorbing, and deeply satisfying. At other times, session work (like training to change thought processes and perspectives) can seem monotonous. At times like this, clients can feel less interested in the process (which is why feedback on progress can be crucial). When this occurs, it can feel similar to a gym membership. When we begin, we are motivated and excited about reaching our goals. As time goes on, however, it becomes easier to lose interest, then to drop out entirely.

There are other aspects of the therapy process that can make a client feel less inclined to continue, despite positive progress. For example, negative emotions that are triggered can be helpful in reducing general feelings of depression, but these emotions can be disconcerting. Although these issues should theoretically be addressed—and hopefully resolved—in therapy, this doesn’t always happen.

Sometimes it takes only one or two sessions that seem a bit repetitive or difficult to cause a person to consider stopping therapy. When you add to this the need to travel to the therapist, possibly find parking, wait if running early, then repeat the process at the end of each session, this can tip the scales.

Convenience aside, there are a number of factors that should be taken into account when considering a therapy venue. What these all have in common is that they are very personal. I have had clients who couldn’t imagine therapy that was not in-person. Other clients have tried teletherapy and will never try it again. Others feel that there is not much of a difference between the two. Yet others find that they can be more open during video sessions, while others like neither video nor face-to-face, preferring phone sessions.

You mentioned your assumption that in-person sessions would be more effective. I would venture to say that you are probably right—but this is only with reference to you. I believe that you are likely correct because I am assuming that you are imagining what sessions would be like from your perspective and given your personality. If, however, your sense that in-person sessions would be better is simply because they seem to be the standard, you should consider your emotional needs as well.

The rapport between client and therapist has been shown to be one of the most important aspects of the therapeutic process. A good cognitive and emotional connection can greatly increase the efficacy of therapy. Though personal preference, nature, and personality can factor in to the ability to form a connection both remotely and in person, in-person sessions most often lend themselves to this. If you believe that you are more likely to forge a positive relationship with a therapist in the office, I would suggest that you consider this for at least the first few appointments (or until you feel that your relationship is in a good place).

From a therapeutic modality perspective, there are some modalities that typically work better in person than via video; these are also usually better via video than by phone. For instance, psychoanalysis often uses physical factors like mood, lighting, seating, and placement to set the mood. Cognitive therapy, however, can often be as effective remotely. Eclectic therapy (use of numerous modalities depending on the need) can often be more effective than focus on one modality. When eclectic therapy is being used, session venue can be decided in advance based on the particular modality to be used in each session.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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