The Good News: Teletherapy Works
At Least, When the Therapist is Skilled
Seattle handles rain pretty well. But it does NOT handle snow. At all. The county’s general approach to snowstorms is “Let’s just wait a few days; maybe it’ll melt.”
In the winter of 2018/2019, a debilitating snowstorm hit the Seattle area. We lived on a steep hill on the side of a bigger hill, about 500 meters uphill from my therapy clinic which sat near the bottom of a steep parking lot.
And ice. Everywhere was ice.
At the time, hubby and I were considering moving to Europe, so I’d already been looking into teletherapy. The snowstorm pushed teletherapy to the forefront. I contacted clients and said: “Let’s give it a shot, shall we? First session will be free while I work out the bugs. Wanna play?”
I got about a 95 percent Yes rate. Nobody else wanted to leave the house either, and so my teletherapy practice was born.
Now that I’m more than five years into being entirely online, I think I have some insights into teletherapy vs in-person. My verdict: I’d never go back. Here’s why.
Follow the Science
Before I give you all my reasons, it’s fair to ask: Does teletherapy even work?
Seems like that’s a hard Yes. Research says it’s as effective as in-person therapy. Following the COVID-19 lockdown, researchers Davis et al. (2023) embarked on a journey to unravel the mysteries of teletherapy versus traditional in-person sessions. What they found was enlightening: Teletherapy held its ground, proving just as effective in forging strong therapeutic alliances and achieving positive clinical outcomes. Intriguingly, the study uncovered nuances related to race, ethnicity, and financial stress, shedding light on the multifaceted nature of mental health treatment in an increasingly digital world. For those curious about navigating the virtual therapy landscape, this study serves as a beacon.
Lin et al. (2022) compared the effectiveness of synchronous teletherapy (i.e., talking; they didn’t measure other forms of teletherapy such as texting) with traditional in-person therapy. Their study was a meta-analysis of randomized clinical trials. That exploration revealed a crucial insight: Synchronous teletherapy stands on par with in-person therapy, making it a viable clinical tool.
One unexpected finding of the study: Clients tend to drop out of teletherapy with trainee therapists; not so much with more experienced licensed therapists. I’m going to guess that has nothing to do with the mode of therapy, and everything to do with the skill (and support network) of the clinician. Just my own suspicion.
In any event, both of these landmark studies affirmatively answer questions about teletherapy’s efficacy and pave the way for its widespread use in clinical practice.
13 Reasons Teletherapy is Better than In-Person
After years of doing therapy both in-person and online, I’m convinced that teletherapy actually beats in-person, hands down. Here are 13 reasons why (tl;dr? See video below).
Authenticity. When you’re at home, I get to see you in a real setting, rather than the pseudo-reality of a clinical office. That environment tells me a lot about you, your values, and your personality. Clients frequently take me on video tours of their kitchen remodels, their new rosebushes, their grandmother’s china hutch, and the view from their back window. It gives me a much better sense of who I’m talking to, when we aren’t working around the odd formality of meeting in a clinical setting.
Pets and Kids Welcome. Because I had in-person clients with pet allergies and serious health issues, I couldn’t allow pets in my therapy clinic — which made me feel like a bouncer at a lemonade stand. But with teletherapy, I’ve met countless cats, dogs, hamsters, birds, and even a horse. As your therapist, I love meeting your pets, babies, and teenagers. It gives me a much better sense of who you are and what you value. So I encourage clients to bring anybody they love to their teletherapy sessions — where they never have to worry that somebody else’s skittish furbaby will take a swipe at theirs.
Personal Comfort. Clients show up in jammies and slippers, work gear, and sometimes, on nice summer days, even swimsuits. That’s hard to pull off if you’re coming into town for an in-person therapy session.
Amusing statistic: About half — fully 50 percent — of my clients talk to me from bed. Works for me! Fluff up the pillows and let’s chat!
Save Time and Money. In our little village in France, every afternoon at about 5:20 pm, we have a traffic jam. Instead of the usual three minutes getting from one side of the village to the other, it can take a whole four or five minutes.
If that was the way rush hour worked in big cities, nobody would mind. But trying to dodge relentless stop-and-go traffic to make it to an after-work therapy appointment probably causes more problems than therapy can fix.
Add to that the cost — both in real financial terms and ecological ones — of putting more miles on your vehicle and spending your finite life in traffic, and the cost of therapy skyrockets. Not even the best health insurance covers lost time, spent petrol, or wear and tear.
Buh-Bye, Babysitting. Speaking of saving money, sending the kids off to bed or upstairs to play while you and your sweetie have a therapy session is vastly cheaper than hiring a sitter or answering nosy questions from grandma when you have to ditch the kids for therapy. In my clinic, I have late night and early morning hours so you’re free to chat with me when the kiddos are sound asleep.
Guarantee Privacy. Maybe it’s not as embarrassing as hearing the school nurse announce your weight in front of your classmates, but it’s still pretty awkward to sit in a clinic waiting room with distant acquaintances you didn’t expect to see. When you’re working with your therapist online, there’s no chance you’re going to accidentally run into your boss or your gossipy neighbor. There is no shame in counseling, of course, but it’s weird answering awkward questions about your private business.
No Geographical Boundaries. Medical deserts are a real problem around the world: Not enough doctors and too many hurting people — and that’s just in the desirable places to live. In many agricultural communities, impoverished neighborhoods, and small towns around the world, there are zero, zero, mental health professionals. I see clients anywhere in the state of Washington and in countries around the world, even tiny little one-horse towns. Your geography doesn’t matter when we’re meeting online.
Accommodate Any Schedule. When I did in-person therapy, I closed up shop at 7 or 8pm, and even that felt a little unsafe. Like most women, I’m not comfortable being out and about alone after dark. But as a teletherapist I have office hours in the evenings and mornings — literally, any time from 8pm through the night and early morning until noon, Pacific Coast time. Many of my clients do counseling just before they fall asleep at night, or before they even brush their teeth in the mornings. Telecounseling makes that possible.
Take Therapy Anywhere. On vacation? A business trip? Hanging at the beach? No need to cancel your fun. Teletherapy fits into your travels, and mine. I’m in an old village in Greece this week, still seeing clients in the mornings and wandering the island in the afternoons. How great is technology?
Ensure inclusivity and accessibility. For clients who have mobility challenges, teletherapy means no climbing stairs, looking for ramps, hunting for parking, or jamming into a waiting room. We’re right here, accessible by video, by audio, by text, by email, by phone, by laptop, or pretty much any device or tool that works for you.
One unexpected accessibility solution: Clients who are deaf or hard-of-hearing, who have cognitive impairments, or for whom English is not a native language, can do more than just turn up the volume. New technologies provide real-time closed captioning and translation for therapy sessions, making communication online far easier than it would be during an in-person session.
Ease Initial Session Nerves. In a life packed with anxiety, you don’t need the added anxiety of sitting in a public waiting room and coming into a formal office the first time we meet. If nerves get the best of you, you can even turn off your camera if that makes things easier for you. No judgment here while we work together on calming your panic.
Avoid Inclement Weather. That blizzard kicked off teletherapy for my clinical practice, but it could just as easily have been blistering heatwaves, windstorms, flooding, or downpours. Trudging through cold rain or nauseating heat to get to therapy in an office that’s probably not equipped to handle harsh climates is something nobody enjoys. It’s just not a problem with teletherapy.
Evade Swapping Sickness. I started offering teletherapy in a more optimistic time, before the global pandemic lockdowns. I’m a lot more cynical now about getting sneezed on — as I’m sure you are. It’s not just covid that I don’t want to share. I’m not down with seasonal colds, swine flu, mad cow, chicken pox, leprosy, or any other grody disease I don’t want to battle. Neither of us wants to share one another’s smallpox, hoof-and-mouth, rabies, or leprosy. Teletherapy means we all keep our own sickness contained. Happy to do my small part to delay the next worldwide lockdown!
If you’re a resident of Washington State, or live outside the United States, I’m happy to help you and your partner address conflict around communication, finances, intimacy, parenting, entrepreneurship, and managing life transitions. Visit my website, Allied Family Therapy, and click the blue “Schedule Me” button.
Citation List
Davis, K. A., Zhao, F., Janis, R. A., Castonguay, L. G., Hayes, J. A., & Scofield, B. E. (2023). Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic. Psychotherapy Research. https://doi.org/10.1080/10503307.2023.2229505
Lin, T., Heckman, T. G., & Anderson, T. (2022). The efficacy of synchronous teletherapy versus in-person therapy: A meta-analysis of randomized clinical trials. Clinical Psychology: Science and Practice, 29(2), 167–178. https://doi.org/10.1037/cps0000056
Dr. LauraMaery Gold publishes occasionally on Medium, but you’ll find more at Ascend Magazine, published on Substack. We invite you to subscribe at ascendpsych.substack.com
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Originally published at https://ascendpsych.substack.com.
