Both online and in-person therapy offer opportunities for healing and improved well-being, but they differ in some important ways. It’s important to understand these differences, as different people and different diagnoses may respond better to one or the other.
In this article, we’ll look at the main ways online therapy differs from in-person therapy and when one should be prioritized over the other. We’ll also see what the science says about their respective effectiveness and what professional therapists think about online therapy.
Online therapy involves speaking with your therapist remotely, via text or voice message, telephone, or video calling. For some, especially if they have grown up with this technology, it can feel safer and more familiar, making it easier to be open and honest. It also makes online therapy far more accessible, especially for those living in rural areas or who have trouble getting around. All you need is a good internet connection.
On the other hand, some people find the physical presence of their therapist comforting. A reassuring smile or hand can help promote openness and trust. In addition, therapists may be less able to read physical cues or miss out on them entirely. Posture, facial expressions, and tone of voice have all been traditionally used by therapists to aid in diagnosis and treatment.
Good therapy comes down to communication. Whichever you choose, try to be honest, accurate, and expressive with your thoughts and feelings.
On average, online therapy is less expensive than traditional therapy. Most online platforms will cost anywhere from $50 to $90 per session, whereas traditional therapy can run up to well over $150 per session. Unless you live in a big city, you’re also likely to have a wider selection of plans and providers to choose from.
Traditional therapy, however, can be a bit more flexible in its payment terms. You can usually pay for single sessions, choose the number of sessions you want per month, and pay by cash or check. Online therapy platforms, on the other hand, tend to charge a fixed amount for a set number of sessions (e.g., 4 per month, billed monthly), and you’ll need to pay by credit or debit card online.
If cost is a significant factor, you’ll likely find a more affordable per-session rate with online therapy. Just make sure the plan includes everything you need and nothing you don’t.
The Health Insurance Portability and Accountability Act (HIPAA) extends to online therapy, which means that your therapist and the platform are both bound by law never to disclose anything you discuss unless you or somebody else is in serious danger of harm.
With online therapy, you’ll also want to make sure your provider has excellent security. Look for 256-bit (“banking-grade”) and SSL encryption, like that offered by Betterhelp . If your online therapy platform doesn’t support voice- or video-calling, make sure you communicate using HIPAA-certified, end-to-end encrypted technology, like Zoom or GoToMeeting.
It is also important to know that, while online therapy technically falls under the HIPAA, it is a loosely regulated space, and the exact definition of what constitutes “health information” is poorly defined. For example, some platforms alert third-party providers like Facebook and Google every time users access the app and the length—though not the contents—of users’ messages. They may also transmit de-identified information from onboarding surveys. Read privacy policies carefully and don’t hesitate to enquire directly.
Most online therapy platforms rigorously vet therapists and require them to send copies of their accreditations and licensing. However, licensing does differ by state. When choosing a therapist online , you may want to check how their state’s licensing requirements differ from those of your home state.
In-person therapy should be prioritized in cases of serious mental illness, especially if you’ve already been diagnosed with a serious illness like schizophrenia.
If you are experiencing thoughts of self-harm or suicide, or feel that you might hurt yourself or somebody else, online therapy is not an appropriate solution. Immediately call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free, open 24/7, and completely confidential.
If you live outside the United States, you can find a list of international suicide prevention hotlines here.
When online therapy was first introduced, many therapists were skeptical. However, more than a decade of research has shown that online and text-based therapy can be just as effective as in-person therapy. One comprehensive review of the literature found that outcomes for online therapy were on par with in-person therapy and “provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity.”
Patient experience has been found to be just as positive. One study published in the Journal of Telemedecine and Telecare found that “telepsychiatry clients felt that they could present the same information as in person (93%), were satisfied with their session (96%), and were comfortable in their ability to talk (85%); this was similar to the in-person clients.” These patients “demonstrated significant improvements on pre- and post-(intervention) mental health measures.”
There are some forms of therapy that still haven’t been fully incorporated into telemental health, like art therapy and music therapy. However, online therapy has proven to be an innovative field. If you discuss these approaches with your therapist, you may find a way to combine the two.
Perhaps the best endorsement of teletherapy is the fact that tens of thousands of therapists have chosen to offer their services online. Testimonials from online therapists can be very telling.
“I was so worried it may be more difficult to accurately track shifting emotions, facial expressions, or body language via video chat. I was also concerned I may come across as more clinical, less warm, or empathetic, making it more challenging to build rapport. I had conjured up these fears that since it was online, some crucial element would be missing—but I couldn’t pinpoint what that would be, exactly.
It was quickly revealed all these fears were unfounded. If anything, I find that both myself and the individuals I work with probably project more authentic versions of ourselves from the comfort of our own homes. The thing I place the most emphasis on—the integrity of the therapeutic relationship—is not diluted in any way because we are connecting through a screen. In fact, people often tell me that their online experience has been more satisfying than their previous in-person therapy.”
Technical problems, like frozen screens and dropped calls, can be frustrating and are hardly “conducive to the therapeutic experience.” Nonetheless, many therapists agree that online platforms helped normalize therapy and make it accessible to a far wider audience than ever before, even with the occasional glitch.
Online therapy and in-person therapy differ in a few key regards. The former tends to be more affordable and more convenient, and may feel more comfortable. In-person therapy is better suited to serious forms of mental illness. Both are effective at improving well-being and have similar outcomes for depression, anxiety, and other mental health problems.
Any therapy is better than no therapy. If you feel you could benefit from therapy or you just want somebody to talk to, you can start by comparing the best online therapy services using our chart and comprehensive reviews.