The demand for online, virtual therapy has skyrocketed since the beginning of the pandemic, and understandably so. Teletherapy is an incredibly efficient and effective way of overcoming some of the main obstacles that people face when trying to access in-person therapy, such as having a limited range of therapists in their local area, time constraints, financial constraints, and more. With online therapy, individuals can communicate with their therapist anywhere that they have an internet connection.
Teletherapy can be a great way for people with low-intensity mental health conditions to get some support for these problems, and has been found to be equally as effective. A review of 24 studies, found that in nearly all cases, phone and video therapies were just as effective at treating certain conditions, like anxiety and depression, as in-person therapy.
In one study, 93% of telepsychiatry patients said that they felt they could present the same information virtually as they could in person, 96% were satisfied with their sessions, and 85% were comfortable in their ability to talk. However, the study found that they felt slightly less supported and encouraged during teletherapy compared to in-person therapy.
While teletherapy has been a great solution to overcome the problems we’ve faced during the pandemic, now that the world is returning to a new sort of normal, there’s concern that teletherapy will replace in-person therapy as the new primary form.
In this blog we will discuss the downsides of teletherapy, and why in-person therapy should always be the preferred therapeutic format if it’s available to you.
The boom of online therapy
In the last 3 years or so, there has been a significant increase in the number of online therapy companies and apps that have appeared on the market. And while the premise behind these companies is to increase the accessibility of therapy and to reduce some of the anxieties that may occur around seeing a therapist in person, there are several downsides.
Firstly, as these apps and services are created by large for-profit companies, their primary focus is to increase their profit, and not necessarily to offer you good therapy, or therapy that is tailored and right for you as an individual. This can lead to several downsides, such as:
Privacy issues: If therapy is not delivered across a secure, encrypted channel, third parties may be able to access sessions or session notes. Some online therapy apps also log the user's IP addresses for risk management concerns, however, this can present confidentiality issues. Additionally, it might be difficult for you and/or the therapist to find a private space to meet.
HIPAA compliance: Similarly to the previous point, not all online therapy apps are HIPAA compliant. HIPAA, the federal health data law, often doesn’t apply to all the information collected by these apps, and therefore your information may not be as confidential as you might think.
Limited ability to manage risk: Some online therapy companies don't have clear guidelines for handling risk, such as if someone is reporting suicidal thoughts or tendencies through a text therapy service. Due to the nature of the app format, it can make it much more difficult for a therapist to help you in a crisis situation.
Limited evidence that text therapy is beneficial: As the American Psychological Association (APA) notes, online therapy is still very new and "hasn't yet shown that stand-alone therapy online or via texting is effective for everyone in every situation."
Why teletherapy might not be for everyone
While teletherapy can be highly effective for some people and is definitely a good alternative to in-person therapy, it shouldn’t be assumed that it will be beneficial for everyone. There are limitations to what we currently know about the effectiveness of teletherapy.
For example, according to a recent study, it’s currently unknown as to which type of remote therapy, such as video versus telephone, is best, and much of the research that’s been conducted on the effectiveness of teletherapy to date, has used patients with low-level mental health conditions who are more likely to respond to treatment regardless of the format in which it is delivered.
Teletherapy for serious mental health conditions or symptoms
Many experts, as outlined in this article by the American Psychological Association, advise against using online therapy, especially as the primary form of therapy, to treat more acute mental illness symptoms. More often than not, clients experiencing more serious symptoms that may arise from Post Traumatic Stress Disorder, Addiction, Major Depressive Disorder or severe anxiety, need more intensive treatment than online therapy can provide. And there are several types of therapy that simply cannot be conducted properly in a virtual environment.
In addition, the management of risk is much more difficult for both therapists and clients when conducted virtually, especially for high-risk clients. One of the main responsibilities of a therapist is to make sure that their clients are safe and not at harm from themselves or others. And while ensuring the safety of a client is possible virtually, it’s a lot harder than doing so in person. Not only is it difficult to create a safe environment for a client to explore suicidal thoughts, but it is also difficult for the therapist to ensure that the client is safe before they end the session.
Internet disruptions, body language, and external distractions
Another disadvantage of teletherapy includes smaller, yet equally disruptive problems such as internet drop-outs, speech delays, audio and video issues, and around-the-house distractions. Internet distractions can significantly affect the therapeutic experience, despite how insignificant they may seem. Only half hearing what your therapist is saying, and vice versa can prevent effective communication and can lead to misunderstandings. It also inhibits your therapist's ability to understand the bigger picture as effectively.
Similarly, by having therapy virtually as opposed to in-person, the element that body language plays is significantly reduced, especially if using text-based or telephone therapy. Your therapists cannot see your facial expressions, vocal signals, or body language and these signals are often very important for your therapist to observe as they can contribute to a more accurate picture of your feelings, thoughts, moods, and behaviors. Some delivery methods such as video therapy can provide a clearer picture of the situation, but they often lack the intimacy and personal connection that real-world sessions offer.
In addition, external distractions can impact the effectiveness of teletherapy. If you don’t have a quiet space in your house where you can guarantee that you won’t be distracted by family members, children, your phone notifications, or things around the house, then it can be difficult to mentally get yourself into the therapeutic environment. Some people have likened online therapy to having a conversation on the phone while driving—you’re only half-listening and distracted by paying attention to the road and everything else that’s going on in your immediate surroundings.
Children and teletherapy
Teletherapy can be particularly ineffective and difficult for children as younger children may struggle to sit still and concentrate, and are much more likely to get distracted than if their sessions were in person. Lots of parents have seen firsthand during this pandemic how hard it has been for children to stay focused in school when learning from home.
Additionally, learning social skills is a large part of therapy for children, and this can be especially difficult to do through virtual channels and therefore in-person sessions are usually much more effective.
For children and teens who have difficulty paying attention, in-person therapy is much better at keeping them more engaged. Especially if a child has ADHD, they may find sitting still difficult and it may require a lot of energy, which in turn makes online therapy more challenging for them, their parents, and their therapist. Therefore in-person therapy is generally more effective with children and teens who struggle to pay attention and are easily distracted.
So which is best?
As we mentioned at the beginning of this blog, teletherapy has been found to be just as effective and beneficial for lots of people—especially those who don’t have access to many local therapists, who are struggling financially, or those who have more mild mental health difficulties. But online therapy is not suitable for everyone.
We are social beings and we are meant to communicate with each other in person. While communicating virtually has been an incredibly helpful tool and is a wonderful alternative, in-person therapy still offers lots more than virtual therapy, and therefore in-person therapy should still be recommended over teletherapy when it’s available and a viable option.
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