Online therapy has steadily increased in popularity, especially since the COVID-19 pandemic. In fact, according to a nationwide poll published by the American Psychiatric Association (APA), approximately 38% of people use telehealth services to meet with a mental health professional in 2021, compared to 31% from the fall of the previous year.1
This statistic underscores a growing trend: the pandemic revealed the flexibility and convenience of virtual therapy to a wider audience, making mental health support more feasible and accessible for many. However, while online therapy has lowered the barrier of entry for those who are disabled, live in remote areas, or simply prefer care from the comfort of their own home, many people still wonder, “Is therapy as effective online? And how does it compare to in-person therapy?”
Here’s a breakdown of what online therapy is, how it compares to traditional in-person therapy, and the benefits and limitations of this format.
What Is Online Therapy?
Online therapy — also referred to as virtual therapy, teletherapy, or e-therapy — offers an accessible way to receive therapeutic support. It’s provided remotely through phone calls or the internet, and sessions are conducted by a certified mental health professional (marriage and family therapist, professional clinical counselor, clinical social worker). While talk therapy sessions have historically required face-to-face meetings, the advancement of the internet and advent of online video chat services have paved the way for a growing number of people to opt for virtual formats.
It should be noted that online therapy specifically refers to services delivered directly by certified mental health professionals, as opposed to therapeutic apps or third-party platforms that may offer mental health support but aren’t provided by licensed therapists. Additionally, any therapeutic modalities can be performed online with promising results, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal therapy (IT).
What is online therapy like? Understanding virtual options and formats
While many assume that teletherapy only involves video calls, it can be structured in a variety of formats, including:
- Video conferencing involves you and your therapist communicating through a secure, HIPAA-compliant live video-call platform. Although not always required, you may be encouraged to turn on your camera so your therapist can read your facial expressions and body language to better understand your responses.
- Phone calls — also called voice call therapy — are performed via traditional phone call, with no video component required. This format offers accessible therapy to those who may lack reliable internet access, don’t have the the technology needed for video conferencing, or who wish to maintain privacy during sessions.
- Text therapy is not as common as other forms of virtual therapy and is conducted on text messaging platforms that are protected, secure, and HIPAA-compliant. It can take the format of either asynchronous messaging available 24/7, or scheduled texting sessions — which both rely on written expression of thoughts and feelings.
- App-based therapy typically utilizes video conferencing therapy in tandem with guided meditations and mood tracking tools to use between sessions, offering a comprehensive approach to online mental health treatment.
Aside from asynchronous texting, online therapy will be scheduled at a specific time where you’ll be offered a safe and confidential period to discuss thoughts and feelings and learn valuable skills for coping with stress and regulating emotions.
Can an online therapist diagnose you?
Licensed mental health professionals and associate clinicians can provide diagnoses through online therapy, following the same assessment protocols and clinical standards outlined in the DSM-5-TR that are used in face-to-face settings. The diagnostic process may include structured interviews, symptom questionnaires, and standardized assessments — all of which can be conducted effectively through secure telehealth platforms that comply with privacy regulations.
Related: A Comprehensive Guide To Who Can Prescribe Antidepressants
Online vs. In-Person Therapy: Key Differences and Similarities
There are some key differences between online and in-person therapy that may influence your healing journey, so it’s important to know what sets these two types of therapy apart to find the best one for you.
Development of the therapeutic alliance
In virtual therapy, the rapport between you and your therapist — also known as the “therapeutic alliance” or “working alliance” — may be built differently by nature of using digital interfaces. For example, you may need to put some extra effort into clearly and thoroughly communicating to accommodate the limitations on your therapist’s ability to read nonverbal cues. Additionally, you and your therapist can be more susceptible to getting distracted, as many therapists report struggles with remaining present during online sessions.2 Technical difficulties and less control of your session environment can further complicate the therapist-client relationship in virtual settings.
On the other hand, teletherapy may also benefit the strength of the therapeutic alliance as attending sessions in a familiar environment can help you open up and reduce anxiety if you get nervous in new settings. Furthermore, many people feel less intimidated by the perceived power dynamic with their therapist, prefer using familiar communication channels to initiate tough conversations, and benefit from increased accessibility that drives consistent engagement.
A meta analysis of the alliance-outcome association — or the relationship between treatment outcomes and the therapeutic alliance — indicated small but significant impediments to the strength of the therapist-client relationship in virtual formats.3 To ensure you’re doing your part to build a strong therapeutic alliance, make sure to reduce distractions during sessions, practice “backtracking” or circling back to topics, choose a private space where you feel free to express yourself, and prepare topics you want to discuss.
Session structure and environment
For the most part, online therapy follows the same structure and approach as in-person formats, with the exception of asynchronous messaging. However, in teletherapy, you won’t be attending sessions in a dedicated therapist’s office space, which is often designed to reduce distractions, encourage calmness, and maximize privacy. Furthermore, the boundary between your therapeutic space and personal space can become blurred when you attend sessions at home, and it may be more difficult to leave emotional baggage and difficult conversations “at the door” like you would in-person.
Alternatively, receiving online therapy from your home means you’ll be in a familiar setting and have access to comfort items to support you during difficult conversations. Your therapist may even gain additional insight into your psychological well-being by observing aspects of your living environment visible during video sessions. Furthermore, online therapy is more flexible in structure and can better accommodate last-minute requests for a crisis support session.
To alleviate any potential concerns regarding the effectiveness of your online therapy environment, consider designating a specific area of your home that’s dedicated to taking calls, create a pre-therapy ritual to transition mindsets, and use headphones for privacy. When designating a therapy area in your home, try reducing distracting items or decorations in the space, and be mindful of the lighting to create a calm environment. These protocols can help you maximize the benefits of therapy while mitigating its limitations.
Treatment approaches and adaptations
Licensed therapists may modify therapeutic modalities to be effective through the online format. For example, online talk therapy will likely require you to emphasize verbal communication, or in the case of text-based therapy, written communication. Additionally, CBT may use digital worksheets to track thoughts and emotions, apps for homework assignments between online sessions, and adapt behavioral experiments for at-home settings. DBT may require you to hop on group calls to discuss skills training and crisis coaching may be adapted to accommodate your specific area or proximity to resources.
Related Article: Comprehensive Guide To Addiction Therapy
What Are the Benefits of Online Therapy?
For those unfamiliar, online therapy has many benefits and can be just as effective at treating certain mental health conditions as in-person therapy. Here’s a breakdown of this format’s advantages who might be a good candidate for online therapy.
Accessibility and convenience
Virtual therapy has opened a lot of doors for people seeking mental health treatment, lowering barriers to accessibility that previously may have prevented people from finding help. For example, the removal of geographical barriers means people who don’t have easily accessible transportation can now access sessions virtually.
Additionally, people who live in rural areas can save on travel time and costs if they don’t live near a therapy provider. Approximately 90 million people live in a Mental Health Professional Shortage Area (MHPSA) — an area or population with a shortage of mental health providers — and online therapy can help increase engagement for these individuals.4 With all of these factors working together to make therapy more convenient, many clients experience less anxiety and apprehension regarding treatment, allowing them to engage more actively and receive more effective mental health care.
Comfort and reduced stigma
If your home is your safe space, you may feel more comfortable divulging vulnerable information, though this doesn’t always apply — for some, the home is a stressful and toxic environment. Although in-person therapy is designed to ensure confidentiality, you may feel an increased sense of privacy when you can attend sessions from a familiar, controlled environment. This quality of virtual therapy can further reduce anxiety and facilitate more open communication.
Additionally, many people may have internalized stigma surrounding mental health services and treatment — particularly older generations, teenagers, and those from certain cultural backgrounds. One study revealed that 72% of adolescents would use online teen therapy if they experienced a mental health problem, with stigma reduction among the most valued draws of this format.5 For those who consider therapy a taboo topic, the online structure can reduce resistance to treatment as clients may perceive it to be more private, potentially less of a commitment, and that they are essentially “sampling” the experience.
Related: Understanding and Addressing Teen Anxiety
Specialized care access
Depending on your location, you may be able to find a qualified in-person therapist that can support your mental health needs, but the internet unlocks more providers than could ever be reasonably accessed in person. This can be helpful if you are seeking a therapist that demonstrates cultural competence — which is their ability to properly understand and respect your cultural background — or prefer one with a shared identity to help you feel more heard and understood. There’s growing research which may indicate that therapists who have relevant cultural competence or who culturally adapt treatments produce more effective therapeutic results.6
Cost considerations
The costs associated with in-person and online therapy will vary depending on the mental health clinic, your state’s regulations, and your insurance coverage’s co-pay policy. In general, both therapies are priced similarly,7 and most states have parity laws that require insurance companies to cover online therapy and in-person therapy equally.8
Additionally, most major insurance companies cover necessary mental health treatment, regardless of if it’s in-person or online. Beyond service charges, there are also reduced indirect costs associated with online therapy, such as transportation, childcare, and time off work.
At Neuro Wellness Spa, we work with most major health insurance providers to cover the cost of both online and in-person psychotherapy.
Related: How Much Does a Psychiatrist Cost?
What Are the Negatives of Online Therapy?
Despite the many advantages of virtual therapy, there are still some limitations that should be considered when choosing your format of therapy.
Technical challenges
You may experience technical difficulties during virtual therapy sessions, which can include internet connectivity issues, poor cell service, device limitations, or even digital platform reliability concerns. Online therapy can also be difficult for people who struggle with navigating technology, which is generally more true for the elderly population. Privacy could be a concern as well if you attend online therapy sessions outside of your home or have roommates.
Clinical limitations
In virtual environments, therapists may find it difficult to accurately complete assessments due to reduced nonverbal cues or increased distractions that may come with your home. Without being able to adequately read body language, your therapist may not be fully in tune to your feedback regarding uncomfortable topics or your mental health needs.
Another important consideration is that if you are experiencing a severe mental illness or suicidal ideation, crisis management is considerably hindered in online formats, and intensive in-person care is recommended for these individuals. Additionally, certain types of therapy like somatic experiencing (SE), play therapy, and art therapy are less effective through a screen.
Regulatory and legal considerations
Some considerations when you’re seeking virtual therapy include location-specific restrictions. While most states have laws regarding online therapy that regulate privacy, documentation, and consent, therapists can typically only practice within states where they hold a license.
This means if you move states, you may not have continuation of care, and there may be insurance reimbursement issues. Additionally, professional online therapy services provided directly from a healthcare provider should have the digital infrastructure to meet stringent HIPAA requirements regarding client privacy.9
Is Online Therapy as Effective as In-Person Therapy?
Multiple studies have indicated that online therapy is equally effective for common mental health issues and more serious conditions alike. One study of over 900 clients revealed that there were no significant variations in treatment outcomes when comparing the efficacy of online therapy to face-to-face therapy. This trend remained consistent for a range of mental health concerns, from low mood to substance use disorders (SUD), chronic conditions, and eating disorders, underscoring online therapy’s effectiveness. However, the study also noted that more research needs to be done on the efficacy of online therapy for treating schizophrenia and bipolar disorders.10
Other studies have shown that certain therapeutic modalities, such as CBT and DBT, are just as effective when adapted for online formats as in person.11,12 Furthermore, clients who see a therapist online view the therapeutic alliance as one that’s a healing relationship rather than one that’s hindered by using technology.13 Understanding that online therapy is as effective as face-to-face sessions can help you gain the confidence you need to start virtual mental health treatment.
Related Article: Therapy for New Parents
How Neuro Wellness Spa Can Provide Evidence-Based Therapy Online
At Neuro Wellness Spa, we pride ourselves on offering effective online therapy and counseling conducted by compassionate providers who adapt treatment for depression, anxiety, and other mental health conditions to the digital format. We understand that accessibility and care preferences are different for everyone, so we offer a variety of support including online CBT, DBT, medication management, and psychiatry.
Seeking online therapy can be life-changing for those who don’t have convenient access to in-person therapy, so call Neuro Wellness Spa today to get you started on your path to enhanced mental health, virtually. We are here for you and ready to provide you with convenient, confidential, and effective online care.
References
- New nationwide poll shows an increased popularity for telehealth services. (n.d.). https://www.psychiatry.org/news-room/news-releases/new-nationwide-poll-shows-an-increased-popularity
- Békés, V., Doorn, K. A., Luo, X., Prout, T. A., & Hoffman, L. (2021). Psychotherapists’ challenges with online therapy during COVID-19: Concerns about connectedness predict therapists’ negative view of online therapy and its perceived efficacy over time. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.705699
- Doorn, K. A., Spina, D. S., Horne, S. J., & Békés, V. (2024). The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clinical Psychology Review, 110, 102430. https://doi.org/10.1016/j.cpr.2024.102430
- Online Mental Health Therapy: Is it Right for Me? (2024, January 2). https://www.ncoa.org/article/how-to-improve-mental-health-for-older-adults-living-in-rural-areas/
- INVENT | Internet Interventions | Vol 15, Pages 1-126 (March 2019) | ScienceDirect.com by Elsevier. (n.d.). https://www.sciencedirect.com/journal/internet-interventions/vol/15/suppl/C
- Asnaani, A., & Hofmann, S. G. (2012). Collaboration in multicultural therapy: Establishing a strong therapeutic alliance across cultural lines. Journal of Clinical Psychology, 68(2), 187–197. https://doi.org/10.1002/jclp.21829
- What you need to know before choosing online therapy. (2015, October 7). https://www.apa.org. https://www.apa.org/topics/telehealth/online-therapy
- Telehealth Private insurance Laws. (2025, May 7). https://www.ncsl.org/health/the-telehealth-explainer-series/telehealth-private-insurance-laws
- Calkins, H. (n.d.). Online therapy is here to stay. https://www.apa.org. https://www.apa.org/monitor/2021/01/trends-online-therapy
- Greenwood, H., Krzyzaniak, N., Peiris, R., Clark, J., Scott, A. M., Cardona, M., Griffith, R., & Glasziou, P. (2022). Telehealth versus face-to-face psychotherapy for less common mental health conditions: Systematic review and meta-analysis of randomized controlled trials. JMIR Mental Health, 9(3), e31780. https://doi.org/10.2196/31780
- Zandieh, S., Abdollahzadeh, S. M., Sadeghirad, B., Wang, L., McCabe, R. E., Yao, L., Inness, B. E., Pathak, A., Couban, R. J., Crandon, H., Torabiardakani, K., Bieling, P., & Busse, J. W. (2024). Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. Canadian Medical Association Journal, 196(10), E327–E340. https://doi.org/10.1503/cmaj.230274
- Lakeman, R., King, P., Hurley, J., Tranter, R., Leggett, A., Campbell, K., & Herrera, C. (2022). Towards online delivery of Dialectical Behaviour Therapy: A scoping review. International Journal of Mental Health Nursing, 31(4), 843–856. https://doi.org/10.1111/inm.12976
- Zech, J. M., Johnson, M., Pullmann, M. D., Hull, T. D., Althoff, T., Munson, S. A., Fridling, N., Litvin, B., Wu, J., & Areán, P. A. (2023). An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus group findings. JMIR Formative Research, 7, e41428. https://doi.org/10.2196/41428