Online therapy has become increasingly popular in recent years. The COVID lockdowns left therapists quickly getting online to continue providing therapy, and many continue to work online with their patients for myriad reasons.
Online therapy – or teletherapy – is certainly convenient. It reduces travel time, travel costs, and makes it possible to work with therapists from anywhere, as long as they’re licensed to work with patients in your state and have the proper credentials to practice tele therapy across state lines (this requires additional training and credentialing to be possible, so be sure to look/ask for that if you opt for teletherapy).
Despite online therapy’s current level of acceptance, in-person therapy remains the preferable approach due to several critical aspects. These include the quality of communication, the overall therapeutic environment, and the development of the therapy relationship. The quality of the relationship you have with your therapist is the best predictors of your therapy being a meaningful and helpful experience for you.
The quality of communication in in-person therapy is unmatched. Albert Mehrabian is known for saying that “93% of communication in nonverbal.” Meaning, nonverbal cues such as facial expressions and body language, along with the way we say something account for much more than the specific words we actually say. And while we can debate the breakdown of those percentages and exactly how much is non-verbal, it’s safe to say that body language, facial expressions, and eye contact are all essential components of effective and meaningful communication. Therapy is certainly a place where you want to really dive into the fullness of what you’re communicating with someone you trust.
These more subtle cues convey more than words alone and provide therapists with valuable insight into a patient’s emotional state. Online therapy, even with a camera turned on, can limit these non-verbal signals and therefore limit effective communication and processing.
The setting – or ‘therapeutic environment’ – is usually more conducive to effective therapy. Therapy offices are thoughtfully designed to be safe, confidential, and comfortable spaces. These offices are meant to help patients feel at ease and share whatever is on their mind. Distractions and the external environment are intentionally minimized, and perhaps most crucial, confidentially can be assured by your therapist in such an environment.
Patients using online therapy often face numerous distractions in their home. Interruptions from family, work, or pets are common. Even knowing that interruptions are possible can decrease the level of comfort and privacy. And if the therapist is remote, they may suffer from similar drains on their attention. These distractions – and a potential decrease in sense of confidentiality – can significantly reduce the effectiveness of the sessions.
A quality bond between the patient and therapist – referred to as a therapeutic alliance – is critical for successful outcomes. In-person interactions tend to naturally foster trust and rapport. And, often times, a reassuring gesture or a change in tone don’t come across as well through a monitor or phone. A physical presence can help patients feel more secure, heard, and understood, which increases one’s willingness to engage more deeply in the process.
Whether to engage in face-to-face therapy, online therapy, or a hybrid model comes down to personal preferences of both patient and the therapist. Like other decisions in therapy, it is valuable to have a conversation with a professional about what might be best for you.
Dr. Wayne Bullock is a compassionate, experienced, and licensed counselor in Washington D.C. focused on the needs of gay men and the LGBTQ community. Specialties include the treatment of trauma, depression, anxiety, and sex therapy.
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