Deciding Between In-Person Therapy And Online Counseling

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Although one in five adults in America experiences a mental illness, less than half of them seek treatment, according to the Substance Abuse and Mental Health Services Administration. Of those people, most say the reasons holding them back are accessibility, cost, scheduling, and the stigma associated with getting treatment. However, the number of people suffering without treatment clearly shows that it’s nearly impossible to conquer the illness on one’s own. Avoiding mental illness will not make it go away. For that reason, it shouldn’t come as a surprise that according to the National Institute of Mental Health, 80% of patients who sought treatment, either in-person or online, say they have seen improvement.

For those who stick with treatment, the odds of success are even greater. Therefore, if you are one of the millions of people struggling with mental illness and have yet to get help, you’re not alone. The good news is it’s easier than ever before to seek treatment with a licensed counselor thanks to online therapy. The above excuses are simply no longer valid. Online therapy can be a cost-effective and easily accessible option for those struggling with depression and anxiety. There are times when it should not be used, for example, for those with extreme mental illness who may be in danger of self-harm. For those, though, who would otherwise not go to therapy; online counseling is a good alternative to in-person therapy.

If you’ve ever scrolled through social media and have seen the ads for online counseling, you’ve probably wondered if it really is as easy as it looks, or if it’s a valuable solution. You may have even gone as far as clicking on the website, watched a video, or filled out the form without hitting submit. All of these actions and common questions are completely normal. Taking that first step for self-care, however, is the hardest. Once you do, you’ll wonder why you didn’t do it sooner. To help you make strides in caring for your mental health, here is a list of the pros and cons of in-person and online therapy. Use it as a guide to competently decide between the two.

A Variety of Services

An in-person therapist or counselor typically has an office, and patients go there to meet with a psychiatrist or psychologist regularly. Patients have a face-to-face meeting and chat with the counselor. The therapist can gain insights based on a patient’s body language, tone of voice, eye contact, and general presence. Note that a psychiatrist is a trained medical doctor who can prescribe medication. They will spend much of their time on medication management throughout the patient’s treatment. A psychologist, however, focuses more on psychotherapy and treating the patient’s mental and emotional suffering through behavioral intervention.

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Online therapy is different in that there are more options, allowing you to choose a therapist that best fits your needs. These therapists can be anywhere in the world, rather than in your neighborhood. As the popularity of online therapy has grown, many licensed therapists who see patients in-person are also offering their services to their clients through their private online practices. Additionally, there are third-party directories like that remotely connect users with licensed therapists. These services typically include therapy sessions by phone, chat, video, and messaging. There are treatment services for anxiety and depression, as well as more specific counseling such as couples counseling.

Features and Platforms of Online Therapy

The features and services offered depend on the type of platform you choose, but some may include unlimited messaging so you can connect with a licensed therapist anytime and anywhere, as long as you have an Internet connection.

Options that include video or voice chat are dependent on the availability of your therapist. Though the platforms usually guarantee some kind of immediate response, your specific therapist will only reply as soon as they are able to. Much like an in-person therapy session, phone sessions and video sessions are scheduled in advance. They are conducted through the app platform or with the therapist directly, depending on which option you choose.

Cost

The out-of-pocket cost of traditional therapy can be extremely high depending on your location and therapist. Not all therapists are covered by insurance so the price of traditional in-person therapy could run anywhere from a few dollars to hundreds of dollars for a typical 60-minute session. According to the Healthcare Bluebook, an online site that uses data to estimate national healthcare costs, the average cost of traditional therapy is $175 a session. Considering most patients meet once or twice a week for a session, in-person therapy can become a real financial burden for some. However, the cost of online therapy is much more affordable. Prices vary, but the average cost is between $65 to $100 a week. It’s a much more reasonable cost, and in some cases, you get more for your money. Some platforms even offer a discount if you bill the treatment several months in advance with a long-term membership.

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Convenience

From transportation limitations to scheduling conflicts, there are multiple reasons why an individual might find it difficult to keep an in-person therapy appointment. Even anxiety and depression, the very reason a licensed counselor is needed, could hold a person back from getting in their car for an in-person meeting. Physical disabilities, trouble finding childcare, inability to take time off from work, or distance from the therapy office, are all significant issues that make therapy inaccessible.

With online therapy, as long as an individual has an Internet connection, they can participate in a therapy session and effectively communicate with their therapist. That does, of course, mean that the patient and therapist are at the mercy of one’s Internet provider, which could be seen as a downside. However, most people with Internet use streaming services without any problems. Because of the accessibility of the Internet, a patient could be anywhere in the world and still have a meaningful session. Sometimes just being in one’s own home can help a person feel more at ease, and when the client feels comfortable, they are more likely to be honest and open with their therapist.

The job of a therapist is to make a client feel safe. If a patient already feels secure in their home, then the therapist’s job is that much easier, and the sessions could be more effective. Unfortunately, if the patient is not in the same room as the counselor during a crisis, for example if the client is feeling suicidal; things can be much more complicated. The therapist only has their voice to ensure the patient stays safe and doesn’t harm themselves. If a therapist does foresee a crisis during an online session, they can immediately look up the emergency contact information the patient provided during onboarding. If a patient is making suicidal threats, has a seizure, faints, or experiences any number of other potentially life-threatening problems, the therapist has the patient’s address and can send an ambulance immediately to their location.

Confidentiality

As with any medical professional, the therapist you meet with in-person will keep your records private. Also, like a medical doctor, there will be some paperwork you must fill out before your treatment with a therapist. As healthcare providers, they must follow guidelines according to federal laws known as the Health Insurance Portability and Accountability Act (HIPPA). Not everything you share with them can be kept confidential. This is true for in-person and online counseling. There are laws in all 50 states requiring a therapist to contact authorities if they suspect a child is being abused or if they believe the patient is a danger to him/herself or others. Before you start any therapy treatment, in-person or online, you should familiarize yourself with their confidentiality policies.

All licensed therapists abide by the same confidentiality laws. New patients will need to fill out a variety of paperwork such as a privacy notice, informed consent, and emergency contact information form. Electronic signature technology is used because it makes filling out all forms associated with online therapy much more manageable. In most cases, all client communication will be kept safe using HIPPA-compliant software.

Before you sign up for online therapy be sure that the platform is HIPAA compliant and that the therapist you are seeing is licensed in the state in which you live. If the onboarding form is generic or extremely short, ask for further documentation. If they cannot provide proof of HIPAA compliance then do not continue. In addition, onboarding is the time in which you should learn more about the platform’s record keeping practices. Ideally, everything should be encrypted to protect you against all cyber-attacks. All policies and procedures should adhere to the APA’s record-keeping guidelines as well as to your state’s record-keeping laws. 

Effectiveness

Numerous studies have examined the efficacy of online counseling for different types of mental illnesses and disorders. The Canadian Medical Association Journal recently published evidence that online cognitive behavioral therapy (CBT) may effectively reduce symptoms of depression and other mental health issues. In some cases, the study showed, CBT was even more effective online than traditional in-person therapy. With young adults consistently seeking online therapy, it’s becoming evident, as shown in the above-mentioned study, that therapy that uses text messaging is appealing. These are young people who have grown up in a world where all they know is communicating that way. But because it’s easy for conversations to lose context and for meanings to get lost in translation, some therapists do message-based therapy only in conjunction with video or phone therapy to make the treatment as effective as possible.

The CBT method as treatment involves engaging in a certain amount of sessions with a therapist to understand patterns in the patient’s negative thinking. From there, the patient learns how to respond to those thoughts in challenging situations more effectively, so they will be in less emotional distress.

Online therapy has come a long way in the last decade, but even as far back as 2014, studies showed that teens treated online for their obsessive compulsive disorder found just as much success in their treatment than those who met with a therapist face-to-face. Similarly, veterans who experienced PTSD and those suffering from eating disorders, responded just as well with online video conferencing for their treatment than those who visited a therapist in their office.

Many long-term patients would say that the relationship with their therapist is what makes the therapy effective. Building trust in-person might be easier initially, but it’s not impossible with online counseling if the patient sticks with the treatment. So far, research on online counseling shows that whether a patient is treated in-person or online, therapy can reduce symptoms and support recovery, and can work equally well as antidepressants as long as the treatment is consistent.

Many suggest that someone with severe mental illness should start with in-person therapy, but after the patient has their condition under control, they may want to choose online therapy as a cost-effective and more efficient option. Experts suggest the evidence supporting online therapy is strongest when it’s used to treat anxiety, depression, and stress.

Which Treatment is Right For You?

There is no “right” way to connect with a therapist. Ultimately, it depends on your personal preference and what will work best for you, so that you will stick with the treatment. After all, any therapy is better than no therapy at all, so don’t delay in finding the help and support you need.

Amanda is a wellness writer & enthusiast with over 12 years writing in the industry. She has a bachelors degree in Creative Writing from NYU. She is certified by the American College of Sports Medicine and the American School of Nutrition & Personal Training. Amanda is also a celebrity publicist.