How does face-to-face therapy compare to online therapy?


Cognitive Behavioral Therapy Mental health Psychotherapy


Daniela Rocha IJzerman

Are you wondering whether online therapy works? For some people the idea of talking to a therapist on video call instead of face-to-face seems like yet another barrier to break through. During this pandemic, it can be especially a turn off to do therapy online.  You may well doubt that online therapy is as efficacious as an in-person session or it may simply be hard to imagine to open up to a therapist that is not physically present. 

I have been working with clients online since 2012. At that time I was working at a practice in Amsterdam, the Netherlands. Some of my clients lived quite far from the practice where I was working, making the weekly commute to therapy a problem for them. After I started working with them online, I started to be convinced that discussing emotional problems through the screen seemed to work quite well and perhaps even better than expected. I became more confident about my work online when I read a meta-analysis (a quantiative review of studies) comparing Internet-Based Cognitive Behavioral Therapy to in-person Cognitive Behavioral Therapy. 

In Internet-Based Cognitive Behavioral Therapy, clients usually do most of the work by themselves by watching videos or reading material regarding psychoeducation and instructions on exercises they can do. Clients doing Internet-Based Cognitive Behavioral Therapy can be guided or not by therapists. In this meta-analysis only studies involving guided Internet-Based Cognitive Behavioral Therapy were included, meaning that clients received some guidance from a therapist for completing homework assignments. They found that Internet-Based Cognitive Behavioral Therapy was as effective as in-person Cognitive Behavioral Therapy for social anxiety, panic disorder, depressive symptoms, body dissatisfaction, tinnitus, male sexual dysfunction, and spider phobia. 

Internet-Based Cognitive Behavioral Therapy involves less involvement from the therapists than the online therapy I provide. The work I do with my clients online is exactly the same one I do in in-person sessions. This means that we have sessions with the same frequency and duration. The way I structure the content of our sessions and my interventions are exactly the same. The only difference is that I give some explanation about the environment where I am (for example confidentiality; how I see them on my screen) and also about potentially unexpected things clients may see from me  (I may look down to take some notes about what they are saying). I like to say these things to my clients because those are things that they would be able to see if we would be face-to-face and I want them to know that I am fully engaged with them while we talk. 

If you were wondering about starting therapy and online therapy seem to be ideal for you, I hope you feel more encouraged to give it a try. Right now the pandemic is the main reason why people are doing online therapy. But in other times, in a pandemic-free world, I hope you don’t give up on reaching out for online help because you don’t have enough time to commute to a therapist. If you need to, you can always schedule a call to get to know me and learn about online therapy with me first.

Photo by cottonbro from Pexels

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