The COVID-19 pandemic sent many therapists and their patients online, sparking a huge increase in the use of telehealth that has outlasted quarantine and social distancing guidelines. Patients went virtual and have not looked back.
Today, more than half of all mental health appointments, about fifty-five percent, take place remotely. Telehealth therapy--where patients meet with their clinician through video conferencing or a phone call--has transformed the landscape of mental healthcare. It is a convenient and often more accessible alternative to traditional in-person therapy.
Still, some patients worry that telehealth may not be as effective as traditional face-to-face sessions, and clinicians have raised concerns about the efficacy, privacy, and equity of virtual treatment. Could telehealth negatively impact the therapeutic relationship, reduce patient engagement, or even harm treatment outcomes?
The advantages of telehealth in mental healthcare
One of the most significant advantages of virtual therapy is its accessibility. Telehealth removes geographic barriers, enabling individuals in remote or underserved areas to access therapy that may otherwise be unavailable. Additionally, virtual sessions are more flexible in terms of scheduling, which can be especially beneficial for people with busy lives, disabilities, or poor access to transportation. The ease of attending therapy from the comfort of one’s home can also reduce the stigma some individuals feel when seeking help, as they may be less concerned about being seen publicly at a therapist’s office.
The ability to participate in therapy from the privacy of home can also help patients feel more comfortable in session. Patients with mood and anxiety disorders like social phobia, agoraphobia, or obsessive-compulsive disorder often find the online environment more comfortable and less threatening than an in-person setting. For these patients, the comfort of therapy from home makes starting treatment and opening up less daunting.
The therapeutic relationship and telehealth
Research has consistently shown that a strong therapeutic alliance, or the relationship between a therapist and client, is critical for successful treatment. The quality of a clinician and patient’s therapeutic alliance is a strong predictor of therapy outcomes.
Some patients and clinicians fear that virtual therapy may inhibit the formation of trust and rapport between a therapist and their client. Will patients feel as connected to someone they have never met in-person? Does the barrier of a computer screen inhibit relationship building?
Therapists do use nonverbal cues in sessions--reading body language, facial expressions, and tone of voice to gain deeper insight into a patient's emotional state. These nonverbal cues may be more easily assessed and responded to in-person. Still, video calls do allow therapists to pick up on nonverbal cues communicated from tone of voice or facial expression.
More research is needed to assess the impact of telehealth on the therapeutic alliance, but early research suggests that patients outcomes for in-person and telehealth therapy are similar--or even better in the telehealth context. A 2022 study found that virtual therapy programs saw higher attendance and completion rates than in-person treatment programs, for example.
New approaches may be needed to ensure a strong therapeutic alliance in the virtual context. But, the success of virtual therapy in early effectiveness studies is a strong indication that telehealth does not necessarily inhibit relationship formation between therapist and client.
Is telehealth for me?
When it comes to effectiveness, research suggests that virtual therapy can be just as beneficial as face-to-face sessions. The choice between virtual and in-person therapy ultimately depends on individual needs and preference. For busy adults seeking convenience and flexibility, virtual therapy can be a highly effective option. However, in-person therapy may still be preferable for individuals who struggle to connect with a therapist virtually or who have a difficult time using technology.
Ultimately, the most important factors in therapy will always be the quality of the therapeutic relationship and the client’s engagement with the process. This is true whether treatment is delivered virtually or in-person.
