Is a Online Psychotherapy Does that make sense?

When the COVID-19 pandemic began and online therapy became the only option, I was working with 30 patients. Twenty-nine of them wanted to continue online. After about a year, in-person therapy became possible again, and with one exception, all of them returned to the office, even though some had to travel significantly farther to get there. That surprised me at the time. Convenience actually seemed to favor online therapy: no commute, no wasted time. Nevertheless, almost all of them preferred face-to-face contact.

But not everyone has that choice. Long wait times, rural areas without therapists nearby, stays abroad, limited mobility, etc. At the same time, my daily work and personal experience show me that there is a demand for online therapy.

The scientific understanding is now solid in some areas of application, but significantly less robust in others.

A systematic review, published in an article in the journal JMIR Mental Health It synthesized twenty randomized studies involving a total of approximately 2,800 patients; the conditions treated were post-traumatic stress disorder, depression, and anxiety disorders. It found no significant differences between online and in-person treatment, neither in terms of effectiveness nor in patient satisfaction, the therapeutic relationship, or the dropout rate.

The same applies to Internet-based cognitive behavioral therapy. A Meta-analysis in *World Psychiatry* It directly compared them—across 31 studies and 16 clinical conditions—with traditional in-person treatment and found both formats to be equally effective. However, one word in this sentence carries half the weight: “therapeutically supervised.” The study evaluated online treatment provided by a therapist, not a program that runs on its own.

The ground varies in firmness from one disturbance pattern to the next. For established trauma therapies conducted via video, the following apply: reliable evidence before. How EMDR Works Online I'll explain when it makes sense to do this in a separate article. Also, when it comes to chronic pain and at Sleep Disorders Internet-based programs are effective, though they are less effective than in-person treatment for sleep disorders. And the effects last: a Analysis of 154 studies With over 45,000 participants, the online therapy was found to be effective even a year or more after the end of treatment.

There is also a finding that points in the opposite direction, and I'd rather mention it than leave it out. A Overview of 29 Studies found that video and in-person therapy were equally effective for post-traumatic stress disorder, but in-person therapy performed slightly better for depression. A similar pattern emerges regarding the therapeutic relationship: a Meta-analysis on Video Therapy The study found a slightly weaker therapeutic relationship when using the screen, despite the same improvement in symptoms. This aligns better with what I observe in my own work than a blanket claim of equivalence. Whether a Psychotherapy Is Helpful For me, anyway, the format is rarely the deciding factor.

Since early 2024, I’ve been working exclusively online. Since then, I’ve heard several times—especially from clients who are struggling—that they’d prefer in-person treatment. If you’re having a really hard time right now, I would definitely try to arrange in-person treatment if I were in your shoes. However, if you don’t have a therapist lined up for the long term, or if you’d like to seek advice or get your bearings first, you’ll likely find what you’re looking for online sooner.

I’ve experienced both formats—as a client and as a therapist. I’m also currently receiving online therapy from a psychotherapist in Germany whom I previously saw at her office. Intuitively, I would always prefer in-person therapy. However, online psychotherapy doesn’t feel like a second-best solution to me.

Psychotherapy over the phone can also offer advantages in certain situations. Some people feel less self-conscious on the phone and are able to relax more easily. Since the visual element is missing, other aspects—such as tone of voice and content—come more into focus. About one-third of my patients prefer this approach, and I see no difference in the quality of care. Research points in the same direction, with one caveat: In a randomized study published in the journal JAMA Patients were significantly less likely to discontinue treatment over the phone than in the office—20.9 percent versus 32.7 percent—and fared just as well at the end of treatment. Six months later, however, the in-person group was doing better. In my experience, psychotherapy works just as well over the phone as it does in person.

In my view, online therapy is not always equivalent to in-person therapy in every situation, but neither is it a stopgap measure that inevitably leads to poorer outcomes.

Self-help apps can certainly be useful for some patients, just like a good book. However, they aren't interacting with someone who has spent decades learning how to support others with mental health issues.

Some digital programs are evidence-based and can be helpful. Digital assistance can serve as a stopgap, a supplement, or a low-threshold entry point. The extent of its benefits is demonstrated by a Meta-analysis of 176 randomized trials in *World Psychiatry*: Real, but small, effects on depressive symptoms and anxiety. About one in twelve users benefits from it who otherwise would not have.

Two figures set the record straight. Programs that include personal support perform better than those that don't, and The greater the initial burden, the wider the gap becomes. And almost no one sticks with it: across more than 93 popular apps, after thirty days On average, 3.3 percent of users still use the app.

A major problem I see with these apps is that health insurance companies and clients can use them to shirk their responsibilities. For the insurance companies, it’s yet another excuse to say, „Yes, we do offer our customers something,“ instead of helping to ensure there are enough psychotherapists available. For clients who lack motivation, these apps provide an excuse to continue avoiding effective treatment. „Honey, I know I still slap you sometimes, and at night I sleep with our kids. But now I have this app!“

Whether ChatGPT: An Alternative would represent, or what the The Difference Between Psychological Counseling and Psychotherapy You can read about this in these articles.

The biggest advantage of online apps and online treatment is that they help overcome barriers to access. Rural areas often lack local specialists. People with limited mobility have a hard time finding accessible medical offices. And those with demanding jobs or who are caring for young children are often unable to make appointments during regular office hours.

That depends entirely on where you live and what cover you have. In many countries insurers now treat a video session much like an office visit, at least for some conditions, but the details differ enormously: which providers qualify, how many sessions are covered, and what has to happen before the first one. The professional bodies have moved faster than the payers, and the guidelines for treating patients remotely are by now well established.

The word that decides most cases is eligible. Cover almost always attaches to the provider rather than to the technology. If a therapist sits inside your plan's network, or holds the licence your insurer recognises, video sessions tend to be reimbursed on the same terms as sessions in a room. If not, the format changes nothing.

That makes one question worth more than an hour of reading: ask your own insurer before you book, and ask in writing. Does my plan cover online sessions, with which kinds of provider, and what do I need to submit afterwards? Five minutes of typing saves people a lot of grief later, and a written answer is worth considerably more than a phone call nobody wrote down.

Anyone searching for help online will find services of wildly different quality, and the differences that matter most are the ones you cannot see from the outside. Which rules apply depends on where you are: in the United States the relevant framework is HIPAA, in the UK and the EU it is the GDPR. None of them guarantees that the particular tool in front of you is a good one, and what popular mental health apps actually transmit suggests the gap is wide.

Researchers once took 36 of the best-known depression and smoking-cessation apps apart and watched what left the device. Eighty-one percent were sending data to Google or Facebook for advertising and analytics, and most of them never told their users. A privacy policy is not the same thing as privacy, and an app being popular says nothing about where your data sleeps at night.

So the practical version, for you: you are allowed to ask. Which video platform does this provider use? Is the connection encrypted? Has it been checked for health data specifically, rather than just being the tool everyone uses at work? Anyone offering online sessions should answer that without shuffling. Being well known and being suitable for medical data are two different qualities, and only one of them protects you.