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Gone are the days when the only way to receive mental health care was in-person. Many people are now choosing teletherapy over in-person counseling because of its flexibility, convenience, and access to more care providers. And research shows that teletherapy is just as effective as in-person therapy and both forms have benefits.
The National Institute of Mental Health’s teletherapy definition is “the use of telecommunications or videoconferencing technology to provide mental health services.” Teletherapy can occur over the phone or by video as long as it’s compliant with the Health Insurance Portability and Accountability Act (HIPAA), which protects patient information and privacy. Telemental health services involve interactive, real-time communication between providers and clients.
Teletherapy is similar to in-person counseling except sessions are virtual or over the phone. Telecounseling and in-person appointments last the same amount of time and may include individual, group, couple, or family therapy. Virtual therapy requires a laptop, computer, tablet, or smartphone, as well as internet access, speakers, and a webcam or built-in camera on the device.
Telemental health services should be delivered through HIPAA-compliant virtual communication that protects patient privacy like Zoom Telehealth or teletherapy apps clients download and use a link and password to connect to their mental health provider.
Sure, it’s convenient, but is teletherapy effective? Many studies show that yes, virtual therapy is just as effective as in-person counseling, and may even help people achieve their goals faster.
“The research aligns well with what I see in my work,” said Julia Tisdale, LMFT, a therapist in Lyra Health’s blended care program. “I see high success rates in terms of reduction in mental health symptoms, and many clients reach their goals and find they no longer need therapy.”
There has also been research conducted on virtual cognitive behavioral therapy (CBT) as well as telemental health for specific conditions and population as well as engagement quality.
“I think the last three years has made us think about optimizing therapy by expanding access to personalized, high-quality care,” said Emily Lattie, PhD, clinical product director at Lyra. “In my work, I’ve seen Lyra’s blended care model continuing to deliver a lot of evidence around getting clients engaged in synchronous, real-time sessions, and giving them really valuable and engaging exercises so they can start feeling better fast.”
At a time when over 50 percent of counties in the United States have no psychiatrists, telemental health is chiseling away at location barriers to mental health care. Medical professionals say over 80 percent of their patients now have more access to care through telehealth. “Teletherapy increases your choice of therapists if you’re from a rural area or looking for a specific type of provider,” said Tisdale. “It widens your provider options significantly and gives you access to several different providers you wouldn’t be able to see otherwise.”
Virtual therapy can also lower barriers to mental health care for people with disabilities, health issues, and limited transportation options.
Mental health stigma is another barrier that keeps some people from getting the help they need. “There have been some studies looking at stigma and face-to-face services vs. remote service, and some people perceive stigma to be lower for remote services because they don’t have the fear of being seen,” said Lattie. Accessing care from the comfort of their own home reduces the fear of driving to a hospital or mental health care facility or being recognized by others at that facility—barriers that often prevent people from accessing care or encouraging others to seek care.
Some digital technology and mental health experts report higher retention rates in teletherapy vs. in-person therapy. Researchers have also found better retention rates for over-the-phone CBT vs. in-person therapy. “The research out there is good that clients are showing they can form positive alliances in mental health counseling when meeting in teletherapy platforms that they use regularly,” said Lattie.
Virtual therapy can help prevent the spread of communicable diseases between the provider, office staff, and clients. It also means people who are ill but feeling well enough to attend therapy can still do so without exposing others to germs.
With travel time, a one-hour therapy session can require a commitment of three or more hours for some people. Teletherapy mental health care is a flexible option for those who wouldn’t otherwise pursue counseling because they can’t take that much time away from their work or family responsibilities.
Since everyone’s situation is unique, virtual therapy may not be for everyone. Some people may prefer in-person therapy over telecounseling for the following reasons.
Some people feel more connected to their therapist when they share the same physical space. “It may take longer for certain clients to develop the level of connection in teletherapy than it would for in-person therapy,” said Tisdale. “At first, teletherapy can feel like a talking head if you’re new to it, and it may take a few more sessions than in-person therapy to develop a strong connection.” Some research suggests that people under age 60 may develop online relationships easier than older clients since virtual technology has been around for a good portion of their lives.
Pets, smartphones, appliance sounds, noisy neighbors, kids—it can be tough to limit these interruptions for an hour of virtual therapy. “For some, it may be easier to focus in a therapist’s office because it’s separate from work and home,” said Tidale.
A virtual setting can also limit therapists’ ability to detect physical cues that indicate distress like fidgeting, tensing muscles, or poor hygiene, or if a client is under the influence of drugs or alcohol.
Some people lack access to digital devices and wifi, or have unreliable connections. Others have steep learning curves for technology, which can be a barrier to telemental health.
While some people feel more at ease with virtual therapy, others may feel safer going outside the home for appointments. They may feel uncomfortable telling household members why they need silence and their door closed, or fear they’ll be overheard.
Therapy is beneficial both virtually and in-person. It’s about finding the approach that’s the best fit for your mental health needs and lifestyle. Factors to consider when choosing virtual vs. in-person therapy include:
Virtual therapy often makes it easier to fit mental health care into busy schedules. Maybe that’s your lunch break, early morning, or right before you pick the kids up from school. Eliminating the in-person aspect of therapy opens up many more scheduling possibilities.
“We know Americans are overscheduled and overworked, so in many ways, teletherapy allows people to stay meaningfully engaged in treatment,” said Lattie. “This is partly because of time commitment. It’s going to be more sustainable for their lives, even if it’s just six to eight hours over the course of eight weeks.”
A therapist can help you determine the best approach for you, but research on telemental health care shows it’s effective even with complex conditions like bipolar disorder, post-traumatic stress disorder, and with people at risk for suicide. “We’ve seen people with suicidality well-served in teletherapy with appropriate safety measures,” said Lattie. “They can build strong relationships and continue therapy in effective ways.” And, of course, it doesn’t need to be one or the other. Telecounseling can be combined with in-person therapy for those who would benefit from both if it’s clinically indicated. For example, you might benefit from receiving couples therapy in person while seeing an individual therapist over telemental health. The most important thing is to communicate with your provider about what care you’re hoping to receive and discuss appropriate treatment options based on your presenting concerns.
To get the most out of therapy, you should have an hour away from work, kids, partners, and roommates so you can focus on the counseling session and feel comfortable sharing openly. If it’s tough to find a private space for virtual therapy, in-person may be a better choice.
Teletherapy may be a good option if you don’t have reliable transportation or need to travel long distances or sit in heavy traffic for an in-person therapy visit.
If you decide to try teletherapy for mental health, there are a few things you can do to make it the best possible experience.
Prepare ahead of time for virtual therapy by making sure your technology is working and your setting promotes comfort, emotional safety, and focus. Ensure you have reliable wifi and everything is up and running well ahead of the appointment so you can make other arrangements if necessary. Download any telemental health applications you need and check that your technology supports the teletherapy platform you’re using.
Research shows that the mere presence of smartphones affects focus. If you’re not using your phone for the appointment, leave it in another room, or at minimum, put it on silent mode.
If you’re using a computer for teletherapy, close all other tabs and applications, or put yourself on “Do not disturb.” This limits temptations to check email or browse the internet.
Carving out a regular day and time for virtual therapy sessions can provide structure and accountability. If this isn’t possible, make an intentional decision to dedicate time to teletherapy just like you would in-person therapy.
Since physical cues can be harder to detect virtually, it’s helpful to name and describe your feelings throughout the session. For example, “I’m noticing I’m feeling tense and wringing my hands right now, and I’m curious what that’s about.” This transparency also helps your therapist to better support you and tailor teletherapy treatment to your individual needs.
Treat teletherapy like you would an in-person appointment. Be sure to share if there’s something specific you want to talk about or accomplish in each session.
Regardless of how or where it happens, mental health counseling can be life-changing and your options are flexible. “It’s important to know that it doesn’t need to be just one or the other,” said Tisdale. “Some people may benefit from a blend of virtual therapy and in-person counseling. It’s whatever works for you.”
Lyra offers care options that suit personal preferences and lifestyles, including in-person, video conferencing, and text messaging. Our culturally responsive approach to care breaks down barriers to mental health treatment and is proven to help more people get better.
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