The Potential Downsides Of Online Therapy

There are a number of reasons why in-person therapy may not work for you. Perhaps you want something more affordable, or maybe you live in a remote location. If so, you may have discovered a solution: online therapy. Many believe that this type of treatment is just as effective as therapy conducted face-to-face. According to a 2014 study published by World Psychiatry, many are in support of the use of telehealth sessions for common mental disorders, and another 2014 study published by Current Opinion in Psychiatry says that psychotherapy conducted over the internet has proven to be helpful for anxiety. 

In addition, there are also a number of considerable benefits that come with online therapy, which include being more accessible, especially to those with physical limitations, usually cheaper, and could feel more comfortable for some (via the 2014 study). At the same time, there are some downsides, including the seven you'll find below. If you're trying to decide between telehealth or in-person sessions, weighing the pros and cons of both types of therapy is recommended.

If you or someone you know needs help with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.

The first downside is that your insurance may not cover your telehealth sessions, as per Healthline. Therefore, even though they may cost considerably less than in-person options, you may still end up paying more. This could be a huge concern, as therapy is not cheap. Most online appointments will cost somewhere between $100 and $300.  

If this is your main barrier to beginning online therapy, it's important to talk to either your insurance provider about your plan or your preferred online therapist to see if they take your insurance. When wondering which therapy websites are known for accepting insurance, look into TalkSpace, which sometimes has extra deals when you get started, Brightside Health, which specializes in anxiety, depression, and panic, or MDLive, which is best for people who like talking over the phone instead of video chat (per Healthline). Additionally, if you're looking for Christian-based therapy, Faithful Counseling may be good, while those in the LGBTQ+ community may want to check out Pride Counseling.

The second issue that could arise is unreliable technology. Because poor or slow connection could be an issue with anything conducted over the internet, this will continue to be a problem that mental health professionals and patients have to work through. For instance, a screen could freeze, or a phone call could cut out, which can make it difficult for the session to continue and for help to be administered.

The 2014 study published by World Psychiatry says that one of the main limitations of telehealth is that things can get lost over the internet, as therapists could misinterpret or mishear what their patient is saying. This could easily occur if technology malfunctions or if there's any background noise that makes the patient difficult to hear. Because of this, therapists are encouraged to repeat and confirm the information with the patient, a technique that's sometimes called parroting.

Along with using technology also comes privacy risks. In the 2014 study published by World Psychiatry, this is the most crucial downside to telehealth sessions, as the security of the patient's information is extremely important. In fact, a 2021 article by Frontiers says something similar. The study asked therapists about their main concerns with online therapy, and the patient's privacy was one of their top answers.

One of the biggest differences from in-person therapy is not only the use of technology but also the challenge for the patient to find a quiet and private space away from others. With technology, there's always the risk of the session being hacked or illegally recorded without the patient's permission. With that being said, if the patient cannot find a quiet place to meet, they may be less likely to open up with their therapist out of fear that those near them could hear, which may make the sessions less effective.

Since both the patient and therapist will be in their own spaces, they'll each be subjected to different distractions, which could also make the session less effective. The experts at Routledge refer to this as the question of presence. In other words, when there are distractions in either environment, neither the patient nor the therapist will be as present as they might be in a quiet, secluded room in an office. During telehealth sessions, there are often more things fighting for the attention of both people involved, which makes it much harder for them to connect.

Additionally, therapists can lose control of the setting in telehealth sessions. While a perfectly decorated and optimal office sends the message that they care, this message is not so easily sent over the internet. To combat this, therapists are encouraged to tell their patients to use a quiet, private space, but this can sometimes be difficult to find.

While in session over video chat, the face is seen. However, not the patient's whole body. In this case, the importance of body language is often minimized. Unfortunately, this is a big disadvantage, as body language is crucial to not only the therapist understanding the patient but also to both parties establishing a connection. The issue could be called a disembodied environment, where the senses of sight, smell, touch, and hearing are limited (Routledge). Therefore, therapists are encouraged to focus on facial expressions and to ask their patients to move closer or further away from the screen as needed, but this still isn't the same experience as being in person with someone.

As a matter of fact, even facial expressions can be hard to read through the barrier of the screen, which could lead the therapist to misinterpret something or the patient to not pick up on what the therapist is saying. Overall, the screen can become an extremely hard barrier to cross and may make the appointments less effective. 

People in need of treatment with serious mental illnesses or those in danger may not be able to partake in online therapy sessions, as these individuals may require more personal and face-to-face interaction (per BetterHelp). Additionally, making a diagnosis for a court order cannot be done over the internet, and medication cannot be prescribed, either. The 2014 study published by World Psychiatry points out that self-assessments taken over the internet cannot replace diagnostic interviews, which need to occur in person.

A 2020 study published in Frontiers also says that one of the most pressing ethical concerns when it comes to telehealth is the lack of action a therapist could take in an emergency situation. If a patient was struggling with a serious matter, for example, that required the assistance of another mental health professional in a particular field, it would be much harder for an online therapist to find them help than it would be if they were to meet in person.

Overall, many also report that there is less emotional connection online than there is with in-person therapy sessions. According to the 2021 research article conducted by Frontiers, one of the most important challenges that many online therapists noted was a lack of connection. They described this in a number of ways, including feeling disconnected from the patient, having trouble reading the patient's emotions, and struggling to express or feel empathy through a screen.

This issue along with others adding to the downsides of online therapy could make it more difficult for the therapist to provide their services. Therefore, before signing up for any type of online therapy, whether it be over video chat or just talking over the phone, it's best to do your research and take into consideration the drawbacks listed. Nevertheless, there's always the chance you can work with your therapist and do some sessions through video chat and some in person.