The Pros and Cons of Teletherapy
The term teletherapy refers to mental health counseling over the phone or online. Teletherapy is one subset of an overarching field of telehealth: health-related services and information distributed the same way. Both have increased since access to medical care has been limited due to recent pandemic actions and shelter-in-place orders. For the purposes of this post, I am discussing therapy sessions delivered via telephone or video, not online via apps.
Initially, I felt that the concept of teletherapy was great as it gave people continued access to mental health services, which are certainly needed during these unprecedented times. As I read more and spoke to therapists I knew, however, I realized that there were both pros and cons to the situation. I have only experienced therapy sessions in person, so I reached out to some who I knew had personal experience with both.
Just as it’s important to find a therapist who’s a good fit, it’s important to consider the pros and cons of teletherapy to determine if it works for you. There’s no one-size-fits-all when it comes to therapy, so what works for one may not work for another. In my opinion, if it’s a matter of teletherapy vs. no therapy, get the help wherever you can. It may be a temporary arrangement given the state of the world, or you may find that it works better for you long-term. Either way, here are both sides to help you decide.
Continued Access to Therapy
This is probably the biggest pro for teletherapy. It allows therapy sessions to continue, offers increased flexibility, and removes commute time. Both therapists and clients are grateful that their work can continue despite the lack of physical access.
Kaitlyn McQuin, who has been outspoken about her transition to teletherapy, explains her situation this way:
At first, I was nervous about not physically being in my therapist’s presence, because I feared connection would be lost and I wouldn’t feel as comfortable sharing through a computer screen, but those fears quickly subsided as soon as I had my first session. I keep certain things consistent to get me in my therapy mindset. I wear my therapy cardigan (which is just a normal cardigan, but one I’ve worn to all my sessions because it’s cozy), light a candle, play some music in the background (mostly for privacy because I live with a roommate), and prepare myself to share. Most times, it’s even easier for me to dive right into my emotions since I’m in the comfort of my own room.
Providing therapy online provides an option to certain populations who may normally have barriers. Elderly, rural, student, and disabled populations are just some who may benefit from teletherapy.
Insurance companies sometimes offer lower rates for teletherapy vs. seeing a therapist in person. Each insurance plan is different, so make sure to check with yours to see your particular benefits. In the experience of Dr. Ashlee Reed, “most insurance companies have offered full coverage for tele-therapy services in this time, waiving co-pays that may otherwise have been a barrier to receiving treatment.”
Even if you don’t have insurance, self-pay rates for teletherapy tend to be lower than in-person sessions.
Privacy & Confidentiality
Teletherapy may work well if you are living by yourself or with those you have a positive relationship, as in McQuin’s case above. Unfortunately, this is not the case for everyone, which can make opening up to a therapist difficult. Teenagers and children may not feel as safe opening up if they are having sessions in a house within earshot of their parents. Clients who have damaged or violent relationships with someone they live with are less likely to speak openly about those people while in the same house. Cori Nelson, a therapist-in-training, emphasizes that “confidentiality should be thoroughly discussed to ensure the safety and privacy of the client.”
I think we are all familiar with the issues of technology. Calls dropping, video stills, and sound issues are just a few of the problems that can arise during a teletherapy session. Clients in rural settings may have unreliable internet. According to Reed, “a video connection going out in an ill-timed moment with a client can be challenging. A sound issue requiring asking the client to repeat in a moment of heightened emotion can be frustrating for the clinician as well as the client.”
Lack of Personal Connection
A big part of the therapeutic relationship is the rapport between therapist and client. Physically being in the same space allows for the observation of more subtle cues such as body language and eye contact, things which are harder to take into account when separated by a screen. Phone sessions provide no visibility into those things at all. Nelson is someone who bases a lot of her work around that personal connection. “For me personally, a con is that I can’t do a lot of hands on activities that would require the toys/supplies in a therapeutic playroom. I love doing arts, crafts, role-playing, structural, and other forms of hands-on therapy.” If the type of therapy that works best for you is more hands-on, it can be harder in a virtual setting.
Ultimately, there are many variables when considering teletherapy. It’s important to consider your situation and decide what’s best for you. As always, therapy is personal and it’s important to figure out what will offer the most benefit to the client.
McQuinn, who was quoted above, also noted that although it’s been great having therapy at home, she is “eager to get back into her office…not only to see her in person, but also because she has really cool affirmation cards. I always pull one before each session. But, having therapy from my own bedroom has been pretty amazing, so, until then, I’ll take it.”