Telehealth Therapy vs. In-Person Therapy

In recent years, telehealth therapy has emerged as an alternative to traditional in-person therapy. In fact, the data shows that the virtual therapy market is expected to grow by more than 27% by 2030.

Telehealth therapy (or online therapy) allows therapists to provide services via digital platforms, while in-person therapy refers to face-to-face sessions in physical locations.

In this article, we’ll discuss some pros and cons of each approach to help you decide which option works best for your practice and your clients.

What is online therapy?

Online therapy, also known as telehealth therapy or virtual therapy, refers to counseling and therapeutic services provided through digital platforms. This allows practitioners to connect with clients remotely.

Sessions typically take place via video conferencing tools, but they can also involve phone calls, depending on the practitioner’s preference and the client’s needs.

A variety of technologies can be used to deliver online therapy, including dedicated telehealth software. Although many virtual meeting platforms are convenient, it’s essential to ensure that your chosen platform provides a secure, HIPAA-compliant environment to help ensure client confidentiality and safety.

Pros of online therapy

Online therapy offers several advantages for both practitioners and clients.

Here are some of the benefits:

• Convenience and Flexibility: Both practitioners and clients can enjoy the convenience of scheduling sessions that fit their busy lives. Clients can join appointments from anywhere, and practitioners can set their hours without the constraints of a physical office.
• Accessibility: Telehealth therapy is especially valuable for clients in rural or remote areas, as well as those with mobility issues who might otherwise struggle to access in-person care. It breaks down geographic barriers and brings therapy right to the client’s home. Telehealth simply offers a wider range of options for clients; they’re not limited to only working with providers within their geographical region. This can be especially helpful for people with a very specific need or presenting concern.
• Cost-Effectiveness:
  • For practitioners, online therapy can reduce overhead costs by eliminating the need for an office outside of the home, including utilities and maintenance for a separate office space.
  • For clients, it reduces travel costs and time spent commuting to and from appointments. Some practices also offer lower rates for telehealth sessions, making mental health care more affordable.
• Reduced Stigma: Online therapy can be a more discreet option for clients worried about the stigma of seeking mental health help. It allows them to avoid the potential of running into acquaintances in waiting rooms or on the way to appointments, particularly in smaller communities where privacy is harder to maintain.
• Reduces Cancellations: Online therapy removes some of the external barriers that may prevent a client from attending an in-person appointment. For example, if the client’s vehicle breaks down or their child is unwell, they may still be able to attend an online appointment. Alternatively, if a client who usually attends in person is unwell or running late, they may be offered an online appointment to avoid a cancellation and loss of income.

Cons of online therapy

While online therapy offers advantages, it does come with challenges:

• Lack of Physical Presence and Connection: Without being in the same room, some therapists and clients may feel a weaker sense of connection. Nonverbal cues, such as body language, may also be harder to notice or interpret.
• Technical Difficulties: Glitches such as poor internet connections or audio issues can disrupt sessions. Additionally, some clients, particularly those who aren’t as tech-savvy, may struggle with using the technology required for telehealth.
• Privacy Concerns: Finding a quiet, private space for therapy can be a challenge for some clients, especially those living in shared or busy households. There may also be safety factors to consider, such as in situations where there is family violence. Background noise and interruptions may cause discomfort or make it difficult to focus during sessions.
• Not Suitable for Every Client or Condition: Online therapy isn’t always the right fit for everyone. Certain conditions, such as severe mental health issues or complex therapeutic needs, may require the in-person support and structure that only face-to-face therapy can provide.

What is in-person therapy?

In-person therapy, also known as traditional face-to-face therapy, allows clients to meet with their therapist in a physical setting, such as a clinic, office, or counseling center.

These sessions provide a private, controlled environment where the therapist and client can engage directly.

Pros of in-person therapy

In-person therapy offers several distinct advantages that make it a preferred choice for many practitioners and clients:

• Physical Presence and Connection: Face-to-face sessions can foster a stronger sense of connection between therapist and client, which can help to build trust and rapport. Many people report that in-person therapy feels more intimate due to the co-regulating nature of being in the same space together.
• Enhanced Observation of Nonverbal Cues: In-person sessions allow therapists to pick up on subtle nonverbal cues, such as body language, facial expressions, and even shifts in posture, which may not be as visible during online sessions. These insights can provide valuable context for understanding a client’s emotional state and can be helpful for clients with attention-deficit challenges.
• Ideal for In-Depth Therapeutic Interventions: Certain therapeutic approaches, such as trauma-focused therapy or therapies involving physical or experiential activities (such as art or play therapy), may be more effective in person. The structured, safe environment of a therapist’s office is better suited for these intensive interventions.
• Separation from Everyday Life: For many clients, physically going to a therapist’s office provides a sense of separation from their daily environment. This neutral space can make it easier to open up about sensitive or difficult topics without the distractions or emotional baggage of home, creating a safe, dedicated space for reflection and healing.

Cons of in-person therapy

Despite its benefits, in-person therapy also has some drawbacks worth noting:

• Limited Accessibility: In-person therapy can be challenging for clients living in remote areas or for those with mobility limitations. Parents with young children may also find it challenging to access in-person therapy due to frequent childhood illnesses or not having access to childcare. Travel to an office can pose significant barriers, preventing some individuals from receiving the care they need.
• Higher Costs: For the therapist, a physical office comes with expenses, including rent, utilities, and maintenance, which can lead to higher fees for clients. Additionally, clients may incur transportation costs, making in-person therapy less affordable for some.
• Discomfort or Anxiety Related to Traveling: For some clients, the process of traveling to a therapy appointment can cause anxiety or discomfort. This may be especially true for individuals who struggle with transportation issues, social anxiety, or other related concerns.
• Increased Risk of Exposure to Illness: In-person therapy carries a greater risk of exposure to illnesses, especially during cold and flu seasons or in the wake of pandemics. This concern can deter some clients from seeking necessary support, particularly those with underlying health conditions.

Common misconceptions about online therapy

Some clients have existing ideas about online therapy and may challenge its validity as a therapy option. Misconceptions and questions may include:

Is online therapy real therapy?

Yes. The core of any therapeutic relationship is the quality of the conversation, the consistency of the relationship, and the skill of the practitioner. None of which depend on being in the same room. Video sessions follow the same clinical frameworks as face-to-face ones.

Can a therapeutic connection really form online?

It can, and the evidence supports this. A 2021 meta-analysis published in Psychological Medicine found that the therapeutic alliance in video-based therapy was comparable to in-person treatment across a range of conditions. Many clients also report feeling more at ease in their own environment, which can support openness rather than hinder it.

Is in-person therapy more effective than online therapy?

No, therapy efficacy depends far more on the fit between client, practitioner, and treatment approach than on the delivery format. For presentations like anxiety, depression, and stress-related conditions, a 2021 study in the Journal of Affective Disorders found that online CBT produced significant symptom improvements comparable to face-to-face delivery.

In-person therapy may have an advantage in specific clinical contexts such as certain trauma-focused approaches, interventions involving physical assessment, or working with clients whose presentation requires close in-room observation.

Is online therapy private and confidential?

Yes, with the same caveats that apply to any clinical setting. Reputable telehealth platforms use end-to-end encryption and meet the relevant compliance standards: HIPAA in the US and equivalent frameworks in other jurisdictions.

The part of confidentiality that technology can’t control is the client’s environment. For example, a client taking a session from a shared living space is a more common risk than a platform breach and is worth covering in your informed consent process.

Can I switch between online and in-person sessions with the same therapist?

Yes, if your therapist offers both. Many practitioners now work across a hybrid model, with clients moving between formats depending on what suits them week to week. The clinical considerations are the same regardless of format, but it’s worth agreeing up front how the switch works in practice. Communicate clearly whether it requires advance notice, whether it affects billing, and whether there are session types reserved for in-person only. Licensing also applies here, and if you or your client travels interstate, the jurisdictional rules apply regardless of which format the session takes.

Is online therapy suitable for children and adolescents?

It can be, though the evidence base is less settled than for adults. A 2024 systematic review published in JMIR Mental Health found that online interventions for children and adolescents showed promising results for anxiety, depression, and social functioning, particularly when a therapist was actively involved rather than the intervention being fully self-directed.

Younger children present more practical challenges such as maintaining attention, the absence of parental involvement in the room, and the difficulty of reading nonverbal cues through a screen. For adolescents, the research is more encouraging. As with adults, the suitability depends on the presentation, the individual client, and whether a safe and private space is available at home. Parental consent requirements also apply, and informed consent documentation should reflect the online delivery method explicitly.

Costs and insurance considerations

When your clients are weighing up online therapy versus in-person sessions, cost is almost always part of the conversation, even if they don’t say so directly. Understanding what drives their decision-making helps you have an informed discussion with them.

Costs for clients

For clients, online sessions mean no travel time, no parking, and no need to take time off work for a longer trip. For clients in regional or rural areas, those indirect costs can be substantial.

Insurance coverage

Whether telehealth is covered under a client’s insurance policy depends on their insurer, their plan, and where they’re located. Coverage expanded during the COVID-19 pandemic. Since then, some insurers have maintained broad telehealth benefits, others have pulled back or introduced conditions, such as requiring video rather than phone sessions or limiting covered diagnoses.

Your clients will often assume their coverage hasn’t changed. Point them toward their insurer directly, rather than making assumptions on their behalf, to get clarity on their coverage. Encourage them to ask specifically whether telehealth sessions are covered, at what rate, and whether any conditions apply.

If you bill insurance, check the telehealth billing codes that apply in your region and review them regularly. Insurance companies may have different documentation standards for telehealth. It’s your responsibility to track any trends and double-check with each payor to understand their requirements.

Some practitioners offer sliding scale fees for telehealth, such as those in practices that accept both insurance and private paying clients. This can make ongoing therapy more accessible.

Is online therapy or in-person therapy right for your practice?

This is a decision that you have to make for your practice.

Online therapy offers convenience, accessibility, and cost-effectiveness, which makes it an attractive option for many clients. However, it may lack the physical presence and connection that some individuals prefer, and technical difficulties can pose challenges.

On the other hand, in-person therapy provides the benefits of direct interaction, enhanced observation of nonverbal cues, and a structured environment for deeper therapeutic interventions. Yet, it can be less accessible for those in remote areas, may incur higher costs, and could lead to discomfort or anxiety related to travel.

Some practices find that a hybrid approach combining both online and in-person therapy works best, as they can cater to a broader range of client needs. This flexibility can enhance accessibility and provide opportunities for face-to-face connection when needed.

Ultimately, the decision on which format to adopt lies with each practice. It’s important to consider your business model, your clients’ preferences, and the types of services you wish to provide.

FAQs

Is online therapy as effective as in-person therapy?

For most common presentations, including anxiety, depression, grief, and relationship difficulties, research suggests online therapy can be as effective as in-person treatment. A 2018 meta-analysis combining results from 20 studies found online CBT was just as effective as in-person CBT for anxiety and depression. A more recent large study tracking 2,300 patients across depression, anxiety, PTSD, and OCD found recovery rates remained stable even as nearly half of all visits shifted online.

Where in-person therapy tends to have an advantage is with more complex presentations: severe psychiatric conditions, acute crisis situations, and cases where a client can’t access a safe and private space at home.

Can online therapy treat serious mental health conditions?

It depends on the condition and the client. Online therapy works well for a range of serious presentations, including PTSD, OCD, and depression, when it’s delivered by a qualified practitioner with the right supports in place.

Do therapists have to be licensed to provide online therapy?

Yes. Licensing requirements for online therapy follow the same rules as in-person practice. In most jurisdictions, a practitioner must hold a current licence in the state or country where the client is located at the time of the session, not where the practitioner is based. In the US, the APA’s telehealth guidance is clear on this, though interstate compacts like PSYPACT and the Counseling Compact have made cross-state practice more accessible for eligible practitioners. In Australia, AHPRA’s telehealth guidance covers registration requirements for practitioners seeing clients interstate or overseas. Seeing a client in another jurisdiction, even briefly, can create compliance issues, so check with the relevant regulatory body before taking on clients outside your usual practice area.

---

No matter which approach you choose, Zanda has the tools you need to run and grow your allied health practice.

Ready to see how Zanda makes practice management easy? Sign up for a 14-day Free Trial today, no credit card required.