Does Telehealth Therapy Really Work?
Prior to the pandemic, most of us had the same relationship to telehealth that we had to driving a Lamborghini. We knew it was an option, but most of us hadn’t had the opportunity to try it. Over a few weeks, that changed suddenly, and we found ourselves relying on telehealth for everything from routine care to therapy, connecting with our healthcare providers through screens, often from whatever location we could find. I remember having sessions from my dining room while my clients found privacy in their cars, laundry rooms, bedroom closets, and garages. Since the end of the pandemic, telehealth has remained a significant part of my practice, as many of my clients have embraced it for the undeniable financial and logistical benefits.
The convenience of telehealth is real, and the costs can be lower. Some insurance companies waive copays for online sessions. Not paying for gas or tolls is also a financial relief for those with tight budgets, and for those who rely on public transportation, online therapy is often their only option. Outside of these benefits, though, some clients still question whether telehealth offers them the same opportunities for growth and improvement as in-person sessions. This is a very valid question, and I sometimes have to address this at the start of my working relationship with a client. Generally, the existing research supports fairly equivalent outcomes when comparing in-person mental healthcare to telehealth delivery. There can be some significant advantages to telehealth for certain populations, while in-person therapy can be more beneficial for others.
According to a 2021 study (Bulkes, Davis, Kay and Riemann), telehealth therapy produced similar outcomes to in-person delivery for a population receiving care in an intensive outpatient program for the treatment of depressive symptoms. Both groups reported significant improvement in overall quality of life, as well. Those receiving care remotely actually remained in the program for longer than those required to attend in person, and there were fewer logistical barriers to accessing care on an almost daily basis from home.
In an analysis of 12 randomized controlled trials, telehealth via phone or video was shown to have similar outcomes as face-to-face therapy for eating disorders, addiction issues, childhood mental health conditions, and management of chronic physical disorders that included mental health treatment (Greenwood, Krzyzaniak, Peiris, Clark, Scott, Cardona, Griffith, and Glasziou. 2022). The study also found that telehealth made specialized care more accessible to those living in remote areas or for those seeking treatment options with fewer qualified specialists available. Access to online or telephone sessions also offered financial benefits for patients who would otherwise have pursued in-patient programs due to a lack of outpatient options in their communities.
Some research contradicts the findings that remote delivery improves participation and continuation in therapy. Swint, Fischer, Zang, and Zang (2025) found that drop-out rates were slightly higher among patients receiving telehealth delivery, though the reasons could not be explored in depth with the data available. The quality of the therapeutic relationship with the care provider might have had some impact on the decision to leave therapy prematurely, but, overall, this study also found little difference in the outcomes of telehealth versus in-person delivery for the treatment of anxiety and depression. Both groups demonstrated similar levels of symptom reduction and overall improvement in functioning. For those seeking treatment for PTSD, remote therapy appeared more effective, with telehealth clients reporting slightly more significant reductions in symptoms.
Whether telehealth is a viable option for the management of more severe mental health issues, including Bipolar Disorder and Schizophrenia, is less clear. Since these conditions often require years of sustained management and specialized treatments, the long-term data just is not there, but this is a growing area of study. One of the hopes is that online remote care may provide options for patients living in rural areas to access consistent care in their communities, which would allow them to remain in their own homes and forego more expensive treatment through hospitalization, residential programs, or halfway houses.
In my own practice, I have personally witnessed clients thriving through telehealth, but I have also worked with people in situations where online therapy is not the most beneficial option. For some clients, coming to see me in the office is the only time they leave their homes during a given week, and this forced exposure to the outside world can have a positive impact on mood and functioning. There have also been clients in unsafe living situations who struggled with complete transparency, as their partners or other family members were in the home during sessions. The fear of being overheard inhibited progress, though there have been workarounds for this, such as using the chat feature to convey more sensitive information. There have also been times when telehealth offered a lifeline to a client experiencing a manic episode that might inhibit driving to my office. For clients who may disassociate, in-person sessions can generally be better to manage the issue and work with them to keep them grounded.
Given the research, though, the benefits of therapy do not appear linked to the method of delivery. Both telehealth and in-person sessions provide similar benefits and outcomes. Electing one method of delivery over the other is generally dependent on preference, finances, and logistical barriers to attending sessions on a regular basis.
Written by Deanna Diamond, LPC. Schedule an appointment with her here!
References:
Bulkes, N. Z., Davis, K., Kay, B., and Riemann, B. C. (2021, Nov.). Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults, J Psychiatr Res, 3;145:347–352. doi: 10.1016/j.jpsychires.2021.11.003
Greenwood, H., Krzyzaniak, N., Peiris, R.., Clark, J., Scott, A.M., Cardona, M., Griffith, R., and Glasziou, P. (2022). Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials, JMIR Ment Health; 9(3). doi: 10.2196/31780
Swint, J., Fischer, M., Zhang, W. and Zhang, X. (2015). Therapy Without Borders: A Systematic Review on Telehealth’s Role in Expanding Mental Health Access. doi: https://doi.org/10.1101/2024.07.30.24311208
