The entire world changed with the COVID-19 pandemic, and the field of therapy was no exception. Many therapists, like myself, were faced with the challenge of shifting their practices to be entirely online. This larger challenge revealed others: finding confidential spaces from which to work, ensuring that online care platforms were sufficiently secure, and adapting the nuances of “in real life” encounters to the screen. Since those early days in 2020, online therapy has come a long way, and we are able to offer therapy online with a lot more experience and confidence.
Personally, most of my current clients enjoy something of a “hybrid” model, where sessions are sometimes held online and sometimes held in-person, depending on several factors. But the outset of therapy allows us and our clients to ask the question more clearly: is online or in-person therapy best?
Looking to the research, we know that both online and in-person therapies are generally found to be equally effective (Lippke et. al., 2021). Given that there is not a heavy preference within the evidence base, we can then look at client characteristics and context to help guide the decision. Here are a few of the factors I speak to clients and their families to help make the decision: Will we be meeting online or in-person?
- Age: Indeed, in my experience, younger kids generally have more difficulty with online therapy. Although age does not necessarily mean a child can’t meet online, it means that we may need to make some arrangements for online therapy to be most successful while it’s taking place through the screen. We may arrange shorter sessions or have grown-ups play a more significant role in the flow of sessions. We may request certain materials (toys, fidgets) to help young people stay with the online sessions.
- Geography: When clients have a longer commute to make it to sessions, there may be a strong preference for online meetings. Importantly, though, many clients (especially young clients brought to therapy with one of their grown-ups) find the commute to and from therapy to be an important ingredient in their overall experience of therapy. That is, the time spent going to and from therapy could be quality relationship time. Alternatively, if travelled alone, the commute might also be a time to mentally prepare before therapy and to decompress afterwards. Having a commute is not necessarily a bad thing nor a definitive reason to select online care.
- Convenience: All families are busy. Some families are busier than others, and the convenience of removing a commute to and from therapy is extremely appealing or even necessary for fitting therapy into the fold. Online care may be the only or the best way for a family to prioritize regular therapy sessions.
- Focus skills: Most people tend to have multiple tabs open at once, both within their mind and on their devices. Meeting online makes distractions much more readily available. Before and during online sessions, it takes reflection about one’s ability to direct focus to the “therapy tab.” Some people struggle more than others to put distractions out of reach and to keep them there. Although no one has flawless focus, perfectly directed and sustained for the entire session, it is important to be honest with oneself. Do the more accessible distractions of the online world make it a less wise choice than meeting face-to-face?
- Previous therapy experience: Some clients come to therapy having had previous experiences of in-person, online, or hybrid therapies. Information about your experience in the past can help us to co-consider what might be best for the next therapy experience.
At KaZa Family Centre, each of our clinicians offers therapy virtually, in-person, or in some combination of the two. We also shift our practices as needed and invite ongoing discussion about whether the current approach is suiting you best. Please reach out to us with your questions about therapy. And, while we have you, are there other factors you consider when it comes to the question of online or in-person therapy?
References
Lippke, S., Gao, L., Keller, F. M., Becker, P., & Dahmen, A. (2021). Adherence With Online Therapy vs Face-to-Face Therapy and With Online Therapy vs Care as Usual: Secondary Analysis of Two Randomized Controlled Trials. Journal of medical Internet research, 23(11), e31274. https://doi.org/10.2196/31274
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