Online Therapy & Face-to-Face Therapy: What does the Scientific Literature Says?
Written by Lilly Rosado MA, LMFT-A Supervised by Kelly McCabe LMFT-S, LPC-S
Online therapy is characterized as communication between a licensed therapist and a client through video conferencing, web-based environments which allow clients to access structured content, email, chat, phone, virtual reality, and artificial intelligence. (Fernandez-Regueras, Calero-Elvira & Guerrero-Escagedo, 2023)
According to (Chipps, Petzoid, Adams, & Jackson, 2020) mental health issues are commonplace, and everyone will experience at least one mental health disorder in their lifetime. The researchers quote (Dowling & Rickwood, 2013) as stating that although most mental health problems are mild to moderate 22% are severe enough to cause significant distress and functional impairment. (Dowling & Rickwood, 2013) They go on to explain that not everyone who is diagnosed with a mental disorder will have access to mental health services, because there are barriers to traditional face-to-face therapy. They include lack of accessibility for rural communities, isolated localities, perceived social stigma associated with psychiatric disorders, lack of transportation, poverty, and lack of financial resources. (Chipps, Petzoid, Adams, & Jackson, 2020)
Online therapy has its limitations and as discussed by (Shaw & Shaw, 2000) Online therapy is not appropriate for certain presenting problems like sexual abuse, violent relationships, eating disorders, psychiatric disorders that involve distortion of reality, suicidal and homicidal ideation. (Shaw & Shaw, 2000) Care must also be taken when working with minors to ensure a consenting adult is present and divorce decree or custody agreement are obtained by the therapist before the session. Online therapy is not for everyone, and it seems to be better suited for mild to moderate mental health issues and not appropriate for crisis situations.
According to (Fernandez-Regueras, Calero-Elvira, & Guerrero-Escagedo, 2023) there is substantial research evidence supporting the effectiveness of teletherapy interventions using Cognitive Behavioral Therapies for mental health disorders such as, depression, anxiety, post-traumatic stress disorder, and somatic disorders. Some research findings based on Meta Analysis suggesting that Online video conferencing is just as successful as Face-to-Face therapy (Berryhill, Hali-Tierney et.al., 2018; Rees & McClaine et.al., 2015)
The (Fernandez-Regueras, Calero-Elvira, & Guerrero-Escagedo, 2023) study found a greater percentage of fulfilled objectives at the end of Online therapy as compared to face-to-face therapy. No significant difference was found in the proportion of dropouts between both modalities. Regarding efficacy, both face to face and Online videoconferencing were found to achieve successful treatment outcomes. They found no evidence that one modality was associated with greater therapeutic success. Both face to face and Online therapy were found to be associated with therapeutic improvement. (Fernandez-Regueras, Calero-Elvira, Guerrero & Escagedo, 2023) (Lee, Heyman, Winkelman, Sneed, & Sametz, 2023) found that participants in Online Therapy were satisfied with their experience. Three factors played a part in client satisfaction: Ability to apply counseling sessions to life circumstances, frequency of counseling, and counselor providing skills that help the client. According to the researchers this study findings support the continuation of Online therapy, because of its ability to produce successful outcomes. (Lee, Heyman, Winkelman, Sneed, & Sametz, 2023)
A study conducted by (Chipps, Petzold, Adams, & Jackson, 2022) looked at the reduction in symptoms, client satisfaction, and the cost-benefit ratio of Online Therapy. They found reduction of symptoms in the following mental health disorders: Major Depressive Disorder, Bulimia Nervosa, Panic Disorder, Post Traumatic Stress Disorder and Alcohol Use Disorder. Participants reported improvement in quality of life, once again demonstrating that Online therapy can reduce symptom of psychological distress and improve general functioning. Client satisfaction was also high. The researchers also found Online Therapy to be cost effective as it eliminates need for transportation and can serve as an adjunct to face to face therapy. (Chipps, Petzold, Adams, & Jackson, 2022)
The development of a working alliance is a concern that is often expressed that Online therapy disrupts this important process to the therapy experience. The working alliance speaks to the therapeutic relationship between the client and the therapist as the main component to successful face-to-face therapy. (Richard et.al., 2013) found that a stable and positive therapeutic alliance can be developed via Online therapy and that there is no significant difference to the bond established with face-to-face therapy. Similarly (Sucala et.al., 2012) supports these findings. In their study they found a strong and stable therapeutic relationship can be established Online that is compatible to face-to-face therapy and that it correlates to positive treatment outcomes. (Sucala et.al., 2012)
The scientific literature is lacking specifically on how Online therapy is impacting minority groups as discussed in the Content Analysis conducted by the American Counseling Association 2000 to 2018. They expressed concerns for greater inclusion in the research for non-English speakers, Asians, Latinos, and African Americans living in poverty with limited access to mental health services. (Woo, Dondanville, Jang, Na, & Jang, 2020) More diversity studies are needed to capture the full range of how Online therapy is impacting the counseling field. These findings also support the view that Online Therapy is finding its niche in the world of counseling. Online therapy may be able to help reduce some of the barriers inherent in face-to-face counseling. (Chipps, Petzoid, Adams, & Jackson, 2020)
Due to the limited research literature on the subject more studies are needed to substantiate these early findings. However, these results are promising that Online therapy may have a role to play not as replacement for face-to-face therapy, but as a different modality with its own unique limitations and strengths. (Dhillon & Verma, 2022) similarly suggest that Online therapy has emerged as helpful and beneficial as traditional face-to-face therapy. (Dhillon & Verma, 2022)
References
Chipps, W., Petzold, A., Adams, C., & Jackson, K. (2020). Online therapeutic methods: A systematic review. Current Psychology, 41(5), 2835–2847. https://doi.org/10.1007/s12144-020-00791-4
Fernández-Regueras, D., Calero-Elvira, A., & María Cristina Guerrero-Escagedo. (2023). Comparison of clinical indicators between face-to-face and videoconferencing psychotherapy: Success, adherence to treatment and efficiency. Psicología Conductual, 30(3), 543–562. https://doi.org/10.51668/bp.8323306n
Lee, D. J., Heyman, A. N., Winkelman, L., Sneed, Z., & Sametz, R. (2023). Effectiveness of Teletherapy During the COVID-19 Pandemic. Journal of Mental Health Counseling, 45(2), 147–165. https://doi.org/10.17744/mehc.45.2.04
Sharma, S., & Bahuguna, A. (2022). What Medium of Mental Health Services do Clients Prefer – Online or Offline? Journal of Psychosocial Research, 17(2), 451–466. https://doi.org/10.32381/jpr.2022.17.02.17
Shaw, H. E., & Shaw, S. F. (2006). Critical Ethical Issues in Online Counseling: Assessing Current Practices With an Ethical Intent Checklist. Journal of Counseling & Development, 84(1), 41–53. https://doi.org/10.1002/j.1556-6678.2006.tb00378.x
Woo, H., Dondanville, A., Jang, H., Na, G., & Jang, Y. (2020). A Content Analysis of the Counseling Literature on Technology Integration: American Counseling Association (ACA) Counseling Journals between 2000 and 2018. International Journal for the Advancement of Counselling, 42(3), 319–333. https://doi.org/10.1007/s10447-020-09406-w
