Face-to-face vs Online Therapy Sessions
When I first started working with clients in my placement back in 2018, all sessions were held face-to-face. Online therapy wasn’t really something any of us were even considering offering, and there didn’t appear to be much demand for online sessions. My personal therapy sessions were always face-to-face too, and it had never occurred to me to explore online therapy as an option.
In March 2020 I, like so many other therapists, had to adapt my whole working model to be able to continue supporting my clients through the Covid pandemic. At first, I was wary about working online because it was a completely new way of approaching therapy, and I wondered if I’d be as effective as a therapist.
Over the last 18 months, I’ve settled in to working online as well as face-to-face, and continue to offer both options for sessions. More clients have been requesting face-to-face sessions recently, but having the back-up of working online available has given them some extra reassurance.
With experience of both options as a therapist and a client under my belt, I thought I’d share some of my thoughts on the pros and cons of face-to-face and online therapy.
Face-to-face sessions
Pros
Easier for both therapist and client to read non-verbal cues
Although many therapies are “talking therapies”, non-verbal communication is still a vital part of the process. Our body language can provide lots of useful information and insight into how we feel, and as a therapist, I can pick up on unconscious movements that can open up another layer of the therapy.
Sometimes what we’re saying doesn’t match our body language, so it’s easier to spot these inconsistencies and explore them. This is especially important when working with clients who have a tendency to people-please or downplay their issues, because their real thoughts, feelings and needs can get missed, and this can reinforce negative beliefs.
The energy is different in a shared physical space
There’s something about being in a shared physical space for therapy that seems to shift the process in a different way to working online. We can tune in to the energy and notice subtle changes that might be missed online, and be curious about what might be behind the changes.
I notice this a lot in my own personal therapy. When I’ve talked about things that are especially challenging and upsetting for me in sessions, my therapist’s presence has helped me to stay grounded and reminded me that I don’t have to sit with the tough stuff alone.
That’s not to say it’s impossible to get this from online sessions, but I do think it’s different.
Creative interventions are easier for therapist to facilitate spontaneously
As a therapist, it’s important for me to be able to respond to and meet my clients where they’re at. For some clients, talking about their thoughts, feelings and experiences is too overwhelming or they simply don’t have the words. This means that it can be easier for them to show me what goes on for them.
Sometimes, I’ll use resources like buttons and perhaps invite the client to map out the significant relationships in their life with them. Or they might prefer to use some art materials as a way of expressing their thoughts and feelings, or perhaps to use objects to represent them.
It’s much easier to do this spontaneously in face-to-face sessions because I usually have the resources to hand, and clients can talk me through the process as they do so, without any delays from technology. This helps the session to flow more naturally and organically, and clients often find it easier to work in this way.
Privacy and reduced chance of being interrupted
I would argue that this is the biggest advantage of face-to-face sessions, mainly because therapy is such a personal experience. From the moment you enter the therapy room, that time and space is protected, and your therapist will do everything they can to minimise the chances of the session being interrupted.
When I was looking for a room to use for therapy, I wanted it to be in a building with lots of different types of businesses in it. This is because I felt that it would help clients to feel more comfortable about coming to see me if they were coming to a building that wasn’t “obviously” where a therapist is based.
The anonymity and privacy helps clients to feel more settled and comfortable, and this can make the therapy process feel much easier and safer. All therapists want clients to feel safe and comfortable in sessions, so the right space is an essential part of this.
Time to decompress and process the session while travelling to / from it
Therapy can bring up all sorts of intense and challenging thoughts and feelings, and having the time to decompress and process sessions can help enormously. The travel time to-and-from the session gives you the space to reflect on what’s come up for you, and to rebalance before going back into the “everyday reality”.
It can be especially helpful to allocate extra time for this around the session itself so that you can collect your thoughts and pause for a bit. Going straight back into work or family life may leave you feeling overwhelmed and adrift, so giving yourself some breathing space can help you to ease back in to the rest of the day.
Cons
May be less accessible for people with reduced / no mobility, health issues
Attending sessions in person can be impossible for some people, which makes face-to-face sessions inaccessible and impractical. There are lots of barriers to accessing therapy, and physical ones can be especially frustrating and challenging.
Some therapists (myself included) are limited in the accessibility of their therapy rooms, and this is something that needs to be clearly stated so that potential clients can make an informed choice about who to work with and how to access sessions.
Have to account for travel time to-and-from the session, as well as the session time itself
With face-to-face sessions comes the extra time for travel, which means that a bigger chunk of the day needs to be allocated to account for this. This can impact on getting to other meetings and commitments, and it might feel like therapy is taking up a lot more time than you initially planned for.
Can be difficult to fit around other commitments
Life can often get very busy, so making time for therapy sessions - especially if they’re face-to-face - can be challenging if you have a lot of other commitments. Some therapists offer clients a fixed, regular session day and time every week or fortnight, which can be great if you need the consistency.
However, this approach to scheduling can be too restrictive if unexpected or irregular commitments clash with the fixed session time, and many clients find it easier to have a flexible session time.
Have to allow enough time to park / for delays on public transport - can heighten stress and anxiety
Getting to a session can be the most stressful part of the therapy experience, especially if it’s the first time you’ve been to meet the therapist in person. This can leave you feeling flustered and stressed, which isn’t a great headspace to be in if you’re already anxious about the session.
Online sessions
Pros
Convenient - can fit around other commitments, as don’t have to account for travel time
Online sessions are much easier to fit into the day around other commitments, as there isn’t the addition of getting to-and-from them. For clients who need to fit sessions into their lunch break, for example, working online gives them the flexibility to do this without impacting too much on their working hours.
I also offer clients the option to have their session online if they’re unable to attend in person at short notice. This helps to sustain the continuity of therapy, which is especially important if clients are working through challenging and distressing issues.
More accessible for people with reduced / no mobility, health issues
This is such an important advantage of online sessions! Being able to access therapy, regardless of any mobility and health issues, means that clients aren’t restricted by whether or not they can physically get to sessions.
For clients with chronic illnesses, or health problems that can fluctuate dramatically in their day-to-day impact, having the opportunity to work online with a therapist means that they can still have sessions when their health isn’t at its best.
Accessible for people who struggle to leave their home (especially those with agoraphobia)
For some clients, the idea of therapy itself isn’t the barrier; instead, it’s the idea of actually leaving the house and getting to sessions. This may specifically be in relation to anxiety about using public transport or having to drive, but it may also be linked to a fear of leaving a place that feels safe.
Having therapy sessions online means that these issues are less likely to be exacerbated, and therefore it may feel easier to engage with therapy because there isn’t the added pressure of getting past the fear and anxiety of having to go out.
May feel more comfortable, as client can be in a space that feels safe and familiar for them
Some clients find it much easier to open up in therapy when they’re having sessions online from home or another place that feels safe and comfortable for them. I’ve had sessions with clients who have been sitting in their cars because it’s felt like the most suitable place for them.
Being in their own space can also enable clients to use their own belongings creatively to help move the therapy process forwards. For example, some clients have been able to show me photographs of people and places that have meaning for them as part of the work, and this has opened up a new layer of understanding and insight.
Cons
Can be harder to read non-verbal cues
Unlike face-to-face sessions, there can be delays and interruptions to video during online sessions that can make it difficult to read non-verbal cues. This means that it can be easy to miss or misinterpret facial expressions and body language, so it’s really important that a therapist keeps checking out what’s going on for the client.
Telephone sessions can be especially challenging, as there’s no way of picking up on any visual cues from body language or facial expressions. Silences can also be tricky to interpret, as it may be that one party is simply reflecting on what the other has said for a moment, or that the line has cut out! How this is managed can have a huge impact on the therapeutic process, so it’s something to think about if you’re considering having telephone sessions.
Greater chance of being interrupted / lack of privacy
When sessions are online, the device that’s being used will likely still show notifications and updates, which can be a significant distraction. This can be especially difficult to manage if the session is taking place during work hours, and the client is receiving emails and updates from colleagues about tasks, meetings, etc.
These distractions can make it difficult for a client to fully engage with the session and to stay present, so the therapy process is likely to be less effective. If the client is having their session on a device at work or home, and is worried about being overheard, this can also make it difficult for them to feel able to talk openly.
‘Zoom fatigue’
After so many months of living life online, having therapy sessions online as well can add to the feeling of ‘Zoom fatigue’. This can make it difficult to engage with the therapy process, and it might feel overwhelming to be doing yet another thing online.
It’s likely that your eyes will feel tired and weary if you’ve spend long periods of time looking at a screen, so giving them a rest by taking regular breaks away from the screen is important.
May not have time to decompress and process the session afterwards
I personally felt the impact that the lack of decompressing time had on me when I was working exclusively online. Going straight from the therapy session into another task or meeting immediately afterwards was exhausting, and I often felt like I hadn’t had time to reflect on it properly.
It’s worth scheduling some “buffer time” around the session itself so that you can ground yourself and reflect on it if you need to. Some people find that they need to have a short nap after the session, so it can be helpful to make time for this too.
Client may not feel comfortable talking about certain issues if they worry they will be overheard
Therapy should feel like a safe and comfortable space to speak openly about whatever is going on for you. If you’re worried about being overheard or interrupted, working online may not be the best option, especially if you have notifications on that are likely to distract you.
Relies on working technology
One of the biggest drawbacks with online sessions is the reliance on technology working as it should. I’m sure we’ve all experienced technology faltering just at the crucial point of a conversation, and know how frustrating this can be.
It can be especially difficult if this happens in a therapy session, as these interruptions can interrupt the “flow”. If a client has managed to start talking about something that is especially difficult or distressing for them, technology cutting out can be the thing that stops them from re-engaging with the process.
As you can see, there are significant advantages and drawbacks to both face-to-face and online sessions. I think the most important thing is for each individual to go with what feels most comfortable for them.
As a therapist, I for one will always aim to accommodate a client’s preference, and to be flexible if a client wants to have some sessions online and others face-to-face. If you’re considering starting therapy and trying to decide whether to have face-to-face or online sessions, I really hope that this post has helped you to weigh up some of the pros and cons of both options.
At the time of writing this post, my caseload is full so I’m not taking on any new clients. If you’re struggling and would like some suggestions for other potential therapists and resources, feel free to contact me using the form below, via email to emma@emmapooleytherapy.com, or on Facebook and Instagram @emmapooleytherapy.