Online psychotherapy and face-to-face psychotherapy sessions: Which one is right for me? How do I choose which one to attend?

Written by Heartscape Psychology Intern, Charmaine Chia

Choosing between online psychotherapy and face-to-face sessions can be a challenging decision. Traditionally, in-person therapy was the norm, and the idea of discussing personal issues online might seem strange, lacking the intimacy of a physical connection. However, with the advent of COVID-19, social distancing, and the rise of remote work, online psychotherapy has become a convenient alternative. Both modes have been found equally effective in reducing psychological distress (Lerardi et al., 2022), leaving individuals contemplating which option is best for them.

Examining the advantages of online psychotherapy sessions:

Online Psychotherapy sessions are so convenient

Access therapy from the comfort of your home at any time, eliminating the need for travel. This saves time, energy, and money compared to commuting to a therapist's office.

As long as you have a device and a stable internet connection, you can access therapy at the comfort of your homes, anywhere and anytime. You can access therapy services even when you are working from home. You do not have to travel down to your therapist’s office, and make you feel more tired, especially when the therapists’ office is very far away from where you are at.

For instance, imagine a case where you are living in Toa Payoh and your therapist office is in Pasir Ris, you would have to take the public commute or drive a 30 mins drive, just to go and see your therapist in Pasir Ris. Considering how inconvenient it was, you could use that time to watch a Korean drama or cook up a proper meal for yourself, and get yourself more ready to see the therapist.

You can save a lot of money in the long run, especially if you had to spend money on traveling to visit your therapist in his/her office

Again, going back to the same scenario, imagine you are living in Pasir Ris and you live in Boon Lay, you could drive to see your therapist, to reduce the amount of traveling time, if you take public transport. Regardless of the mode of transport you used to commute to see your therapist physically, it is hard to deny the fact that traveling costs will be incurred, on top of the consultation fee that you had to pay to see your therapist face to face.

By avoiding travel expenses, individuals can save money in the long run, similar to a monthly Netflix subscription.

Besides saving a lot in the long run on traveling, for those who experience a lot of anxiety being vulnerable in front of a stranger face to face, having an online psychotherapy session would reduce anxiety sharing your deepest emotions to your therapist and make it less nerve wrecking for yourself.

Imagine yourself in a face-to-face therapy session with your therapist. Suddenly, you find yourself freezing upon seeing your therapist, leading to an awkward 30 minutes of both of you simply staring at each other. Meanwhile, your mind is consumed with overthinking, contemplating things like how your therapist is sitting, and deliberating on how to open up about your deepest issues. As you continue, you start observing your therapist's office, noticing numerous family photos adorning the space, which becomes a stark contrast to your desire to express feelings of disdain towards your own family members.

For those who harbor apprehensions about vulnerability and tend to overthink in face-to-face conversations, online environments offer a potential alternative by reducing the need to navigate numerous social cues, a common challenge in in-person interactions.

If sharing emotions face-to-face feels uncomfortable, online therapy sessions provide a reassuring environment, alleviating anxiety. Here, you can concentrate on expressing yourself without the burden of managing the non-verbal cues inherent in face-to-face conversations. If you grapple with social anxiety in traditional interactions, initiating therapy online might be a more comfortable starting point. Additionally, according to Mehta and colleagues (2015), online environments provide a degree of anonymity, empowering individuals to regulate the information they disclose and promoting openness through an online disinhibition effect. This separation of actions from real-world identity allows better control over the extent of information shared with the therapist, offering a sense of ease and confidence for those with heightened anxiety about discussing their deepest emotions face-to-face.

However, with all the above being said, the anxiety about being vulnerable and physically present during social interactions would be important matters to address within therapy sessions too!

Cons of online psychotherapy sessions:

Prone to technological disruptions

Imagine you are talking to your therapist on zoom and you are sharing something vulnerable about yourself, then your therapist keeps asking you to repeat yourself because she could not hear what you are saying. In such cases, I bet you would feel annoyed because you were immersed in your own emotions and someone else could not hear what you were saying, then kept asking you to repeat yourself. Online sessions are susceptible to technical issues, potentially interrupting the flow of communication and causing frustration.

It's challenging to entirely sidestep scenarios like the one described above or instances where the therapist's voice, though audible, presents difficulty in understanding. Such technological disruptions are fairly prevalent and can impede clients in comprehending the therapist's message.

2. Distractions: The ease of accessing other online platforms during therapy sessions may lead to reduced focus on the therapeutic conversation.

Have you ever experienced a situation where your boss is talking to you on a zoom call, but you are actually replying to a whatsapp message by your colleague? For students, I bet the situation where your teacher is talking on zoom, whilst you are playing roblox isn’t exactly foreign to you.

As technology keeps us constantly informed about current events, the accessibility of various browsers during online therapy sessions poses a challenge. Managing ongoing message platforms or resisting the temptation to engage in unrelated conversations can be difficult. This susceptibility to distractions, such as notifications from other applications, may hinder concentration and focus during the online session.

Online counseling may not be suitable for clients experiencing issues like serious psychotic episodes, substance abuse and crisis

Considering the nature of online counseling sessions, addressing certain issues may necessitate additional evaluation, making it potentially more challenging to effectively treat these cases remotely. In such instances, opting for face-to-face sessions would be more beneficial for the client.

For example, one day you may experience a severe psychotic episode, marked by distressing auditory hallucinations. While seeking help through an online session, the therapist may encounter difficulties in providing timely assistance, leaving you to feel isolated because of the physical absence of the therapist. In situations of heightened distress like this, our recommendation would be to engage in face-to-face therapy. This approach ensures that you feel less alone and allows the therapist to offer more effective assistance in person.

Therapists might miss important non-verbal cues that could be essential detecting your emotional state

In typical social interactions, there are friends who persistently delve into discussions about your past relationships, even when it's evident from your eyes and body language that you feel uncomfortable addressing the topic. They might persist with questions like, "Why did you break up? Was it because of your behavior?"

In virtual platforms like Zoom or Google Meets, expressing disapproval to your therapist becomes challenging, especially if they've breached your boundaries or posed offensive inquiries. While you may convey discomfort through non-verbal cues such as closed body language, tearful expressions, and hand gestures, these signals might go unnoticed by therapists during online sessions (Mehta et al., 2015). This absence of cues can lead the therapist to overlook crucial non-verbal indicators essential for understanding your emotional state, potentially prompting them to press for certain information without recognizing your initial discomfort.

The aforementioned points outline the advantages and disadvantages of online psychotherapy sessions. Now, let's shift focus to discussing my perspectives on the pros and cons of engaging in face-to-face psychotherapy sessions.

Pros of face to face psychotherapy sessions:

Allow the delivery of more hands-on therapeutic treatments for clients who would prefer more hands-on treatment methods

For individuals who find a mere conversation with their therapist less appealing and prefer hands-on therapeutic methods such as experiential therapy (Gestalt therapy), Eye Movement Desensitization and Reprocessing (EMDR) techniques, and Play therapy, face-to-face therapy is recommended. This preference arises due to the use of specialized equipment that may not be readily available in clients' homes, making it challenging to execute these therapeutic approaches remotely.

In the case of children, particularly those diagnosed with attention deficit hyperactivity disorder (ADHD), studies by (Usluoglu and Balık (2023)) indicate that their attention spans are typically short. Managing an online therapy session for these children becomes more challenging, as distractions in their home environment may hinder engagement. Children are more likely to be drawn away from the computer screen during virtual sessions, making face-to-face online psychotherapy a more suitable option. In this setting, it is difficult for them to focus on interacting with a stranger through a computer screen, and the absence of physical engagement may lead to boredom. Therefore, children with a high susceptibility to distractions in their surroundings are likely to benefit more from face-to-face online psychotherapy, where they can engage with the therapist physically through play materials rather than solely through a computer screen.

There is less distraction for you and your therapist, and you can be more focused in the session with your therapist

Imagine conducting an entire therapy session from your home, where the presence of children and various distractions may hinder your complete immersion in the therapeutic experience. Under such circumstances, maintaining full engagement with your therapist becomes challenging, especially when contending with distractions like kids, work emails, and pending assignments. In such cases, your home environment may not be the most conducive for maintaining focus and presence during therapy sessions.

Consider the possibility of transitioning to a therapist's office, which provides a neutral setting devoid of excessive distractions. This change in environment could enhance your ability to concentrate on the session and address essential issues, offering a more focused and productive therapeutic experience compared to dealing with numerous distractions within your home.

Psychologists can provide more immediate support for crisis

Psychologists can intervene immediately if they access that you require immediate support from other avenues. Hence, for more serious issues like active suicidal ideation, psychosis and substance abuse, doing the therapy face to face allows psychologist to conduct more comprehensive assessment of the psychological state of the person and intervene immediately if they require other avenues of support

Cons of face to face psychotherapy sessions:

1. Commitment to travel down to therapists’ office

For people who are dealing with tight schedules and living far away from the therapists’ office, it could be quite difficult to travel down to the sessions, without being late. Therefore, it would be harder for that individual to come down to the clinic to see the therapist and increase chances of canceling the therapy sessions.

2.Traveling costs associated with traveling down to the therapists’ office

Since you had to travel down to the therapists’ office, there will be costs incurred with the traveling. The time used to travel to and fro the therapists’ office would be better used in other areas, especially if you are dealing with a tight schedule.

3.Stigma and Privacy concerns

A study conducted by (Wong et al., 2018) amongst Malaysia University students, results show that most prefer online psychotherapy sessions over face to face psychotherapy sessions. They reported reasons like the stigma, convenience that they can have with attending online counseling sessions, which explains their preference towards online sessions. The stigma towards mental health issues is quite real and so, sometimes people may fear going out and being recognized by someone they know in the clinic, therefore it would be better for that individual to do it online instead.

Now that you have delved into a more comprehensive understanding of the advantages and drawbacks associated with online psychotherapy and face-to-face psychotherapy, I trust you are better equipped to determine which approach aligns more suitably with your current needs. Hopefully, this insight serves as motivation for you to embark on your therapeutic journey.

For your convenience, Heartscape Psychology extends both online counseling and face-to-face counseling services. If you find yourself eager to initiate therapy but still harbor uncertainties about the most fitting method for you, don't hesitate to reach out to us. You can contact us via email at admin@heartscapepsychology.com or message us on WhatsApp at 65924460.

You can’t hide your emotions in front of your therapist and you have to be very honest in front of your therapist

The online setting hinders the therapist's ability to pick up on additional non-verbal cues that could convey your emotions. This can create a more comfortable space, particularly if you prefer not to disclose extensive personal information during the initial sessions. On the contrary, during face-to-face sessions, you may feel compelled to fully expose your vulnerabilities, potentially leading to discomfort. It's important to note that while this openness can foster a deeper connection and aid personal growth, individuals who find it challenging to articulate their emotions may struggle in this setting, especially if they lack real-life experience in being emotionally vulnerable with others.

In conclusion, it's important to acknowledge that both online and face-to-face psychotherapy possess their respective advantages and disadvantages. However, be assured that our psychologists excel in delivering both methods. Whether you opt for online or face-to-face therapy, we guarantee an unwavering level of care and assistance. Take the step towards seeking help with us today.

References

Ierardi, E., Bottini, M., & Riva Crugnola, C. (2022). Effectiveness of an online versus face-to-face psychodynamic counseling intervention for university students before and during the COVID-19 period. BMC Psychology, 10(1). https://doi.org/10.1186/s40359-022-00742-7

Mehta , V., Parakh , M., & Ghosh, D. (2015, November 7). Web based interventions in psychiatry: An overview . Web Based Interventions in Psychiatry: An Overview. https://www.researchgate.net/publication/283546302_Web_Based_Interventions_in_Psychiatry_An_Overview

Usluoglu, F., Balık, E.A. Child therapists’ views and experiences of video conference psychotherapy with children. Current Psychology (2023). https://doi.org/10.1007/s12144-023-04820-w

Wong, K. P., Bonn, G., Tam, C. L., & Wong, C. P. (2018, January 16). Preferences for online and/or face-to-face counseling among university students in Malaysia. Frontiers. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00064/full

Online psychotherapy and face-to-face psychotherapy sessions: Which one is right for me? How do I choose which one to attend?

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