Stuart Cameron, Registered Social Worker #831697 is a Registered Social Worker at MyLife Counselling in Guelph. He works with adult individuals through depression, anxiety, addictions, relationships, stress, major life transitions, and existential issues. Learn more about Stuart here.

Is Remote Therapy as Effective as In-Person?

As we continue in this “post-pandemic” world, remote work and conferences are becoming more accessible and efficient across various sectors. On the other hand, remote therapy continues to be scrutinized. Remote therapy refers to psychotherapy for mental health which utilizes technology to enable it to be delivered virtually. It may even be called online therapy, e-counselling, e-therapy or tele-counselling.

There are already a plethora of studies and research showing the effectiveness of remote therapy, even demonstrating that it can be just as effective for many common mental health struggles, as compared to more traditional face-to-face therapy. Nonetheless, in this post I will put forth the argument that remote counselling can be, and often is, an effective form of therapy.

Research to Date for Remote Therapy and Tele-counselling

This post wouldn’t be making a strong case for the effectiveness of remote and online therapy if it didn’t start with discussing the research to date on remote therapy. But to keep things simple and avoid overloading this post with academic jargon, here’s a simple table breaking down some of the research in areas of remote therapy and the associated findings:

Article Link Summary
A Study of Asynchronous Mobile-Enabled SMS Text Psychotherapy “Mobile-enabled asynchronous text therapy with a licensed therapist is an acceptable and clinically beneficial medium for individuals with various diagnoses and histories of psychological distress.”
Counseling and Technology: Some Thoughts About the Controversy “Tolerance of dual approaches to applying technology in counselling will best permit the counseling field to progress.”
Therapeutic alliance in face-to-face and telephone-administered cognitive behavioral therapy “Results from this analysis do not support the hypothesis that the use of the telephone to provide CBT reduces therapeutic alliance relative to FtF-CBT.”
Telepsychiatry Via Videoconferencing “Not only is telepsychiatry a potentially appropriate technology for the delivery of clinical psychiatric services, distant learning, administration and research; it is likely to change psychiatry as it has been practiced.”
Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study “We propose that text messaging has the potential to improve mental health care broadly, and among low-income populations specifically, with cost-effective means.”
Telemedicine use and the reduction of psychiatric admissions from a long-term care facility “Telemedicine projects using inexpensive technology over standard telephone lines can be successfully used in long-term care settings.”
A Verywell Report: Americans Find Strength in Online Therapy “Online therapy is a true sign of strength and a powerful tool that, if utilized, can help many more Americans maintain better mental health.”
A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis “Our results demonstrated that eCBT was more effective than face-to-face CBT at reducing depression symptom severity. One RCT reported eCBT to be less costly than face-to-face CBT”
Internet-Based Interventions for Problem Gambling: Scoping Review “Internet-based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barriers to accessing professional help.”

More Research is Needed for Remote Therapy

With remote therapy being a relatively new field, more research is needed to continuously improve practices. It’s important for therapists to maintain a critical approach to different strategies which allows attention to be drawn to potential areas that would benefit from improvement or enhancement.
As more research is done, this will likely be the case with remote therapy. We will further understand what is working well with remote therapy and discover areas in need of improvement. As technology progresses quickly, so will research to stay up to date to these advances.

The Pros of Remote Therapy

You Get to Choose from a Larger Pool of Therapists

By its very nature, remote counselling does not require you to live in the same geographic area as your prospective therapist and, thus, allows for a wider “net” when searching. This becomes a bigger “pro” especially for people living in medium to small-sized cities, and even more so for folks living in remote areas.

Convenience and Affordability

By choosing remote therapy, you immediately save on costs associated with transportation and depending on how you earn a living (i.e., time is money) you may be saving even more here.

Remote Therapy Can Be More Approachable

Sometimes folks can experience a stigma associated with walking through the doors of a counselling office. Choosing remote therapy allows for a greater degree of privacy which can be especially helpful when first reaching out for help.

Remote Therapy Offers Choice in Location

With online therapy, you get to choose the location that suits you best. These locations might include:

  • Your living room couch
  • At the Cottage
  • RV Camper
  • Your bedroom
  • Your dining room table
  • Your backyard porch
  • Your car
  • Your home office
  • And even the middle of a lake

It Offers Access to Rural and Remote Areas

Remote therapy offers people living in restricted and rural geographical areas ease of access to mental health care. To say that therapy is only effective in-person is saying that these people must move or travel extended distances to access mental health services.

Disadvantages of Remote Therapy and Tele-counselling

I would not be doing this post and topic justice if I didn’t play “devil’s advocate” and discuss some of the potential downsides to remote therapy. So, let’s break down what can be considered the disadvantages to accessing therapy remotely.

Insurance Companies May Not Cover It

Some insurance companies won’t cover remote therapy. This is far less true nowadays post COVID-19 and typically, now, insurance companies care most about the designations (e.g., MSW, RSW, RP, Psychologist, etc.,).

But it’s always best practice, on the client’s end, to check with your insurance what you are covered for before proceeding with booking a session, to ensure you will receive coverage if it’s available to you.

Some Provinces and States Don’t Allow Out-of-State/Province Providers

While remote therapy allows you to access a larger pool of therapists, you may still be limited by geographical location. For example, I am a Registered Social Worker in Ontario and can only see clients remotely who reside in Ontario.

Confidentiality, Privacy, and Unreliable Technology

Although you have choice in your location during remote counselling and therapy, you may still be limited. This is especially true for people in abusive and controlling relationships who may not have the freedom to access remote therapy at home or nearby.

Additionally, unreliable technology is of course, a big one. If you can be “wired in” (i.e., plugged directly into your modem and not rely on Wi-Fi) you’ll have the smoothest experience.

Lack of Response to Crisis Situations

Remote therapists have less opportunity to help their clients during a crisis, such as a sudden health condition that requires immediate attention for their client.
Best practice for any remote therapy experience is for the therapist to always confirm the client’s location when they start their session, in case they need to pass on any information to nearby emergency response units.

Not Appropriate for Serious Psychiatric Illnesses

Remote therapy is not the best option for people experiencing complex and serious psychiatric issues. It can be after a client or patient has already made progress and is on the road to recovery, in that it can offer easy and convenient opportunities to “check-in” on progress, but it is not ideal for handling complex issues from the outset.

Overlooks Body Language

Body language is a very important aspect for many therapeutic approaches and should be considered in any therapeutic context. Remote therapy, however, often displays only the top half of our body.

As a remote therapist myself, I have the habit of looking directly into my webcam with the intention of offering my clients a better experience, but this means there are times where I am not attuned to my client’s body language.

For a lot of common mental health issues and challenges, this won’t mean a client is less likely to reach their goals, but it is important to note.

Unqualified Providers Are More Prominent

Getting “scammed” is unfortunately an issue with any service online, as the internet makes falling prey to misinformation easy. I discussed earlier how the pool of available therapists opens exponentially when clients are looking for remote therapy, but so does the opportunity for unqualified people to show up in search directories.

By unqualified, I mean people who do not have the certification and/or training to offer mental health services. It can also mean people who were once qualified but have been suspended or “terminated” from being allowed to do so. Best practice is to do your “due diligence” and look for the common qualifications such as

  • Registered Psychotherapist
  • Registered Social Worker
  • Psychologist
  • Psychiatrist
  • Canadian Certified Counsellor

Please note these designations are specific to Canada, and while some may apply to your Country, it is in your best interest to check which designations qualify for mental health services.

Final Thoughts

Remote therapy isn’t for everyone, and that’s ok. But it can work great for a lot of folks, and it has been shown to be just effective in a lot of cases. Remote or in-person therapy is not so “black and white” as often clients will use a “blended” approach and opt for remote or in-person for different occasions. It’s important to understand the benefits and limitations of remote therapy so that you can discuss your options with a qualified mental health professional.

Stuart Cameron, Registered Social Worker #831697 is a Registered Social Worker at MyLife Counselling in Guelph. He works with adult individuals through depression, anxiety, addictions, relationships, stress, major life transitions, and existential issues. Learn more about Stuart here.

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