Since 2020, telehealth services have exploded. Telehealth has increased accessibility for mental health services. Many studies show that telehealth services have similar effects to traditional in-person therapy. This is particularly true when treating anxiety and depression for adolescents and adults (Abrams, 2020; Hagyari-Donaldson & Scott, 2025).

Patients should consider several factors when choosing between telehealth and in-person services. The information in this post will help you make an informed decision about what is best for you.

The Case for Telehealth Therapy

Online therapy is convenient. The main requirement for telehealth service is an adequate internet connection. With this, a patient can access services from home, work, school, or another location. Telehealth is particularly useful for patients who have limited transportation options. In cases where a patient can access services from home or school, it can reduce missed work and class time. Telehealth eliminates travel time to and from appointments. Furthermore, for some individuals such as those with severe anxiety, attending telehealth sessions can be less intimidating. Finally, telehealth services provide a helpful backup for times when patients can’t come in for a regular office visit. Examples of these times are in-state vacation, illness, or college students who go home for the summer.

In some cases, telehealth provides opportunities that are not possible with in-person therapy. This can be particularly true when treating various anxiety disorders. With telehealth, we can work in the patient’s natural environment. For example, the therapist can provide parent training on doing special playtime in the actual location they are using for their daily practice. As another example, telehealth can be used for exposure therapy. The patient can face fears in ways that are not as easy in the clinic. As an example, we can help a patient with cleaning their home.

The increased availability of telehealth services gives individuals a broader choice of potential providers. This may be helpful in shortage areas where there are few choices. In cases when specialized therapy is desired (e.g., a sex therapist) telehealth may provide a greater chance of finding someone who can meet your needs.

Factors to consider for a telehealth therapist

There are some unique factors to consider when looking for an online provider. Here is a list of things to consider when selecting a telehealth provider.

1. What are the individual’s qualifications?

A good online provider will be upfront about what license they are using. There is a great difference between a licensed psychologist, licensed professional counselor, or a life coach.

2. Will you see the same person each time?

Progress in therapy takes time. Therapy requires a strong therapeutic alliance. Due to this, it is best to have one therapist you see each time.

3. Does the therapist know the regional culture and laws?

Some telehealth services originate out-of-state, from large corporate chains. These providers may not know the regional culture. This is a particular issue for school services because each state has its own acronyms and laws for things such as discipline. In contrast, I have lived and worked in the Brazos Valley for 20 years. I know specific information about the schools, programs, and services in the community that someone from outside the community may not know.

The Case for In-person Therapy

Despite the benefits of online therapy, in-person therapy has multiple advantages. We strongly recommend in-person appointments whenever possible. Furthermore, if online therapy has not worked for you, we recommended giving in-person therapy a try. It requires more effort, but it can be more effective, particularly in cases where telehealth services cannot.

As a brief analogy, I remember roasting marshmallows over a campfire as a youth. At the time, I would quickly put the marshmallow in the flame, watch it catch on fire, and then eat it after it burnt out. I thought marshmallows were pretty good that way. Then my scoutmaster had me hold the marshmallow over the fire slowly until it was golden brown. I never wanted to eat burnt marshmallows again. To this day, I still remember that lesson that taking extra effort yields better outcomes.

Advantages to in-person therapy include increased confidentiality, fewer environmental distractions, fewer technical issues, greater ease building a strong therapeutic relationship, and improved help for severe cases.

In-person therapy has increased confidentiality

Telehealth services may seem more confidential. You don’t have to go to a physical location where you could be seen entering the clinic. Although this is a concern, online sessions may be less confidential than patients realize.

Finding a secure place to do telehealth is difficult for many patients. Imagine being a teen talking about relationship issues when parents may be listening outside the door. Our working adults have had co-workers walk into their office during their appointment. Sometimes we were talking about sensitive topics they didn’t want the co-worker to hear.

Our minor patients have joined the telehealth appointment from a room at school. We have done this less in recent years. Schools often want our office to sign an agreement that requires us to share more information with the school than we feel comfortable sharing. One agreement listed potential locations the school could use to host telehealth sessions. One of the examples was the school cafeteria. Our office did not sign this agreement.

Due to these issues, students either connect from a car in the parking lot or drive home. Doing a telehealth appointment from the car is only reasonably confidential. It is also less likely the therapist will get to talk to the parent. (Read our post about parents in therapy).

Anonymity online is somewhat of a myth. Although providers are required to use a HIPPA-compliant platform, patient information is only as confidential as their computer is. This is especially true if you use a computer owned by someone else, such as a school or work computer. For example, many public schools use software that allows teachers to see everything a student does on the school computer.

Due to these potential problems with confidentiality, we feel in-person appointments are more confidential in most cases.

In-person therapy has fewer environmental distractions

Many individuals struggle with environmental distraction, and this is especially true for younger individuals. For this reason, we do not recommend telehealth services for young children, individuals with severe ADHD, or less motivated adolescents. By contrast, during in-person appointments, the setting is specially tailored to create an atmosphere where therapy is likely to be successful. This is particularly helpful when doing things like relaxation strategies that are more affected if the internet connection distorts the sound.  

In-person therapy has fewer technical issues

Technical issues can and will happen. One of the initial reasons for telehealth is to reach people who live in health shortage areas. Unfortunately, many of the places with the greatest mental health shortages still have unreliable internet access. Even when there is a good internet connection, technical issues still happen. This impairs the ability to have an adequate session. Imagine a patient saying they are considering suicide and then the connection cuts off right after this announcement (which has happened). As another example, I find it challenging to conduct guided relaxation strategies via telehealth.

In-person therapy provides greater ease building a strong therapeutic relationship

Although some individuals can build a strong therapeutic relationship using either format, in my experience it is easier to develop a strong therapeutic relationship via in-person sessions. I find in-person sessions more effective when trying to help individuals who are younger, less motivated, have greater difficulty building trust, and have more severe issues.

When working with children, I use toys, games, and other materials to help maintain attention, facilitate communication, and teach valuable skills. When the session is in person, the therapist can pre-select materials they feel will best help the child.   

For individuals who are less motivated or have more severe issues, face-to-face contact allows for greater communication and a greater ability to create a safe space for everyone involved. I find this particularly true for individuals who have difficulty building trust. Some visual cues come through a screen, but a lot may be missed by both the therapist and the patient.

In-person therapy offers improved help for severe cases

Providing service for individuals with more severe concerns is one of the most cited cautions against telehealth in my research for this blog (Stoll, Müller, & Trachsel, 2020, UCLA Health, 2021, Hagyari-Donaldson & Scott, 2025). As mentioned before, imagine the connection suddenly cutting out when someone is strongly considering suicide. It is also hard to convey empathy when either the patient or the therapist must repeat themselves due to spotty internet. In other cases, such as treating eating disorders, it is hard to do things like weekly weigh-ins virtually. Virtual therapy is a challenge for family therapy with multiple people participating when the conversation gets more volatile.

When dealing with high-risk topics, my strong preference is the most reliable tool I can use. In terms of therapy services, in-person services provide an enhanced ability to communicate, manage the environment for confidentiality and safety, and access helpful tools (e.g., comfort items). My strong preference in these cases is in-person therapy.

Conclusion

Telehealth services have a lot of promise and are beneficial for many individuals. This is one of the reasons our office allows telehealth services post-pandemic. On the other hand, telehealth does pose several limitations over in-person therapy.  For this reason, LBHC prefers in-person treatment for our patients.

Contact the office to discuss your needs for therapy today!

Post written by Dr. Gordon D. Lamb, Licensed Psychologist and Clinical Director

Please note posts are educational in nature and are not intended to replace psychological services when needed.

References

Abrams, Z. (2020). How well is telepsychology working? Monitor on Psychology, 53(1), 85.

Hagyari-Donaldson, P. & Scott, N. (2025). Online therapy for children: Yay or nay? Clinicians’ insights from the COVID-19 era. Child & Youth Care Forum, 54, 687-714. https://doi.org/10.1007/s10566-024-09835-3

Stoll, J., Müller, J. A., Trachsel, M. (2020). Ethical issues in online psychotherapy: A narrative review. Frontiers in Psychiatry.10 doi: 10.3389/fpsyt.2019.00993

UCLA Health. (2021). Is online therapy right for me. https://www.uclahealth.org/news/article/is-online-therapy-right-for-you