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  • Kayla Lane Freeman

Does Online Therapy Work as Well as "Real" Therapy?

Online therapy — also known as teletherapy, video therapy, telemental health, telebehavioral health, telepsychiatry and many other names — has been around for a while, first seeing a rise in popularity and usage by mental health professionals in the early 2000s.


Prior to COVID-19, this technology was especially useful for serving people living in rural areas or with mobility issues that made seeing a therapist in-person difficult.


Telemental health has gotten a bad reputation in the past for being less effective or therapeutic than “normal” or “real” in-person therapy, despite research demonstrating that telepsychiatry can be even more effective than in-person therapy in some cases.


Why Online Therapy Has a Bad Rep

Prior to the pandemic, the majority of people who saw therapists online did so through an app like Better Help or Talkspace. These apps pair you up with a therapist based on a questionnaire that you fill out when you sign up for the service. Although you can ask for a new therapist if you don’t like the one they pair you with (Betterhelp) or the three they give you the option of choosing from (Talkspace), in general, the client has very little control over selecting their provider. This is important because the most reliable factor for predicting whether or not a course of therapy will be successful is the therapeutic alliance.


Understanding the therapeutic alliance

The therapeutic alliance is the relationship that develops between the mental health provider and the recipient of therapy. Because the therapeutic alliance is the biggest factor that will decide if therapy is effective, the medium has far less of an impact on the quality of care than you might think. If you have positive feelings toward your therapist, you will likely find telemental health will be just as effective for working with your therapist as if you were sharing the same physical space.

Think about how unenjoyable a Zoom meeting can be compared to the joy FaceTiming friends. It’s not the medium of video that makes the difference, it’s the level of familiarity and comfort you feel with the people you’re engaging with.

Because the relationship with the provider is the most important element when predicting success in therapy, if you don’t really “click” with your therapist, you’re not going to benefit as much from the sessions — whether they’re online or in-person.


How to Make Online Therapy Work for You

Because apps like Talkspace or Betterhelp depend on a steady stream of appointments to sustain their business model, they are not exactly eager to have clients “try out” or “sample” different therapists. However, the process of selecting a therapist through trial and error is a common and necessary part of many people’s therapy journey.


Many users on these apps are new to therapy and don’t even know what to look for when choosing a therapist, so they end up sitting in a video chat with a therapist who may be a quality and professional provider, but who just doesn’t have that special quality that makes the client feel seen, heard and appreciated for who they really are. So after a while when someone doesn’t feel any better, they may question the technology as the barrier instead of their compatibility with that provider.

Because the gains of therapy are largely achieved through the medium of relationship, finding a provider with whom you feel chemistry is incredibly important.

These days, nearly every mental health professional in private practice is offering phone or video sessions, so there’s no need to stick with the apps if you’re looking for more, and often more affordable, options.


Posted by Kayla Freeman, LMSW for RadicalMentalWellness.com. Providing individual, couples and relationship therapy for Texas residents. Offering trauma-informed yoga to compliment your therapy in Austin, Texas. Centering and serving LGBTQ+, queer, bisexual/pansexual, gender queer, trans and nonbinary people throughout the Austin area and beyond.

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