Online vs Face-To-Face therapy

Which to Go For?

Advancements in the digital space have certainly introduced more choice to our lives. It has massively changed the way we consume information, products and services. One quick example close to our (Singaporean) hearts would be food: looking for ideas on what or where to eat by reading reviews, buying ingredients to at the shops and following a video clip at home to cook, or simply browsing online and having it delivered to our doorsteps.

Our environment determines the parameters in how we operate: now, most of us have to stay at home in our bid, as a community, to stop the spread of Covid19. The very nature of this sheltering in place could be affecting our mental health and we need to determine what would work best for us.

I will be using counselling and therapy interchangeably in this article because the modality and delivery are essentially the same.

Counselling/therapy is a service provided by a trained mental health professional that is focused on helping you find solutions to issues that trouble you. It could be addressing a crisis in your life or helping you find ways to manage the adversity. It could be an emotional journey to gain insight on patterns in your life that are perpetuating your problems and learning how to break them. It could be helping you see things in a different way and learn to approach your challenges differently. It could be helping you learn the way to building more meaningful social connections with people who matter to you so you can enjoy a better quality of life. Therapy revolves around conversations with a warm and trustworthy professional who is trained to facilitate the very dialogue that would help you.

So, the question here is whether you can have these useful and honest conversations online or in-person.

Counselling Face-to-Face is the conventional mode of meeting your helper in the physical space. You decide on a therapist you would like to meet, make an appointment and go to a consulting room to meet them. Now, most psychologists and counsellors are first trained using face-to-face sessions and there is plenty of research and guidelines available to inform practitioners on using the physical space.

Online Counselling is using virtual space to meet with your therapist. It is also known as telehealth (like how we refer to it at the Therapy Platform), or e-therapy. Online counselling can include video conferencing, phone counselling, text messaging, live chats, avatar therapy and this mode is continuing to grow. At The Therapy Platform, the current telehealth service is video conferencing.

Here is a table that compares seeking therapy online and face-to-face.

Factors	Online Counselling	Face to Face Counselling
Convenience and accessibility	You can determine the location of accessing online counselling, so long as it is safe and offers privacy. Lesser time spent on commuting could provide greater convenience. For homebound individuals and individuals with mobility issues, this makes therapy more accessible to you. With services accessible just a dial tone or click away, there is less barrier in accessing help. This could be a potential gateway to getting further help through face-to-face sessions.	No issues if you are willing to and can travel to see your therapist. You are limited by the therapists within your geographical location. For individuals not comfortable with talking over the phone or a screen, seeing a counsellor face-to-face is better. A safe space – counselling room – is provided for you. You do not need to share your own private space (e.g., your home or, your bedroom) with your therapist.
Availability	In times of crisis, phone helplines and crisis text lines have been an immediate source of support and an important resource for individuals who do not know who to call or what to do. You have more options for professionals who can help you. You can see someone who is physically located in another continent but has the skills and knowledge that you are looking for.	Most of the time, you can only get the help you need when you can get an appointment. The very act of going to physically see a therapist can be therapeutic.
Rapport and the helping relationship	Somehow, it feels like something is missing when you are not seeing a person in the flesh, not having the physical eye-contact: the virtual space makes it harder to build a relationship. If you do not feel supported, it is difficult to sustain the relationship and this in turn may hinder the helping process. It can be easier to ease into therapy as the virtual space creates a psychological distance which makes the therapy process less intimidating for those uncomfortable to share personal feelings.	You can see and feel that the counsellor is with you and attuned to you and you can build the relationship more quickly. The physical space makes the connection with the therapist more real with available verbal and non-verbal cues. You may feel more supported when you physically see a therapist who shows that they care brings comfort.
Confidentiality and Security	It is harder for therapists to ensure the suitable conditions for the session with you .e.g, whether you are in a safe space without someone else listening in. The security of the medium use for the counselling services relies on the efficacy of the latest security software.	Therapists are well-trained to provide a safe and conducive physical space to ensure privacy and confidentiality.
Effectiveness	There is a general lack of research on this emerging area within an established field. Telehealth practices used to be known as a the “wild west” when it was first adopted as a mode and the onus on providing effective therapeutic interventions was on the therapist and the study of best practices. Therapists trained in the traditional face-to-face mode may not be as effective in the virtual space. A therapist based in a different country may not be familiar with the legislation, the cultural practices and context that you operate in. They may not be familiar with the community resources available to you.	Most research available on the effectiveness of therapeutic practices are for face-to-face counselling sessions. You can expect that the mental health practitioner working with you is familiar with the jurisdiction and legislation of the country you are in. They may find it easier to point you to other forms of support in the community that can further help you.

Our environment determines the parameters in how we operate, but individuals have certain choices to shape what we eventually take action on.

Ultimately, choosing between online counselling or in-person sessions is a matter of preference and what works for you. Some individuals believe whole-heartedly that they can only be helped if they see a therapist in person. Some people switch to online therapy and never want to go back. The most important thing is: what do you want and what works best for you?