Is Video Therapy Right for You?
This blog originally appeared on the website of Atwater Village Therapy.
Up until recently, psychotherapy has been an exclusively in-person experience. Modern technology however has now granted us the ability to conduct therapy via video call across distances. This emerging practice has quickly caught on for some clients and clinicians alike. However, it simultaneously raises some important questions about suitability and how the use of video might change the psychotherapy process. In this blog, I will aim to help readers determine whether video therapy might be right for them by briefly reviewing some of its attributes and potential drawbacks, as well as summarizing some ways in which video and in-person therapy differ. Much of this information can be found in Gillian Isaacs Russell’s book, Screen Relations.
Video-based psychotherapy is frequently referred to as teletherapy and is included under the larger umbrella term of telehealth. Depending on the client and therapist, teletherapy might only be used on occasion (i.e., such as if the client or therapist is traveling), or it may be the main mode of therapeutic interaction (i.e., if the client lives too far from the therapist to attend in-person sessions). Teletherapy is frequently utilized in rural areas, or areas that lack sufficient numbers of local clinicians, but it is increasingly being used within larger metropolitan areas as well.
It is important to note that, currently, all licensed mental health clinicians (e.g., psychologists, marriage and family therapists, licensed clinical social workers, etc.) are licensed at the state level, meaning they are legally only allowed to practice in the state(s) in which they are licensed. Furthermore, licensing requirements vary state to state. While there is some controversy about this issue, and laws vary state-to-state, it is generally unlawful for a licensed mental health clinician to conduct teletherapy with a client who is currently living in a state in which the clinician is not licensed. Therefore, if you are interested in (or offered) teletherapy, make sure that the clinician is licensed in your state. Notably, this restriction does not apply to clients who live outside the United States, though many countries have their own laws and regulations about whether foreign clinicians are allowed to practice.
Beyond these licensing issues, what makes teletherapy different from regular in-person therapy? The use of video conferencing means that therapy can potentially be more accessible, such as for people with limited mobility or transportation. It can also make therapy more convenient, such as by saving the time and hassle of commuting to the therapist’s office. This may be especially important for people looking for certain therapeutic specialties. In addition, there are a number of HIPAA-compliant services that can safely and securely be used to conduct teletherapy, protecting clients’ privacy.
However, the use of computers and video to conduct therapy introduces a number of differences in how therapy feels and proceeds. For example, some people may find themselves more comfortable sharing personal or embarrassing information about themselves to a therapist they only see on a computer screen, versus a therapist they are sitting across from. Therefore, the literal and “felt” distance between client and therapist can, on the positive end, facilitate increased sharing of personal information from the client, which may benefit the therapeutic process.
On the other hand, teletherapy loses an important aspect of traditional in-person therapy: that of the therapist’s “embodied” presence. Much of human communication occurs at the non-verbal and empathic levels. We read not only a person’s body language and subtle facial expressions, but we are also influenced by how a person’s physical presence feels to us. Teletherapy blunts our perception of these subtle and often unconscious streams of information. This may leave some clients experiencing teletherapy as more “distant,” “removed,” or “cold” compared to in-person therapy. In essence, teletherapy compresses the full three-dimensional experience of in-person therapy into a two-dimensional experience. The client sees and hears the therapist, but may struggle to feel them, and vice versa.
Another important difference concerns who is responsible for creating and protecting the “safe space” of the therapy session. During in-person therapy, the clinician ensures that the office is private, quiet, and free of distractions. With teletherapy, it becomes up to the client to find a quiet, private place for session where they will not be disturbed or distracted. This can pose a challenge for some clients, depending on their living arrangements, lifestyle, or culture.
These disparities between in-person therapy and teletherapy mean that teletherapy may not be the most effective option for some issues, or certain clients. For example, the client’s ability to physically and empathically sense their therapist, in the same room, may be particularly important for someone working through complex trauma, severe depression, lifelong relationship or personality patterns, or someone who is experiencing chronic suicidal feelings, among other concerns. While teletherapy may indeed be effective in some cases with these populations, it is likely that in-person therapy would be more beneficial and, in some cases, safer.
However, for other types of clients and concerns, teletherapy may be just as effective and appropriate as in-person therapy. For example, mild to moderate mood symptoms, phase of life challenges, relationship concerns, anxiety, parenting concerns, and many other issues may often be well suited for teletherapy when paired with the potential convenience and proximity benefits.
As a clinician who provides both in-person and teletherapy, I admit that I prefer in-person sessions whenever possible, but I also believe that the benefits of teletherapy far outweigh the limitations for some clients and certain situations. If you are curious about trying video therapy, please feel free to contact me.
