Pre-pandemic, online therapy was the side door. A handful of practices offered it, usually for clients who couldn’t make it to the office — people in rural areas, people with mobility issues, people who traveled for work. Most therapists were polite about it but openly skeptical that it could really do what in-person work did.
Then 2020 happened, and overnight, every therapist in the country became a telehealth provider. We expected it to be temporary. It turned out not to be.
What the research has shown
Research on telehealth therapy in recent years has been remarkably consistent: outcomes for online therapy are comparable to in-person therapy across most presenting issues — including depression, anxiety, PTSD, and couples work. The early skepticism about whether the therapeutic relationship could really form over video has not held up in the data.
That said, “comparable outcomes” is the average across many studies and many clients. The honest answer for any specific person is: it depends on you, on the therapist, and on what you’re working with.
Where in-person genuinely has the edge
For clients with severe trauma or dissociation
Trauma work that involves significant nervous-system dysregulation is often easier in-person. The therapist can read the body more directly. The client can feel the physical presence of someone steady. A grounded, embodied therapist in the room is hard to fully replicate over video.
For clients in active crisis
If safety is an active concern, in-person care — or higher levels of care like intensive outpatient programs — tend to be better fits than telehealth.
For clients who genuinely live alone or unsafely
Some people don’t have a private, safe space at home for sessions. For them, the therapist’s office is the only private hour they get. That can be invaluable.
Where online genuinely has the edge
For consistency
The single biggest factor in therapy outcomes, across decades of research, is whether the client keeps showing up. Online therapy removes most of the friction that causes people to skip sessions — commute, parking, childcare, weather, illness. Clients who do telehealth tend to show up more reliably. That alone often improves outcomes.
For couples therapy
This one surprised everyone. Couples doing therapy from the same room of their own home, on the same screen, often do better than couples in an office — possibly because they are working in the actual environment where the patterns play out, and because the post-session car ride home (sometimes a fraught experience) gets replaced by simply closing the laptop and being in your own space.
For new parents
Postpartum clients can do sessions while nursing, in a bathrobe, with a baby asleep on their chest. Many wouldn’t make it to therapy at all if they had to go to an office.
For people with anxiety about therapy itself
For some clients, having sessions in their own space — their own couch, their own light, their pet nearby — lowers the anxiety enough that they can actually do the work.
What does not change
The core of therapy is the relationship and the methods. Both translate. The therapist is still attuning. You’re still doing real work. The good moments still feel like good moments; the hard moments still feel like hard moments.
The thing that changes most is the threshold to start. Online makes it easier to begin. And beginning is the part most people get stuck on.
Practical things to set up
- A door that closes. Privacy matters. If your home doesn’t have one, your car can work, or a corner of a library, or a friend’s house when they’re out.
- Headphones. Both for privacy and because the audio quality is much better than your laptop speakers.
- A phone or tablet on a stand. Holding the device for 50 minutes gets old. A small stand is a worthwhile $15 purchase.
- A box of tissues. You probably won’t need them, but having them within reach matters more than you’d think.
- Stable internet. If you know yours is shaky, mention it to the therapist on the first call so you have a plan if the video drops.
Want to try it?
At The Therapy Lounge, all our work is online. We see clients across New Jersey and New York, in 50-minute sessions, weekly or biweekly. The free 15-minute consult is the lowest-stakes way to feel out whether telehealth therapy works for you specifically.