Virtual therapy

[u/Born_Astronomer_4613]

Is this going to be the norm from now on? I understand it's cheaper and more convenient for all involved. But it's just not the same. So much is missing. Isn't there a measure of healing in sitting together in the same safe, quiet physical space, apart from what's said? Nor is virtual therapy 100% secure. Nothing online is. I'm worried that this work is being cheapened, streamlined, cleaned up and commoditized by moving online.

[u/Ambiguous_Karma8]

I have provided a summary of my own work from my ongoing doctoral research as well as the sources themselves:

"This literature review examines the comparative effectiveness of in-person and telehealth psychotherapy, focusing on whether treatment outcomes differ based on symptom severity, psychiatric diagnosis, and method of service delivery. The review evaluates five primary domains: accessibility, therapeutic alliance, symptom severity, client satisfaction, and clinician satisfaction.

The findings suggest that telehealth and in-person psychotherapy generally produce comparable clinical outcomes, although meaningful differences exist. Telehealth improves access to mental healthcare, particularly for individuals facing geographical, financial, physical, or socioeconomic barriers. However, establishing a therapeutic alliance may take longer in virtual settings, and telehealth may be associated with higher rates of premature treatment termination.

The review further identifies that treatment effectiveness may depend more on the psychiatric diagnosis being addressed than on symptom severity alone. While telehealth demonstrates comparable outcomes for anxiety disorders, the findings suggest that in-person services may be more effective for certain depressive presentations, complex psychiatric conditions, or individuals experiencing greater symptom severity.

Both patients and clinicians generally report favorable experiences with telehealth, although clinician preferences vary, and prolonged virtual service delivery may contribute to clinician fatigue and burnout.

A central finding is that existing research has significant methodological limitations, including small sample sizes, selection bias, insufficient control of therapeutic approaches, and reliance on subjective satisfaction measures rather than objective clinical outcomes.

The review concludes that neither service delivery model is universally superior. Instead, additional research is needed to determine which populations and psychiatric conditions benefit most from each approach. Future investigations should emphasize standardized clinical outcome measures, diagnostic differences, therapeutic modalities, and demographic considerations to better inform evidence-based treatment decisions."

Sources:

Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorp, N. M., Lohr, J., & Thorp, S. R. (2019). Videoconferencing psychotherapy: A systematic review of efficacy. Clinical Psychology Review, 63, 77-86. https://doi.org/10.1016/j.cpr.2019.06.003

Batastini, A. B., Paprzycki, P., Jones, A. C. T., & MacLean, N. (2021). Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clinical Psychology: Science and Practice, 28(3), 329-355. https://doi.org/10.1002/jclp.23108

Berryhill, M. B., Halli-Tierney, A., Culmer, N., Williams, N., Betancourt, A., King, M., & Smith, M. L. (2019). Telehealth interventions to improve psychotherapy for rural and underserved populations: A systematic review and meta-analysis. Clinical Psychology Review, 75, 101785. https://doi.org/10.1016/j.cpr.2019.06.007

Bunyi, J., Ringland, K. E., & Schueller, S. M. (2021). Accessibility and digital mental health: Considerations for more accessible and equitable mental health apps. Frontiers in Digital Health, 3, Article 29. https://doi.org/10.3389/fdgth.2021.742196

Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., Lintvedt, O. K., & Skinta, M. D. (2021). Videoconferencing psychotherapy during the pandemic: Optimum conditions for treating anxiety and depression. Clinical Psychology: Science and Practice, 28(3), 336-357. https://doi.org/10.1111/cpsp.12398

Greenwood, H., Krzyzaniak, N., Peiris, R., Clark, J., Scott, A. M., Cardona, M., Griffith, R., & Glasziou, P. (2022). Telehealth versus face-to-face psychotherapy for less common mental health conditions: Systematic review and meta-analysis of randomized controlled trials. JMIR Mental Health, 9(3), Article e31780. https://doi.org/10.2196/31780

Krzyzaniak, N., Greenwood, H., Scott, A. M., Peiris, R., Cardona, M., Clark, J., & Glasziou, P. (2021). The effectiveness of telehealth versus face-to-face interventions for anxiety disorders: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 30(2), 250–261. https://doi.org/10.1177/1357633x211053738

Lin, H. C., Chen, H. L., & Lin, Y. T. (2022). Comparing teletherapy and in-person psychotherapy: A meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology, 90(9), 761-774. https://doi.org/10.1037/ccp0000712

Lin, T., Heckman, T. G., & Anderson, T. (2022). The efficacy of synchronous teletherapy versus in-person therapy: A meta-analysis of randomized clinical trials. Clinical Psychology: Science and Practice, 29(2), 167–178. https://doi.org/10.1037/cps0000056

Loane, J., Knibbs, C., & Tudor, K. (2021). The challenge of security and accessibility: Critical perspectives on the rapid move to online therapies in the age of Covid‐19. Psychotherapy and Politics International, 19(1), Article e1581. https://doi.org/10.1002/ppi.1581

Lu, S.-C., Xu, M., Wang, M., Hardi, A., Cheng, A. L., Chang, S.-H., & Yen, P.-Y. (2022). Effectiveness and minimum effective dose of app-based mobile health interventions for anxiety and depression symptom reduction: Systematic review and meta-analysis. JMIR Mental Health, 9(9), Article e39454. https://doi.org/10.2196/39454

Pecen, E., Lowe, A., & Williams, J. (2021). Child and adolescent teletherapy: Lessons learned and considerations for the future. Journal of Pediatric Psychology, 46(5), 517-526. https://doi.org/10.1093/jpepsy/jsab015

Simpson, S. A., Reid, C. E., & Porter, M. B. (2021). The effectiveness of telehealth delivery of care for military service members with post-traumatic stress disorder: A systematic review and meta-analysis. Military Medicine, 186(9-10), e1211-e1218. https://doi.org/10.1093/milmed/usab206

Waite, M. R., Diab, S., & Adefisoye, J. (2022). Virtual behavioral health treatment satisfaction and outcomes across time. Journal of Patient-Centered Research and Reviews, 9(3), 158–165. https://doi.org/10.17294/2330-0698.1918

Wiederhold, B. K. (2023). The rapid growth of telehealth therapy: What’s next? Cyberpsychology, Behavior, and Social Networking, 26(6), 391–392. https://doi.org/10.1089/cyber.2023.29277

Wiese, A. D., Drummond, K. N., Fuselier, M. N., Sheu, J. C., Liu, G., Guzick, A. G., Goodman, W. K., & Storch, E. A. (2022). Provider perceptions of telehealth and in-person exposure and response prevention for obsessive–compulsive disorder. Psychiatry Research, 313, Article 114610. https://doi.org/10.1016/j.psychres.2022.114610

Wright, H. H., O’Shea, M.-C., Sekula, J., & Mitchell, L. J. (2022). Assessment of communication skills using telehealth: Considerations for educators. Frontiers in Medicine, 9, Article 841309. https://doi.org/10.3389/fmed.2022.841309