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The in-person preference: Why traditional therapy still rules over online counseling alternatives

Back when flappers ruled the dance floors, another revolution was brewing — remote health care. A 1925 issue of Science and Invention featured an early concept of a “radio doctor” making house calls without stepping outside their office. Fast-forward a century and telehealth has evolved from a far-fetched idea to a lifeline for millions of people worldwide.

Although virtual health has existed for decades, it didn’t gain momentum until the COVID pandemic, when telehealth visits exploded to unprecedented numbers. Pre-COVID, approximately 13,000 Medicare beneficiaries used telemedicine weekly, compared to a jaw-dropping 1.7 million weekly by the last week of April 2020.

Though the numbers have since dipped — dropping to 30.1% of adults using telehealth in 2022 from 37.0% in 2021 — remote care is here to stay. Industry analysts forecast the market to balloon from just over $97 billion in 2023 to $432.31 billion by 2032, growing at a compound annual growth rate of 19% annually.

As technology advances, the way we approach health care delivery continues to reshape, making it more accessible and efficient than ever with innovations like remote patient monitoring and AI-driven diagnostics. Telehealth allows people to consult with healthcare providers directly from their homes, reducing travel time and making more specialized care available to individuals in remote areas.

The growth within telehealth has proven particularly valuable for mental health services. It allows people to access talk therapy and counseling through video calls, chat platforms or phone sessions and to manage conditions (and even receive prescriptions) for anxiety and depression. Additionally, online health services provide a sense of comfort and anonymity that may encourage people to seek help who might otherwise avoid in-person sessions due to real or perceived stigma. Yet, with all the convenience and innovation, a fundamental question persists: Does virtual care replace the value of in-person visits?

While a significant number of therapy participants prefer in-person counseling, more than a third prefer online options.

While a significant number of therapy participants prefer in-person counseling, more than a third prefer online options.

For many, the personal connection of face-to-face interactions remain irreplaceable, a perspective highlighted in a recent Yahoo-commissioned survey. Conducted by AYTM, a technology-driven insights firm focused on independent testing and research, the survey included 750 individuals who have participated in therapy, either at the time of the survey or in the past. The results revealed that a significantly greater number of respondents (43.2%) favored in-person therapy, while 34.3% leaned toward online sessions and 22.5% expressed no preference.

Even as telehealth becomes mainstream, the data suggests it hasn’t yet dominated mental health care delivery. So why do people prefer in-person therapy sessions and where does telehealth fall short?

To explore this question, we contacted Shelby Harris, a clinical psychologist and associate professor of neurology and psychiatry at Albert Einstein College of Medicine. “People like in-person therapy because it gives them a direct, personal connection with the therapist, which helps build trust. Many also feel their private information is safer in person than online. Plus, meeting face-to-face allows both the client and therapist to see and understand body language, facial expressions and tone of voice, which are important for good communication and empathy,” she explains.

Wondering why traditional therapy remains the go-to choice? Keep reading to uncover the critical reasons behind its lasting appeal.

Building a solid therapeutic alliance — a trusting, collaborative relationship between therapist and client — is often considered the bedrock of effective therapy. Consistent evidence shows that the better the therapeutic alliance, the more successful the treatment, and this holds true across a wide range of people, modalities, struggles and contexts.

In-person therapy could help enhance this relationship. “The personal connection in face-to-face therapy helps create a stronger bond between the client and therapist. This relationship makes clients feel more understood and supported, which can be key for effective therapy,” explains Harris.

Infographic on therapy choices

While most people choose a therapy provider based on insurance coverage, the second-most-important factor is whether the provider offers in-person sessions.

Evidence backs this up: A 2022 study involving 291 participants found that face-to-face therapy sessions resulted in significantly stronger therapeutic alliances than online approaches.

In-office visits allow for a more tangible sense of connection, where the therapist’s focused presence creates a feeling of shared commitment to the therapeutic process. Clients can experience a deeper sense of being seen and appreciated, which is essential for healthy therapeutic engagement. These interactions go beyond talking through problems, offering a more profound sense of understanding that’s sometimes more difficult to achieve in virtual formats. This may also help explain why the availability of in-person sessions was the second-most-cited reason to select a particular therapy provider (second only to a provider’s insurance acceptance).

Nonverbal communication is the silent language of therapy, and it holds considerable weight in face-to-face interactions. Harris explains that posture, facial expressions and gestures can reveal underlying emotions or tensions that a client may not express verbally. For example, shifting positions, clenching fists or tearing eyes might indicate distress or anxiety that they have yet to articulate. “In-person sessions provide more cues, which helps in understanding the other’s emotions better. Online therapy can miss some of these cues, which could lead to possible misunderstandings.” When therapists meet clients in person, they can immediately pick up on nonverbal cues that may not appear on camera (like someone who’s bouncing their foot nervously or fiddling with a ring) and respond instantly, adjusting their approach appropriately.

Evidence suggests that from a neurological perspective, mirror neurons — a specific group of brain cells — are crucial drivers in face-to-face communication that may be lacking in other types of communication. These cells activate when we observe another person’s emotions, enabling us to “mirror” those feelings ourselves, which fosters empathy.

A patient listening to therapist

It’s harder to see and respond to nonverbal cues when engaged in teletherapy. (Getty Images)

When a therapist and client share a space, this mirroring effect can increase emotional attunement, making the client feel more understood and connected to the therapist. The effect may be less intense or fragmented over a digital interface, where some emotional resonance can be lost.

Emotional safety is a linchpin of effective therapy. A calm, present therapist can be a stabilizing force, offering grounding during particularly challenging sessions. The therapist’s physical presence and subtle shifts in their tone or behavior can help ease a person’s distress.

Being physically present with a therapist can also counteract feelings of isolation, providing a sense of human connection that’s crucial when discussing difficult or traumatic experiences. It’s the reassurance that, at this moment, you’re not facing your struggles alone — someone is there, sharing the burden, even if temporarily.

As Harris points out, “Some types of therapy or mental health issues might be better handled in person. For example, intense emotional work or trauma might benefit from the strong presence of face-to-face interaction.” This physical presence can offer an additional layer of support that’s harder to achieve in a virtual setting.

Making the trip to a therapist’s office can greatly affect how clients approach their therapy. “The routine of attending in-person sessions helps clients stay committed to their therapy. The regular visits to a therapist’s office create a clear structure that supports the therapy process,” says Harris.

When clients physically show up for sessions, it feels like a commitment — a reminder to themselves that this time is dedicated to their growth and healing. It also creates a natural divide between their daily lives and their therapy work, making it easier to focus during sessions.

Think of the therapist’s office as a neutral place where people can freely explore their thoughts and feelings without distraction. This dedicated space can feel like a safe retreat, somewhere to process tough emotions that might feel too overwhelming elsewhere.

Plus, walking into the therapist’s office can become a ritual, signaling to the mind that it’s time to shift gears and prepare for deeper conversations. This routine can make therapy feel more structured and purposeful, supporting the process in ways that are difficult to replicate by logging onto a virtual platform.

While it’s clear some people prefer in-person therapy due to the connection it provides, others may elect not to participate in online therapy due to concerns over privacy or challenges with stable internet service.

“Privacy is a big factor in choosing in-person therapy. Many people feel safer discussing sensitive topics in a private office rather than over digital platforms, which might feel less secure,” explains Harris. The potential for digital breaches and data leaks adds to these worries, leaving clients questioning whether their most personal conversations are genuinely safe online. For example, in 2023, the Federal Trade Commission (FTC) accused the online therapy platform BetterHelp of misleading consumers about their sensitive mental health data privacy. Despite assurances of confidentiality, BetterHelp shared clients’ information — such as email addresses and past therapy participation — with social media giants like Facebook and Snapchat.

Technical issues are another hurdle. As Harris notes, “Online therapy can have problems like slow internet or glitches that interrupt sessions and make them less effective.” These disruptions can hinder the flow of a session, reducing its impact and making it harder for clients to stay engaged.

The issue may be particularly pronounced in rural areas, where internet access can be unreliable or slower than in urban centers. According to the government’s Office of Planning, Research and Evaluation, rural communities often face gaps in broadband availability, with many lacking the high-speed internet connections necessary for smooth video-based therapy sessions. This digital divide may make in-person sessions a more reliable option for consistent and uninterrupted support.

Woman using mobile phone and laptop.

Online therapy is accessible and flexible in ways that in-person therapy isn’t, but it also has its downsides. (Getty Images)

Another challenge to consider with virtual therapy is the environment. “Clients at home might be distracted more than in a quiet, controlled therapy office,” says Harris. A therapist’s office offers a sense of privacy that clients may not have at home, where concerns about being overheard by family members or roommates can make them feel less secure. This lack of control over the home environment can leave people feeling more exposed, making it harder for them to open up during online therapy sessions.

Despite our survey finding a preference for in-person therapy, it’s important to acknowledge the fact that digital health options were preferred by more than a third of the survey respondents. Many people find virtual therapy to be as effective as its offline counterpart and studies confirm this assessment. For example, a 2021 systematic review comparing the effectiveness of internet-delivered cognitive behavior therapy (ICBT) with face-to-face CBT for treating anxiety disorders found that both treatment modalities produced equivalent outcomes. However, these results may not stand true for all mental health issues and types of treatments, particularly for more severe mental illnesses.

For many, teletherapy has made mental health care more accessible, especially in areas or situations where options were once limited. While in-person therapy may offer greater depth in terms of personal connection, telehealth bridges gaps due to geographic distance, mobility issues or time constraints, ensuring more people can access support when needed.

Looking ahead, the future of mental health care may lie in a hybrid model, blending the benefits of in-person and online therapy to offer a more flexible and tailored approach. This model allows clients to use face-to-face sessions for deeper emotional work and connection while leveraging teletherapy for more routine check-ins or when logistical challenges make in-person visits impractical. Our survey respondents who hadn’t ever tried online therapy were also overwhelmingly open to the idea of virtual sessions, with more than two-thirds willing to try it.

Infographic concerning people open to trying online therapy

Most survey participants were only familiar with in-person therapy, but the majority of those are open to trying online therapy, which may make hybrid options more appealing in the future.

As Harris notes, “Hybrid models, which combine in-person and online sessions, offer flexibility that allows clients to benefit from both methods depending on their needs and circumstances.”

Though in-person therapy will continue to play a crucial role in mental health care, digital therapy’s popularity may grow as technology advances and online platforms become more refined and secure. “In-person therapy will remain important as digital options evolve. A mix of in-person and online therapy might become common, with each method serving different needs and preferences for patients.” As virtual options improve, they could become even more popular, though they may never fully replace the unique benefits of face-to-face sessions.

While the rise of online therapy has made mental health support more accessible, particularly in rural areas and when in-person visits are impractical, the unique benefits of face-to-face therapy can’t be overlooked. Many people still prefer the tangible connection and emotional safety that traditional sessions provide. Nonverbal cues, the ritual of visiting a therapist’s office and creating a dedicated healing space all contribute to a stronger therapeutic alliance in face-to-face settings.

As the digital health sector grows, online therapy presents opportunities for greater flexibility and reach, but it currently seems unlikely to replace in-person therapy entirely. The future of mental health care may lie in a complementary approach that integrates the best aspects of in-person and online therapies, allowing people to access the care they need in the form that best serves them.

If virtual therapy sounds like a good fit, Yahoo has vetted many of the best options (some, like ThriveWorks, even offer a hybrid model of in-person and online therapy sessions). Check out our top choices for best affordable online therapy, best online psychiatry platforms, best online therapy providers for anxiety, best online therapy for couples, best online therapy resources for the LGBTQ community and best culturally sensitive online therapy resources.

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