Dear Therapist:

Some providers are doing much more therapy via teletherapy these days. While it started during the pandemic it still seems to have become more common even after things have opened up. I would appreciate if the panelists can share their perspectives on therapy effectiveness in this mode of communication. What are the pros and cons of Zoom therapy versus in person? Are there specific areas such as attachment styles etc. that are better to be worked on in person, and if so, can you specify which and the reasoning?
Thank you for your informative articles



Your question is one with which people regularly grapple—and likely will for some time. We can make some general statements as to which types of people are likely to more significantly benefit from in-person therapy. However, I have found that—at least superficially—it comes down to individual preference.

Teletherapy can be audio-visual or audio alone. Some people are largely visual learners while others are primarily auditory learners. Similarly, in therapy some people are able to attain similar results regardless of the medium, while others struggle with one form or another. There are some people who are better able to focus on the therapy process by eliminating all but the audio aspect, while others struggle with visual-only therapy—or with any form of teletherapy.

Humans are highly adaptable. Over time, the efficacy dynamic will likely change along with the social dynamic. As we increasingly utilize technology that removes the in-person component in many areas of our lives, we will likely develop different learning styles that help us to better perform in remote settings

You mentioned attachment styles. On the face of it, it would seem that those who require close physical attachments would better benefit from in-person therapy, while those who are more comfortable with more distant attachments would be more open to teletherapy. For instance, people who have trouble with eye contact would appear to benefit from traditional phone therapy. However, unconscious needs and insecurities that play into attachment styles should be taken into account.

Therapists need to be cognizant of their client’s needs. These include both those directly identified by the client and those that are less conscious. Generally speaking, I believe that at least the first session should be conducted in person. This gives the therapist and the client the opportunity to observe and acknowledge visual and other cues. It allows the therapist to aid the client in better identifying their reasons for their individual preference. It helps to identify whether the person prefers teletherapy due to avoidance of issues like confrontation. For instance, someone who has social anxiety may attempt to avoid the social aspect of therapy by insisting on teletherapy. In instances like these, this possibility should be explored so as to provide the best possible therapeutic experience.

For some clients, it may be deemed important to actively challenge the avoidance by specifically doing in-person sessions. For others, a plan may be put in place to more slowly move in that direction. Regardless, this should be a collaborative effort by the therapist and the client.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 author of Self-Esteem: A Primer / 516-218-4200