Telehealth or not to Telehealth: Is in-person delivery of therapy more effective?
Telehealth Therapy: Is It Actually Effective?
If you are considering online therapy, you may be wondering:
“Am I compromising on quality by not attending in person?”
The short answer, based on current research, is no, not for most people.
A large 2024 systematic review comparing telehealth with in-person care across 77 studies found that, in many areas of behavioural and mental healthcare, outcomes were comparable (Hatef et al., 2024). Differences, when present, were often small and not clinically meaningful.
In some domains, telehealth even demonstrated advantages, including:
· Lower rates of missed appointments
· Higher adherence to treatment
· Greater accessibility
For structured, evidence-based approaches such as Cognitive Behavioural Therapy (CBT), telehealth performs particularly well.
But What About Studies Showing In-Person Can Be Stronger?
It’s true that some research suggests in-person therapy may produce slightly larger effect sizes in certain contexts. For example, a 2025 study comparing in-person and telehealth CBT found both were effective, but the in-person group showed greater magnitude of improvement in distress and resilience (Aliyari et al., 2025).
However, context matters:
· The sample involved individuals recovering from COVID-19, a group experiencing heightened isolation and trauma-related stress.
· The study was small and quasi-experimental.
· Both formats produced statistically significant improvement.
This tells us something important: telehealth works.
In-person may amplify certain outcomes in specific populations — but telehealth remains clinically sound.
What Actually Determines Outcomes?
Research consistently shows that outcomes are less about format and more about:
· The strength of the therapeutic alliance
· The therapist’s competence
· The appropriateness of the intervention
· The client’s engagement
Telehealth does not prevent the development of a strong therapeutic alliance. Studies have repeatedly shown alliance ratings to be comparable between modalities.
The modality is the vehicle. The therapy is the engine.
When Online Therapy Is Particularly Effective
Online therapy tends to be especially effective when:
· Clients are motivated and self-reflective
· Treatment is structured (e.g., CBT, ACT, skills-based work, etc.)
· Accessibility barriers would otherwise delay care
· Psychological safety increases in one’s own environment
For many clients, attending therapy from their own space reduces anticipatory anxiety and increases openness.
Resources for further information
Hatef, E., Wilson, R. F., Zhang, A., Hannum, S. M., Kharrazi, H., Davis, S. A., Foroughmand, I., Weiner, J. P., & Robinson, K. A. (2024). Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: A systematic review. npj Digital Medicine, 7, 157. https://doi.org/10.1038/s41746-024-01152-2
Aliyari, Z., Ahmadizadeh, M. J., & Fathi Aghdam, G. (2025). Comparing the effectiveness of in-person and telehealth cognitive-behavioral therapy on psychological distress and resilience in people recovered from COVID-19: A quasi-experimental study. International Journal of Applied Behavioral Sciences, 12(1), 1–11. https://doi.org/10.22037/ijabs.v12i1.46953
Zimmerman, M., D’Avanzato, C., & King, B. T. (2023). Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: Comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment. Journal of Affective Disorders, 323, 624–630. https://doi.org/10.1016/j.jad.2022.12.015
