In an increasingly digitizing world, on the tail-ends of a public health crisis which has strained the public’s mental health, remote therapy may be here to stay. But is it an adequate substitute for in-person therapy? The research says it is certainly a great option to have — but not the only one.
Virtual Therapy Effectiveness
How useful therapy can be is subjective from person-to-person, and virtual therapy is no exception.
“For pure effectiveness, I would say it’s something we call ‘non-inferior,’” says Laura Murray, senior scientist at the Johns Hopkins University Bloomberg School of Public Health.
Indeed, a study in 2022 tracking patients’ preferences of mental health treatments for 16 months over the course of the pandemic found that getting more exposure over time to care online increased preferences and satisfaction for virtual therapy.
Researchers also found that similarly to face-to-face treatments, online therapy was nearly as effective in reducing university students’ psychological distress such as depression and anxiety.
Where virtual therapy gains an edge on in-person treatments is the fact that it eases the problem of distance and access — notoriously big obstacles in preventing people from getting the help they need. Patients in rural areas without healthcare infrastructure or who can’t physically move around, for example, benefit from accessing psychotherapy from their own homes.
Read More: Sometimes People can Have Multiple Mental Conditions at a Time, Called Comorbidities
Challenges of Virtual Therapy
But situating healthcare in the virtual world comes with a myriad of complicating factors. One 2022 study in the journal Research in Psychotherapy: Psychopathology, Process and Outcome, for instance, found some group therapy patients noted changes in the relationship dynamics between themselves, their therapists, and with one another.
Murray, who is also a clinical psychologist, adds anecdotally that almost every provider she works with finds virtual treatments more challenging. Looking and talking to someone in a small box on a computer screen removes the many crucial bodily cues and non-verbal tells that come naturally when sitting in front of someone.
Plus, concerns about data security and privacy regarding sensitive information comprise a notable concern as documented in a Nature article. Under certain insurance plans, not even digital therapy could be covered, and not every person is technologically savvy enough to make the change smoothly.
“I think telehealth is fascinating and interesting and so good that we have it,” Murray says. “I also don’t want the pendulum to shift so that’s all we should offer. Because I would say, when I look at the literature, it’s about a 50-50 split of who it’s good for and who it’s not good for.”
What Would Make Mental Healthcare More Effective?
The problem for professionals like Murray, then, isn’t whether therapy, especially long-term treatments, is more effective over the computer or inside a therapist’s office. Murray believes the bigger issue is the quality and method of treatment in the first place.
When people say they’re in therapy, they may not typically have an endpoint to their treatment in mind.
“They’re just always there, and that’s a model a lot of us are really pushing to get out of: It’s expensive, it’s not helpful, it means you’re not getting quality care — unless you just want to talk to someone,” she says. “But most people don’t have the insurance or the money or the ability to just hang out with someone.”
Murray specializes in researching evidence-based treatments, which are defined as methods utilizing the best and most current research in combination with clinical expertise to make decisions on patient care. Most evidence-based practices, which typically have undergone at least two randomized clinical trials, are short-term, so they don’t go on indefinitely.
“When we do studies of an evidence-based treatment, and we deliver it in-person or [via] telehealth, there’s no difference in time length,” Murray says. “I don’t think it’s the telehealth factor or the timeline. I think it’s that most people are not getting evidence-based services.”
Evidence-Based Treatments
Evidence-based practices began gaining attention during the 1990s and have over time made their way into the mental healthcare industry as well. But progress of integrating them into care has been slow, and the pandemic further revealed those discrepancies.
Research has shown that training professionals in evidence-based protocols enhances their skills, clinical prowess, and general awareness of the industry, but it’s costly and time-consuming to make the shift.
To implement evidence-based care in psychotherapy, Murray says the field of mental healthcare is increasingly shifting toward a new method: transdiagnostic systems of care.
Transdiagnostic care promotes a more universal way of approaching mental health. Essentially, it allows professionals to treat psychiatric issues without needing to cleanly categorize something that isn’t inherently neat.
Read More: How to Improve Your Mental Health
The Future of Telehealth
Remote therapy is ultimately here to stay, given the access it can provide to patients who were previously shut out from healthcare. By offering a more flexible work environment, it could also plug some holes in the workforce shortage crisis providers are currently facing.
But Murray argues it won’t be the key to finding industry solutions in the long run.
“Remote’s only as good as how many bodies you have. Everyone’s like, ‘remote is the answer.’ Not if you don’t have 20 extra providers who are actually going to do this work,” she says.
While Murray and other experts are pushing for the broader adoption of evidence-based treatments, that field also has its own kinks to work out. Ultimately, integrating one form of practice does not necessarily mean doing away with the other entirely. Psychotherapies may employ more existential and humanistic models of care, for example, while many evidence-based practices focus on the cognitive and behavioral.
One consensus that experts seem to arrive at is that the efficacy of any kind of therapy, whether it’s deemed as empirically backed or happens face-to-face versus video call, depends on what the patient first and foremost hopes for.
“If your outcome is, ‘I really enjoyed it. It calmed me. It helped me feel less anxious,’ maybe you get some impact,” Murray says. “It’s really important to look at what people are wanting to get out of this.”
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