Telehealth therapy went from niche to mainstream during the pandemic, and for many people it’s become their preferred — or only — way of accessing care. For others, it still feels like a lesser substitute for “real” therapy, or they’re simply not sure what to expect.
Having worked with clients both in person and via telehealth, I want to offer an honest picture of what online therapy is actually like, where it works well, and where the in-person format has real advantages.
A telehealth session is a video call — typically 50 to 55 minutes, at the same frequency as in-person sessions. You connect through a secure, HIPAA-compliant platform, and the session proceeds much the same way an in-person session would: conversation, reflection, working through whatever you came to work on.
The main practical differences are location and logistics. You don’t commute. You’re often in your own home, which some people find makes it easier to settle in and some people find distracting. You don’t have a waiting room, which removes one transition point — but you also have to create your own transition into and out of the session.
The research is fairly consistent: for most presentations, telehealth therapy produces outcomes comparable to in-person therapy. Anxiety, depression, grief, relationship concerns, life transitions — these tend to respond similarly regardless of format.
There are some areas where in-person work has advantages. Somatic or body-based approaches are harder to do well through a screen. Some people find it more difficult to feel fully present via video, especially if they’re in an uncomfortable or non-private space. And for clients in acute crisis, in-person connection with a provider can be important in ways that a screen can’t replicate.
That said, telehealth also has real advantages that aren’t just about convenience. People in rural areas — like much of Jefferson County — who would otherwise face a long drive for mental health care can access consistent, quality therapy without that barrier. People with physical health concerns, demanding schedules, or caregiving responsibilities can access care that wouldn’t otherwise be possible. And some people actually find it easier to open up when they’re in a familiar, comfortable space rather than a therapist’s office.
A few things that help telehealth sessions work well:
Create a private space. The single biggest barrier to good telehealth work is not having a place where you can speak freely. A car parked outside, a room with a closed door, headphones if needed — finding privacy is worth the effort. It’s very hard to go deep when you’re monitoring who might overhear.
Treat it like an appointment. It’s easy for a home-based session to get swallowed by the rest of the day — a notification here, a family member knocking there. Protecting that hour matters. When possible, build in a few minutes before and after to transition in and out.
Tell your therapist what’s not working. If the format doesn’t feel right — if you’re struggling to feel present, if the tech is getting in the way, if you’d rather try in-person — say so. The format is in service of the work, not the other way around.
Check your setup. Good lighting, a stable connection, and a position where your therapist can see your face makes a meaningful difference. It sounds mundane, but it affects how present both people feel.
Telehealth is a good option for most people seeking therapy. It’s particularly well-suited if you value the flexibility, if transportation or geography is a factor, or if you’ve already established care with a provider and want to continue when in-person isn’t possible.
If you’re considering starting therapy and aren’t sure whether to pursue telehealth or in-person, it’s worth talking through with a potential provider. I offer both, and part of an initial conversation is figuring out what format will serve you best — not just what’s convenient, but what will actually let you do the work.
The goal is for you to have access to support that helps. The screen is just one way to get there.