In-Person vs Online Therapy: Which is Right for You?

The therapy room has changed. What was once exclusively a quiet office with a sofa and a box of tissues is now just as likely to be your kitchen table, laptop open, headphones in.

Online therapy—variously called teletherapy, e-therapy, or virtual counselling—isn't new. It's existed in various forms since the late 1990s. But the COVID-19 pandemic transformed it from a niche offering to the mainstream default almost overnight. In March 2020, BACP reported that over 80% of therapists shifted entirely to online delivery within a matter of weeks.

Now, as in-person sessions have become widely available again, many clients (and therapists) face a genuine dilemma: which format is actually better?

The answer, as with most things in therapy, is: it depends. On you, your circumstances, what you're working through, and what you value in the therapeutic relationship.

Let's break it down properly.

TL;DR:

• Online therapy is as effective as in-person for most conditions (anxiety, depression, PTSD)
• Key advantages of online: flexibility, accessibility, reduced cost, no travel
• Key advantages of in-person: fuller presence, physical boundaries, richer non-verbal communication
• Some issues (severe trauma, eating disorders) may benefit more from face-to-face work
• Many people use a hybrid approach

The Evidence: Does Online Therapy Actually Work?

Let's address the elephant in the Zoom room: is online therapy as effective as the traditional model?

The short answer, according to a growing body of research, is yes—for most presentations.

What the Research Shows

A 2023 meta-analysis published in The Lancet Psychiatry reviewed 17 randomised controlled trials comparing online therapy to face-to-face therapy. The findings:

Condition	Online Therapy Efficacy	Key Finding
Depression	Equivalent to in-person	No significant difference in outcomes
Generalised Anxiety	Equivalent to in-person	Both formats showed substantial improvement
PTSD	Equivalent to in-person	Dropout rates slightly lower online
Social Anxiety	Equivalent to in-person	Some evidence online may reduce initial anxiety about attending
OCD	Equivalent to in-person	Exposure work can be effectively delivered remotely

A separate 2022 study in the Journal of Medical Internet Research found that therapeutic alliance—the relationship between client and therapist, consistently shown to be the strongest predictor of outcome—develops just as strongly in online settings as in-person.

Expert insight: "Initially, I was sceptical about online work. I worried we'd lose the nuances of body language and presence. But what I've found is that clients often feel more comfortable opening up from their own space. The medium becomes almost invisible after the first few sessions." — Dr Emma Brennan, Integrative Psychotherapist, 12 years experience

Where Online Therapy Might Fall Short

Important caveat: online therapy isn't universally equivalent.

Research suggests certain presentations may benefit more from in-person work:

• Severe eating disorders (where body-based work is central)
• Acute crisis situations (where immediate physical intervention might be needed)
• Complex dissociative disorders (where grounding techniques benefit from physical presence)
• Some forms of trauma therapy (though EMDR and trauma-focused CBT have been successfully adapted for online delivery)

Additionally, people with limited digital literacy, unstable internet connections, or lack of private space at home may struggle with online formats.

The Case for Online Therapy

1. Accessibility and Flexibility

This is the big one. Online therapy removes significant barriers:

Geographic accessibility: You're not limited to therapists within a 10-mile radius. Living in a rural area with few local therapists? Online opens up the entire UK (and beyond).

Schedule flexibility: Easier to fit a session into a lunch break or between other commitments when you don't have to factor in travel time.

Disability access: For people with mobility issues, chronic pain, or conditions that make leaving the house difficult, online therapy can be genuinely transformative.

Travel cost and time: No commute means no petrol, parking fees, or train tickets. A 50-minute session stays a 50-minute session, not a 2-hour chunk out of your day.

Real example: Sarah, 42, lives in Cornwall with chronic fatigue syndrome. The nearest BACP-registered therapist specialising in trauma is 40 miles away. Online therapy gave her access to specialist support she simply couldn't have accessed otherwise.

2. Comfort and Safety

There's something powerful about being in your own space.

Reduced social anxiety: For people with social anxiety, the idea of sitting in a waiting room, potentially bumping into someone you know, or navigating public transport can be genuinely distressing. Online removes all of that.

Control over environment: You choose the lighting, temperature, whether you have a blanket or your dog nearby. These small comforts can help you feel safer and more able to be vulnerable.

Easier to manage emotional intensity: After a difficult session, you're already home. No need to compose yourself for the bus ride back or make small talk with the receptionist.

3. Lower Barrier to Starting

Online therapy often feels less intimidating for first-timers.

"It felt less 'official' somehow," one client told me. "I could almost pretend I was just having a video call with a friend. That made it easier to take the first step."

4. Cost-Effectiveness (Often)

Many therapists charge slightly less for online sessions than in-person (typically £5-15 less), as they save on room rental and associated costs.

Subscription-based platforms like BetterHelp or Talkspace offer unlimited messaging plus weekly video sessions for around £40-80/week, which can work out cheaper than traditional private therapy.

The Case for In-Person Therapy

1. Fuller Presence and Connection

There's something about sharing physical space that's hard to replicate digitally.

Richer non-verbal communication: In-person, you pick up on micro-expressions, subtle shifts in posture, the quality of someone's handshake. Some of this translates online; some doesn't.

Undivided attention: No email notifications, no housemates walking past in the background, no tech glitches pulling you out of the moment.

Energetic presence: This is harder to quantify, but many people describe feeling a quality of "being with" someone in person that doesn't quite translate through a screen.

Client perspective: "I did six months of online therapy during lockdown and it helped. But when I switched to in-person, the difference was palpable. I could feel my therapist's warmth and calm in a way I couldn't through Zoom. It sounds woo-woo, but it mattered." — Michael, 36

2. Clear Physical Boundaries

The therapy room provides a psychological container.

Separation from daily life: Walking into a therapy room is a ritual that signals to your brain: this is a different kind of space. That boundary can make it easier to access difficult emotions.

Transition time: The journey to and from a session provides processing time. You arrive, settle in, leave, decompress. Online, you can go from therapy to a work call in 60 seconds flat.

3. Fewer Distractions and Tech Issues

Let's be honest: screen freezes, audio cutting out, the cat jumping on your keyboard—these things happen. And they disrupt the flow.

In-person sessions don't have these issues. The technology is just... you and another human in a room.

4. Better for Certain Therapeutic Approaches

Some modalities translate less easily to online formats:

Body-based therapies: Somatic experiencing, sensorimotor psychotherapy, some forms of Gestalt work rely heavily on bodily awareness and physical presence.

Art therapy, sand tray work, psychodrama: These modalities require physical materials and space that can't be replicated virtually.

Side-by-Side Comparison

Let's make this concrete:

Factor	Online Therapy	In-Person Therapy
Accessibility	✓✓✓ Excellent (anyone with internet)	✗ Limited by geography
Cost	✓✓ Often cheaper	✗ Typically more expensive
Convenience	✓✓✓ Highly flexible	✗ Requires travel time
Presence & connection	✓ Good (some nuance lost)	✓✓✓ Excellent
Privacy	✗ Requires private space at home	✓✓ Guaranteed private space
Tech barriers	✗ Requires digital literacy & stable connection	✓✓✓ No tech needed
Boundary clarity	✗ Home environment can blur boundaries	✓✓✓ Clear separation from daily life
Crisis management	✗ Limited options for immediate intervention	✓✓ Easier to respond to acute distress
Non-verbal communication	✓ Visible but less nuanced	✓✓✓ Full range
Comfort level	✓✓✓ Your own space	✓✓ Comfortable but unfamiliar

The Hybrid Model: Best of Both Worlds?

Here's what many therapists and clients have landed on post-pandemic: a flexible, hybrid approach.

Common hybrid arrangements:

• Primarily online, with occasional in-person "anchor" sessions (monthly or quarterly)
• Start in-person to build the relationship, then shift to online for ongoing work
• In-person for difficult sessions, online for maintenance
• Alternate weekly: one week online, one week in-person

At Kicks Therapy, we offer full flexibility. Some clients come to our Fulham practice weekly; others connect via Google Meet from Scotland or while travellling for work. A growing number do both, depending on what's happening in their lives that week.

The beauty of the hybrid model is that you're not locked into one format. Had a rough week and can't face the commute? Switch to online. Feeling stuck and need the clarity of in-person work? Book a face-to-face session.

Decision Framework: Which Format is Right for You?

Still unsure? Work through these questions:

Choose online therapy if:

• You have limited access to qualified therapists in your area
• You have mobility issues or health conditions that make travel difficult
• Your schedule is erratic and you need maximum flexibility
• You feel more comfortable opening up in your own environment
• You experience social anxiety and the idea of a waiting room feels overwhelming
• Cost is a significant factor

Choose in-person therapy if:

• You value the ritual and boundaries of a dedicated therapeutic space
• You struggle with distractions at home
• You don't have reliable internet or a private space for video calls
• You're working through severe trauma or complex issues that benefit from physical presence
• You respond better to the energetic quality of face-to-face connection
• You're exploring body-based or creative therapies

Consider hybrid if:

• You want flexibility to switch based on circumstances
• You'd benefit from an initial in-person connection before shifting online
• You have unpredictable work or travel schedules
• You're working on different things at different stages of therapy

Practical Considerations for Online Therapy

If you decide to try online therapy, set yourself up for success:

Tech Requirements:

• Stable internet connection (minimum 10 Mbps for video calls)
• Device with camera and microphone (laptop, tablet, or smartphone)
• Headphones (improves sound quality and privacy)
• HIPAA-compliant platform (reputable therapists use secure platforms like Zoom Healthcare, VSee, or Doxy.me—not regular Zoom)

Environment:

• Private space where you won't be interrupted
• Comfortable seating (you'll be there for 50 minutes)
• Good lighting (facing a window or lamp so your face is visible)
• Minimal background noise

Etiquette:

• Test your tech 10 minutes before the session
• Turn off notifications on your device
• Be on time (just as you would for in-person)
• Dress appropriately (this signals to your brain that it's a professional space)

Cost Comparison: What Should You Expect to Pay?

Here's a realistic breakdown of UK therapy costs across formats (as of 2024):

In-Person Private Therapy:

• Standard rate (qualified counsellor): £50-£80/session
• Experienced therapist (5+ years): £70-£100/session
• London/specialist: £90-£150/session

Online Private Therapy:

• Standard rate: £45-£75/session (typically £5-10 less than in-person)
• Experienced therapist: £65-£90/session

Subscription Platforms (BetterHelp, Talkspace, etc.):

• £40-£80/week for unlimited messaging + weekly video session
• Pros: Lower cost, high flexibility
• Cons: Less continuity (you might not see the same therapist), limited session time

NHS Talking Therapies:

• Free (both in-person and online options available)
• Waiting times vary (typically 4-12 weeks)

Low-Cost Options:

• Training clinics: £10-£30 (both formats)
• Charity services: £15-£40 (both formats)

FAQs

Can I switch from online to in-person (or vice versa) with the same therapist? Many therapists offer both. It's worth asking during your initial consultation. Switching formats mid-therapy doesn't disrupt the relationship—it's just a change in delivery method.

Is online therapy secure and confidential? Reputable therapists use encrypted, HIPAA/GDPR-compliant platforms. However, you're responsible for ensuring your environment is private. Don't do therapy sessions from a coffee shop or shared office space.

What happens if my internet cuts out mid-session? Most therapists have a protocol: they'll wait a few minutes for you to reconnect, then may call your phone or send a message. You're typically not charged for time lost to tech issues.

Can online therapy work for couples or family therapy? Absolutely. Many therapists offer couples/family sessions via video call. You'll need to ensure you have a space where you can both be visible on camera.

Will my insurance cover online therapy? Many UK private health insurance providers (Bupa, Aviva, AXA) now cover online therapy at the same rate as in-person. Check your policy details.

The Verdict

So, which is better: online or in-person therapy?

There isn't a universal answer. Both formats are evidence-based and effective. The "best" option is the one that removes barriers and allows you to engage fully in the therapeutic process.

For some people, that's the convenience and accessibility of online therapy. For others, it's the presence and ritual of in-person sessions. For many, it's a flexible blend of both.

What matters more than the format is:

1. The quality of the therapist
2. The strength of the therapeutic relationship
3. Your commitment to the process

A mediocre therapist won't help you whether they're in the room or on a screen. And an excellent therapist can facilitate profound change regardless of format.

My recommendation? Try both if you can. Book an initial in-person session to build connection, then experiment with online for a few weeks. Notice what you prefer. There's no wrong answer.

At Kicks Therapy, we offer both in-person sessions at our Fulham practice and secure online sessions via video call. We're genuinely flexible about format and happy to switch based on what works for you.

Ready to get started? Book a free 15-minute consultation (in-person or online!) to discuss which format might suit you best.