Telehealth vs In-Person Counseling

by Tonya Ratliff, LPC, ACS

Tonya Ratliff is the Owner and Director of Counseling Services for Trinity Family Counseling Center. In addition to her individual, couple, and family clients, Tonya is also the lead facilitator of the Walk With Me Grief Support Group, an aftercare program sponsored by Wm. Sullivan and Son Funeral Home in Utica, MI.

Counseling services have historically been conducted in a private room with the client and counselor face-to-face. The COVID-19 pandemic changed everything. Virtual therapy conducted via a telehealth platform was our only option during that time to continue to assist people with their mental health challenges.
 
Not surprisingly, there are many counseling practices that have remained entirely virtual. Here at Trinity, we are routinely asked if we conduct telehealth sessions?
 
So, how are telehealth sessions different—if at all—than sitting face-to-face with your counselor? Let’s consider a few features of both options.
 
First, two positive aspects associated with telehealth sessions:
 
1) Convenience
There is no doubt that the convenience of engaging with your counselor from your own home is appealing. No commute time, no traffic, no gas usage, and the most efficient use of time. For many clients, these are some significant pros to telehealth sessions. The ability to log on from work during their lunch hour, for example, precludes the need to commit to an evening appointment, away from their family.
 
2) Safety and Comfort
Many clients struggling with certain types of anxiety have reported feeling safer in their own home.  With that sense of overall safety, can also come a deeper level of vulnerability in discussing the really ‘tough stuff’ with their counselor.
 
Comfort is another factor when attending counseling from one’s home. It can be argued that there is less stress in talking about difficult issues when you feel comfortable physically. We have seen clients routinely log on to their session from their bedrooms and their beds!
 
Next, let’s look at some of the pros of in-person counseling sessions:
 
1) Immediacy
One of the hallmarks of positive engagement with a professional counselor is the interpersonal relationship that develops between the parties. Rapport, a sense of emotional safety, and trust are essential for the client to be willing to reveal the details of their circumstances, and the depth with which they suffer. After all, the issues bringing the client into counseling have likely been troubling them for some time. It takes tremendous courage to make that initial call for help.
 
The ability for the client to experience immediate and uninterrupted attention, support, and validation from their counselor can mean the difference between finally taking that initial step forward toward change---or continuing
to feel ‘stuck’ and often, hopeless. Immediacy in a counseling session offers the opportunity for that “a-ha” moment that is so often thought of as a goal of the counseling experience.
 
2) Accountability
Accountability is defined as, “…an assurance that an individual will be evaluated on their performance or behavior related to something for which they are responsible…”
 
In the counseling arena, this means that clients are asked to “own” their thoughts, words, choices, actions, mistakes, and misdeeds. The counselor’s ability to address these issues and to hold the client accountable involves not allowing the client to make excuses, deny, or avoid their responsibility for their circumstances. This can be a powerful moment between client and counselor, and the beginning of the client’s recognition of the things they have the power to change. Being held accountable is often much more impactful when confronted face-to-face.
 
3) Privacy and Confidentiality
For many clients, privacy and confidentiality are of extreme importance. As counselors, we are ethically and legally responsible to protect our clients’ privacy, and to assure their confidentiality to the best of our ability. This includes things like protecting the contents of their records, obtaining a Release of Information form to discuss a client with another professional or family member, and most importantly, simply assuring our client that their conversation is with us--and us alone. * The private counseling room offers the best possible opportunity to honor these needs.
 
Every client opting for telehealth sessions should be informed that there are limits to our ability to guarantee privacy and confidentiality in a virtual scenario. For example, another person in their home—in another room—could overhear their session, or someone could unexpectedly walk into the room uninvited and overhear their session. And, while the professional counselor should be conducting the session from a private, soundproof area of their home or office, the reality is that many do not. Therefore, the client cannot know for certain that the session is private from the counselor’s end of the connection.
 
4) Confidence that the session will occur and not be interrupted!
An in-person session is a commitment of 50-minutes, uninterrupted by both the counselor and the client. We have all had our share of intermittent internet connections, difficulty connecting at all, and dropped connection once initiated, when conducting any type of exchange over the internet. There is no quicker way to have a telehealth counseling session go awry, than to experience the frustration of internet sabotage!
 
Finally, having conducted telehealth sessions with my own clients exclusively during the pandemic, I can say without a doubt, that I prefer seeing my clients in-person! There is great value in witnessing my client’s body language, physical demeanor, and unfiltered and immediate emotion. I also know that I personally bring more energy and more focus to the experience of having a client seated before me, than behind a screen!
 
While telehealth sessions can offer convenience, safety, and comfort for clients, I believe that the features of immediacy, accountability, privacy, confidentiality, and certainty of the dedicated time are all the reasons I need to continue to encourage in-person sessions with my current and future clients.
 
See you in the session room!
  
* Exceptions to this promise, dictated by law, are topics related to harm to others or self-harm.

---