Video sessions went from a niche option to an ordinary one in a few short years, and many mental health providers now offer both formats. For most people the question is no longer whether telehealth works, but which format fits your life, your concern, and the way you like to connect.
This guide covers what the research has found, the practical tradeoffs of each format, how to set up a private space at home, why the state you are sitting in matters, and how to make the choice.
What the research says about video therapy
Researchers have now compared live video therapy with in-person therapy across dozens of studies. The overall picture is reassuring: for many common concerns, the format appears to matter less than the treatment itself and the relationship you build with your clinician.
A 2021 meta-analysis by Fernandez and colleagues pooled 56 within-group and 47 between-group studies. Video-delivered therapy outperformed wait-list conditions, and the difference between video and in-person therapy was negligible. Effects were strongest for cognitive behavioral therapy and for anxiety, depression, and PTSD.
A 2022 meta-analysis of randomized trials for depression (Giovanetti and colleagues) found similar symptom improvement with video and in-person therapy, and no meaningful difference in how often people dropped out.
One finding is worth knowing about. A 2018 review by Norwood and colleagues found symptom outcomes with video were not inferior to in-person care, but clients rated the working alliance — the sense of partnership with the clinician — somewhat lower over video, and the evidence base was small. If connection matters a great deal to you, that is a reasonable thing to weigh and to talk about openly.
Much of this research focuses on structured approaches such as CBT, and studies report averages. Your own experience is the most useful data you have.
The practical tradeoffs
Time and travel
Video removes the commute, parking, and waiting room. For people with demanding schedules, caregiving responsibilities, chronic illness, or limited transportation, that can be the difference between attending consistently and not attending at all.
Access to specialists
Telehealth widens your options to clinicians anywhere in your state. If you are looking for a specific kind of training — ERP for OCD, a perinatal specialist, an eating disorder clinician — that wider pool can matter more than proximity.
The room you are in
In person, the clinician provides a quiet, private space built for the work. At home, you provide the space, which can feel comfortable and familiar or can come with interruptions, thin walls, and other people nearby.
Presence and connection
Some people find it easier to open up from their own couch. Others feel more grounded sitting in the same room, where body language and silence are easier to read. Neither preference is wrong.
Technology
Video depends on a working device and a stable connection. Many clinicians agree on a backup plan in advance, such as switching to a phone call if the video drops.
Privacy and setup at home
Telehealth privacy is partly in your hands. The U.S. Department of Health and Human Services offers practical suggestions for patients:
- Find a quiet spot where you can talk freely. If home is crowded, a parked car or another private space can work.
- If you cannot find full privacy, use headphones, angle your screen away from others, and avoid speakerphone.
- Turn off nearby smart speakers and home security cameras so they are not recording.
- Use a personal device and network rather than a work computer or public Wi-Fi.
- Choose a well-lit spot, and connect a few minutes early to check your camera, microphone, and volume.
Why the state you are in matters
Licensure follows the client, not the clinician. In general, a mental health provider must be authorized to practice in the state where you are physically located at the time of the session. California’s Board of Behavioral Sciences, for example, states that a current and active California license or registration is required to provide marriage and family therapy, clinical social work, or professional clinical counseling to clients located in California.
California’s rules also ask clinicians to confirm your full name and current address at the start of each telehealth session, and to identify emergency resources in your area before telehealth begins. So if your clinician asks where you are today, that question is part of careful practice. If you plan to travel or move, mention it before your next session, since a session from another state may not be permitted. Tandem lists mental health providers licensed in Arizona and California, and each listing shows where a clinician practices.
When in-person may fit better
California’s regulations ask clinicians to assess whether telehealth is appropriate for each client and session, including your circumstances at home. In practice, in-person sessions may suit you better if you have no private place to talk, if screens leave you feeling distracted or disconnected, or if you simply feel steadier in a shared room. Your clinician may also recommend in-person care, or a higher level of support, depending on what you are working on. Many clinicians offer a hybrid of both.
If you are ever in crisis or thinking about harming yourself, call or text 988, the Suicide & Crisis Lifeline, any time, day or night, wherever you are.
Questions worth asking a provider
- "Do you offer video, in-person, or both? Can we switch formats later?"
- "Which platform do you use, and how do you protect privacy on it?"
- "What happens if the connection drops mid-session?"
- "Are you licensed in the state where I will be during sessions?"
- "What is your plan if I am in distress during a video session?"
- "Does the approach you use for my concern work well over video?"
- Meta-analyses suggest video therapy and in-person therapy produce similar symptom outcomes for many common concerns.
- Video offers access and convenience; in-person offers a ready-made private space and, for some people, a stronger sense of connection.
- Your clinician must be authorized to practice in the state where you are during the session.
- Set up a private, quiet spot, use a personal device, and agree on a backup plan.
- Choose the format you will attend consistently, and revisit the choice as your needs change.
Whichever format you choose, the clinician’s training in your specific concern matters most. The verified specialists below list whether they see clients by video, in person, or both.
References
- Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., & Aboujaoude, E. (2021). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy, 28(6), 1535–1549. https://doi.org/10.1002/cpp.2594
- Giovanetti, A. K., Punt, S. E. W., Nelson, E. L., & Ilardi, S. S. (2022). Teletherapy versus in-person psychotherapy for depression: A meta-analysis of randomized controlled trials. Telemedicine and e-Health, 28(8), 1077–1089. https://doi.org/10.1089/tmj.2021.0294
- Norwood, C., Moghaddam, N. G., Malins, S., & Sabin-Farrell, R. (2018). Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis. Clinical Psychology & Psychotherapy, 25(6), 797–808. https://doi.org/10.1002/cpp.2315
- California Board of Behavioral Sciences. Are You Going to Provide Telehealth Services in California? Telehealth Information and FAQs for Licensees and Registrants. https://www.bbs.ca.gov/pdf/publications/provide_mh_svs.pdf
- U.S. Department of Health and Human Services. Telehealth privacy for patients. https://telehealth.hhs.gov/patients/telehealth-privacy-for-patients