My Thoughts on Remote, Online, or Virtual Therapy

If someone had asked me in 2019—before the onset of the COVID pandemic—what my opinion might be of the effectiveness of marital or relationship therapy conducted over the internet utilizing Zoom or other similar platforms, I would have replied with very little enthusiasm and a great deal of skepticism. I would likely have said that meeting a couple “virtually” would resemble “in-person” therapy to the same degree that watching a video of someone eating a healthy and nourishing meal might compare to the viewer eating that same meal in their own home.

My prediction would have been that online therapy would not have been as helpful nor the virtual meal as nourishing as the actual in-person event. I would have predicted that both would be experienced as faint, barely visible, images of the real thing.

However, regarding “online,” “remote,” or “virtual” therapy—the three terms are often used interchangeably—I would have been absolutely WRONG!

In fact, what I have learned in the past two years is that remote or online therapy can be, and almost always is, just as effective as meeting with that individual or couple in person. And the bonus is that many of the predicted disadvantages of remote therapy have been shown to make that mode of treatment even more effective than its in-person alternative.

By making it unnecessary for individuals to spend time driving to and from the therapist’s “bricks and mortar” office, more time can be spent in the therapist’s virtual office with fewer couples finding that they are either late for or unable to keep a previously scheduled appointment. An additional bonus is that those individuals unable to leave work during the day to keep a doctor’s appointment might still be able to attend therapy sessions with both me and their spouse during a lunch break—all while the three of us are in different locations.

My initial concern that not being physically present with my clients and therefore not able to see the “entire” person would result in my missing important non-verbal cues about each client’s state of mind turns out to not be the case. In fact, whatever nonverbal or subtle visual cues that might be missed over the internet are more than made up for by providing me a window into the home life of the client. It is actually quite helpful for me to be able to observe how my clients deal with the unexpected interruptions of a typical day that occur during our meetings. It’s those very interruptions and distractions from their children, dogs, and unexpected Amazon deliveries that provide me with real time data about the day to day life of my patients that I would be unlikely to learn about were we to be meeting in person in my office.

One related bonus is that meeting my patients while they are in their homes makes it possible for me to observe them in a setting that is more comfortable for them thus allowing me to work with an individual who is likely to feel significantly less anxious than he or she might otherwise have felt in my professional office. Before the pandemic arrived in 2020, in order to observe couples in that more familiar or comfortable environment, I would frequently request that one of our couples meetings be conducted in the couple’s home. I no longer see the need to schedule such meetings since I get most of the information I need in the natural course of my online meetings with these couples.

And if we use my clients’ own expressed preferences for meeting with me virtually versus in person in my office as a measure of their satisfaction with therapy, virtual therapy wins out with more than 95% of the patients’ that I have polled.

Finally, there is one last significant advantage of considering virtual therapy for help addressing marital, relationship, and sexual concerns. As a clinical psychologist who has limited his practice to a fairly small niche—the treatment of individuals and couples experiencing marital, relationship, and sexual concerns as well as the treatment of those individuals experiencing the traumatic aftereffects of learning of a partner’s infidelity—I often get calls from individuals who call asking for referrals to individuals who treat the same problems as I do but have offices closer to where the potential client or patient might live. In many cases my answer to their request is that I know of no one in that part of the state to whom I can refer them. With the increased availability of virtual therapy those individuals can now choose to see any Maryland licensed psychologist which gives them a larger pool of clinicians from which to select.

As a Maryland licensed psychologist I have always been permitted to see patients residing anywhere within the state of Maryland. However, until the onset of the pandemic made online therapy a necessity, I had never given serious consideration to seeing patients anywhere other than in my actual office in Baltimore, thereby making it impractical for patients to see me who lived outside of a 30 to 45 minute drive to Baltimore. That is no longer the case. In the last two years individuals living as far away as Annapolis, Bethesda, Potomac, Columbia, and Western Howard County, some living over 90 minutes away, have all located me on the internet and whom I have subsequently proceeded to treat on my virtual platform. Although I am enthusiastic about the convenience and advantages of seeing individuals and couples on my “doxy.me” virtual platform, this is not to say that virtual therapy is always the appropriate treatment of choice.

Since I have begun limiting my practice to individuals who would be most likely to profit from virtual therapy, I have an ethical responsibility to provide appropriate referrals for those individuals who would likely not be appropriate candidates for online therapy. Those individuals experiencing severe psychological distress, those with serious mental health disorders, or individuals with severely debilitating symptoms such as paranoid or suicidal ideation are often best treated in an in-person setting.

The fact that virtual therapy might not be the best option for all individuals makes it particularly important that individuals considering pursuing online therapy be a wise consumer and carefully interview any potential therapists with whom they might consider working to ensure that he or she is qualified to conduct a comprehensive mental health evaluation to assess the client’s suitability for online treatment. Not all mental health providers are trained or qualified to carry out such an assessment.

If you reside anywhere in Maryland including the greater Baltimore/Washington DC metropolitan area including Towson, Pikesville, Owings Mills, Columbia, Bethesda, Silver Spring, Chevy Chase, or the greater Annapolis metropolitan area and you are experiencing distress associated with marital, relationship, and /or sexual concerns, pain resulting from or related to infidelity, anger, or any of the other issues described on this website, please feel free to call me at 410-377-4343 or email me at babass@towson.edu.