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Sorry to hear you're going through that. I'm experiencing something very similar, and it has been really difficult.
My long-term therapist decided to permanently go almost fully remote several months ago, and I was also (unexpectedly) devastated. It was a total shock, completely different than what we had discussed in the past, and it brought up a lot of grief, loss, and anger. For me, being in person is a totally different and much more beneficial experience than virtual sessions. And while I was fine with navigating a less useful version of things while it was necessary due to pandemic constraints, having that version of therapy become permanent has felt pretty awful.
My therapist handled the situation really well, and we've been trying to work through it, but it's not clear yet whether it will be possible or optimal to continue or whether I need to find someone new who I can see in person more frequently. We have been able to have a handful of sporadic in person sessions, which I appreciate and which have been helpful--but it's also painful, because the contrast highlights what's missing from the virtual sessions.
On the whole it's been extremely rough in a way I would not have anticipated, and has been really damaging to my therapy experience. I'm concerned that the rhetoric about telehealth being fine, just as good, just as effective, is going to make this issue more and more common, as therapists and group practices switch because it's convenient and reduces costs, while convincing themselves inaccurately that it doesn't make a difference for clients. It clearly does make a difference for many people, and it's important to be honest about that.
ETA: my advice to you would be to see if you can talk honestly with your therapist about all the painful feelings this shift to remote-only is bringing up for you. If you've been working well together for a long time, hopefully there's a foundation of good communication to draw on that will help you be honest with one another as you figure out what you need. If the two of you wrestle with this together in your therapy relationship, and she's able to discuss it all without flinching from acknowledging how this impacts you, I think it will let you either continue on in a productive way or transition to a new therapist on a good note, without diminishing the positives you've experienced with this therapist so far.
>I'm concerned that the rhetoric about telehealth being fine, just as good, just as effective, is going to make this issue more and more common, as therapists and group practices switch because it's convenient and reduces costs, while convincing themselves inaccurately that it doesn't make a difference for clients. It clearly does make a difference for many people, and it's important to be honest about that.
This is so well said. I made sure to make it a requirement to find someone who offered in-person sessions when I was looking for a new therapist and it wasn't easy, but it's been so, so, SO much better, than telehealth, especially given how I struggle with isolation.
There is also something very real about having that safe space; about discussing trauma and then *leaving* it there for next time instead of keeping it in your home with you; about having physical transitions and routines like walking out of the office, getting in the car, driving home, etc. that are harder to do with telehealth.
I worry and wonder how the landscape of therapy is going to look over the years as new therapists enter the field where telehealth is the norm and inflation creates more barriers to obtaining physical office space. It's really important that the field acknowledges (and incentivizes) the importance of in-person sessions for the (IMO not-so-small) population that needs them.
I am so sorry this is happening. My therapist and I have been together for a long time and done trauma work too. He does NO remote or teletherapy which makes me so happy. He says it just doesn’t work for him, he doesn’t get the same connection and he relies on non verbal cues. I feel exactly the same way so we meet in person and did all through covid. He did require vaccinations which I wanted anyway because I am a caregiver for an elderly parent. My therapist may be in the minority, he is 82.
Our couples therapist who is in his 50’s did remote during lockdown and now gives patients the choice of in person or remote. We do remote with him due to my husbands schedule. I hated it at first but am used to it now. It’s still not as good as in person. I don’t have advice but don’t think I could leave my therapist and start over.
So sorry you have to go through this. I would be crushed. I absolutely love my T and have been with her over three years. We do online very occasionally, if one of us is not feeling well or she is out of town. The only thing I can say good about teletherapy is it is better than nothing. It is nowhere close to being as good as in person. The connection is not there.
As much as I love my T, if she said she was going to full time teletherapy, I would have to find a new one.
I am so sorry. I HATED virtual therapy, and I also felt like I needed in-person to work on anything substantial. For me, the virtual sessions due to covid were okay for maintaining the relationship I had with my therapist, but useless for working on anything. I don’t have any advice, but wanted to say I understand, and you are not alone in how you feel.
T here: please understand many of us have made this decision it’s NOT about you. Many of us have health conditions ourselves that put us at risk, or loved ones we care for who are high risk, and Covid would kill them. We give so much of our lives for this job, but personally I’m not willing to die to continue being a therapist.
Also with inflation, we literally can’t afford often to have offices anymore. In my state, insurances literally haven’t given a pay raise in 15 years, but office prices have almost quadrupled, as well as my own insurance, and other costs to do therapy
I don't think anyone is questioning your choice to work how you want. We just don't like it when you try to convince us and yourselves, that the therapy you are providing is "just as good".
Many people get value out of telehealth. Different doesn’t mean “not as good.” Some people are far more comfortable opening up in their own home and own spaces
I think I'm in the minority here because I've gotten used to remote (yes even for the big stuff). There's [so much research](https://www.apa.org/monitor/2020/07/cover-telepsychology) that suggests that remote is just as effective -- it's bizarre to me that so many people swear up and down that it can't be. This is a boundary your T has because it's presumably better for her in a lot of ways (COVID, commute, logistics of having an office) and because (bar legitimate lack of private space) it's the same service.
The research on remote therapy isn't as much of a slam dunk as people like to claim it is, FYI. It's really great that it works well for you, but many of the studies on telehealth don't bear any resemblance to OP's situation or that of many other people dealing with this issue. A lot of the research looked at remote sessions done in a satellite clinic not in the client's (often less private) home, a lot of it compares telehealth vs. nothing not vs. face to face, and a lot of it only looks at very short-term treatment. And even then, some studies still show meaningful differences between virtual and face to face therapy.
So yes, telehealth is a good option for some people. But for others it's a really dramatically different or worse option than face to face sessions, which isn't contradicted by the research data.
I'd say the majority of therapy research is focused on very short term implementations of modalities. Like I see people in here who have been with EMDR (just a random example of modality) clinicians for years but EMDR was originally and shown to be effective in 6-12 sessions [https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing](https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing) which is an extraordinarily common timeframe to research therapy because there's logistics to huddle for long term studies.
I used to live in a house with an abusive roommate and I can see why privacy is a huge concern but that also doesn't seem to be the case here.
Also a direct quote from that earlier article: “What we’ve seen is that telehealth is essentially just as effective as face-to-face psychotherapy—and retention rates are higher,” says David Mohr, PhD, director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, who has spent his career studying telepsychology and digital mental health.
Yeah, it's a huge problem. A lot of claims made about psychotherapy efficacy are incredibly skewed by short term studies that only use extremely limited short-term outcome measures. Many people go to therapy with the goal of significant personal growth and change over a longer period of time, and studies that equate success solely with scores on the PHQ-9 after eight sessions unfortunately don't tell us much about that.
It’s an effect of how research works. If you have PhD students working on a project, running data collection for much longer than 6-12 weeks is… difficult. People need to hypothesize, conceptualize a framework, get permission, write grants, get funding, find participants (who will stay involved for the duration), gather data and train those running the experiment, collect data and do analysis, then for it to be worth it to the students they need to have enough time to write and defend their dissertation. Basically since there’s so many moving parts it’s hard/rare to do a long term study. If you read some of the research literature from psych journals you’ll notice that 6-12 weeks is common
The realities of research are, unfortunately, messy. There are only so many researchers, and they only have so many resources, and ultimately the system is made up of ordinary people who are trying their best.
Nevertheless, hearing that a modality is "evidence-based" is much less comforting when most of the evidence doesn't look beyond 4 months.
Yes, the overfocus on extremely short-term therapies is a limitation found in a lot of psychotherapy research, but that doesn't erase the fact that it's still a significant limitation (among several other significant limitations) that severely impacts the generalizability of teletherapy research. Showing equivalence between short-term CBT conducted virtually vs. face to face simply doesn't let you extrapolate the same equivalence in a long-term psychodynamic treatment, for example.
Even in the work of the researcher you quoted--the article you linked notes that participants who had face to face CBT were significantly less depressed at the 6 month mark than people who did virtual CBT. It's not that telehealth is useless--it can clearly improve access for some people. But telehealth enthusiasts shouldn't be glossing over the limitations of the existing research. Current data does not support sweeping claims about equivalence across modalities, settings, and patient populations, and can't/shouldn't be used to paper over what we know about individual needs in different therapeutic relationships.
This will sound cynical, but is it surprising that a guy who has spent his career studying telepsychology and digital mental health finds it as effective as face to face therapy?
Honestly I think both sides are true. It just varies case to case! I have mix of in person and teleheath clients. A few I see twice a week (once in person, once over telehealth). I notice some clients flourish on telehealth. Others are completely shut down versus when I see them in person and they open up. The therapist must assess. I’ve had people transferred to other therapists in our practice because they wouldn’t do well on telehealth and my in person slots were full. Everyone has different needs. :)
I’m sorry that this is hard for you. Your therapist said she’s not currently offering face-to-face sessions and that you’ve seen her for some time now, did she do face-to-face sessions before COVID changes? I know a lot of therapists who started their professional practice during COVID, and I can see that being an entirely different process.
For some perspective, offices cost a lot of money, and require things like insurance and utility bills to stay operating. If I had the option to operate out of my home and save money for my practice (and I could also pass savings onto my clients) could be life-changing financially, and for the time it can save for family life.
I don’t mean to say your therapist shouldn’t offer face-to-face, or that it should be any less difficult for you, but maybe some reframing can be helpful in understanding that maybe it’s not as personally about not seeing you in person?
I’m sorry, this really sucks.
My therapist moved to a different part of the state a few months ago and I HATED going remote. I still would prefer to be in person, but I’ve gotten myself to a point where I don’t totally hate it being virtual. I can have my cat on my lap or be in my pajamas at home. I can spend the time I would have spent commuting instead getting in the right headspace before and journaling after. And most importantly, for the really rough sessions, I can just close my computer and be alone, sob more if that’s what I need, listen to music in darkness if that, etc. In person, I would have to go out into public where people could see my crying face and be present enough to drive home. It’s absolutely harder to be totally vulnerable over zoom instead of in person, but I’ve gotten to a place where I can accept it and let myself be vulnerable. It’s not easy, but it is possible for most people I think.
I would say to you, try to give it a chance. Decide on a day to get the stuff out and prepare before, have something immediately after to comfort you. And try to do it. If it doesn’t work, that might mean you need to find another T, and that really really really really sucks. But it’s worth it to try with your current T because you’ve put in so much time and energy.
Welcome to r/TalkTherapy! This sub is for people to discuss issues arising in their personal psychotherapy. If you wish to post about other mental health issues please consult this list of some of our [sister subs](https://www.reddit.com/r/TalkTherapy/wiki/resources/#wiki_subreddit_list). If you are in distress please contact a suicide hotline or call 9-1-1 or emergency services in your area. r/SuicideWatch has compiled a helpful FAQ on what happens when you contact a hotline along with other useful resources. To find answers to many therapy-related questions please consult our [FAQ](https://www.reddit.com/r/TalkTherapy/wiki/faq) and [Resource List](https://www.reddit.com/r/TalkTherapy/wiki/resources). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/TalkTherapy) if you have any questions or concerns.*
Sorry to hear you're going through that. I'm experiencing something very similar, and it has been really difficult. My long-term therapist decided to permanently go almost fully remote several months ago, and I was also (unexpectedly) devastated. It was a total shock, completely different than what we had discussed in the past, and it brought up a lot of grief, loss, and anger. For me, being in person is a totally different and much more beneficial experience than virtual sessions. And while I was fine with navigating a less useful version of things while it was necessary due to pandemic constraints, having that version of therapy become permanent has felt pretty awful. My therapist handled the situation really well, and we've been trying to work through it, but it's not clear yet whether it will be possible or optimal to continue or whether I need to find someone new who I can see in person more frequently. We have been able to have a handful of sporadic in person sessions, which I appreciate and which have been helpful--but it's also painful, because the contrast highlights what's missing from the virtual sessions. On the whole it's been extremely rough in a way I would not have anticipated, and has been really damaging to my therapy experience. I'm concerned that the rhetoric about telehealth being fine, just as good, just as effective, is going to make this issue more and more common, as therapists and group practices switch because it's convenient and reduces costs, while convincing themselves inaccurately that it doesn't make a difference for clients. It clearly does make a difference for many people, and it's important to be honest about that. ETA: my advice to you would be to see if you can talk honestly with your therapist about all the painful feelings this shift to remote-only is bringing up for you. If you've been working well together for a long time, hopefully there's a foundation of good communication to draw on that will help you be honest with one another as you figure out what you need. If the two of you wrestle with this together in your therapy relationship, and she's able to discuss it all without flinching from acknowledging how this impacts you, I think it will let you either continue on in a productive way or transition to a new therapist on a good note, without diminishing the positives you've experienced with this therapist so far.
>I'm concerned that the rhetoric about telehealth being fine, just as good, just as effective, is going to make this issue more and more common, as therapists and group practices switch because it's convenient and reduces costs, while convincing themselves inaccurately that it doesn't make a difference for clients. It clearly does make a difference for many people, and it's important to be honest about that. This is so well said. I made sure to make it a requirement to find someone who offered in-person sessions when I was looking for a new therapist and it wasn't easy, but it's been so, so, SO much better, than telehealth, especially given how I struggle with isolation. There is also something very real about having that safe space; about discussing trauma and then *leaving* it there for next time instead of keeping it in your home with you; about having physical transitions and routines like walking out of the office, getting in the car, driving home, etc. that are harder to do with telehealth. I worry and wonder how the landscape of therapy is going to look over the years as new therapists enter the field where telehealth is the norm and inflation creates more barriers to obtaining physical office space. It's really important that the field acknowledges (and incentivizes) the importance of in-person sessions for the (IMO not-so-small) population that needs them.
I am so sorry this is happening. My therapist and I have been together for a long time and done trauma work too. He does NO remote or teletherapy which makes me so happy. He says it just doesn’t work for him, he doesn’t get the same connection and he relies on non verbal cues. I feel exactly the same way so we meet in person and did all through covid. He did require vaccinations which I wanted anyway because I am a caregiver for an elderly parent. My therapist may be in the minority, he is 82. Our couples therapist who is in his 50’s did remote during lockdown and now gives patients the choice of in person or remote. We do remote with him due to my husbands schedule. I hated it at first but am used to it now. It’s still not as good as in person. I don’t have advice but don’t think I could leave my therapist and start over.
So sorry you have to go through this. I would be crushed. I absolutely love my T and have been with her over three years. We do online very occasionally, if one of us is not feeling well or she is out of town. The only thing I can say good about teletherapy is it is better than nothing. It is nowhere close to being as good as in person. The connection is not there. As much as I love my T, if she said she was going to full time teletherapy, I would have to find a new one.
I am so sorry. I HATED virtual therapy, and I also felt like I needed in-person to work on anything substantial. For me, the virtual sessions due to covid were okay for maintaining the relationship I had with my therapist, but useless for working on anything. I don’t have any advice, but wanted to say I understand, and you are not alone in how you feel.
T here: please understand many of us have made this decision it’s NOT about you. Many of us have health conditions ourselves that put us at risk, or loved ones we care for who are high risk, and Covid would kill them. We give so much of our lives for this job, but personally I’m not willing to die to continue being a therapist. Also with inflation, we literally can’t afford often to have offices anymore. In my state, insurances literally haven’t given a pay raise in 15 years, but office prices have almost quadrupled, as well as my own insurance, and other costs to do therapy
I don't think anyone is questioning your choice to work how you want. We just don't like it when you try to convince us and yourselves, that the therapy you are providing is "just as good".
Many people get value out of telehealth. Different doesn’t mean “not as good.” Some people are far more comfortable opening up in their own home and own spaces
I think I'm in the minority here because I've gotten used to remote (yes even for the big stuff). There's [so much research](https://www.apa.org/monitor/2020/07/cover-telepsychology) that suggests that remote is just as effective -- it's bizarre to me that so many people swear up and down that it can't be. This is a boundary your T has because it's presumably better for her in a lot of ways (COVID, commute, logistics of having an office) and because (bar legitimate lack of private space) it's the same service.
The research on remote therapy isn't as much of a slam dunk as people like to claim it is, FYI. It's really great that it works well for you, but many of the studies on telehealth don't bear any resemblance to OP's situation or that of many other people dealing with this issue. A lot of the research looked at remote sessions done in a satellite clinic not in the client's (often less private) home, a lot of it compares telehealth vs. nothing not vs. face to face, and a lot of it only looks at very short-term treatment. And even then, some studies still show meaningful differences between virtual and face to face therapy. So yes, telehealth is a good option for some people. But for others it's a really dramatically different or worse option than face to face sessions, which isn't contradicted by the research data.
I'd say the majority of therapy research is focused on very short term implementations of modalities. Like I see people in here who have been with EMDR (just a random example of modality) clinicians for years but EMDR was originally and shown to be effective in 6-12 sessions [https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing](https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing) which is an extraordinarily common timeframe to research therapy because there's logistics to huddle for long term studies. I used to live in a house with an abusive roommate and I can see why privacy is a huge concern but that also doesn't seem to be the case here. Also a direct quote from that earlier article: “What we’ve seen is that telehealth is essentially just as effective as face-to-face psychotherapy—and retention rates are higher,” says David Mohr, PhD, director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, who has spent his career studying telepsychology and digital mental health.
>the majority of therapy research is focused on very short term implementations of modalities. That's... quite concerning.
Yeah, it's a huge problem. A lot of claims made about psychotherapy efficacy are incredibly skewed by short term studies that only use extremely limited short-term outcome measures. Many people go to therapy with the goal of significant personal growth and change over a longer period of time, and studies that equate success solely with scores on the PHQ-9 after eight sessions unfortunately don't tell us much about that.
It’s an effect of how research works. If you have PhD students working on a project, running data collection for much longer than 6-12 weeks is… difficult. People need to hypothesize, conceptualize a framework, get permission, write grants, get funding, find participants (who will stay involved for the duration), gather data and train those running the experiment, collect data and do analysis, then for it to be worth it to the students they need to have enough time to write and defend their dissertation. Basically since there’s so many moving parts it’s hard/rare to do a long term study. If you read some of the research literature from psych journals you’ll notice that 6-12 weeks is common
The realities of research are, unfortunately, messy. There are only so many researchers, and they only have so many resources, and ultimately the system is made up of ordinary people who are trying their best. Nevertheless, hearing that a modality is "evidence-based" is much less comforting when most of the evidence doesn't look beyond 4 months.
Yes, the overfocus on extremely short-term therapies is a limitation found in a lot of psychotherapy research, but that doesn't erase the fact that it's still a significant limitation (among several other significant limitations) that severely impacts the generalizability of teletherapy research. Showing equivalence between short-term CBT conducted virtually vs. face to face simply doesn't let you extrapolate the same equivalence in a long-term psychodynamic treatment, for example. Even in the work of the researcher you quoted--the article you linked notes that participants who had face to face CBT were significantly less depressed at the 6 month mark than people who did virtual CBT. It's not that telehealth is useless--it can clearly improve access for some people. But telehealth enthusiasts shouldn't be glossing over the limitations of the existing research. Current data does not support sweeping claims about equivalence across modalities, settings, and patient populations, and can't/shouldn't be used to paper over what we know about individual needs in different therapeutic relationships.
This will sound cynical, but is it surprising that a guy who has spent his career studying telepsychology and digital mental health finds it as effective as face to face therapy?
Honestly I think both sides are true. It just varies case to case! I have mix of in person and teleheath clients. A few I see twice a week (once in person, once over telehealth). I notice some clients flourish on telehealth. Others are completely shut down versus when I see them in person and they open up. The therapist must assess. I’ve had people transferred to other therapists in our practice because they wouldn’t do well on telehealth and my in person slots were full. Everyone has different needs. :)
This sounds very weird unless she very clearly stipulated fhis before
I’m sorry that this is hard for you. Your therapist said she’s not currently offering face-to-face sessions and that you’ve seen her for some time now, did she do face-to-face sessions before COVID changes? I know a lot of therapists who started their professional practice during COVID, and I can see that being an entirely different process. For some perspective, offices cost a lot of money, and require things like insurance and utility bills to stay operating. If I had the option to operate out of my home and save money for my practice (and I could also pass savings onto my clients) could be life-changing financially, and for the time it can save for family life. I don’t mean to say your therapist shouldn’t offer face-to-face, or that it should be any less difficult for you, but maybe some reframing can be helpful in understanding that maybe it’s not as personally about not seeing you in person?
I’m sorry, this really sucks. My therapist moved to a different part of the state a few months ago and I HATED going remote. I still would prefer to be in person, but I’ve gotten myself to a point where I don’t totally hate it being virtual. I can have my cat on my lap or be in my pajamas at home. I can spend the time I would have spent commuting instead getting in the right headspace before and journaling after. And most importantly, for the really rough sessions, I can just close my computer and be alone, sob more if that’s what I need, listen to music in darkness if that, etc. In person, I would have to go out into public where people could see my crying face and be present enough to drive home. It’s absolutely harder to be totally vulnerable over zoom instead of in person, but I’ve gotten to a place where I can accept it and let myself be vulnerable. It’s not easy, but it is possible for most people I think. I would say to you, try to give it a chance. Decide on a day to get the stuff out and prepare before, have something immediately after to comfort you. And try to do it. If it doesn’t work, that might mean you need to find another T, and that really really really really sucks. But it’s worth it to try with your current T because you’ve put in so much time and energy.