How to Choose Between In-Person vs Online Therapy for Kids

Choosing the right therapist for your child is a big step. One factor that many families consider is whether they want the therapist to provide services online or in-person. In-person therapy has been the more traditional route, but recently, especially since the Covid-19 pandemic, online therapy has become more and more common. Both in-person and online therapy for children are effective. The “right” choice just depends on your child’s needs, as well as your family’s preferences.

In this article, you’ll learn what research says about online therapy for children, what factors to consider when deciding, and how to choose the option that helps your family actually start and stay in treatment.

Factors to consider when choosing between in-person vs online therapy

There isn’t necessarily one right answer regarding whether online or in-person therapy is right for your child. What’s best depends on many factors. Here are some factors to consider:

Child’s age and developmental stage

To fully participate in online therapy, your child needs to be at a developmental stage where they’re able to understand how to engage in this way. For example, they need to be able to use the technology. It’s best for them to be able to participate independently for at least part of the session. This helps protect their confidentiality.

In addition, play therapy is difficult to deliver online alone. Play therapy is often recommended for children, so age plays a role here as well.

Severity and type of condition

Children with more severe mental health conditions may benefit more from in-person or hybrid therapy sessions. Seeing the child in person can sometimes give therapists more insight into their symptoms. It’s sometimes easier in person to keep children safe in a crisis.

Family logistics and location

Logistics around location and transportation also play a role. Online therapy is especially helpful for families who live in rural or remote areas. You may not have transportation to get to sessions, or there may not be enough mental health providers in the area. For these families, online therapy can fill an important gap.

Technology and privacy requirements

The family must also have the basic technology to participate in online sessions. For example, they should have a computer or smartphone and a stable internet connection. It’s also ideal for them to have a separate and private space to protect confidentiality.

Child’s personality and preferences

Lastly, the child’s preferences should be taken into consideration as much as possible. Some children may simply connect better with therapists in person, while others might feel more comfortable online. For example, research shows that many teens are comfortable with receiving online care.

Key differences between online and in-person therapy

Both online and in-person therapy can be effective. The main differences usually come down to convenience, logistics, and fit for your child.

Accessibility and convenience

Many families choose online therapy because it’s more accessible. It doesn’t require you to commute to a physical office to receive mental health services, which means it takes up less of your time. The cost of therapy can be lower with online sessions as well. Even if the sessions themselves cost the same, you save money on transportation and missed work hours.

Engagement and rapport

The therapeutic relationship (often called the therapeutic alliance or rapport) is a key factor in determining the effectiveness of therapy. Many parents worry that their child will have a harder time building a relationship with their therapist through online sessions only. However, most young people today are very used to communicating and building relationships online, so this may not be as big a factor as you imagine.

Effectiveness and clinical suitability

Online therapy, especially for children, is relatively new, so we’re still gathering research about how effective it is.

But the research we do have tells us that online therapy can be just as effective as in-person therapy, for adults and children alike.

There’s no big difference between the two in this regard.

However, online therapy may be more clinically suited for certain mental health conditions and clients. For example, children who would benefit most from play therapy might be better suited for in-person therapy.

Cost and insurance coverage

The difference in cost between in-person and online sessions depends on your insurance plan. Most therapists set similar rates for both types of sessions, but your insurance may have different coverage rules or copays for telehealth versus in-person care. Check with your insurance carrier to be sure. 

Parental involvement

Parents play an important role in mental health care for children. Online therapy can make it easier for parents to join briefly from work or home. In-person therapy allows parents to participate more directly and may make it easier to practice skills in the room with the therapist.

Decision framework: Step-by-step guide

Here are some questions to consider when you’re deciding between online and in-person therapy for your child. 

1. How old is your child? If they’re over the age of 5 and comfortable using technology, then online therapy may be possible. If they can’t use technology due to age or developmental reasons, then in-person therapy may be the better fit.
2. Do you have access to reliable transportation means? If it’s difficult for your family to commute to and from the therapy office, then online therapy might be the best fit.
3. Are there mental health providers in your local area? Many areas are facing a mental health provider shortage. If there aren’t enough mental health professionals in your area, online therapy can widen your search to the whole state.
4. Does the child have a private and safe place in which to participate? If the child doesn’t have a place to speak confidentially with their therapist, then going to the therapist’s office could be a better choice.
5. What do you and your child prefer? Your personal preferences matter. If you and your child are more comfortable speaking with a therapist online (or in-person), then this should be taken into account.

Weighing the pros and cons of both online and in-person therapy

Each therapy format comes along with benefits and limitations. The lists below outline the pros and cons of online therapy and in-person therapy. 

Benefits of online therapy

• It eliminates the need to commute, which saves time and simplifies scheduling.
• It allows children to receive care from the comfort of home, which can make them feel more relaxed.
• It can reduce missed appointments due to transportation issues, household illness, or bad weather.
• It makes therapy more accessible for families in rural or underserved areas.
• It allows parents or caregivers to participate more flexibly in sessions.
• It helps maintain continuity of care during moves or transitions.
• Research suggests teletherapy can be as effective as in-person therapy for many conditions. And some people report greater satisfaction with treatment with online therapy when they complete the treatment process.

Limitations and challenges of online therapy

• It requires reliable technology, a stable internet connection, and a private space.
• It can be difficult for very young children to stay engaged on a screen.
• Although sessions are expected to be confidential: home distractions (like siblings, pets, or background noise) can interfere with focus.
• Some therapy approaches, such as play therapy, can be harder to adapt to an online setting.
• Managing safety concerns, crises, or severe mental health concerns may be more challenging without face-to-face interaction.

Benefits of in-person therapy

• In-person therapy offers a structured environment with fewer home distractions.
• It allows the therapist to use hands-on tools like toys, games, and art materials.
• It can make it easier for the therapist to pick up on nonverbal cues and body language.
• It can help children feel more grounded in a consistent therapy space.
• It may be better suited for younger children.
• It can feel more personal and relational for some children.
• It allows for easier safety planning in case of crises or more severe mental health needs.

Limitations and challenges of in-person therapy

• It requires commuting, which can take extra time and planning.
• Scheduling may be less flexible, especially for busy families.
• Illness, weather, or transportation issues can lead to more cancellations.
• It may not be feasible for families who live far from mental health providers.
• For children who experience anxiety about new environments, it may feel intimidating at first.

Why choosing the right therapy format matters

According to research, online therapy and in-person therapy are equally helpful. It’s not so much about choosing the “best” format for your child as it is about choosing the right format for you and your family.

Choosing the right therapy format can make a big difference in making mental health treatment as accessible for your family as possible. In a world where only a small percentage of people get the mental health support that they need and deserve, accessibility is critically important.

Choosing the right therapy format for your child and family, at the end of the day, is about choosing the one that will help you stay in treatment.

The right therapy format for you should make it as easy as possible for you to start and stay in therapy.

Get online child and family therapy with Emora Health

Whether you choose in-person or online therapy is entirely your choice. But online therapy has been helpful for many children and families — and if you decide to go this route, Emora Health is here for you.

Emora Health offers online therapy for children, teens, and families. Our licensed mental health professionals can help you find a format that works for your child’s needs and your family’s schedule. All of our therapists are vetted and have specialized experience working with children and teens.

Get in touch today to learn more about our online mental health services for children and start therapy in as little as 2 days.