Beware of Claims for Teletherapy

there is insufficient evidence that teletherapy (FaceTime, Zoom, Whats App) is superior to telephone assisted therapy,  that is the take home message from a just published review by Markowitz et al (2021) in this months American Journal of Psychiatry Am J Psychiatry 2021; 178:240–246; doi: 10.1176/appi.ajp.2020.20050557. Interestingly the preference of some clients with social anxiety disorder and PTSD is for telephone assisted therapy.  Markowitz et al (2021) also regard the claim that Teletherapy is as good as in person therapy as not proven. They voice a fear that remote therapy could become the new norm because of cost and convenience than because of evidence of equivalence with in-person therapy. Whilst there is undoubtedly a convenience value to teletherapy for clients and therapists with availability problems, there are also disadvantages such as managing a client who has become suicidal, missing non-verbal cues because of ‘talking heads’ together with technical problems, such as a poor internet connection, freezing screens etc. Further the poor and the elderly may not be able to afford the cost.

Markowitz et al (2021) opine that for the duration of the pandemic teletherapy may be very important but long term it should become, like telephone assisted therapy a useful option. I would hope so. But looking at the way in which IAPT has dominated the field with its low intensity (low cost) interventions bereft of a credible evidence base, I suspect teletherapy will continue to be a mainstay despite the jury being out on its’ efficacy. 


Dr Mike Scott