In-Person Therapy Is Better

Remote therapy’s popularity has made in-person therapy a challenge to find in NYC

Early in 2020, the world moved online. Some professions made this life-changing shift more smoothly than others. Video and phone therapy were far from new—every therapist had already worked remotely when in-person therapy wasn’t possible. However, the success and functionality of online therapy as the sole or main format for mental health treatment were unproven. Mercifully, to the benefit of those seeking or wanting to continue treatment for their mental health conditions, the format proved viable, though not without its difficulties or trade-offs.

Gradually, therapists, psychiatrists, and patients alike became used to remote therapy’s conveniences: the ability to save commuting time to the office, take a session from anywhere, and run a load of laundry or roast a chicken while doing it. For therapists, especially in a competitive real estate market like New York City, giving up in-person work in whole or in part saved the huge expense of maintaining an office for in-person therapy.

Because online therapy works, the status of in-person therapy in the last several years has been in limbo. Many providers kept their former office listed on their websites and online profiles (perhaps intending to return or out of an affinity for their old neighborhood since many they treated still lived or worked nearby). Other mental health professionals returned to the office a few days a week only to discover, like many office workers, that “hybrid” often means doing a good deal of remote therapy from the office. A smaller number have returned in person. Still, all therapists are doing more online therapy than ever before.

Our therapists are in the office full-time because in-person therapy is just better

At Tribeca Therapy, our licensed therapists (including LCSWs and LMFTs) are in our Manhattan office full-time to be available for in-person therapy. Our providers offer individual therapy, including for adolescents and kids, couples therapy, and family therapy online. Yes, the convenience of remote work is wonderful, and the setup is better mental health care for certain individuals, such as disabled patients for whom travel is difficult, or for whom immune compromises make in-person work prohibitive. These benefits are clear: access matters, and our ability to provide therapy remotely allows for that.

However, the truth is that, no matter the type of therapy, in-person therapy, even therapy that is only partly or occasionally in person, is just better for most people’s mental health and behavioral health.

Remote therapy comes with privacy challenges that in-person therapy doesn’t

Before the pandemic, it would seem redundant or unnecessary to say that therapy requires privacy. Almost by definition, therapy is a space to talk about parts of yourself that can’t be talked about elsewhere, at least in the same way. When therapy moved remotely into the home, office, or anywhere else in the world, finding privacy for talk therapy about mental health issues became a serious challenge. Noise traveled, and coworkers interrupted sessions at the office. Home could present even more difficulties as patients had to carve out a space and time without the distractions of kids, a spouse or partner, or a roommate.

In-person therapy sidesteps the unique needs of these privacy negotiations. So much so that the importance of privacy to the quality of therapy can be taken for granted in person. Privacy affects how much you can open up. Certain parts of our lives—of ourselves—are hidden to some degree even from ourselves. Some of the most meaningful moments in therapy are when you “discover” something you know or feel that you didn’t realize you needed to talk about, like remembering a previously forgotten memory, identifying a deeper feeling about someone in your life, or getting in touch with a feeling that’s been sublimated so that the feeling and its consequences can be dealt with more directly. An essential condition for these moments to occur is a sense of privacy. This includes just the perception of privacy—even if no one else is in the apartment listening, the idea that they could be can censor the ability to do this deeper work.

Bodies matter in therapy: Subtle cues can be easily missed on the screen

It’s terribly easy to reduce the experience of therapy to words, broadly, and evidence-based interventions, specifically. However, therapy is a relationship that engages the whole body. To be clear, much of therapy is the transaction of verbal ideas. But, hearing breathing, sensing embodied responses, observing how a patient moves through a space, and noticing ourselves mirroring can all be raw data to be used in a session. While bodies can relate across screens and over phone lines, more happens in person. There are subtle cues that don’t show up on the screen or can be easily missed.

This can be both challenging and essential for people who are working through traumatic experiences. Traumatic experiences are often embodied, such as physical or sexual abuse or assault, and they also happen in the context of a relationship, frequently a close, trusted relationship. On the one hand, this is an instance where telehealth therapy sessions can be helpful to provide the safety of physical distance. On the other hand, the work of therapy isn’t just to create a safe experience; it’s to help someone be in the world, improve their mental health, and have the option of being in embodied spaces where they can contend with being around other bodies, including the fraught sense of potential danger, within an environment of safety.

In-person therapy offers a separate space for a separate kind of work

Many have heard the sleep-hygiene advice given to teenagers: “Don’t study in bed.” Therapy operates similarly. Therapy is difficult, often expensive work, and the stakes can be high. This separate kind of work benefits from being in a separate space like the therapist’s office. Remote therapy is almost always done from a place where you do other things, whether work, eat dinner, or sleep. It’s also done on a device where you work, use the phone, or scroll through social media. In a world increasingly maximized for efficiency, it can feel quaint to advocate for a place for a certain kind of work. However, in-person therapy can be a place solely devoted to reflecting on the rest of your life. The therapy office provides a kind of container—a space that is neither work nor home, where your partner, children, and boss never visit, making it a space where you’re more likely to speak freely.

In particular, separating therapy from the rest of your everyday routine can help things emerge in session that weren’t planned or fully thought through. The surprises of “I didn’t think I was going to talk about this today” or “Now that you mention it” can be some of the best opportunities in therapy for your well-being, even with a strong treatment plan. While this can happen anywhere, having a disruption of routine in a specific, consistent place can be especially encouraging.

The commute to and from the therapy office offers time to reflect on and absorb what you are working on

A commute, as annoying as it may seem, can be an advantage. The transition from home or work to the therapist’s office (and back) can be a time to reflect on what you are working (or just worked) on and focus on the bigger tasks in therapy. When working through trauma or notable past experiences, transitioning both your mind and body into a mindset specific to therapy can be essential. Therapy shakes loose and rattles. Patients benefit from time to absorb and perhaps cry after the session (or before) before jumping straight into the next work assignment or housework. Leaping into the next thing or finding the closest immediate distraction can be its own defense against fully feeling.

A therapist’s office is both a home and part of them

In a world where so much of our lives are lived and monetized online, it’s easy to forget that space matters: a plant, a piece of art, disordered papers on an antique desk, the smell, the neighborhood, or the subway stop. Yet, all of us can remember specific details about where we were when a particular conversation was had. This includes conversations had in therapy.

Many stories about therapists begin with a description of their office. The content and the setting exist in relation to one another. Managed care and manualized techniques seek to reduce therapy to its most mechanical parts, but therapy is a relationship, particularly with the right therapist, and the office is, in a sense, both a home and part of them. In the deepest emotional work, who the therapist is matters a great deal. Like the patient needs to be seen in their fullness, the therapist also needs to be seen in their entirety. Their office is a part of this.

In-person therapy is also better for therapists

The ways that remote work is isolating have been well established, and therapists’ work was already isolating. Many therapists work in private practice. Even those of us who work as a part of a group practice spend our days in (necessarily) sound-proof rooms, engaging in (necessarily) private conversations. The additional removal of in-person connection and all the “accidental” exchanges with colleagues in hallways or break rooms is all the more consequential.

All of the previously discussed advantages of in-person therapy are as beneficial for the therapist’s wellness as they are for the patient. In-person therapy services give therapists a space to concentrate, connect, attend, and notice. Connecting through a screen is not impossible, but there are things exchanged in therapy that go beyond words and facial gestures. At its heart, in-person human interaction is good for humans, therapists included.