Couples Therapy: Online vs. In Person

For most couples, there will be ups and downs in their relationships. While we would love to live in the bliss and infatuation that often accompanies the honeymoon period, we will all at some point have a rough patch.

Relationship satisfaction can look like a roller coaster. Ideally, this would be the most boring roller coaster that is all height without the fall, but usually, there are dips.

First of all, this is normal and not a sign that your relationship is doomed. Secondly, many couples find great success in increasing satisfaction by entering into couple’s therapy.

In the modern world, there are many options for therapy and counseling. Much of the success of therapy comes from the “fit” between the therapist and client(s).

Shopping for therapists is a normal and healthy process to find one whose style works for you. Some will be more directional, others more facilitative of processing emotions.

More recently, online counseling and therapy are becoming options therapists provide. This might be part of the shopping process for you as you begin to assess what your needs and desires are for therapy. Before getting into this distinction, however, it would be good to understand what the process of therapy will look like from either method (online or in person).

What Does Couples Therapy Look Like?

Regardless of whether you’re coming in or participating in couples therapy online, the general structure will look similar. Below I am going to outline what you might expect from myself, a marriage and family therapist that often utilizes an approach called Emotionally Focused Couples Therapy popularized by Sue Johnson.

This approach seeks to help couples identify underlying patterns of behavior and the emotions associated with them. It presumes that romantic relationships are seen as attachment relationships, similar to those shared between infants and their parents. Your responses to your partner depend on how well you are attached to them.

Therefore, underlying couple’s therapy is the process of increasing and bettering attachment. Emotionally Focused Therapy is just one modality of therapy, so depending on the therapist the process of couple’s therapy can look different. However, in general, there can be seen three broad phases of therapy for couples.

Phase One: Patterns and Problems

In this first phase, I, as the therapist, will be focusing on getting to know you two as individuals. Not only what is going wrong, but I will be curious about what is going well. A lot of this time is spent simply information gathering.

Other questions will include, what do you two like to do for fun? How did you meet? What did you bond over? What do you like about the other person? Further, I will inquire about background physical and mental health histories.

Once these basic background questions have given me a picture and hopefully some trust between us is built, I will begin to ask you about the problem behaviors you are identifying in each other and in your relationship.

Further, what emotions are accompanying these behaviors as well? When she does x, how do you feel? And when he does y, what emotion comes up for you.

Specifically, I am concerned with the expression of emotions and feelings, not just thoughts. Many couples find it easy to share thoughts, it is emotional content I will be seeking to uncover.

Phase Two: Healing

Once the patterns have been established and made apparent, healing from these hurtful patterns can begin. Much of this healing will involve both you and your partner identifying the emotions you are experiencing and truly identifying with them.

Once you can identify your own, I will ask you to reflect and respond to your partner’s emotions as well. This process really gets at fostering attachment and truly being heard and understood. Often, this gives space for reconciliation and forgiveness for past hurts to be had as well.

Phase Three: Maintenance and Prevention

Once a couple has made significant progress and appears to be doing well, we often move to sort of a maintenance and prevention of further hardship. At this point, I like to turn over a lot of the control in the process to you, the couple, to help navigate potential future disagreements and how to handle them when they come up.

At this point, these conversations can be had in a much calmer and more productive manner. Often, these are the sorts of conversations you were trying to have that didn’t go well, ultimately leading you to come into therapy.

Pros and Cons of Couples Therapy Online

Now that you know the outline of the process, then, does online or in person counseling seem like a more appropriate fit for you? Classically, therapy and counseling have always been in person. Sometimes, sessions might be had over the phone, but therapists often rely on body language as well as words, so this mode is not often preferred.

However, video conferencing has become much more mainstream and common, allowing for body language to be a part of remote therapy as well. While the general process remains the same, there isn’t yet good research on the effectiveness of video counseling for couples, or at least how the process is affected. Let me go through some potential pros and cons.

Pros

Convenience

Probably the most obvious reason for people to ask for video counseling is the convenience it provides. By doing couples counseling online, you can participate from whatever safe and confidential place you have with an internet connection. This could be in your home or office, for example.

Usually, a therapist will still be in their own office and, if not, will definitely be in a space that assurance privacy and compliance with HIPAA regulations.

Further, another layer of convenience is that perhaps you and your partner are not on similar schedules, and this allows for you both skype in from separate locations (if three-way calls are an option for your therapist) in order to be able to make a timeslot work for you.

Finally, depending on where you live this may be the only feasible option for you. If you live deep in a rural environment, the nearest therapist’s office might be a very long drive away, and, even then, it might not be a good fit.

This allows you to shop for a therapist that is licensed anywhere within your state (outside of your state, things get more complicated and most therapists won’t be able to work with you unless they hold a license in your state as well).

Comfort

By joining in counseling via a video feed, you might be able to do so from a location that you are comfortable in. You can be on your own couch in your own living room! You get to choose the place and can do more to make yourself comfortable.

Safety

Perhaps you and your partner don’t feel like you can even sit in the same room right now, participating in couple’s therapy from a distance, with everyone in their own physical location, can provide more safety. The physical distance often translates to an intimacy distance, allowing for conversations to escalate less quickly.

Real World Setting

While the previous three reasons are for you, the therapist might appreciate seeing you in your own real-world setting. Often, couples and individuals step into a therapy office and it feels like a whole different universe in there. Progress made in the room might not translate once you step past the door. By doing couple’s therapy online and in your own abode, you are able to make changes in an environment that will stay with you.

Cons

Separation

As I mentioned above, the physical separation can lead to a sort of intimacy separation. This can occur between you and the therapist and you and your partner if everyone is calling in from different locations.

Over time, this can slow progress. While you might make good progress in session, if you are limiting your face to face time, there is less soil for your relationship to grow.

Screens and Connectivity

While technology is great and constantly improving, you run the risk of technological issues coming up. Internet connections can fail, computers can decide to update at any moment, and other distractions can easily pop up if on your computer.

Physically, if you both are trying to get in on one camera it can be difficult to get everyone in the frame. This constant moving around makes you less comfortable and some of your attention drifts from the conversations at hand to just making sure the connection works.

Lack of Presence

This final issue comes from some personal experience on the side of the therapist, and it is that no matter how good the call and connection is, there feels like a lack of presence in the room.

This isn’t to say that it is impossible to do counseling online, but the process feels slower. Generally, we look away from the computer and the person we are talking to much more frequently than we do in a session, leading us to feel much more distant.

A Third Way?

Weighing these pros and cons, perhaps the answer isn’t necessarily an either/or, but rather a both/and. I think online counseling allows a format for increased continuity of care that wasn’t previously available.

One of the greatest things it allows is for existing clients to continue seeing me when they move out of the immediate area.

It is hard and a daunting task to start with a new therapist who will require much time to get caught up to your own personal history, so you might take this option to stay with the therapist you are currently seeing.

Another way of using both online and in person couple’s therapy is to do some sessions in person and some online. It might feel like you need the distance to start out so that you don’t get as heated in session, but once you have made some progress meeting together in the same room might feel more doable.

In some ways, this allows for couples to engage in the process where they didn’t feel comfortable doing so previously.

Ultimately, online video counseling for couples is a new tool that is being developed, and it should be used in a manner that makes the most sense for you as a couple.

Why online?

In shopping for your therapist, now beyond fit and style of counseling, you get to consider online or in person. I would encourage you to consider, then, why online therapy? Is there a fear of jumping into the process?

Online counseling does provide a distance that creates safety. However, by seeking that option are you hiding from the potential for better growth?

It can be a scary proposition to begin couples counseling, and it is an invitation to deal with more intimate dealings of the heart. If you are able to come into sessions physically, I would encourage you to seek this route and truly buy into the process yourself. The more you buy in, the more effective it can be for you!

Ultimately, if you have made it this far couple’s therapy must be something you and your partner are considering! Let me leave you with this last thought: most couples I see, report that they wish they would have come in at least a year sooner. Don’t delay beginning this process!

If online counseling makes it more doable, then pursue that route. If in person makes sense, then let’s get you scheduled! You have so much to gain by engaging in couple’s counseling: personal happiness, marital satisfaction, lowered stress levels, increased job performance, and more! Get your relationship right and start your journey towards increased relationship satisfaction today!