In-person vs Virtual Therapy

The remote diagnosis and treatment of patients by means of telecommunications technology.

-definition of telemedicine

My therapist has challenged me with writing a post for the blog, despite my depression induced writer’s block. For better or worse, here it is.

I’ve had my fair share of appointments. I used to only have one per month. Other times in my life (like right now) sixteen or more per month.

In the days pre-COVID, everything was in person. For meds, you needed to see the psychiatrist. For therapy, the psychologist or counselor. You go to your GP (general practitioner) for a physical, and of course that’s in person. In fact, I can’t think of any medical appointment that I would attend in the past that wasn’t at a physical location with the actual care giver.

Then COVID came around, and suddenly we’re all going online to take care of our health care and mental health issues. On one hand, it’s nice not to have to actually go somewhere, but I do miss the excuse to go through a drive through and get some overpriced coffee for a treat. In this post I’ll be giving my experience and opinions on the good and the bad of the virtual care world.

In person care

First, the pro category.

I enjoy meeting my care team in person when possible. I feel like they can get a better sense of me, my current mood, and pick up on any finer body language I may be throwing at them. It also helps me build trust. I haven’t had many I didn’t like, but the few that I wasn’t comfortable with have been in person. I don’t know if that means I have a poorer intuition with the few members of the team I haven’t actually met in “real life.” I not only build relationships with my primary docs, but with the staff, too. I like it when I go to check in and they know me by name. It makes it easier to get me checked in, but it also makes me feel a bit more like someone the organization cares about. The nursing staff are often there long enough to recognize me, or at least I can recognize them. If you’re going to get a shot, it’s better to get it from someone you feel you know than from a complete stranger.

Paperwork and diagnostics are easier in the physical world. When I get my PHQ-9 and GAD-7 (mental health inventories) they usually give me a clipboard. More novelty, but I like it. Meds, too, are easy to procure when you’re coming out of a physical visit. Pop on over to the local pharmacy, or in my case if I’m at the hospital I can just stop by the pharmacy there, prescriptions all ready to pick up.

For my GP who is downtown, I get to walk around and pretend to be a contributing member of society, maybe get lunch at one of the places I used to frequent. For those suburban appointments it gives me an opportunity for that drive through coffee I mentioned, or just driving around listening to music too loud. It can be a great way to kill an afternoon.

When it comes to doing group in person, I think there are some important advantages. Group therapy usually has some rules about what you can or cannot say in order to protect privacy, but more often prevent triggering behaviors. Rather than saying you were researching suicide, you have to say you were engaging in a problem behavior. It makes sense. But before and after group, or on a break in the middle if it’s a long one, you can actually chat with your group-mates. Not to talk about anything the program doesn’t want you talking about, but just life stuff. I’ve made more than one good friend on those breaks. That’s something I miss about virtual.

And the Cons..

Of course, if you don’t want to kill an afternoon, that can be problematic. Those in-person appointments require you to actually get there. So tack on a half an hour or whatever before and after the appointment. What was an hourlong appointment now takes up two hours of your time. This also makes scheduling the appointment more difficult. Can’t just slot it in an hour between meetings. It can actually block three of your hour slots, if you have any. And mileage and gas and whatnot counts too.

Remember what I said about prescriptions? The pro is also the con. If you don’t have them routed to your favorite pharmacy, you need to take the script there, and then wait for come back. Wait in line, as well. I actually get mine mailed to me, so I avoid all of this at the cost of waiting one or two days. And yeah, it’s only one or two days, if you can believe it. Something is super efficient in that system. Of course, I expect my next refills will take two weeks now that I’ve jinxed myself.

Getting dressed is another con to the in-person appointment. That sounds like a joke, but if you’re in a state where getting out of bed is difficult, taking a shower and putting on clothes (hope you did your laundry) can be a herculean task. If you have social anxieties, going out can trigger those.

Ok, enough haranguing on reality.

Let’s get Virtual

Most points are just opposite mentions of the above. If that’s an actual phrase. So these are pros and cons, all muddled up

You only have to technically dress from the waist up. Pajamas and the largest sweater I own seems to work for me. That doesn’t do a lot for my motivation to shower, unfortunately. And I find when I shower and dress at least I feel a bit more like a human being. Also, it doesn’t get me out of the house. While it’s only an hour block I get anxious beforehand and don’t want to go anywhere in case I’m late. I don’t get the return home trip to blow off steam or have some physical activity. As a result I’m usually pretty down, deflated, and crash hard after calls. You just can’t win for losing, I guess.

You don’t really get to see the care team or your group therapy peers very well. Yeah, there’s on screen, but I usually run in gallery view, so they’re at most half the display. And I find if I turn the view to only one specific person I feel like a creepy guy. That, and a quarter of the time it seems like someone is not showing video that day. Or is in such a way that you can’t really see them very well. (I’m looking at you poorly backlit with a virtual background on..) As for care team members, I can see them but I wonder how well they can see me. My DBT coach did say she noticed I avoid eye contact when I talk about safety or suicidal ideation, so apparently they can see somewhat well.

The video platforms are varied and extreme. Google Meet is quick and dirty, but seems sensitive to network issues. Zoom feels heavy handed and, well, heavy. My psychiatrist’s clinic uses their own flavor, and it’s super simple to the point of too simple. You never know if you’re waiting or need to click somewhere, or what. Quality is okay though. The end result is that it feels like a different experience for almost every clinic you work with.

The technical skills of the people on the other end of the line can be a real pain, too. The ones who don’t know how to mute, or less annoyingly don’t know how to unmute. Good microphones and bad microphones make it feel like everyone doesn’t have an equal ability to share. One peer has a mic so bad I just can’t understand anything they are saying. I don’t know if a facilitator has mentioned it, but I certainly am not. Which makes me wonder – how does my mic sound? It’s a high end mic and I record myself often, but on that platform do I sound like a duck talking through a toilet paper tube? It’s like wondering if you have bad breath.

That paperwork I used to do in the clinics are either no longer used, or done through an online tool. If you thought video platforms were a mess of differences, online assessment tools are even worse. Did you finish the assessment? Or did it not register so you have to do it again? Got your login credentials handy? I had one clinic switch systems and I’m honestly not sure which system was better or worse. What I am sure of is the fact that I have yet another account to keep track of. It’s health information, so you don’t want your browser to save your credentials, but LastPass doesn’t always remember to save your information. And if it does, you may have three different entries to pick from next time you log in. (Tip: It’s not the one you chose)

Meds are another one of those things that can go either way. As I mentioned mine are mailed, so the doc just puts it in the system and it shows up in the mailbox a couple days later. But if it’s something new I’m wanting to start right away, or a med for an acute issue, waiting for it isn’t always a comfortable option.


Honestly, virtual just isn’t real life. It’s easier, yeah, but that doesn’t make it better. The unhealthy side of me likes virtual so I can hermit better. But the other unhealthy side of me likes getting my Lattes in the drive through. I feel a bit like this was a bit of a pointless post, as virtual appears to be here to stay. I still get to go in for therapies that do something to me, like Ketamine, electroconvulsive therapy or upping my VNS. At least until they figure out how to do that remotely..

What do you think? Big fan of either direction? Got any good horror stories to tell – or better yet success stories? Take the fifteen microseconds it takes to share something in the comments. Thank you for reading!

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