Whether you’re meeting your therapist in an office, over video, or while walking through a park, research shows that therapy can be effective across a range of formats. Studies consistently highlight that for many common concerns—like anxiety, depression, PTSD, and stress—online therapy can be just as effective as in-person sessions. Meanwhile, in-person and walk-and-talk therapies offer unique relational and environmental benefits that some clients may find more impactful. The key factor across all formats? A strong, trusting relationship between client and therapist. Below is a breakdown of the strengths and limitations of each approach, grounded in current research to help you make an informed and personalized choice.
Online Therapy (Teletherapy)
Evidence says:
Online therapy is just as effective as in-person therapy for many common issues—especially anxiety, depression, PTSD, and stress.
- A 2020 meta-analysis in the Journal of Anxiety Disorders found no significant difference in effectiveness between online and face-to-face CBT (Cognitive Behavioural Therapy).
- Research during and after the COVID-19 pandemic confirmed that therapeutic alliance (the quality of the therapist-client connection) can be strong even online.
- Bonus: Clients often report feeling more comfortable opening up from home.
Limitations:
- May be less effective for severe mental illness, trauma work that requires somatic (body-based) processing, or for clients without private space or stable internet.
- Some people miss the sense of physical presence and nonverbal cues.
In-Person Therapy
Evidence says:
Long considered the “gold standard,” in-person therapy allows for full use of body language, eye contact, and shared space, which can enhance the therapeutic relationship.
- Some studies show slightly stronger nonverbal connection and emotional attunement in person, particularly for trauma, grief, or deep relational work.
- May be preferable for people who struggle with screens, dissociation, or sensory issues.
Limitations:
- Less accessible: requires transportation, time, and mobility.
- Can feel intimidating for those new to therapy or with social anxiety.
Walk-and-Talk Therapy
Evidence says:
While research is still emerging, early studies and pilot programs suggest positive outcomes:
- Movement and nature can lower stress hormones, improve mood, and help clients think more clearly.
- Some clients report feeling less “on the spot”, leading to greater openness.
- A 2015 study in the Journal of Holistic Nursing found that walk-and-talk sessions improved emotional well-being and increased client engagement.
Limitations:
- Not ideal for trauma processing, privacy-sensitive issues, or weather extremes.
- Less controlled environment can be distracting or overstimulating.
Bottom Line (According to Research):
- The strength of the therapist-client relationship is the #1 predictor of positive outcomes—regardless of format.
- Client preference and comfort strongly influence engagement and effectiveness.
- A hybrid or flexible approach (e.g., switching between formats) can be both effective and sustainable.
Learn more about Walk-and-Talk Therapy
