Online or face-to-face counselling – A matter of choice.


A recent conversation with a woman revealed that although she had needed therapy, the stigma attached to visiting a counsellor prevented her from seeking that help. She said she struggled to deal with the anxiety of having to travel to the office of a counsellor, find the building and sit in a waiting room. A further concern was if someone found out that she had gone for counselling. This is a genuine and understandable fear for many people who may be in need of counselling, a fear that is extremely difficult to overcome. At the end of our conversation, she conceded that the issue remained as she had never dealt with her problem.


My first thought was, why do people rush off to a doctor to look after their physical health but fear seeking assistance for their mental health. Not that I feel one is more important than the other but looking after your well-being requires a healthy body and a healthy mind. What then are the perceptions of online counselling, visual or not?


The new millennium has brought with it, new forms of technological social interaction, and opened the doors for the emergence of online psychological counselling. Online counselling has been one of the most discussed and debated topics in therapeutic literature with debates raising ethical and legal considerations, licensing issues, benefits and limitations, and fees. Discussing all these issues in depth is beyond the scope of this article, but let’s consider some of the main issues.


The telephone is easily the most used form of crisis counselling, and technology is playing a large role in real-time counselling. So, could this apply to routine short, and longer-term counselling, and is face-to-face counselling better than online counselling. To address, this let us consider the position of the client. I do believe that the greater benefit for counselling would be face to face. The counsellor is able to draw on verbal and non-verbal cues such as body movements which include hands, leg and feet. In most online counselling, only the head and shoulder may be visible, taking away many of the non-verbal cues which form an integral part of traditional counselling. Furthermore, if the client does not have a quiet place for the session, they may be distracted by noise or interruptions. Building a rapport with a client may well be more difficult online, and there is less control of the situation online. All it takes is the push of a button for an upset client to switch you off. All counsellors should present a client with a confidentiality agreement, however online guarantees of confidentiality are questionable. Online counselling practices should be using compliant HIPAA video software ensuring your call is completely secure and confidential. Skype is not secure, and confidentiality can be compromised.


But let us consider why online counselling has a place in today’s world. Research reveals that adults and children have disclosed information sooner on computer than on face-to-face counselling. Lack of geographical access to a counsellor poses problems to certain communities. I have already mentioned the fear, but what of the stigma? The choice is the clients whether to initially have the camera on or off and there is no need to leave their safe place to find the counsellors office. What about costs? Online counselling has traditionally been cheaper than face-to-face counselling. From my personal experience as much as 25% cheaper. Counselling should be accessible to everyone, and online counselling offers affordability and an opportunity. If you do not have flexibility or the time to travel to a counsellor, online counselling offers an alternative. In reality, if you or your family have a counsellor and relocate, you are still able to continue counselling from the other side of the world. The same principle applies to small or rural communities where people wish to maintain their anonymity. Without leaving the comfort of their home, they can still have access to counselling.


For some forms of therapy, online counselling can be just as effective. I do however believe that face-to-face has an advantage over online counselling. The choice depends on the individual. Consideration should be given to factors such as, availability, flexibility, personal feelings with regard to receiving counselling, affordability, confidentiality issues, and the willingness to seek help. The debate will continue but one thing I am certain of, is that you need to look after your mental health. The choice should therefore not be “if”, but which mode of counselling you should choose.



Alleman, J. R. (2002). Online Counselling: The internet and Mental Health Treatment. Psychotherapy: Theory Research, Practice, Training 39(2): 199-209. Doi:10.1037/0033-3204.39.2.199
James, K.R., & Gilliland, B.E. (2013). Crisis intervention strategies. USA: Cengage Learning.
Rochlen, A. B., Land L. N., & Wong,Y. J. (2004). Male Restrictive Emotionality and Evaluations of Online Versus Face to Face Counselling.Psychology of Men & Masculinity, 5(2), 190-200.