Is Online Couples Counselling as Effective as In-Person?

A few years before the COVID-19 pandemic, when I was living and working in Dublin, I began offering online counselling. One of the first couples I worked with online had previously attended sessions with me in person. After returning to their home country, they wanted to continue working with me as they faced the challenges of leaving behind a life they had built over almost a decade and settling into an environment that, although familiar, had changed in many respects.

At that time, online therapy was already being used in many practices, with encouraging results. Even so, I had some concerns, particularly about working with couples online. I wondered whether I would be able to observe and manage their interactions and pick up on the subtle non-verbal cues that are often so telling of important relational dynamics between two people.

When the couple sat close together in front of their laptop, for example, it was harder to observe their body language. In an in-person session, when they were sitting in the same room with me, I could more easily notice how they positioned their legs and upper bodies, what they did with their hands, whether they turned towards or away from each other, leaned in or withdrew. These movements do not provide direct explanations, but they can offer useful insights into interaction patterns.

Online, I found myself relying more on facial expressions, tone of voice and hand gestures, as well as the movements of the upper body that remained visible on screen, such as a hunched posture or leaning forward. Despite my initial concerns, however, after a few sessions I found that working with couples online was entirely feasible, although it required some adjustments to the way I worked. Like in-person counselling, online counselling has its advantages and trade-offs. Accessibility and convenience

One of the most significant advantages of online counselling is accessibility. It can make support available to people living in remote or underserved areas, or in places where services that meet their particular needs are not available. It can also make online counselling in Budapest accessible to expats living abroad who value working with a therapist who understands the city and the cultural environment they come from. More generally, it can bridge geographical distances and make it possible for couples to continue working with a therapist when one or both partners move to another city or country.

Another significant benefit for both clients and therapists is the time and energy saved by not having to travel. For some people, being in familiar surroundings can also make it easier to talk about difficult things and feel more at ease during sessions.

But does online counselling deliver the same results?

Comparative studies have found similar improvements in couples’ relationship satisfaction in online and in-person counselling. However, some research suggests that the pace at which these improvements occur can differ, partly in connection with how the working relationship develops.

The working relationship between the counsellor and the clients may take longer to develop in an online setting if the therapist approaches it in exactly the same way as they would in person. The digital setting offers more limited sensory channels. Not all non-verbal communication is equally accessible, and some cues that would be available in the consulting room may not be noticeable or harder to attune to online.

From a systemic perspective, this is particularly relevant in couples counselling. The therapist is not only building a working relationship with each partner individually, but also observing and working with the relationship between them. How they respond to each other, how they negotiate speaking time, who moves towards or away from a difficult conversation, and the feedback loops that develop between them are all important parts of the systemic picture.

In an online setting, it can be more challenging for the therapist to follow these interactional patterns as they unfold. This does not mean they cannot be observed, but it may require a more conscious effort from the therapist to notice them and check whether the assumptions and hypotheses drawn from the observations are accurate.

This also means finding ways to compensate for some of these limitations in the way the therapist works. Rather than relying as much on non-verbal observations, it may be useful to rely more on verbal communication: to share what they notice more explicitly, check their interpretations with clients, ask what is happening for them in a particular moment, and give clearer verbal feedback. Extending this approach to more frequent bodily check-ins can also help clarify what each partner is experiencing physically and whether this corresponds with the therapist’s reading. Interactive tools can also make greater use of the visual channel when they serve a particular purpose in the work, such as psychoeducational visuals, worksheets, or homework exercises.

Managing strong emotions online

When intense emotions arise during online couples counselling, the structure of the sessions becomes particularly important. Clear agreements about how partners communicate during sessions need to be established beforehand. With couples who are more prone to rapid escalation, the counsellor may need to intervene early and firmly, oftentimes interrupting repetitive patterns in a kind and respectful way, to prevent an argument from taking over the session. This is not exclusive to online counselling, of course, but the digital setting makes it particularly important to be attentive to how interactions unfold and to have a clear framework for managing them.

Practical considerations

There are also practical considerations that are worth thinking about before choosing online counselling. Both partners need a sufficiently private space where they can speak freely without being overheard or interrupted. A stable internet connection is also important. If the partners are joining from separate locations, this needs to be considered when setting up the sessions and agreeing on the practical arrangements.

For some couples, being in the same room as the counsellor may feel more containing or reassuring, particularly when they are dealing with emotionally difficult themes. Others may find it easier to talk about sensitive subjects from the familiarity and comfort of their own environments. Neither response is by nature better; what matters is whether the chosen setting allows both partners to participate openly and work on the issues that brought them to counselling.

So, is online couples counselling as effective as in-person couples counselling?

Physical co-presence is not a prerequisite for therapeutic change in relationship counselling. At the same time, the quality of the therapeutic work does not depend on the medium alone. How counselling is structured and delivered, the therapist’s ability and skill to adapt to the online setting, the couple’s circumstances, and the nature of the issues they bring to therapy can all influence how well the format works for them.

Online and in-person counselling are not necessarily better or worse than one another. They offer different conditions for the work, and what matters is whether those conditions allow the couple and the therapist to do the work effectively.

References:

• Aviram, A., & Nadan, Y. (2024). “I miss not being able to offer my couples a box of tissues…”: Couples’ and therapists’ perspectives on the therapeutic alliance with the transition to online couple therapy. Journal of Marital and Family Therapy, 63(1), 163–175.
• Bradford, A. B., Johnson, L. N., Anderson, S. R., Banford-Witting, A., Hunt, Q. A., Miller, R. B., & Bean, R. A. (2024). Call me maybe? In-person vs. teletherapy outcomes among married couples. Psychotherapy Research, 34(5), 611–625.
• Bradford, A. B., Banford-Witting, A., Anderson, S. R., Johnson, L. N., Hunt, Q. A., Miller, R. B., & Bean, R. A. (2024). Lost in translation: Therapeutic alliance as a mediator in the relationship between teletherapy and marital satisfaction. Family Process, 63(4), 1775–1789.
• de Boer, K., Muir, S. D., Silva, S. S. M., Nedeljkovic, M., Seabrook, E., Thomas, N., & Meyer, D. (2021). Videoconferencing psychotherapy for couples and families: A systematic review. Journal of Marital and Family Therapy, 47(2), 259–288.
• Kysely, A., Bishop, B., Kane, R. T., McDevitt, M., De Palma, M., & Rooney, R. (2022). Couples therapy delivered through videoconferencing: Effects on relationship outcomes, mental health and the therapeutic alliance. Frontiers in Psychology, 13, Article 773030.
• Seuling, P. D., Fendel, J. C., Spille, L., Göritz, A. S., & Schmidt, S. (2024). Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 30(10), 1521–1531.