Can Couples Therapy Work Online?

The very short answer—yes. Research on online therapy validates that it can be just as effective, and in some cases, even more beneficial than in-person work for some couples. I’ll go over both the pros and cons to this format.

After the changes the pandemic created, like most therapists, I was a bit skeptical if I could properly do my job virtually. Many couples also wonder if substantive change can occur if they’re not sitting in the same room as a therapist. Though there are many benefits to meeting in person, I’d say the depth and quality of work is not lost by meeting virtually.

First I’ll start with the pros and things that are still retained through online sessions before going into what I’ve experienced as some of the losses.  

Pros or What is Still Effective (or even better)

Accessibility & flexibility! This factor cannot be underestimated enough. Because of the virtual option, I’m probably seeing 5X more couples than if I stuck to the traditional in person only format. Most couples who see me in person either have a). extremely flexible work schedules where commute time is also factored in or b). they live/work very close by and can make arrangements to be seen in person. By offering virtual sessions, I’m able to see couples from all over the state and where partners can also zoom in from different locations if one or both are at work. Ideally, couples will be together in the same space, however, in some cases, I’ve asked couples to be in separate spaces because of how quickly they activate each other or when their dynamic is so volatile that the additional barrier helps contain emotions so they can begin to communicate with more intention and clarity.

Comfort. One thing from traditional in person therapy that I encourage people to retain is a consistent and primed space to dive into the emotionally taxing work couples therapy often involves. People are often more comfortable at home and I ask couples to think about a spot in their house that is cozy, but isn’t necessarily a place they use frequently for other things—such as their bed; I prefer couples keep their bed for sleeping or physical intimacy and not associate it with whatever comes up during their time in therapy! Familiar environments can also help people feel safe, more in control, and allow some people to open up faster because of the distance between screens.

Also, many people who take the call from their work place are able to find a private room free from distractions that allows them to “set switch” into the session and out before returning to work. When possible, I ask couples to carve out 5-10 minutes before the session to journal or just reflect on what they want to bring up and also do the same after the session ends. Quick transitions in and out from work can feel overwhelming.

Connection isn’t about the room but about the relationship. At the heart of couples therapy is emotional presence and being able to read people’s facial expressions, tone, body language, make direct eye contact, and be emotionally responsive. I can still properly do all of these things when I see people clearly through a screen AND I can sometimes see them more vividly as people are “closer” to my line of sight (I have a large monitor).

I can process interaction patterns faster and with more clarity. Let me be clear: couples therapy is one of the hardest forms of therapy for any psychologist or therapist to practice because it requires fast processing of the complicated dynamics between two people and our left brains are working just as hard as our right brains! I’ve discovered that in person, I can sometimes get more easily caught up in the emotional intensity between people as my body is also reacting to what is happening in the room. When I see people virtually, particularly more volatile or high conflict couples, I’m able to regulate my internal states more productively as I’m in my safe space at home and I feel more grounded in my body. All of this allows me to see what is happening between partners more clearly and faster—which then in turn allows me intervene with more confidence.

Ok, So What are the Cons?

Built in commute ritual. When couples come in person, they are often commuting together. This is valuable time to both discuss what they want to get into with the therapist and check in about progress on goals AND debrief and continue processing what the couples session opened up afterwards. Though couples can still keep this ritual when meeting virtually, meeting in person guarantees it will happen more consistently.

I can’t always read your full body. Some couples are able to position their screens so I can see their “full bodies” but most people aren’t taking the call from a larger device so I often can only see their upper bodies. This one is very subtle, but being in person allows me to tune in to foot tapping, fidgeting, how someone moves around in their seat, which can sometimes allow me to understand when they are getting uncomfortable or expressing an emotion or reaction that isn’t fully verbalized yet.

The potential loss of shared energy & embodied attunement. This one is difficult to explain and I’d argue is more important for individual therapy. It involves a deep non-verbal and somatic (even spiritual) connection through nuanced in body experiences such as breadth, posture, and synchrony. It’s a “right brain to right brain” experience that builds safety, helps with emotion regulation, and deeper understanding. Though I feel I can still effectively do this virtually, there’s an inexplicable element that is lost when we all are not in the same space.

Tech Issues & distractions.  Though this occasionally occurs, it’s rare. To be blunt, if people are agreeing to pay my fee and are serious about the couples work (very few couples are doing this work due to luxury or leisure), they are often arriving to therapy with a secure internet connection, making sure their other open tabs are closed on their screen, and have put their phones away. When I do notice one or both people seem distracted, I call it out and just ask if they can be more present in session.

Overall, ongoing research and my own experience make me believe that online couples therapy is equally effective to in-person therapy and in many cases, superior to in-person sessions due to the greater flexibility, options for couples to be in the same or separate screens pending their level of emotional dysregulation or logistical needs, and my sharper and more contained analysis and interventions when I’m doing the work from home and in a more grounded space for me.