Canadians now commonly choose between face-to-face counselling and remote care. Research shows both formats can be effective, especially for cognitive behavioural approaches, but many clients and clinicians report meaningful differences in the lived experience of therapy. This article reviews the evidence, explains when in-person work may be important, and offers practical guidance for finding the right format.
What the research says
Systematic reviews and randomized trials from Canadian universities indicate that remotely delivered, therapist-guided cognitive behavioural therapy (CBT) often produces outcomes comparable to in-person CBT for conditions such as anxiety, depression, chronic pain and insomnia. A McMaster University review that pooled many trials reported findings across thousands of participants and described the overall certainty of evidence as moderate.
At the same time, Canadian teams including researchers at Queen’s and the University of Toronto have published randomized comparisons showing little difference in treatment effect between e-CBT programs and traditional in-person CBT for major depressive disorder. Ontario Shores and other groups have added nuance, noting that virtual care performs well when technical barriers are minimal, but that disruptions and unequal access to technology can undermine the therapeutic experience.
The experiential gap: what in-person brings
Beyond symptom change, many people describe a different quality to in-person sessions. Clinicians can observe subtle body language, shifts in posture, micro-movements and other nonverbal cues that are harder to notice over video. Shared silence, eye contact without a screen, and the physical presence of another person can deepen connection in ways that studies measuring symptom scores might not capture.
Physical rituals, traveling to an office, sitting in a waiting area and closing the therapy door, help some clients mark the session as a distinct, protected time. For people balancing caregiving or demanding schedules, that ritual can support focus and emotional safety in a way remote sessions sometimes do not.
Modalities that often favour in-person work
Certain therapeutic approaches rely heavily on embodied experience, materials or movement and are usually easier to deliver in person. Examples include:
- EMDR and some trauma-focused interventions that use bilateral stimulation and grounded techniques.
- Somatic and body-based therapies that track physiological responses and use touch-free, in-room interventions.
- Art, play, and expressive therapies that depend on physical materials and shared space, especially with children.
What people commonly report
- Some say virtual care "feels thinner", it’s useful and convenient, but less intimate than being in the same room.
- Others appreciate remote options for times when travel or illness make in-person sessions impractical.
- Many emphasise that seeing full body language improves their sense of being understood.
Who may need in-person therapy more
Surveys of Canadian youth and family caregivers suggest a notable preference for face-to-face care in certain situations. For example, in studies of young people and parents supporting relatives with severe mental illness, about two-thirds of youth and nearly half of parents expressed a preference for in-person sessions, citing privacy and feeling safer discussing difficult topics as key reasons. For people living in crowded homes, in close quarters with others, or where safety or confidentiality is a concern, an office can offer a safer place to speak freely.
Virtual therapy: strengths and limits
Remote therapy has expanded access for many Canadians. It can overcome geographic barriers for people in rural and northern communities, reduce travel time for those with mobility challenges, and provide flexible scheduling for busy households. Research from university programs, including online therapy initiatives, shows that asynchronous formats (for example, email- or text-based CBT) can help people who prefer written reflection or who benefit from having a record of the work.
However, technology is imperfect. Connectivity issues, frozen screens, and limited privacy at home can interrupt sessions or reduce the sense of safety. Regulatory rules also affect access: in Canada, professional registration and telepractice permissions are governed provincially, so practitioners generally need to be licensed in the province where the client is located. Rules for temporary or interjurisdictional practice vary by profession and province.
A realistic middle path: hybrid care
Many clinicians and clinics now offer hybrid models, combining in-person visits when deeper work or specific modalities are required with virtual appointments for maintenance, check-ins or when life circumstances make travel difficult. Hybrid approaches give clients flexibility and allow therapists to match the format to the clinical task, whether it’s a traumafocused intervention, an initial assessment, or brief follow-ups.
Practical tips for choosing a format
- Ask about modality options when you contact a therapist and discuss what you hope to achieve. Some clinicians will recommend an early in-person session for assessment, then switch to virtual if appropriate.
- If privacy at home is limited, consider whether you can arrange a private space or whether in-person sessions are a safer choice.
- For trauma work, somatic therapy, play or art therapy, ask whether the therapist prefers in-person delivery and why.
- Check provincial regulatory guidance if you are working across provincial borders or with a clinician licensed in a different jurisdiction.
- Consider a trial period: try a few virtual sessions and a few in-person sessions to see which feels more effective for you.
Frequently asked questions
Is face-to-face therapy clinically better?
Not universally. Research supports both formats for many diagnoses, but personal experience and therapeutic relationship quality can differ. For some clients and interventions, in-person work brings added value.
Why do some people prefer in-person sessions?
Privacy, sensory cues, and the ritual of attending an office are common reasons. Being physically present can make it easier to talk about painful or complex material.
Can all therapies be adapted to virtual care?
Many can, but some therapies, particularly those needing specialised equipment, materials, or embodied techniques, are generally better delivered in person.
How should I find a Canadian therapist who offers both options?
Search provincial regulatory college registries and reputable professional directories, and ask prospective therapists about their experience with virtual care, privacy practices, and whether they provide hybrid scheduling.
Sources and further reading
- McMaster University review on remote therapy effectiveness
- Ontario Shores research on e-CBT and virtual care
- Randomized trials from Queen’s University and the University of Toronto comparing e-CBT and in-person CBT
- Studies on youth and caregiver preferences for in-person care (PubMed/PMC)
- University of Regina Online Therapy Unit publications
- Canadian Psychological Association and provincial regulatory college guidance on telepsychology and interjurisdictional practice
This piece was prepared for AddictionTube to help Canadians weigh the benefits and limits of both in-person and virtual therapy. It is educational in nature and not a substitute for individualized clinical advice.
