You know, I’ve sat with this question a lot over the years, and I want to give you a real answer rather than a diplomatic one.
The honest truth is that the research on telehealth therapy, including couples work, has become genuinely solid. For a lot of couples, online therapy works. It removes barriers, it gets people in the room who would otherwise never show up, and sometimes people are actually more open when they’re in their own space rather than sitting in a therapist’s office feeling like they’re being observed.
That said, here is what I have noticed in my own clinical work that I cannot fully resolve through a screen.
When two people are in the room with me, I can feel the energy shift. I can see one partner’s body close down before they even speak. I can notice when someone is holding their breath. I can feel the temperature of the room change after a hard thing gets said. That is not nothing. That somatic, embodied attunement is part of how I track what is happening between two nervous systems in real time.
Online, some of that gets flattened. You are looking at two faces in two boxes, and you lose a lot of the body language below the shoulders. You lose the shared physical space that can itself become a kind of container for hard conversations.
There’s also something about sitting together in the same room that makes the work feel more substantial, more real. It’s harder to check out mentally when you can’t just close the laptop. The ritual of driving somewhere, walking into an office, sitting down together, it creates a different kind of commitment to the process.
But here’s what I’ve learned: for some couples, online therapy is the only way they’ll start at all. Maybe one partner travels constantly. Maybe childcare is impossible. Maybe the nearest qualified couples therapist is two hours away. Sometimes the perfect becomes the enemy of the good enough.
I’ve also noticed that certain types of conversations actually go better online. When shame is running the show, some people find it easier to say hard things when they’re not making direct eye contact with their partner. When one person tends to dominate the physical space, those little boxes can actually level the playing field.
My honest clinical preference is in-person when it’s available and when the couple can access it without it being a barrier that keeps them from starting at all.
But I will tell you this: the most important variable is not the medium. It’s whether both people are willing to show up and do the work. A committed couple in an online session will go further than an avoidant couple sitting three feet away from me.
The question isn’t really which format is better in some abstract sense. The question is which format will actually get you both in the room, ready to lean into the discomfort of real change.
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Figs is a licensed marriage and family therapist with 16+ years of experience working with couples. He’s the co-founder of Empathi, host of the “Come Here to Me” podcast, and author of an upcoming book on relationships and the systems that shape how we love.
Read more: What to Expect in Your First Couples Therapy Session
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