Permission from OnlineTherapy.com
Expert reviewed by: Caitlin Kingston, LCSW
Our new survey found that while the COVID-19 pandemic has accelerated mental health care’s shift from an in-person to virtual practice, the transition is not without its challenges.
According to the survey, 42.5% of mental health professionals say they primarily saw clients in-person before the pandemic, while 29.5% primarily conducted virtual sessions, and 28% saw clients both in-person and online. Since the start of the pandemic, 83% of therapists who previously only saw clients in-person have begun offering virtual sessions in the form of video chats, phone calls, and live text chats.
A significant portion of the 600 mental health professionals we surveyed have a favorable view of virtual therapy. However, our survey also found that the shift has left some therapists struggling with issues like staying focused, tuning out distractions, and providing the same quality of care to online clients as they do for in-person clients.
- Nearly 50% of therapists prefer conducting virtual sessions over in-person sessions
- 39% of therapists admit to being distracted by social media and email during virtual sessions
- 21% of therapists report difficulties remaining focused while conducting virtual sessions with clients
- One-third of therapists say they are providing a lower level of care to clients while conducting sessions virtually
- 16% of therapists report substance use before or during virtual sessions
1 in 5 mental health professionals say it’s difficult to remain focused when conducting online sessions
As anyone who has sat through an online meeting knows (and at this point, that’s most of us), staying focused while staring at a screen can be hard. Therapists are no different.
When asked how easy it is to stay focused during virtual sessions, 16% of respondents say it is “somewhat difficult,” and 5% say it is “very difficult.”
Older therapists are more likely than younger therapists to struggle with staying focused during virtual sessions. Twenty-seven percent of therapists ages 54 and older say that it is somewhat or very difficult to remain focused, compared to 19% of therapists ages 35-44, and 23% of therapists ages 45-54.
Nearly half of therapists blame technology issues for distracting them during virtual sessions
When asked which distractions cause them to lose focus, nearly half of all respondents, 48%, blamed technology issues, including poor audio or video quality, and connectivity problems.
However, when the Internet is working correctly, it can also be an issue. Social media, including Facebook, Twitter, and Instagram, and responding to communications, like emails or text messages, tied for second as the most-cited distraction, with 39% of respondents admitting to multitasking while conducting virtual sessions. Thirty-five percent of therapists also say they are guilty of browsing the Internet while on calls with clients.
Working from home is also challenging for therapists. Thirty-eight percent say distractions from a partner or spouse, kids, pets, and/or roommates cause them to lose focus, while 33% say similar distractions on their client’s end make it hard for them to concentrate.
1/3 of therapists say conducting sessions virtually has led to a decline in quality of care
Overall, 32% of therapists say they’ve noticed a decline in the quality of care they are providing, while the plurality, 43%, say the quality of care they provide has improved since conducting sessions virtually, and 25% say there has been no change.
This struggle to stay focused correlates to a decline in the quality of the care some therapists feel they are providing to their clients.
Among therapists who say it is somewhat or very difficult to stay focused during online sessions, 52% say they think the quality of care they provide via virtual sessions is inferior to that of in-person sessions. Twenty-nine percent of respondents in this group say there is no change in the quality of care they provide, and 19% say, despite their lack of focus, the quality of care has improved.
Once again, age appears to play a role in how well therapists feel they are doing with online sessions. Forty-eight percent of therapists ages 54 and older say they feel the quality of their care has declined since switching to virtual sessions, compared to 24% of therapists 35-44, and 36% of therapists 45-54.
A therapist’s assessment of the quality of care they are providing via virtual sessions also appears related to their overall feelings about virtual sessions compared to in-person therapy. For therapists who say the quality of their care has declined, 62% like virtual therapy less, and only 19% like it more than in-person sessions.
Meanwhile, among therapists who say the quality of their care has improved or remained the same, 60% like virtual sessions more and only 17% like them less than in-person therapy.
56% of therapists say their clients are more easily distracted during virtual sessions
Fifty-six percent of mental health professionals say that clients are more easily distracted during virtual sessions and cite that as a reason quality has declined. Meanwhile, only 41% of therapists chose “I am more easily distracted” as a reason why quality of care is suffering.
Fifty percent of respondents say that it is harder to assess and engage with clients without in-person interaction, making it more difficult for them to provide their usual standard of care. Thirty-five percent of therapists also blame screen fatigue for a poorer quality of care.
Half of therapists report experiencing symptoms of anxiety, depressive disorders during the past year
Although counselors and therapists are the ones people turn to when struggling with mental health issues, they’re not immune themselves, especially in a year fraught with challenges.
Overall, 90% of the mental health professionals we surveyed say they experienced some type of mental health-related symptoms in the past year, including anxiety disorder symptoms (50%), depressive disorder symptoms (48%), and trauma- or stressor-related disorder symptoms (26%).
Seventeen percent of all responding therapists say they have seriously considered suicide in the past year. That percentage was even higher for Black therapists, 28% of whom struggled with suicidal ideation. Black therapists also report higher rates of depressive disorder symptoms (59% compared to 48%), substance abuse (33% compared to 22% overall), and trauma-related disorder symptoms (34% compared to 26%).
These issues may also be affecting their ability to provide care to clients. Sixteen percent of the mental health professionals we surveyed admit to drinking or using drugs before or during virtual sessions.
Nearly 1/3 of therapists have not sought professional help for their mental health-related symptoms
To cope with these issues, some, but not all, therapists have started receiving their own mental health counseling during the past year.
Thirty-eight percent of those surveyed say they were already in therapy before the pandemic, and 25% of respondents say they started seeing a mental health professional during the pandemic. However, 29% did not seek any type of professional help.
Among therapists who say the quality of care they provide has declined, nearly half, 48%, have not sought care to help them with their own mental health issues, while only 17% of people in this group have started therapy.
More Black therapists started their own therapy in the past year than their White and Hispanic/Latinx counterparts (34% compared to 21% and 30%, respectively).
47% of therapists prefer virtual sessions to seeing clients in person
Despite the challenges mental health professionals are facing in this time of transition and uncertainty, our survey did uncover many positives as therapists adjust to new models of providing care.
Overall, 47% of therapists say they like virtual sessions more than in-person sessions, compared to 31% who like virtual sessions less, and 22% who are neutral.
Additionally, the majority of all respondents, 63%, say it is very easy or somewhat easy to stay focused during virtual sessions. An additional 16% are neutral.
For those therapists who say they are providing better care to their clients via virtual sessions, 55% attribute it to the elimination of their daily commute, which gives them more time to work; 44% of respondents also cite more flexibility and availability as a reason why they feel the quality of care has improved.
Additionally, 55% of therapists say that, even without in-person interaction, it is easier to assess clients when seeing them in their own homes, while 41% say they find clients are more open when speaking via video chat or phone, as opposed to in-person, leading to a higher standard of care.
1/4 of therapists want to stick to virtual appointments exclusively after pandemic
As the end of the pandemic comes into view, questions about what changes are here to stay abound. For mental health care, it appears that virtual sessions will become a permanent fixture of many therapists’ practice.
Twenty-five percent of therapists we surveyed say that post-pandemic they “always” want to conduct virtual sessions, while 27% want to conduct virtual sessions “often,” and 26% are open to seeing clients this way “sometimes.” Only 22% of respondents say they “rarely” or “never” want to conduct virtual appointments going forward.
In another sign of shifting trends, younger therapists are more likely than older therapists to say they want to conduct virtual sessions “always” or “often.” Sixty percent of therapists ages 45-54 express this preference, as do 55% of therapists ages 35-44, compared to 41% of therapists 54 and older.
The data from this report comes from an online survey created and paid for by OnlineTherapy.com. The survey was administered by online survey platform Pollfish on March 29, 2021. We surveyed 1000 American mental health professionals about their experiences and preferences regarding virtual therapy sessions, as well as the state of their own mental health during the pandemic.
Full Survey Results
Q1. Prior to the start of the COVID-19 pandemic, how did you conduct sessions with clients?
- Primarily in-person sessions: 42.5%
- Primarily virtual sessions: 29.5%
- Both in-person and virtual sessions; 28%
Q2. Since the COVID-19 pandemic began, have you offered virtual sessions, including video calls, phone calls, and/or live text chats?
- Yes: 83%
- No: 17%
Q3. Compared to in-person sessions, how much do you like conducting sessions virtually?
- I like it more: 47%
- I like it less: 31%
- Neutral: 22%
Q4. In your opinion, what effect has conducting sessions virtually had on the quality of care you provide?
- The quality of care has improved: 43%
- The quality of care has declined: 32%
- The quality of care has not changed: 25%
Q5. What has caused the quality of care to improve while conducting counseling sessions virtually? (Please select all that apply)
- Elimination of commute allows for more time to work: 55%
- I’m more focused: 51%
- Easier to assess clients in their own homes: 55%
- Clients are more open when speaking via phone or video chat: 41%
- I’m working in a more comfortable environment: 43%
- I have more flexibility and availability for clients: 44%
- I take more notes when meeting clients virtually: 32%
- Sessions are less frequently delayed due to a client arriving late: 32%
- None of the above: 2%
- Other: 3%
Q6. What has caused the quality of care to decline while conducting counseling sessions virtually (Please select all that apply)
- I am more easily distracted when conducting virtual sessions: 41%
- My clients are more easily distracted when participating in virtual sessions: 56%
- It is harder to assess and engage with clients without in-person interaction: 50%
- Lack of privacy for clients: 30%
- I take fewer notes when meeting clients virtually: 28%
- I get screen fatigue: 35%
- None of the above: 5%
- Other: 3%
Q7. How easy is it to stay focused when conducting virtual sessions?
- Very easy: 28%
- Somewhat easy: 35%
- Neutral: 16%
- Somewhat difficult: 16%
- Very difficult: 5%
Q8. Which, if any, of the following distractions cause you to lose focus during virtual sessions? (Please select all that apply)
- Internet browsing: 35%
- Social media: 39%
- Communications (answering emails, text messages, instant messages, etc.): 39%
- Technology issues (poor audio/video quality, connectivity issues, etc.): 48%
- Distractions at home (Partner/spouse, kids, roommates, pets): 38%
- Substance use prior to or during sessions (drinking, drug use): 16%
- Eating/snacking: 26%
- Noise/activity in home or neighborhood: 30%
- Uncomfortable work-from-home set-up: 21%
- Distractions on client’s end (noise, pets, other people): 33%
- None of the above: 4%
- Other: 6%
Q9. How often do you want to conduct virtual sessions post-pandemic?
- Always: 25%
- Often: 27%
- Sometimes: 26%
- Rarely: 15%
- Never: 7%
Q10. During the past year, have you experienced any of the following mental health-related symptoms? (Please select all that apply)
- Anxiety disorder symptoms (anxiety, excessive worry, fear, insomnia, etc.): 50%
- Depressive disorder symptoms (feelings of sadness, loss of interest, change in appetite, etc.): 48%
- Substance abuse: 22%
- Seriously considered suicide: 17%
- Trauma and stressor related disorder(s) symptoms (PTSD, ASD): 26%
- Other: 7%
- None of the above: 20%
Q11. Have you sought counseling or other mental health care to help you cope with these or other issues?
- Yes, I have been in counseling since before the pandemic: 38%
- Yes, I started receiving counseling during the pandemic: 25%
- No, I have not sought counseling in the past year: 29%
- I’d rather not say: 8%