Reflections Mental Health Services

By Alphonso Gaita, LCSW, Reflections Mental Health Services. Telehealth across New York State.

Five years ago, in-person therapy was the default. Now telehealth is. The pandemic forced the switch, but the change stuck around: roughly 60% of mental-health visits in New York are still telehealth in 2026 (Connolly et al., 2022). The short version of why is that it works.

That doesn’t mean telehealth is right for everyone. So here’s an honest, clinician’s-eye comparison of telehealth vs in-person therapy: where each one is strong, where each one comes up short, and how to figure out what fits you.

What the research says about telehealth vs in-person therapy

For most common mental health conditions, telehealth works about as well as in-person therapy (Hilty et al., 2013; Connolly et al., 2022). That covers:

• Anxiety: multiple meta-analyses show equivalent outcomes
• Depression: equivalent for mild to moderate, close for severe
• PTSD: equivalent in most studies, including with veterans
• Couples therapy: equivalent satisfaction and outcome ratings
• OCD with ERP: sometimes actually better over telehealth, since exposures can happen in the client’s real environment

Telehealth has also been shown to cut no-show rates by roughly 50% compared with in-person care, mostly because it removes the transportation hurdle.

Where telehealth shines

• You’re a parent or caregiver. No childcare to arrange.
• You work full-time. A lunch-break session becomes doable.
• You have mobility limitations or chronic illness. No commute, no waiting room.
• You live anywhere outside Manhattan. Therapist density drops off fast, and telehealth takes geography out of it.
• You travel for work. You keep the same care from any private space in your licensure state.
• You have social anxiety. Starting from home is often easier than walking into an office.
• You’re looking for a specialist. Telehealth opens up the whole state instead of just your neighborhood.

Where in-person still wins

• Severe dissociation or psychosis. Higher acuity often does better in the same room.
• Active suicidality that needs close clinical monitoring.
• Eating disorder treatment with weight monitoring.
• Body-based modalities (somatic experiencing, EMDR with full bilateral stimulation).
• Children who can’t sit still for video. Younger kids usually need play therapy in a physical office.
• You don’t have a private space at home.
• You just hate video calls.

Hybrid is also an option

A lot of therapists now offer hybrid care: some sessions in the office, some over telehealth. Reflections is a fully telehealth practice, which lets us see clients across all of New York State instead of one neighborhood. That’s a deliberate tradeoff. It means we can match you with the right clinician no matter where you live.

What makes telehealth go well

• A door you can close. Privacy is the single biggest factor in whether it works.
• Decent internet. Wired or strong Wi-Fi.
• Headphones. Better audio and better privacy.
• The same physical space each week.
• Phone on Do Not Disturb.

Telehealth vs in-person therapy: how to decide

1. Do I have a private space at home where I can talk freely?
2. Is commuting to a weekly appointment realistic for my schedule?
3. Do I want the widest choice of therapists (telehealth) or the closest office (in-person)?
4. Do my specific concerns really call for being in the same room (rare, but real)?

For most people, the answer tips toward telehealth. Reflections offers no waitlist telehealth therapy across all of New York State. Make an appointment and we’ll help you figure out if it’s the right fit.

Cost and insurance: telehealth vs in-person therapy

In New York, cost is usually not the deciding factor between telehealth vs in-person therapy. State rules require most insurance plans to cover telehealth mental health visits the same way they cover office visits, so your copay is typically identical. If you pay out of pocket, telehealth practices often charge less, because there is no office rent built into the fee.

The hidden costs are where telehealth tends to win. There is no commute, no parking, no childcare to arrange, and no lost hour of work getting to and from an appointment. For many New Yorkers those savings add up to more than the session itself. You can see our full breakdown in how much therapy costs in New York.

Common questions about telehealth vs in-person therapy

Is telehealth as effective as in-person therapy? For most common concerns, including anxiety, depression, and stress, research finds outcomes are very similar. The National Institute of Mental Health has a helpful overview of the main types of talk therapy, most of which work well over video.

Can I switch later? Yes. Many people start with telehealth because it is easier to fit in, then decide whether they want an office setting. Choosing between telehealth vs in-person therapy is not a permanent decision.

What if I do not have a private space? A parked car, a quiet office room, or a walk with headphones can all work. Your therapist can help you problem-solve the setup in the first session.

References

• Connolly, S. L., et al. (2022). Rapid increase in telemental health within the Department of Veterans Affairs. JAMA Psychiatry, 79(2), 105-107.
• Hilty, D. M., et al. (2013). The effectiveness of telemental health: A 2013 review. Telemedicine and e-Health, 19(6), 444-454.
• American Psychological Association. (2024). Telepsychology Best Practices.
• Bashshur, R. L., et al. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health, 22(2), 87-113.