What is it about?
This large study compared face-to-face therapy, video-based therapy and a mixed approach combining both. Online therapy produced outcomes broadly comparable to face-to-face care, while the mixed approach was linked to better outcomes and greater engagement. A strong and improving relationship between the client and therapist was associated with better results. Differences between therapists also mattered, particularly when young people received therapy online.
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Why is it important?
Online therapy has expanded rapidly, but questions remain about how well it works in everyday practice. This study is important because it draws on outcomes from almost 80,000 adults and young people receiving routine care. Uniquely, it compares online, face-to-face and mixed therapy while also examining the therapeutic relationship and differences between therapists. It shows that mixed delivery may improve access, engagement and outcomes, while highlighting the particular importance of therapist skills in online therapy with young people.
Perspectives
I believe this study is particularly timely because online therapy is now a routine part of mental health care, yet decisions about how it should be delivered are not always informed by evidence from everyday practice. What I find most important is that the findings move the discussion beyond whether online or face-to-face therapy is “better.” They suggest that offering people flexibility and choice may improve engagement and outcomes, while also showing that the therapist remains central—particularly when working online with young people.
Daryl Mahon
Outcomes Matter, Ireland
Read the Original
This page is a summary of: An evaluation of teletherapy and mixed models of delivery in adult and youth populations., Practice Innovations, September 2026, American Psychological Association (APA),
DOI: 10.1037/pri0000341.
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