We are the team at Eye Cue Mental Health, and clients across California ask us this all the time before they book a video session: what are the downsides of virtual therapy? The honest answer is that online therapy has five real downsides, and every one of them has a practical work-around. Technology can interrupt a session, body language is harder to read on camera, private space at home is not always easy to find, telehealth is not the right level of care for every situation, and a screen can make it easier to check out. None of those are reasons to avoid online therapy. They are just things worth knowing so you can set yourself up well.
We founded this practice to make good therapy reachable, and telehealth is a big part of how we do that. So we would rather be straight with you about where virtual care gets bumpy, and show you how we and our clients smooth each bump out. Here are the five downsides, one at a time, with the fix for each.
1. Technology can interrupt the session
The first downside is the obvious one. Online therapy runs on a video connection, and video connections drop, freeze, and lag. A frozen screen in the middle of a hard sentence can break the moment you were building toward. For people who are not comfortable with apps and cameras, the setup itself can feel like one more thing to get wrong before you have even said anything.
Why does this matter more in therapy than in a work call? Because a session depends on a steady sense of being with someone. Clinicians call that the container. When the picture stutters or the audio cuts out, that container gets poked, and it takes a beat to settle back in.
The work-around is preparation, and it is simpler than it sounds. Test your camera, microphone, and internet a few minutes before your first appointment rather than at the appointment. Use a wired connection or sit close to your router if you can. Close the other apps eating your bandwidth. And agree on a plan B with us up front: if the video fails, we switch to a phone call and keep going. When both sides know the backup, a dropped connection becomes a small hiccup instead of a lost session.
2. Body language is harder to read on a screen
The second downside is that a camera only shows part of you. So much of therapy lives in the small stuff, the shift in posture, the way a breath catches, the hands that go quiet when a subject gets tender. On video, the frame usually crops to your face and shoulders, and those fuller-body signals get lost. Eye contact gets strange too, because looking at someone's eyes on screen and looking into the camera are not the same thing.
This runs in both directions. We read less of you, and you read less of us, which can make an online session feel a little flatter than sitting in the same room.
The work-around is to make the invisible visible on purpose. Set your camera back far enough that your shoulders and hands are in frame, and put it at eye level so the angle feels natural. On our side, we lean on naming things out loud: we will check in more often, ask what you are noticing in your body, and say what we see rather than assume it. When both people narrate a bit more than they would in person, the missing cues get filled back in with words. In practice, most clients stop noticing the difference within a session or two.
3. Private space at home is not always easy to find
The third downside catches a lot of people by surprise. Therapy needs privacy to work, and home is not automatically private. Thin walls, roommates, kids who wander in, a partner in the next room, all of it can make you hold back from saying the real thing. In many of the households we serve across California, including multigenerational and immigrant families under one roof, a truly private hour is genuinely hard to carve out.
Holding back is the risk here. If part of your attention is on who might overhear, you are not fully in the session, and the work slows down.
There are more work-arounds for this than people expect. Headphones keep our side of the conversation to yourself. A small white-noise machine or a fan outside the door covers your voice. Some clients take their session in a parked car, which turns out to be one of the most private rooms available. Others schedule during school hours or a quiet stretch of the day. And we will always help you problem-solve this at intake, because with a little planning, private space is usually more findable than it first seems. That flexibility is one of the real strengths of telehealth therapy across California.
4. Online therapy is not the right level of care for everyone
The fourth downside is one we take seriously. Virtual therapy is a great fit for a lot of people and a poor fit for some situations. During an active crisis, or when someone needs a higher level of care than weekly talk therapy can provide, a video call is not the right tool. Trying to force telehealth to do a job it cannot do helps no one.
This is not about virtual care being weaker. It is about matching the level of support to the need, the same way you would match any kind of care.
The work-around starts with an honest first conversation. When you reach out, we talk through what you are dealing with and whether online therapy is a good fit or whether you would be better served by in-person care or a higher level of support. If it is a fit, we begin. If it is not, we help point you toward the right resource. And for an emergency, telehealth is never the front line: if you are ever in crisis or thinking about harming yourself, call or text 988 any time, day or night. Knowing where the line is makes the care on either side of it safer.
5. A screen can make it easier to check out
The fifth downside is quiet but real. When therapy happens through a laptop in your own space, the same setup that makes it convenient also makes it easy to drift. Notifications ping. A browser tab is one click away. You are surrounded by the small distractions of home, and the physical distance of a screen can make it feel easier to keep things at arm's length than it would be face to face in an office.
The relationship still forms over video, and the trust still builds. It just asks for a little more intention from both of us to stay fully present.
The work-around is to give the session the same weight you would give an in-person appointment. Pick one consistent spot and use it every time, so your brain learns that this chair is for this work. Close your other tabs and turn your phone face down in another room. Log on a few minutes early to shift gears instead of jumping straight from a meeting. Small rituals like these signal that the hour matters, and they keep online therapy from blurring into just another thing on the screen.
The questions we hear most about the downsides of online therapy, answered plainly.
Ready to try online therapy the right way? Let's talk
Every downside on this list has a fix, and none of them are reasons to put off getting support. If you have been curious about virtual therapy but unsure whether it would work for your setup, the simplest next step is to reach out through our contact page and tell us what you are dealing with. We offer online therapy across California, we accept Medi-Cal and many private plans, and we will help you get the technology, the privacy, and the fit right before your first session so it works from day one.
This article was written and reviewed by the clinical team at Eye Cue Mental Health, a psychotherapy practice based in Cerritos, California, offering telehealth therapy to clients across the state. Our team reviews the practice's mental health guides for accuracy.
Frequently asked questions
What are the downsides of online therapy?
The most common downsides of virtual therapy are technology interruptions, harder-to-read body language on camera, finding truly private space at home, the fact that telehealth is not the right level of care for every situation, and a screen distance that can make it easier to disengage. Each of these has a practical work-around, which is why online therapy works well for many people across California when it is set up thoughtfully.
Is online therapy as effective as in-person therapy?
For many common concerns like anxiety, stress, and low mood, therapy delivered by video can be a strong fit, and plenty of people find it just as useful as sitting in an office. That said, results depend on the person, the concern, and the relationship with the clinician, and no honest practice can promise an outcome. A licensed clinician can help you decide whether telehealth or in-person care makes more sense for you.
Does Medi-Cal cover online therapy in California?
We accept Medi-Cal, and telehealth therapy across California is covered by many plans. Coverage details can vary, so the simplest path is to reach out and let us confirm your benefits before your first session. That way you know what to expect and there are no surprises.
When is online therapy not a good idea?
Virtual therapy is not the right tool during an active crisis or when someone needs a higher level of care than talk therapy alone can provide. If you are having thoughts of harming yourself or someone else, call or text 988 any time. Otherwise, an honest first conversation is the best way to sort out whether telehealth fits your situation.
Online therapy across California, covered by Medi-Cal. Reach out whenever you are ready to start.
Learn moreEye Cue Mental Health is a psychotherapy practice. This article is educational and is not a diagnosis or a substitute for professional care. If you are in crisis, call or text 988 (Suicide and Crisis Lifeline) any time.
