Telehealth Therapy in Texas: Is It as Effective as In-Person?

The pandemic forced an experiment that ten years of research couldn't have produced this fast: tens of millions of people doing therapy over video. Five years in, we know a lot more about what works and what doesn't. Here's what the evidence actually says.

The short answer

For most clients, for most issues, telehealth therapy is as effective as in-person therapy. This is one of the more well-established findings in modern psychotherapy research. The studies are large, the effect sizes are comparable across modalities (CBT, EMDR, IFS, etc.), and the dropout rates for telehealth are sometimes lower than for in-person.

That said, there are real exceptions and nuances worth understanding.

What works particularly well over telehealth

• CBT and ACT. The work is largely cognitive and verbal. Translates very cleanly.
• MBCT and mindfulness-based work. Often improved by being in a familiar environment.
• Anxiety treatment. Many clients regulate better in their own space.
• OCD and ERP (exposure and response prevention). Often more effective when conducted in the environment where the OCD triggers live.
• IFS. Translates well; the relational work continues.
• EMDR. With on-screen visual tools or audio bilateral stimulation, EMDR works well over telehealth. Many EMDR therapists who switched during COVID kept telehealth as a permanent option.

What's harder over telehealth

• Severe dissociation and acute crisis. When grounding work needs to be deeply somatic and the therapist needs to physically be present, in-person is often safer.
• Couples work in high-conflict relationships. The shared physical space helps when partners are escalated.
• Eating-disorder treatment requiring close clinical monitoring. Especially when medical safety is a concern.
• Some somatic therapies. Sensorimotor and Somatic Experiencing can be done online, but practitioners often prefer in-person for the work.

What to consider when choosing

Logistics. Will telehealth make therapy more likely to actually happen consistently? For most working adults, the honest answer is yes. Removing the drive, the parking, the transition time between work and session often makes therapy stick.

Your living situation. Telehealth requires a private space with reliable internet. If you don't have that — roommates, kids, thin walls, unstable wifi — in-person may serve you better.

Your nervous system. Some clients regulate better in their own space; some need the structure of going somewhere. Notice which one you are.

The modality. Most modalities translate fine. A few work better in-person (see above).

The legal nuance: Texas-licensed only

If you're in Texas and you want a Texas-licensed therapist, you can do telehealth with anyone licensed in Texas, regardless of where in the state you live. You can't typically see a therapist licensed only in another state via telehealth, even if you're physically in Texas at the time. There are exceptions through interstate compacts, but they're narrow.

Haven & Harbor and telehealth

Brittany offers telehealth across Texas. Most clients who choose telehealth do so because of logistics — kids at home, work schedules that don't permit a midday drive, living too far from the office for weekly in-person work to be sustainable. Many do hybrid: some sessions in person, some over telehealth.