It is tempting to think that therapy might be done on-line with the same effect that it can be done face to face. Unfortunately, most of the time, this probably isn’t true.

Some people are certainly more comfortable with the computer and that can be part of the problem. The face-to-face contact, in a supportive environment, is something that is beneficial. By pursuing therapy without direct human contact they may be avoiding something about which they are afraid. If that is the case, the therapy will, by definition, miss dealing with the very thing that the patient needs to tackle and confront.

Then, too, part of the therapy process involves having the courage to be with the therapist, alone in the same room with one other person and the words and feelings that are the substance of your life; to make the effort to come to his or her office; to be on time and value the human contact together in a setting where one learns that it is safe to discuss the most intimate, personal things in one’s life.

If you have been to an extremely moving or exciting concert you probably known what direct contact with the event means. Music that can overwhelm in the concert hall is likely to be less powerful when heard in a recording of that concert in your living room. Something inexplicable but precious and unreproducible can happen in the few moments of connection between the human beings who are musicians and the human beings who are the audience. Just so, between the therapist and the patient, something remarkable and fragile is too often missed when the medium that carries the message is electronic.

Even with the aid of video communication between the therapist and client, it is too easy for the counselor to miss the subtle signs of discomfort or sadness, the body language, the perspiration, the incompletely formed tears in your eyes, the ever so slight furrow of your brow; the subtle vibrations, tremors, and eye movements; the nervous bouncing of a leg, or sometimes the disinterest or boredom that it is crucial for the therapist to observe. Equally, the patient cannot see the intensity and concern and dedication of the therapist, or, more appropriately, cannot so easily “feel” them as when he is seated only a few feet away looking directly into his eyes.

A famous musician once described the difference between a “live” performance and a recording as like the difference between “sleeping with Bridget Bardot (a famously beautiful movie star of 1950s and 1960s) or sleeping with her picture.” A crude comparison, perhaps, but it does get to the human contact that happens between two people when they are face-to-face, versus the more artificial quality of that interaction when they might be separated by thousands of miles and living in different time zones.

Of course, one might add that medical insurance may not pay for such an electronically mediated encounter as on-line therapy, but that is not the essential point. The essential point is that the best of life and healing occur in the context of a caring professional who you get to know in a personal way and who gets to know you in the same way. However advanced technology becomes, at least until it allows a convincing hologram of you to be in the same room as the therapist, something will be missing and lost in media-mediated encounters.

That said, if you live at a significant distance from a good therapist, therapy over the phone or on-line might be your only alternative. Still, it is important to recognize that there will almost certainly be something lost. And, depending upon what you need, what is lost may well be the crucial element in your healing.