Why I Don’t Offer Online Couples Therapy
Updated: Oct 13
By Shira Hearn, LMFT — Radical Relationship Transformation
I offer couples therapy in person. I’ve tried doing it online, and I find it much harder to get a feel for what is happening between two people. The connection doesn’t feel the same to me. Getting everyone logged in, hearing each other, and keeping the technology working adds another layer of difficulty to work that already asks a lot of everyone involved.
I want to see what happens between you
When you sit down together, I’m listening to the problem you came to talk about. I’m also paying attention to what happens as you talk about it.
Perhaps one of you says, “It’s fine,” while turning away. Your partner notices, stiffens, and starts explaining again. The explanation gets longer. The other person gets quieter. Soon you’re both frustrated, and neither of you feels understood.
Those small changes give me something to ask about. I don’t assume I know what a gesture means. I want to notice it, slow things down, and understand it with you.
On a screen, I find that harder. The camera gives me a particular view. Sometimes it includes both people clearly; sometimes it doesn’t. I have to work harder to follow what is happening between you while also maintaining my own connection with each of you.
Being in the same room helps me feel more involved in the conversation and more able to respond as it unfolds.
The connection with your therapist matters to me
Couples therapy can involve saying something you’ve been afraid to say, then waiting to see how your partner responds. I want to feel fully present with both of you during that moment.
My approach is Emotionally Focused Therapy. In our work, we pay attention to the pattern you get caught in and the feelings that are difficult to share underneath it. I want to help you have a different experience of reaching for each other.
For me, that work feels more natural in person. I find it easier to stay with the emotion, notice a shift, and check whether something I’ve said has landed the way I intended.
Other EFT therapists have described similar difficulties. A survey of 69 certified EFT therapists found mixed experiences: some felt online work was similar to working in person; others described missed cues, fatigue, and difficulty staying connected or slowing escalating conflict. The study described therapists’ experiences; it did not establish that online EFT produces worse outcomes. Edwards and colleagues, 2025
Technology changes the conversation
There is the practical side: finding the link, logging in, sorting out the camera, and figuring out why someone cannot hear.
Then there is what can happen once the conversation starts. If the sound lags, it becomes harder to tell when someone has finished speaking. If the audio cuts out, a quiet response can disappear. An interruption that would feel gentle in person can feel abrupt through a delayed connection.
Imagine finally saying something vulnerable and having to repeat it because the sound failed. You may be able to return to the moment, but first you have to deal with the interruption.
That is the part I find especially frustrating. I want my attention on you. I don’t want either of you worrying about whether the microphone picked up what you just managed to say.
What the research says about online couples therapy
In a study of 1,157 married clients, online and in-person couples therapy produced comparable improvements. The therapeutic alliance—the working relationship between clients and therapist—developed differently: alliance scores improved at roughly twice the rate in person. The study was observational, so it cannot establish that the format caused the difference. Bradford and colleagues, 2024
That is the part of online work I struggle with. I need to build a relationship with two people while following the relationship between them. I find that harder through a screen.
The small randomized Couple CARE study found improvements in both formats, with no statistically significant differences. But look at what it tested: 30 couples completed a six-session behavioral education program. Participants had mild relationship distress; couples with clinically significant distress were excluded. Even the video sessions took place in a clinic, with the couple and therapist in separate rooms. Those results cannot tell us how the same approach would work with a highly distressed couple connecting from home. Kysely and colleagues, 2022
There is also evidence for online EFT. A 2026 study of 79 veteran couples reported improvements in relationship satisfaction across telehealth and in-person delivery. Those findings support online EFT as an option, although this was not a randomized trial establishing that the two formats are equivalent. Ceja and colleagues, 2026
I can respect those findings and still choose how I practice. I’m responsible for offering therapy in a setting where I can stay engaged, follow both partners, and respond well. For me, that is in person.
I choose the setting where I feel most present
Some therapists enjoy working online and have built their practices around it. Some couples value being able to attend from home. Distance, disability, work schedules, and other practical realities can make getting to an office difficult. I respect that.
If online therapy is what makes help possible for you, my preference is no reason to dismiss it.
I have tried it, and I find that the screen and the practical complications get in the way of how I want to work. I feel more connected when we’re together. I want my practice to reflect that.
Getting here may mean taking time off work, finding childcare, and making the drive. If I’m asking you to make that effort, I owe you my full attention and the best work I can do. I know I’m better able to give you that when we’re in the same room.
Keep reading
Work with me in person
At Radical Relationship Transformation, appointments are in person near Joplin and Webb City, with both partners present. Sessions last 90 minutes and cost $250. The practice is self-pay.
You can read what to expect at your first couples session, or contact me to get started. Call or text 417-768-9089.
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If you are ready to get started, Schedule a Couples Therapy Appointment.
Call or text me at 417-768-9089, or email me at shira@radicalrelationshiptransformation.com.
