Do therapists still need couches?

FOR YEARS, TELETHERAPY HAS BEEN PITCHED AS THE NEXT frontier in mental-health care. Unlike medical disciplines requiring a more hands-on approach—say, physical therapy or surgery—talk therapy has long seemed a natural and effective fit for telehealth. And by taking appointments off the therapist’s couch and into patients’ homes via their devices, advocates argued, telehealth could make counseling more accessible and convenient for everyone, with particular benefits for those who lived in health care deserts or who couldn’t regularly drive back and forth to see a clinician. The hope was that virtual therapy could help democratize a system that allowed almost 20% of white Americans to receive mental-health care in 2019, but fewer than 10% of people identifying as Black/African American, Hispanic/Latino, Asian or Pacific Islander.

Then, of course, the pandemic hit, sending the U.S. health care system into a panic and shuttering clinics and private practices nationwide. Telehealth, once psychiatry’s up-and-comer, was suddenly its lifeline. With impressive speed, a system built around face-to-face visits shifted almost exclusively online. By May 2020, 85% of the American Psychiatric Association’s (APA) surveyed clinician members said they were conducting the majority of their sessions virtually, up from just 2% prior to