Teletherapy Post-COVID-19: Comparisons With In-Person Client Characteristics and Service Utilization in Routine Practice.

Objective: Telehealth psychotherapy (TH) has become widespread since the COVID-19 pandemic and has generally proven to be equally effective and acceptable as in-person (IP) treatment. However, it is unclear how TH and IP client characteristics and service utilization compare in routine practice post-pandemic.

Methods: Individual psychotherapy clients (N = 22,710) receiving routine treatment at 72 university counseling centers from 2021 to 2023 reported on their demographic and clinical characteristics, while service utilization was determined through chart review.

Results: Compared to IP clients, TH clients were more likely to identify as cisgender women, Hispanic/Latinx, and bisexual and were less likely to live with roommates. TH and IP clients reported roughly equivalent symptom severity at the beginning of treatment, but TH clients were less likely to report recent suicidal ideation and more likely to have a history of past psychotherapy and psychiatric medication use. Regarding service utilization, TH clients scheduled slightly more psychotherapy appointments yet attended a lower percentage of appointments, but these differences were small. Exploratory analyses on matched samples of TH and IP clients did not detect differences in pre- to posttreatment symptom reduction.

Conclusion: In routine practice, TH and IP psychotherapy appear to facilitate access to care for slightly different client populations, are associated with similar utilization patterns, and produce similar outcomes in university counseling post-COVID-19. Clinical systems may best serve a diverse public by offering both TH and IP services. Policy-level (e.g., equitable reimbursement for TH) and administrative support are needed to facilitate continued access to both modalities.