Online or In-Person Therapy: Which Is Better for Neurodivergent Clients?

What the Research Says

As online therapy has become more widely available, many families wonder whether it works as well as meeting with a therapist in person. Current research suggests there is no single "best" format. Across a range of therapy goals, online therapy has been found to be broadly as effective as in-person therapy for many people (Kelber et al., 2023). Research specifically involving neurodivergent clients is still growing, but early studies indicate that telehealth is a feasible and acceptable way to provide support for many autistic individuals and families (Ferguson et al., 2019; Sutherland et al., 2018). Rather than one format being better than the other, the best choice often depends on the individual's needs, preferences, and circumstances.

Why Some People Prefer Online Therapy

For some neurodivergent clients, online therapy can reduce practical and environmental barriers. It may:

• Improve access to specialists, particularly in rural or underserved areas

• Reduce travel time and transportation challenges

• Allow sessions from a familiar, comfortable environment

• Make it easier to use sensory supports or move during sessions

• Offer flexibility in pacing and communication, depending on the therapist and platform

Some people also find it easier to engage from home, where they can adjust lighting, reduce background noise, or use comfort items that support regulation. However, everyone's experience is different. Some people may find home environments distracting, have limited privacy, or simply feel more comfortable in a therapist's office.

When In-Person Therapy May Be a Better Fit

In-person therapy may be preferable when:

• Body-based or experiential therapies are being used

• Privacy at home is limited

• Internet or technology is unreliable

• A client strongly prefers face-to-face interaction

• Closer clinical observation or safety monitoring is needed

For many people, the choice is not about which format is "better," but which best supports their engagement in therapy.

Finding the Right Fit

Whether therapy is online or in person, setting up the environment intentionally can make a big difference. Both clients and practitioners can take practical steps to support a positive online experience.

For Clients:Before your session, consider discussing your communication and sensory needs with your therapist. Helpful adjustments include:

• Flexible camera use: Asking if it is okay to turn off your video or look away from the screen when you need to process information.

• Movement and tools: Letting your therapist know you will be using sensory fidgets, comfort items, or taking movement breaks.

• Post-session summaries: Requesting a brief written summary of key points if audio processing or memory is a challenge.

  
  

For Practitioners:Therapists can create a neurodiversity-affirming virtual space by building predictability and flexibility into the platform:

• Reduce visual fatigue: Offer the option to hide self-view and use a neutral, non-distracting background.

• Provide predictability: Send a brief agenda or visual outline before the session so the client knows exactly what to expect.

• Expand communication choices: Allow the client to use the typed chat box, share screen drawings, or use text-to-speech tools if speaking feels overwhelming.

• Normalize regulation: Explicitly invite clients to stim, move around, or change positions during the call to help them feel safe and regulated.

  
  

The Human Element

Across decades of psychotherapy research, one finding has remained remarkably consistent: the quality of the therapeutic relationship is one of the strongest predictors of positive outcomes (Bordin, 1979). Feeling understood, respected, and safe is often far more important than whether sessions happen online or in person.

Online therapy is not inherently better or worse than in-person therapy. Instead, it offers another way to access support. For some neurodivergent people, the flexibility and familiarity of online sessions can improve comfort and accessibility. For others, the structure and relational presence of meeting in person may be a better fit. The best format for effective therapy is one that fits your individual needs, meets you where you are, and helps you feel supported.

References

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. doi.org

Ferguson, J., Craig, E. A., & Dounavi, K. (2019). Telehealth as a model for providing behaviour analytic interventions to individuals with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 49(2), 582–616. doi.org

Kelber, M. S., Sones, A. C., & Marks, J. A. (2023). Evidence-based telehealth interventions for post-traumatic stress disorder, depression, and anxiety: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 29(6), 757–767. doi.org

Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology, 20(3), 324–336. doi.org