Walk and Talk, Online, or In-Person: Navigating Your Therapy Options

The therapy world has remarkably changed in recent years. Gone are the days when mental health support was limited to a physical office space. Today, therapists commonly offer virtual sessions, and have even embraced new approaches such as walk and talk therapy sessions. At Layla, nearly half of our therapist community provides therapy solely through virtual sessions.Comparatively, while some of our therapists offer a combination of virtual and in-person sessions, only an exceptionally small number of our therapist community provides in-person sessions as their sole option. What initially began as a quick response to the COVID-19 restrictions has now become the norm, with virtual therapy settings being recognized for the convenience and accessibility it offers for both clients and therapists. 

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However, with these expanded options come important decisions. Not every approach works for everyone, and the best choice often depends on your unique needs, lifestyle, and preferences. So, how do you determine which type of therapy—online or in-person—is right for you?

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In Person Therapy 

In person therapy is exactly the traditional method of therapy where a client attends the office of a licensed therapist. In-person therapy is a well-established, long-trusted approach to mental health treatment. However, choosing to attend in person sessions comes with certain benefits and challenges which include: 

• Nonverbal Cues: During in-person sessions, therapists have the ability to observe and interpret nonverbal cues that complement verbal communication, and can be effective in their understanding of your needs. This can include things like restlessness, fist clenching, or any other non-verbal cues that we may not be able to observe on screen.
• Physical Presence Preferences for Therapy Modalities: Some therapies such as movement-based therapies, art therapy, and play therapy, often benefit from the physical presence and tools available in in-person sessions. While virtual adaptations of these approaches have proven effective, some providers and individuals seeking these treatments still find that in-person therapy appointments are better suited to the tactile and interactive elements involved in implementing these modalities. 
• Stepping into the Therapy Space: Therapy is not the only service that shifted to virtual during COVID-19. For many of us, we live in a virtual world - holding most of our conversations, health services, and either fully or to some degree - our work. We are constantly on screens. Going to therapy in a neutral location away from your work or home, away from the screen provides a space free from distraction. There is also increased privacy and people are able to transition into the therapeutic space in a physical way. 
• Accessibility: Attending in-person therapy can be challenging due to the time and effort involved. The need to travel to and from appointments adds to the overall time commitment, which can be particularly difficult for those with rigid or busy schedules. For individuals with limited access to transportation or barriers to obtaining accessible travel options, this challenge becomes even more significant.
• Finding the Right Therapist - Limited Options: In-person therapy requires finding a therapist in your local area, which can significantly narrow your options. Effective therapy isn’t just about finding any therapist—it’s about connecting with someone who meets your clinical needs and with whom you can build a strong rapport. For those in smaller or more remote communities, the limited availability of therapists nearby can make this process even more difficult.
• Social Stigma: Social stigma around mental health can prevent some individuals from seeking in-person therapy. Concerns about being seen entering a therapist’s office may bring up considerable anxiety, which could deter someone from seeking therapy. 

Online Therapy 

Online therapy is typically conducted via secure video platforms or via telephone. These sessions closely follow the structure of in-person therapy, with therapists adapting strategies and activities to suit the virtual format. 

Online therapy has proven to be effective, with in person and virtual interventions actually resulting in similar client outcomes. This type of therapeutic setting can increase access to care and increase comfort when discussing sensitive topics, while others may feel technological settings are not for them or feel this type of interaction is too impersonal. 

While effective, it requires reliable internet and privacy, and clients must reside in the same province as the therapist is registered in.Online therapy brings its own set of unique benefits and challenges, which may include: 

• Convenience & Accessibility: Online therapy offers increased flexibility, allowing clients to attend sessions from the comfort of their home or any private space. By eliminating the need to commute, it saves time and effort, making therapy easier to fit into a busy schedule. Removing travel barriers also makes therapy more accessible for some individuals. This is reflected at Layla, as we have seen that 70% of clients who have spoken with a care coordinator over the past 2 years have requested some form of online service (video, phone, or both). 
• Flexible Communication Methods: Online therapy offers a range of options, including video calls, phone calls, and messaging. This flexibility allows clients to choose the mode of communication that best suits their comfort and needs.
• Comfort: Online therapy can feel more private and less intimidating for some, removing the need to sit in public spaces like waiting rooms. Online therapy also allows clients to engage in sessions from the comfort of their own home, which can reduce anxiety about speaking with a new therapist. Being in a familiar environment, surrounded by something that brings comfort —such as a pet or a favorite object—can make it easier for clients to open up and feel at ease during their sessions.
• Technology Barriers: While many people are comfortable using technology, others may find apps and web platforms unfamiliar or intimidating, making online therapy feel less accessible. Additionally, a stable internet or phone connection is essential for virtual sessions, which can pose challenges for individuals in rural areas or with slower connectivity.
•  Nonverbal communication challenges: Virtual sessions can limit the ability to observe full body language and subtle cues, as clients and therapists often see each other only from the chest up. Therapists cannot see nonverbal signals with the same clarity that they would in person, and these barriers are even greater in phone-only sessions where visual cues are entirely absent. 
• Privacy Barriers:While virtual therapy incorporates measures to ensure privacy and confidentiality, not all clients have access to a private space at home. For those in shared living environments, it can be challenging to find a space where therapy sessions won’t be overheard or interrupted.

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Walk & Talk Therapy 

Walk and talk therapy integrates movement, psychotherapy, and the outdoors into a unique therapeutic approach. Sessions take place during a walk in an agreed-upon outdoor location, combining physical activity with conversation. 

Although this therapy setting is increasing in popularity, the research in this area is still relatively new and limited, and it is the least utilized out of the three settings mentioned in this blog. At Layla, we are seeing a very small number requests for walk and talk therapy, but it continues to be the lowest requested setting by clients. However, this can be a promising option for some individuals as walk and talk therapy has been shown to produce meaningful change. This study highlights that participants felt more at ease during their walk and talk therapy experience and were able to disclose personal thoughts and feelings, and participants also saw a decrease in psychological distress. 

While walk and talk sessions generally follow a conversational therapeutic format, this approach may not be suitable for every individual or therapy modality. Walk and talk therapy offers distinct benefits and challenges, which may include:  

• Comforty: For some clients, the traditional therapy setting—sitting in a room while being asked personal questions—can feel intimidating. Walk and talk therapy offers a more casual and less formal atmosphere, which can help ease discomfort and foster openness. This approach can be particularly beneficial for individuals new to therapy, as it may break down perceived power dynamics and make the experience feel more collaborative.
• Engagement and Setting Flexibility: Walk and talk therapy is a valuable option for individuals who find it difficult to sit and focus for an entire hour. The movement and shared activity foster a sense of social connection, which can enhance the therapeutic process. This study, for example, reflects some participants finding the natural outdoor environment freeing, with the surrounding scenery helping to reduce feelings of pressure which creates a more relaxed atmosphere. 
• Benefits of Movement & Nature: The benefits of movement and nature on mental health have been studied extensively. Walk and talk therapy combines movement, nature, and psychotherapy into one interaction. This type of interaction has shown some considerable improvements in mental health. For example, this study highlights various research findings on the positive outcomes of walk and talk therapy along with vast benefits of nature in general. 
• Privacy and Confidentiality: While therapists take precautions and discuss privacy considerations with clients, walk and talk therapy presents unique challenges. There’s a risk of encountering someone either the client or therapist knows, or having pieces of a conversation overheard by passersby. These factors should be carefully evaluated to determine if this setting is suitable for the client’s needs. 
• New & Emerging Research: walk and talk therapy is a relatively new approach in psychotherapy, and while it is becoming increasingly popular, the research is still emerging. Studies have shown promising results, but further investigation is needed to fully understand its effectiveness across different modalities and mental health challenges. For certain therapeutic approaches, adaptations may be necessary to ensure the therapy is carried out effectively in an outdoor setting. These adjustments should be discussed between the client and therapist to determine if walk and talk therapy is a suitable fit for their specific needs.

So, which is the best? 

In short, there is no definitive “best” therapy setting. Research demonstrates that both in-person and online therapy are effective for most mental health challenges. As evidence for walk and talk therapy continues to grow, it’s emerging as another promising option.  Many therapists offer multiple settings, allowing clients to alternate based on their needs and circumstances.

Ultimately, the choice isn’t about one setting being better than another—it’s about what works best for your needs. This article provides a starting point for reflection, helping you consider the factors that may influence your decision and find a therapy setting that aligns with your preferences and goals.

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References: 

Calkins, H. (2021). Online therapy is here to stay. American Psychological Association. https://www.apa.org/monitor/2021/01/trends-online-therapy?utm_source=chatgpt.com

Connolly, S. L., Miller, C. J., Lindsay, J. A., & Bauer, M. S. (2020). A systematic review of providers’ attitudes toward telemental health via videoconferencing. Clinical Psychology: Science and Practice, 27(2), e12311. https://pmc.ncbi.nlm.nih.gov/articles/PMC9367168/ 

Gillihan, S. J. (2024, February 28). 8 ways that walking can transform the therapy experience. Psychology Today. https://www.psychologytoday.com/ca/blog/think-act-be/202402/8-ways-that-walking-can-transform-the-therapy-experience-0

Ko, N. (2024, April 10). Virtual therapy vs. in-person therapy. Psychology.org | Psychology's Comprehensive Online Resource. https://www.psychology.org/resources/virtual-therapy-vs-in-person/?utm_source=chatgpt.com

Prince‐Llewellyn, H., & McCarthy, P. (2024). Walking and talking for well‐being: Exploring the effectiveness of walk and talk therapy. Counselling and Psychotherapy Research, 11-11. https://doi.org/10.1002/capr.12847 

Zandieh, S., Abdollahzadeh, S., Sadeghirad, B., Wang, L., McCabe, R. E., Yao, L., Inness, B. E., Pathak, A., Couban, R. J., Crandon, H., Torabiardakani, K., Bieling, P., & Busse, J. W. (2024). Therapist-guided remote versus in-person cognitive behavioural therapy: A systematic review and meta-analysis of randomized controlled trials”. Canadian Medical Association Journal, 196(14), E488-E488. https://doi.org/10.1503/cmaj.240432