What is Telehealth Psychology - and how did we get here?
As we approach the 10-year mark of telehealth psychology being introduced under Medicare in Australia, it’s a good time to reflect on how we got here, why telehealth is here to stay, and how it compares to face-to-face therapy. For those who don’t know me, my name is Tom Ford. I am the principal Clinical Psychologist and Founder of Forward Thinking Psychological Services - an online platform for mental health support.
What is Telehealth?
Telehealth psychology refers to two main models of remote therapy: sessions conducted over the phone, or via secure video call. Both allow individuals to attend therapy remotely, usually from their home or another private space of their choosing. In contrast, face-to-face (or in-person) sessions involve travelling to a psychologist’s office.
Early stages of Telehealth
Up until 2020, sessions via phone were (in my experience) more common than video calls, but still not utilised anywhere near the rate we see today. In truth, in most services I worked for we would do just about anything to see a client face-to-face - including going to them in their own home. While I actually quite liked this (your biscuit-intake can easily quadruple), it’s not a very efficient service model and there are genuine health and safety concerns.
Medicare first introduced telehealth psychology billing items in 2017, primarily to improve access to mental health care in rural and remote areas where in-person services were limited. While some psychologists may have offered telehealth privately before 2017, widespread accessibility was relatively recent.
The importance of telehealth access for all health services is captured well in the following Medicare statement:
“Telehealth has been transformational to Australia’s universal healthcare program, Medicare. It has played a critical role in ensuring the continuity of care for hundreds of thousands of Australian patients. Telehealth allows you to get the health care you need, where and when you need it.”
The Covid effect
Telehealth received a major boost during the COVID-19 pandemic and associated lockdowns (was that really six years ago?!). At that time, many people were unable or unwilling to attend in-person appointments but still required mental health support. In response, the government introduced a nationwide telehealth expansion (i.e., no longer specifically for remote/regional areas) and temporarily increased Medicare sessions from 10 to 20 per calendar year (this has since reverted to 10).
This increase in access coincided with a significant rise in demand for mental health services, as many people sought therapy for the first time during what was undeniably a mental health crisis.
At the same time, we saw rapid improvements in online meeting platforms (such as Zoom) and the development of software tailored specifically to health professionals - with improved privacy, security, and usability.
COVID effectively introduced four major drivers of telehealth growth:
Reduced ability to attend in person
Increased funding availability
Increased demand for mental health services
Improved and more secure digital platforms
So, what was it actually like for clinicians?
Despite this, it wasn’t a universal flood into telehealth services. From a clinician’s perspective, I would estimate that around half of my caseload remained face-to-face during early lockdowns. For some clients, therapy was one of the few legitimate reasons to leave the house and maintain some structure or routine. Being able to leave home, and having a tea/coffee whilst speaking to a therapist became, for many clients, even more significant and helpful than therapy might have been previously.
Importantly, telehealth was not part of my formal training at the time, and as a relatively early-career clinician, I had to learn quickly how to ensure sessions still felt intentional, structured, and therapeutic - rather than simply like just another catch-up over the phone. Over time, research and professional training has evolved alongside practice, and telehealth delivery has become increasingly evidence-informed and refined.
The Benefits of Online Therapy
Telehealth psychology offers a range of benefits for both clients and clinicians.
Time and Planning
The most obvious advantage is the reduction in travel time and logistical nightmares. In areas like the Central Coast - and certainly in more congested regions - a 50-minute session can easily become a two-hour commitment once commuting, parking, and traffic are factored in. Arriving late after sitting in school traffic with a car so close behind you can see the whites of the driver’s eyes, hardly sets the tone for a “calm, restorative therapy session”.
For clients balancing work, family, and other responsibilities, practical convenience can be the difference between attending therapy and not attending at all. Being able to attend in a lunch break, or duck away in the day without it being a major commitment can be a game-changer.
Cost and Fees
Cost reduction is another important factor. Exclusively online practices significantly reduce overheads such as rent, utilities, and office-related expenses. For practices like Forward Thinking Psychological Services, this reduction in fixed costs is passed on to clients, who would expect to save over $50 per session in out-of-pocket fees compared to seeing me at a physical location.
While this is beneficial on a per-session basis, the more meaningful advantage may be in sustainability. Clients who can afford to attend sessions consistently over a longer period are more likely to experience better therapeutic outcomes. Research suggests that an adequate “dose” of therapy is associated with improved outcomes, although this is not entirely straightforward and does vary depending on the individual and presentation.
Comfort in the physical setting
Online sessions also allow clients to attend from a familiar and comfortable environment. For some individuals - particularly those with trauma histories, social anxiety, neurodivergence, or panic symptoms - being in a clinical office can feel claustrophobic or overwhelming. Even the most welcoming therapist cannot completely remove the unfamiliarity of a new space. For these clients, attending therapy from home can significantly increase a sense of comfort and psychological safety.
Speaking candidly, I have provided psychology support in some absolutely dire offices (and sometimes calling it an office would be generous). In these situations, the space can actually detract from the quality of the therapy - and again there is only so much a therapist can do if a client is distracted by the smell of mould or a persistent drip.
Choice and Options
Another major benefit is increased choice. Telehealth removes geographic limitations, allowing clients to access a broader range of psychologists. While psychology is not traditionally viewed as a competitive field, increased choice naturally encourages innovation, professional development, and responsiveness to client needs - which is a good thing.
In summary, telehealth expands choice, reduces logistical barriers, increases accessibility, and can lower financial burden - all of which may contribute to improved mental health outcomes.
The Limitations of Online Psychology
Of course, telehealth is not without limitations.
Rapport and Connection
Some clients may find it harder to build rapport or feel emotionally connected online. While research suggests therapeutic alliance can be comparable between telehealth and in-person therapy, these findings reflect averages, and again individual preferences will naturally vary.
For some, being physically present in the same room enhances a sense of warmth, containment, and connection. Conversational flow can feel more natural in person, and subtle relational dynamics may be easier to perceive. Being able to see a person can enhance the sense of knowing them and feeling familiar.
Communication
Non-verbal cues - such as posture, restlessness, or micro-expressions - may be harder to observe online. While therapists typically compensate by asking more direct questions about emotional experience, this can sometimes feel less natural and inadvertently highlight the distance barrier. Additionally, turn-taking and conversational flow can be affected by a digital format.
Service and Connection Limitations
Internet and/or phone service reliability and a comfortable private space with limited interruptions are also crucial. A dropped connection during an emotionally intense moment can disrupt momentum and comfort, and add to frustration levels if it is a continuing experience. Although technology continues to improve, it remains a practical consideration and will unfortunately be a barrier for some people.
Therapeutic Limitations
Certain therapeutic approaches may also be better suited to in-person delivery. Trauma-focused therapies (such as EMDR or intensive parts work) can require high levels of containment and emotional regulation. While these can be delivered online, each clinician must carefully assess appropriateness and client safety.
Importantly, within my own practice I tend to steer away from situation in which I’m concerned I won’t be able to adequately support my clients. Especially in the case of trauma-treatment, my goal is to increase clients confidence in being able to relive, retell and re-experience aspects of a traumatic event - so it hardly seems fair to “drop them in the deep end” and then lack the presence and support to help them through it.
Crisis Support
In situations involving acute crisis, high suicide risk, or significant safety concerns, in-person services or higher levels of care may also be more appropriate - and again this is something to take very seriously and consider the best available options.
Who Telehealth Works Well For
Telehealth may be ideal for:
Individuals with busy schedules
People with mobility or transport limitations
Those where cost of services is a major factor in deciding whether or not to pursue mental health support
Clients living in rural or underserviced areas
Those with anxiety or trauma histories who feel safer in familiar environments
Neurodivergent individuals who prefer reduced sensory stimulation
Research suggests telehealth therapy is broadly comparable in effectiveness to face-to-face therapy for many common mental health conditions.
For this reason, I often encourage clients to prioritise finding the right therapist, rather than focusing solely on modality. The quality of the therapeutic relationship is typically more predictive of outcomes than whether sessions occur in person or online.
Who Might Prefer In-Person Therapy
In-person therapy may be preferable for:
Individuals who struggle to build rapport online
If cost is less of a factor - and the experience of being in a comfortable office and professional setting is part of the expectation/preference for therapy
Clients requiring intensive trauma-focused work early in therapy
Situations involving crisis or significant safety concerns
Individuals who strongly value physical presence and embodied interaction
Of course, these preferences are reasonable and valid. Choosing between telehealth and in-person therapy should involve thoughtful consideration of comfort, safety, goals, and practical realities.
Conclusion
Telehealth therapy is now a mainstream, well-supported method of delivering psychological care in Australia. It has improved accessibility, expanded choice, and reduced logistical barriers for many individuals.
While telehealth is suitable for a wide range of people and presentations, it is not the right fit for everyone. Telehealth is not about replacing face-to-face care - it is about expanding access and offering flexibility.
The key question is not really whether telehealth is overall “better” than in-person therapy, but whether it is the right format for you at this stage of your life.
If you, a loved one, or a friend are seeking mental health support, please feel free to reach out. Even if we are not the right fit, we are always happy to help guide you in the right direction.
