Teletherapy Isn't a Compromise? Here's the Evidence!
What happens to the therapeutic relationship when speech and language therapy takes place through a screen rather than face-to-face? More than many people think – and the evidence is surprisingly strong.
Videotherapy began as an emergency solution during the COVID-19 pandemic, but it has since become an established part of healthcare delivery. The question is: has it proven itself therapeutically as well?
A growing body of research suggests that teletherapy is not a compromise. Rather, it is a distinct service delivery model with its own strengths and advantages.
When clinics closed their doors in spring 2020, speech and language therapists faced a simple question: stop therapy or continue remotely? The answer was videotherapy, and it arrived faster than many expected. Temporary approvals from health insurers allowed digital speech and language therapy to be delivered on a large scale for the first time (Lauer, 2020). What began as an exception has now become standard practice.
However, legal recognition alone does not prove therapeutic value. The real question is: what happens to the therapeutic relationship when it moves into the digital space?
The Evidence is hard to ignore
Research consistently shows that
• Teletherapy can achieve outcomes comparable to face-to-face intervention for many client groups.
• Digital delivery often increases access to care, particularly for people in rural areas or with mobility limitations.
• Family members and caregivers are more easily involved in the therapeutic process.
• Clinicians report developing new therapeutic and technical competencies through digital practice.
In a nationwide survey of 816 outpatient speech and language therapists, participants reported not only high levels of teletherapy use but also the development of new technical and therapeutic skills as a result of delivering therapy online (Wittmar et al., 2023).
Teletherapy was most commonly used for speech and language disorders, articulation disorders, and aphasia – all areas where the therapeutic relationship plays a central role.
What began as an emergency response during the pandemic has evolved into a recognized service model supported by a growing body of evidence.
What Digital Therapy Really Changes
The concern is understandable. Speech and language therapy relies heavily on communication – eye contact, vocal tone, facial expressions, and interpersonal connection. At first glance, many of these elements seem diminished when communication happens through a screen.
Research confirms that some challenges exist. Non-verbal cues can be harder to perceive, technical delays may interrupt conversational flow, and rapport-building often requires more deliberate effort, particularly with new clients (Lauer, 2020; Schwinn et al., 2020).
But change does not necessarily mean decline.
A Surprising Finding About Empathy
A study by Sperandeo et al. (2021) found that clients perceived their therapists as significantly more empathic and supportive in digital sessions than in traditional face-to-face therapy.
Several explanations have been proposed. Clients often experience less travel-related stress, greater comfort in their home environment, and more control over the therapy setting. For some individuals, the physical distance of teletherapy may even provide a sense of psychological safety that encourages more open communication.
The findings align with established communication theory. Paul Watzlawick famously argued that it is impossible not to communicate (Watzlawick et al., 2017). Even technical delays, camera-based eye contact, or a brief smile before beginning a Cognishine activity communicate something meaningful.
For clinicians, the implication is clear: communication is not lost online – it simply requires different strategies.
The Therapeutic Foundation Remains the Same
One of the most influential models of therapeutic effectiveness is Edward S. Bordin’s concept of the Working Alliance (1979), which identifies three essential components:
• Goals – agreement on therapy objectives
• Tasks – collaboration on therapeutic activities
• Bond – the emotional connection between therapist and client
Importantly, this framework applies across therapeutic disciplines and can be successfully transferred to digital settings.
A recent scoping review by Hansen et al. (2025) concluded that the therapeutic relationship remains a fundamental contributor to successful speech and language therapy outcomes, regardless of the delivery format.
What changes is not the function of the therapeutic relationship, but its form. Trust, empathy, and shared goals remain essential – they simply need to be established using different methods.
The Three Main Types of Teletherapy
The American Speech-Language-Hearing Association distinguishes three forms of digital service delivery, each of which has a valuable role in speech and language therapy practice (Lauer, 2020).
Synchronous
Live videotherapy sessions delivered in real time. This format offers direct interaction and immediate feedback and most closely resembles traditional face-to-face therapy.
Asynchronous
Digital therapy materials, apps, and therapy content platforms such as Cognishine. Clients complete activities independently, while therapists review progress and adapt future interventions.
Hybrid
A combination of in-person therapy, videotherapy, and digital therapy tools. Hybrid care offers flexibility while maintaining strong therapeutic relationships.
Among these options, hybrid models have proven particularly effective. They allow face-to-face sessions to focus on relationship-building and hands-on intervention, while videotherapy supports continuity and digital platforms facilitate independent practice between appointments.
Cognishine in a Hybrid Therapy Model: A Practical Example
Mr. M., a 58-year-old man with mild to moderate aphasia following a stroke, lives in a rural area and experiences mobility limitations that make regular clinic visits difficult.
His therapy follows a hybrid model:
Monday: Face-to-face speech and language therapy, when transportation is available.
Thursday: Videotherapy delivered through a secure, compliant teletherapy platform.
Daily: Personalised speech and language exercises on the Cognishine platform, selected and reviewed by his therapist.
Mr. M. reports that independent practice through Cognishine gives him a greater sense of control over his rehabilitation. He can see his progress directly, while his therapist can adapt future activities based on his performance without requiring an additional appointment.
The involvement of his wife during videotherapy sessions has also improved the transfer of therapeutic strategies into daily life (Wittmar et al., 2023).
Importantly, Cognishine does not replace the therapeutic relationship – it supports it. That distinction matters.
What Are the Benefits of Teletherapy for Clinicians?
Teletherapy offers advantages not only for clients but also for clinicians.
Research has highlighted benefits including greater flexibility, reduced travel demands, improved continuity of care, and the ability to reach clients who might otherwise struggle to access services. Digital service delivery can also make it easier to involve family members, coordinate support across locations, and provide therapeutic input between appointments.
Many clinicians report that teletherapy has expanded their therapeutic toolkit. Features such as digital whiteboards, screen sharing, interactive therapy activities, and online therapy tools create new opportunities for engagement and participation. Modern therapy software and digital intervention platforms can also streamline session preparation, intervention planning, and progress monitoring.
Most importantly, teletherapy enables clinicians to deliver evidence-based interventions beyond the clinic walls. Whether supporting cognitive rehabilitation, speech and language therapy, occupational therapy, or neurorehabilitation, digital tools help maintain therapeutic intensity and improve access to care.
The goal is not to replace face-to-face therapy. The goal is to give clinicians more flexibility to deliver the right intervention, in the right format, at the right time.
Ethical Principles for Effective Teletherapy
Teletherapy should never become an end in itself. It is most effective and ethically appropriate when three key conditions are met:
1. Choice and Consent
Clients must explicitly agree to participate in videotherapy and retain the right to withdraw consent at any time. Face-to-face therapy should remain available as an alternative whenever appropriate (Hecht et al., 2022).
2. Data Protection
Only certified videotherapy providers with end-to-end encryption should be used. Healthcare data requires particularly high standards of protection and confidentiality.
3. Avoiding Digital Exclusion
Older adults, individuals with cognitive impairments, and people with limited digital literacy must not be excluded from care because of technological barriers. Technical support and caregiver involvement are often essential components of successful implementation (Ehlers et al., 2020).
Conclusion: Teletherapy Is a Service Model, Not a Backup Plan
The original question was simple: can therapeutic connection exist across distance?
bThe evidence suggests that it can.
However, it does not happen automatically. Effective teletherapy requires deliberate communication, structured interactions, and thoughtful use of digital tools.
Clinicians who embrace videotherapy, communicate intentionally, acknowledge emotional cues, and use platforms such as Cognishine to extend the therapeutic environment beyond the clinic can reach people who might otherwise have limited access to services – without sacrificing the core elements that make therapy effective.
That is not a compromise. It is an evolution.
About the Author:
Rebecca Elsner is a Speech and Language Therapist from Germany as well as a Content Contributor and Product Specialist at Cognishine. Passionate about digital therapy, evidence-based practice, and innovative technologies, she combines clinical expertise with the development of modern therapy resources. She is particularly interested in how digital solutions can support therapists and improve access to high-quality therapy. Driven by curiosity, she loves exploring new topics, keeping up with the latest developments in therapy, and continuously expanding her knowledge.
References:
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260.
Ehlers, A., Heß, M., Frewer-Graumann, S., Olbermann, E. & Stiemke, P. (2020). Digitale Teilhabe und (digitale) Exklusion im Alter. Expertise zum Achten Altersbericht der Bundesregierung.
Hansen, H., Erfmann, K., Göldner, J., Schlüter, R. & Zimmermann, F. (2025). Therapeutische Beziehungen in der Logopädie: ein Scoping Review empirischer Studien. Logos, 173–185.
Hecht, A. et al. (2022). Handlungsempfehlungen für die ambulante logopädische Videotherapie [Report]. HAWK.
Lauer, N. (2020). Teletherapie – hat die Logopädie eine digitale Zukunft? Forum Logopädie, 34(5), 12–17.
Schwinn, S. et al. (2020). Digitalisierungschancen – Umsetzung von Videotherapie im Lockdown. Forum Logopädie, 34(6), 36–40.
Sperandeo, R. et al. (2021). Exploring the Question: "Does Empathy Work in the Same Way in Online and In-Person Therapeutic Settings?" Frontiers in Psychology, 12, 671790.
Watzlawick, P., Beavin, J. H. & Jackson, D. D. (2017). Menschliche Kommunikation (13. Aufl.). Hogrefe.
Wittmar, S. et al. (2023). Outpatient speech and language therapy via videoconferencing in Germany during the COVID-19 pandemic. International Journal of Health Professions, 10(1), 1–10.
