The World Is Changing, So Is Therapy

Digitalization of the modern world has affected the field of psychology and therapy, as it has all professions. In particular, shifts in daily needs and numerous system transformations have led to significant changes in therapy that perhaps the schools of therapy did not foresee when they were established years ago. For example, the therapy room used to be located in a particular place. Telehealth has stretched the spatial boundaries of therapy. It facilitated transportation, reduced invisible barriers, and made therapy more accessible to many people. It has also made us think whether a bond established through a screen changes. The digitalization also includes the therapy techniques. For example, virtual reality applications have introduced the power of experiential learning into therapy. Fears, traumas, and bodily reactions are no longer just described; they can be re-experienced in a controlled, safe and structured way. And recently, the way we use technology has gone beyond spatial boundaries and the techniques we are using. Artificial intelligence tools started to be used by many people to explore the way they think and feel. Finally, with all of these recent updates, we might start to think about where technology stands in a healing process built on human connection. Is it a support, an accelerator, or a tool? In this therapy sketch, we examine how therapy is shaped in the digital age.

Digitalization of therapy: When did it start?

The digitalization of therapy did not start with a single day, a single invention or a single crisis. Rather, it was an effort of adaptation that accompanied the acceleration of modern life. As computers entered homes, the internet became part of everyday life, and people turned to screens for support. Therapy appeared on the doorstep of this new space.

The first experiments emerged in the 1990s. At that time, concepts like “e-mental health” were not as familiar as they are today. Therapy was delivered via fixed desktop computers, wired internet connections and often text-based programs. Video links were available but limited; content was more structured, one-way and static. Yet these studies showed something important: Therapy was possible without being physically in the same room.

By the early 2000s, this idea took a slightly bolder form. Online cognitive behavioral therapy programs (iCBT) were developed with modules that mimicked face-to-face sessions and began to be tested in clinical trials. The therapeutic process was no longer based solely on talk therapy but on online exercises, weekly tasks, and digital monitoring. Looking back today, it is no coincidence that internet-based CBT has been around for almost two decades and has become one of the most researched digital interventions. This was the period when digital therapy stopped being an “experiment” and started to gain scientific ground.

In the 2010s, the scene changed once again. When smartphones, mobile apps, and wearable technologies became the center of our lives, therapy also entered our pockets. Mental health apps, online platforms, messaging-based supports and the first virtual reality apps proliferated rapidly during this period. At the same time, academic interest also grew, with a significant increase in the number of studies on digital mental health after 2010.

By the 2020s, digital therapy took on a completely different frame. The concept of “digital therapeutics” (systems in which software is directly organized and controlled as therapy) took center stage. Large-scale digital platforms for young people, VR-based therapies, and AI-powered tools have developed rapidly. The COVID-19 pandemic did not start this process, but accelerated it; remote care went from being an alternative to the norm. Almost every therapy center is providing telehealth options nowadays. Looking back today, the digitalization of therapy mirrors our needs. Let’s take a look at some of the currently popular digital therapy tools.

Telehealth Options

Telehealth offers an important opportunity in terms of rapid accessibility and easier integration into daily life for individuals. It reduces transportation barriers, increases participation, and makes therapy more sustainable for many. However, despite these conveniences, if you are considering telehealth therapy, you may be thinking: “Would in-person sessions be more effective?”

Systematic reviews and meta-analyses show that the therapeutic alliance formed in telehealth therapy is generally comparable to in person therapy, with some studies finding it only slightly weaker. Despite this, the clinical outcomes (like reduction in symptoms, increase in functioning) are often equivalent. So, despite small differences in perception of the relationship, therapy works in a similar way. A large meta-analysis published in 2024 found a significant but small association between therapeutic alliance and outcomes in telehealth therapy. This link was slightly weaker than in in-person therapy. And perhaps the most striking finding is that clients are generally less anxious than therapists. Many studies show that individuals report high satisfaction in telehealth therapy and feel a strong bond with their therapist. The screen is often not a barrier for us; sometimes, on the contrary, it is a space of trust.

For some individuals in particular, telehealth can facilitate the therapeutic relationship. Connecting from home, being in a familiar environment, can reduce the pressure of being physically present in a room. For some, the screen provides a “distance” that facilitates self-disclosure. Telehealth can also increase regular attendance at therapy. Especially for children, adolescents, and families, therapy becomes more sustainable when transportation, time, and logistical barriers are reduced. There are fewer missed sessions, which is really important for the continuation of care.

But this picture is not completely problem-free. The screen makes us lose some of our body language. Micro-expressions, small posture changes, and the energy in the room cannot always be captured. Seeing your own face on the screen, privacy issues, interruptions in the home environment, and technical glitches can tire both you and the therapist. Especially for therapists who are not used to working remotely, this can make building a relationship feel more challenging.

It is important to remember that it is relational skills that strengthen the therapeutic alliance in Telehealth as well. After all, telehealth does not eliminate the therapeutic relationship; it reshapes it in another context. The communication changes, the space changes, the rhythm changes. But the relationship (when well established) continues to exist.

Use of AI

Telehealth has become an accepted part of therapy practice with clear boundaries. Its effectiveness is backed by research, its ethical frameworks are well established and it has become a “usual” option for many individuals. While it is still not ideal for everyone, the debate in the therapy world is no longer whether telehealth should exist, but for whom, when and how it works better. When it comes to artificial intelligence, the picture is more uncertain.

There are many aspects of the effectiveness of psychotherapy, such as the therapeutic relationship, the methods, and techniques used. But each of these involves many complex processes, both emotional and intellectual. Artificial intelligence is limited in bringing these complex and often intuitive processes together. Building a true therapeutic relationship, understanding context deeply and working with the contradictory nature of human experience are still elusive areas for AI systems.

Some studies show that AI-based chatbots, for example apps targeting anxiety and depression, can reduce symptoms. But these effects are generally more limited compared to human therapy. The most noticeable difference is in emotional depth. AI can use supportive language and even be empathetic in individual messages, but this empathy cannot evolve into a relationship-based bond that develops and transforms over time. Empathy in therapy is not just about saying the right sentence. Empathy means tolerating silence, being able to change direction when faced with an unexpected emotion, and being able to recognize what the person cannot say rather than what they say.

Nevertheless, it is not realistic to say that AI has no place in therapy. Using AI makes sense when it is placed alongside the therapist, not in their place. AI is powerful in terms of access and scalability. It can be available, cost-effective, and the first point of contact for groups with limited access to mental health services. It can work very effectively in areas such as screening, symptom tracking, psycho-education and inter-session support.

But this power also carries a risk. Especially in complex, high-risk, or traumatic situations, AI’s limited ethical reasoning, lack of trauma-informed care, weakness in crisis management, and contextual blindness can create serious problems. Additionally, ethical considerations regarding information protection provide another dimension.

AI can be supportive, but it is still important for therapists to make decisions and bear responsibility. The idea that a human being should still be at the center of the therapeutic process is clinically and ethically necessary. Ultimately, when used correctly, AI can lighten the therapist’s load, support the individuals’ engagement and make the healing journey more accessible. But the essence of therapy, especially empathy, relationship, and decision-making, is still human.

Take aways:

As therapy has gone digital, not only have the tools changed, but also the world in which therapy exists. Screens, platforms, and algorithms have surrounded the therapeutic process.
Telehealth has been the most visible and most rapidly adopted step in this transformation, increasing access, supporting continuity, and making therapy possible for many individuals.
Artificial intelligence has emerged as a newer, more controversial, and more cautious part of this journey.
Used correctly, telehealth and AI can expand the boundaries of therapy.
Digital tools are therefore meaningful when they remain in the service of therapy, not in its place. Not to replace the therapy, but to make the therapy more accessible, more attentive, and more human.

References

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