Message from the Director · Sheri Betel, MSW, RSW, Psychotherapist

In-person, online, or AI: an honest look at your therapy options

There have never been more ways to get support, and most of what you’ll read about them is written by someone selling one. I’ve practised psychotherapy for 35 years, and I run a centre where in-person care is the offer, so read me with that in mind too. What follows is the honest comparison I’d give a friend.

Sheri Betel

Key takeaways

  • Online therapy works. Research finds online therapy with a registered professional effective for many common concerns: the honest position, and the one this page takes.
  • Fit matters most. What predicts good therapy best isn’t the format; it’s the fit and quality of the relationship with your therapist.
  • AI is not therapy. AI chatbots can be useful between sessions, but they are not therapy: no registration, no accountability, no duty of care in a crisis.
  • When a room matters. A room earns its keep for specific work: couples, families, children, teens, trauma; and for anyone without a private corner at home.
  • Choose the therapist first. Then choose the format that serves the work you’re doing together.

Can an AI chatbot replace a therapist?

No, and the reasons are structural, not sentimental. A chatbot has no registration, no college, no accountability, and no duty of care when you’re in crisis; what you tell it has none of the confidentiality protections a regulated professional owes you.

That said, honesty cuts both ways: people do find chatbots useful for organizing thoughts between sessions or rehearsing a hard conversation. Used that way (as a notebook that talks back, not as care), they have a place. Therapy is a relationship with a human being who is responsible to you and for you. That part isn’t automatable.

Is online therapy as effective as in-person?

For many common concerns, with a registered therapist, research says online therapy works, and any in-person clinic that tells you otherwise is selling, not informing. A 2026 review of 12 randomized trials comparing therapy by live video with therapy in person found no meaningful difference in how much symptoms improved, though its authors rate the evidence as low certainty and call for larger trials (Meyer-Keirath and colleagues, Journal of Medical Internet Research, 2026).

The honest caveats aren’t about the video call; they’re about the model behind some of the big platforms: matching by algorithm rather than fit, therapy shaped to brief formats, and a company between you and your therapist. None of that is inherent to online therapy: an independent registered therapist on a video call is simply therapy over video. The question that matters more than the format: who chose your therapist, and on what basis?

What does a room give you that a screen doesn’t?

Some work genuinely goes better in person, and it’s worth being specific instead of romantic about why.

Privacy from your own household.

A session in your kitchen is a session with the household in earshot. Many people, most teens especially, have no private corner at home. A private room solves what a mute button can’t.

The whole person in the room.

Posture, pace, what happens in the silences: a therapist works with everything, and more of everything is available in person.

A boundary around the work.

The trip there and back puts a line between the session and the rest of your day. What surfaces in an hour of real attention has room to settle before you’re back at your desk.

Work that needs shared space.

Couples work is the clearest case: one room, both of you heard, nobody talking over a laptop. Family sessions need a room that holds everyone; children do their work through play, in person; teens need an hour that is visibly, physically theirs.

In-the-moment support.

For trauma and high anxiety, a therapist who can help you regulate right there in the room matters.

Less screen, more engagement.

Children and teens already get plenty of screen time. In a room there are fewer distractions, and more real engagement.

So which should you choose?

Choose the therapist first. Decades of research point in the same direction: the quality of the working relationship between you and your therapist is one of the most consistent predictors of how much therapy helps, whatever the approach and whether sessions happen in person or online (a synthesis of 295 studies covering more than 30,000 people: Flückiger and colleagues, Psychotherapy, 2018). Not the brand of therapy, not the format. Find a registered therapist whose focus areas match what you’re facing and whose way of working sits right with you. Then choose the format that serves the work, and for the kinds of work above, that format is a room.

That’s the bet this centre makes: independent registered therapists you choose on fit, in person, close to home.

Sheri Betel, MSW, RSW, Psychotherapist
Director, Cedarvale Therapy Centre

The context worth knowing

About half of Canadians

By age 40, about half of Canadians will have or have had a mental health issue or concern.

Source: Mental Health Commission of Canada, cited by the Canadian Mental Health Association.

About half talk to a professional

Of Canadians 15 and older who met the criteria for a mood, anxiety or substance use disorder in the past year, about half (48.8%) had talked to a health professional about their mental health.

Source: Statistics Canada, Mental Health and Access to Care Survey, 2022.

Getting support (in any format, from a registered professional) beats not getting it. If cost or logistics make in-person impossible, an independent online therapist is a real option, and this page would rather you take it than take nothing.

Sources

Last reviewed September 2026.