Is Online Therapy Effective for Adults with ADHD?
by Arianna Iliff, LMFT
With a seemingly endless number of online platforms available for therapy, you might be wondering about whether online therapy works for adult ADHD. The good news is, it absolutely can be! Let's talk about the whats, hows, and whys of telehealth.
The Research
Virtual therapy means mental health access
The CDC reports that since March of 2020, 30.8% of adults with ADHD have used telehealth for their counseling or therapy, and around half have ever attended a telehealth appointment for their ADHD. So, online therapy is a popular choice. General studies which compare telehealth and in-person therapy show that for conditions like anxiety, depression, and PTSD, people who use telehealth see roughly equivalent improvements in their symptoms, and are similarly satisfied with their care. Across many studies, telehealth works just as well as in-person therapy.
A standard of care exists for teletherapy too: The American Psychiatric Association and the American Telemedicine Association state that a provider of online therapy will comply with HIPAA all the laws of the state where they are licensed, confirm your location in session, and otherwise make sure that their delivery of teletherapy is just as high-quality as their delivery of in-person therapy.
Advantages of Online Therapy for Adults with ADHD
Finding your perfect fit
You've searched for hours, and you've found the perfect therapist for you. They're experienced, they're affordable, they understand the struggles and strengths in neurodivergence, maybe they even offer a new therapy style you'd like to try.
And then you discover: their office is two hours away.
Telehealth has increased accessibility of mental health services to people, and with the rise of online platforms, it's become more evident that there's a slew of qualified mental health providers out there who would love to work with you. The best part of telehealth is getting to find the therapist that works best for you. The therapist whom you connect with is the one who is likely help you the best, and with the power of the internet, you no longer have to be restricted by your city limits.
No commute
Therapy from the comfort of your room.
The Boston area, where I'm located, is famous for heavy traffic and overall stressful driving, with long commute times. You probably already have plenty of difficult or stressful things going on in your life: after all, isn't that part of why you come to therapy? Telehealth is convenient, and as long as you're physically in the state where your therapist is licensed and in a private place, you can have your session anywhere.
More flexible scheduling
Sometimes when you account for work, school, and other responsibilities in your life, the only time available to travel to an in person session is in the evenings--the session time that everybody else wants too. But what if you have a handy hour lunch break? What if you work a split shift and can do a 10am session before work starts at noon? The flexibility of telehealth is a major accessibility win!
When Virtual Therapy is Not a Good Fit
Difficulty remembering appointments
Of course this can be an issue with any sort of appointment, but getting to stay at home for a session might mean getting sidetracked before a session time. If you've ever looked up at the clock and realized you're ten minutes late for your appointment, it's something to be aware of.
Serious distractions
With ADHD, distraction can come with the territory. But for teletherapy, distraction can come a little bit easier. Devices are designed to hijack our attention already, and if our environment at home is cluttered, not private, or full of reminders of tasks that aren't getting done, this can interfere with the process of therapy. This could also mean that if you're open to medication for ADHD, teletherapy may be better-supported when you're also attending medication management appointments.
Serious safety concerns
Studies show that many conditions are suitable for telehealth care, but a few situations are not: If you are in an actively suicidal crisis, weekly telehealth therapy alone is not likely enough to support your needs. It could be that teletherapy might be part of your treatment plan, but not the sole treatment: one study at the US Veterans Administration suggested that virtual care could still be supportive in decreasing suicidal events--and depending on your situation, hybrid care (sometimes in-office, and sometimes online) may also work. Whether someone is a good fit for telehealth is definitely between a client and their provider, and clients deserve
Privacy or technical concerns
Technical issues can derail telehealth sessions
How's your internet connection? One of the biggest drawbacks of teletherapy is the potential for technical difficulties. If you find your internet can be testy when it rains, or you don't have a strong wifi signal in general, online appointments tend to just get frustrating.
If you physically can't get an hour alone in your home, then in-person sessions might be more ideal for you. In-person sessions create a holding space you might not have access to otherwise, keeping more of your inner work separate from your life at home.
Three Green Flags for a Telehealth-Competent Therapist
Takes your privacy seriously: an ethical therapist will never do teletherapy with you while doing dishes or running errands--yes, this has happened. They will also use a HIPAA-compliant video call platform.
Takes your safety seriously: Your provider will confirm your location for a session, in case an emergency occurs.
Can be flexible with how they deliver treatment: Someone who is really comfortable with online therapy may be able to modify treatment to an online platform. For example, they might share their screen when they have an educational visual aid. I like to use an online platform for the reprocessing phase of EMDR, which makes managing this phase nearly effortless. Learn more about the difference between EMDR and standard talk therapy here.
Pros and Cons: Virtual and In-person Therapy
In the spirit of one of my favorite DBT skills, let's make a pros and cons diagram about both options:
Virtual Therapy Pros
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In-person Therapy Pros
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Virtual Therapy Cons
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In-person therapy Cons
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Tips for Getting The Most Out of Your Virtual Therapy Session
Pause and consider your setup mindfully
What's your favorite fidget tool?
In therapy, I invite you to put your phone on do not disturb, close the email app on your laptop, and post your away message. There are influences in our lives that can pull us away from the heavy stuff, and lets be real here for a moment: our brains are simply not always going to want to sit in the heavy stuff. It's important to know and be honest with yourself here: will you be as open to discuss what you need to in your car on your phone?
We can also consider what you need to create a "therapy space" in your home: maybe a soft blanket, something that smells good, fidget tools? Consider your five senses and incorporate your favorite sights, smells, and sensations that make focus or calm a little easier.
Remove distractions
When it comes to the space you choose for virtual therapy, all that's essential is a reliable internet connection, four walls, and a door. But for those of us with ADHD, it can be important to consider what's going on in that space, and how it might influence our ability to focus in session. Is the laundry basket going to bother you? Or alternatively, if you need movement during session in order to process well, could your therapist be open to having you fold the laundry during session?
If you have children, having children out of the room is important. There are some things discussed in therapy that children will process but not understand, especially if they are young, and we can't be certain. Alternatively, consider scheduling your session around naps or school.
Bonus: Have your bullet points ready
Consider having in mind 1-3 topics you'd like to discuss with your therapist that day. You may want to follow up on something from the previous week, or you may have something coming up that you'd like to think about build skills about. Your therapist can help you guide the session to build it around what you need that day, how you want to feel when you leave, and how it all plays into the greater treatment plan you've created together.
FAQs
Is online therapy right for me?
If you have a safe and non-distracting environment to take a call available and aren't actively in crisis, then the odds are in your favor! Talk to your provider if you're not sure, and don't hesitate to talk about your needs in terms of scheduling accessibly or reminder emails and texts. Your therapist will be glad to discuss these things with you (I know I certainly would be!).
What are some questions I could ask a potential therapist about telehealth?
Here are some options!
How do you feel about online therapy, and how much experience do you have doing therapy online?
What happens if I can't make a telehealth appointment, or if I'm late?
Can I do [insert your favorite style of therapy] online?
What's the plan if the connection drops?
What's your opinion on online therapy?
Right now, Inspiration Point Therapy is all online, serving clients in Greater Boston and throughout Massachusetts. I've been regularly providing telehealth since 2022 and I love being able to offer my services on a broader scale. I pride myself on getting creative when needed in order to make online therapy engaging and structured.
Join me online!
If you're ready to give online therapy a try, I'd love to connect with you. I offer free online consultations to answer your questions. Schedule yours here.
Arianna Iliff, LMFT (they/she) is a licensed therapist and the founder of Inspiration Point Therapy. On their blog, The Reroll, they share helpful information about ADHD, DBT, EMDR, and the wide world of mental health.
Works Cited
Greenwood, H., Krzyzaniak, N., Peiris, R., Clark, J., Scott, A. M., Cardona, M., Griffith, R., & Glasziou, P. (2022). Telehealth versus face-to-face psychotherapy for less common mental health conditions: Systematic review and meta-analysis of randomized controlled trials. JMIR Mental Health, 9(3), e31780. https://doi.org/10.2196/31780
Shore, J. H., Yellowlees, P., Caudill, R., Johnston, B., Turvey, C., Mishkind, M., & Hilty, D. M. (2023). Best practices in videoconferencing-based telemental health. American Psychiatric Association & American Telemedicine Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Telepsychiatry/APA-ATA-Best-Practices-in-Videoconferencing-Based-Telemental-Health.pdf
Staley, B. S., Robinson, L. R., Claussen, A. H., et al. (2024). Attention-deficit/hyperactivity disorder diagnosis, treatment, and telehealth use in adults — National Center for Health Statistics Rapid Surveys System, United States, October–November 2023. MMWR Morbidity and Mortality Weekly Report, 73(40), 890–895. https://doi.org/10.15585/mmwr.mm7340a1 Tenso, K., et al. (2024).
Virtual mental health care and suicide-related events among Veterans. JAMA Network Open, 7(10), e2425640. https://doi.org/10.1001/jamanetworkopen.2024.25640