Comparing Online to In-Person Counseling for Eating Disorder Treatment

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More people than ever are receiving mental health services online due to the COVID-19 pandemic. A year later, some facilities are beginning to reopen while giving clients the option of returning to in-person services or continuing virtually. Below are some aspects to consider if you are seeking out eating disorder treatment and are unsure whether to do so online or in person.

Access to Eating Disorder Treatment

The COVID-19 pandemic proved just how helpful virtual services can be in providing access to care. Many have experienced therapy for the first time in their lives due to the increased access to therapy and wider coverage by insurance companies.

Virtual therapy is not only more affordable, but it is also often more convenient. The difficulty of finding time in one’s schedule and commuting to a face-to-face appointment are no longer factors. It also allows for some individuals to receive eating disorder treatment without the expense, time, and complications of traveling to the nearest treatment centers.


The therapeutic rapport between a client and their eating disorder treatment team is one of the most important predictors of treatment success. Whether this rapport can be better developed via virtual means or in-person depends on both the patient and the treatment professional.

If you are considering virtual treatment vs. in-person treatment, consider how comfortable you are engaging on a vulnerable and personal level with others via technological means. For some, particularly younger generations, this comes more naturally, while others may find it forced or uncomfortable. Consider how you might best relate to and communicate with your team to determine whether virtual or face-to-face might work better for you.

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The big question that is asked regarding online counseling for eating disorders is whether or not it is as effective as in-person counseling. An important factor to consider in all of this is the level of care needed.

Woman trying Online Eating Disorder TreatmentIndividuals struggling with more severe eating disorder cases need to receive higher levels of care, such as medical stabilization or residential treatment. These levels of care require that individuals be face-to-face so that they can receive the medical supervision necessary as they experience the refeeding process.

After residential treatment, many step down to Partial Hospitalization Programs (PHPs), which can be provided virtually or in-person. Many facilities have followed these guidelines due to the COVID-19 pandemic, with medical stabilization and residential treatment programs continuing in-person with virtual step-downs to lower levels of care.

One study learned that the biggest difference in effectiveness between virtual and in-person treatment lies in the treatment timeline. As the study reports, “online group therapy can be just as effective as face-to-face treatment, although the pace of recovery may be slower [1].”

Essentially, results found better results in those that received face-to-face treatment for bulimia nervosa than those that received online treatment [1]. However, this gap narrowed when individuals were surveyed at the 12-month follow-up [1].

There are many factors that relate to treatment success, including theoretical viewpoint, program requirements, individual professional skills, therapeutic rapport, and, predominantly, client willingness to engage in treatment and work toward recovery. For some, these factors will align virtually, while for others, they may be more effectively found in-person.

The most important aspect that predicts eating disorder treatment success is the effort of the individuals themselves to fight for recovery.


[1] Unknown (2016). Online group therapy may be effective treatment for bulimia nervosa. Science Daily. Retrieved from

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published March 18, 2021, on
Reviewed & Approved on March 18, 2021, by Jacquelyn Ekern MS, LPC