Pros and Cons of Online Counseling for Bulimia Nervosa

Girl using online screening tool IOI-S to check for eating disorder symptoms

At this moment in time, online counseling is more popular than ever, especially with the COVID-19 outbreak making it, basically, the only option. With almost all of us, social distancing, and self-quarantining, the shift to online therapy and treatment has never been more necessary.

After this, many people and organizations may consider continuing online care for mental health. If this is something you are considering for your own bulimia nervosa treatment, it is important to consider all of the possible pros and cons.

Pro – Accessibility

This is what makes online therapy so beneficial in the current age of COVID-19. Anyone with a smartphone and internet access can continue, or begin, engaging in therapy almost exactly as they did before.

Treatment centers and specialists that may have been inaccessible before, due to geographic location, are now there at the click of a button.

Online counseling is also more accessible financially, as it often costs much less than face-to-face counseling. Healthcare Bluebook estimates that, on average, traditional, in-person therapy costs $175 per session, whereas online counseling ranges between $45 to $100 per session [1].

Con – Lack of “Safe Space”

There is a benefit to physically entering a calming space solely created for you to process, release, and then leave. Going to therapy means you will go to an office that is likely filled with comforting images, furniture, and scents. The office is literally created for you to feel supported and relaxed.

Woman trying Online CounselingWhen we enter these spaces, it changes how we engage with our therapist. Often, we are more comfortable releasing our thoughts and feelings, knowing that we are safe from the eyes and ears of others in our lives.

Not only that, but there can also be immense relief in bringing in your burdens, letting them out, and leaving them in the therapy office.

With online counseling, you may have your session in your living room, bedroom, or office, and family, friends, children, or co-workers may be near. This can make it hard to focus on letting yourself be open and vulnerable.

The environment can do that, as well. Maybe you feel less comfortable baring it all in your office or car.

Pro – Flexibility

While having therapy wherever you want may present a con (above), it can also be a pro. It isn’t uncommon for people to avoid engaging in counseling because they don’t have time to drive to an actual office or can’t find a nearby therapist that takes their insurance or is within their budget.

With online counseling, you do not have to worry about commuting to attend therapy on your lunch break, or while your kids are at soccer practice, you can do it wherever and whenever you want. This is also particularly helpful for eating disorder counseling.

Many online therapists are more accessible in general with their clients, possibly even offering the ability to call for “coaching” or “wellness” calls or texting. Imagine you are in a moment of crisis and feeling triggered to engage in disordered eating behaviors.

With traditional therapy, you would wait until your next appointment. However, with online therapy, you could try to work out an arrangement with your therapist to reach out in these moments and receive support.

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Con – Personalization

Face-to-face contact with people is important for us emotionally, sociologically, and biologically. Reading non-verbal cues and body language, seeing facial expressions, and connecting with the vibe of another individual is huge in the therapeutic relationship for both the therapist AND client.

Technology makes it possible to still “see” the individual, but take it from a therapist currently doing telehealth due to COVID-19; it isn’t the same. This can be detrimental for bulimia nervosa counseling especially, as “getting eyes” on the client can give insights to the reality of their behaviors or emotions that are less easy to read over a video chat.

There are also benefits to you being able to physically be around your therapist, as their presence alone may provide comfort.


Woman reviewing pro recovery article and blogs on her phone and laptopThese are only a few of the pros and cons, and some need less explanation than others. It can definitely be a con if internet service is spotty one day. Maybe you really needed a comforting session, and you end up more frustrated than you began because your audio or video was glitching the entire time.

Other cons include fewer activities that can be engaged in through video, difficulty receiving and printing any handouts, inability to borrow reading materials, and a general lack of human connection that you just cannot get over video.

Other pros may be the ability for those that never considered being able to receive support having access, that online counseling can provide another therapy or support option when stepping down from treatment, or that therapists can work their hours around you more easily and vice-versa.

As a therapist that works both in-person and face-to-face with clients of all mental health diagnoses, I can see the benefits and negative aspects of both sides of the coin. If you are struggling with bulimia nervosa that is categorized as severe or physically detrimental to you, I would advise in-person treatment and therapy.

However, I do not find it a bad option for those in the maintenance stage of recovery. It is always your choice. However, your best option is to consult with an eating disorder specialist, mental health worker, medical professional, or all of these to determine what level of care you need and if this can be provided online.


[1] Caswell, A. (2020). Deciding between in-person therapy and online counseling. 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 April 29, 2020, on
Reviewed & Approved on April 29, 2020, by Jacquelyn Ekern MS, LPC

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