Should you go back to seeing your therapist in person?

The rise of the Delta variant is complicating what was already a difficult decision for many. Nearly all outpatient mental health treatment moved online when the pandemic struck last year. As vaccines rolled out this year, more people became comfortable resuming some in person visits, but now Delta’s surge is creating new uncertainty.

Therapists say there are benefits and drawbacks to both virtual and in-person visits. Some therapists—and patients—say rapport and trust can be easier to build face-to-face, even with masks. That bonding is particularly crucial at the beginning of the relationship or when symptoms are more severe. Therapists say in-person sessions can often work better for children and teens, especially those who are easily distracted or may not be totally on board with the treatment.

Some studies have found that video mental-health therapy can be as effective as in-person treatment. Less research is available for some forms of digital treatment, such as group therapy and couples counseling.

Fans of virtual therapy say convenience is its biggest upside—no long commutes and parking nightmares for a 45-minute visit. Online therapy also allows for shorter and more frequent sessions, something that some therapists say can aid progress. Virtual visits may provide a greater sense of safety for patients worried about Covid-19.

“With adults who are higher functioning and really motivated, it is the same as working with them in person,” says Karen Cassiday, a clinical psychologist and managing director of the Anxiety Treatment Center of Greater Chicago.

As with workplaces, some practitioners and patients are taking a hybrid approach, with some visits in person and others online. Kevin Chapman, a clinical psychologist in Louisville, Ky., says about 40% of his patients are doing hybrid treatment.

Patients like the convenience of telehealth, he says, but often prefer to meet face-to-face when they are doing more intense exposure work, a type of treatment for anxiety disorders that requires people to approach the things they fear. The rise of Covid-19 cases in recent weeks has prompted some patients to go back to all-virtual visits, says Dr. Chapman, founder of the Kentucky Center for Anxiety and Related Disorders.

Sarah Pennington, a 22-year-old student at the Savannah College of Art and Design, has been seeing her Georgia-based therapist via video from her childhood home in Pottstown, Pa., since her classes went online in March 2020. Ms. Pennington, who is being treated for anxiety and the hair-pulling disorder trichotillomania, plans to continue mixing in-person and virtual sessions when she returns to campus in September. She prefers in-person because, “I think it helps me be more vulnerable,” she says. “With the screen, I can hide a little bit more.”

Sarah Pennington prefers in-person therapy because, she says, “I think it helps me be more vulnerable.”

Photo: Justin Cook for The Wall Street Journal

Before the pandemic, Ms. Pennington sometimes found it too difficult to get to her in-person appointments because she has a medical condition that causes an elevated heart rate and fatigue. She would occasionally have to cancel a session or would push herself to attend and then feel wiped out afterward. So she will keep virtual visits as a fallback option when she goes back to Georgia. “I have to be very careful with how I spend my energy,” she says.

The decisions over virtual versus in-person are happening amid a backdrop of regulatory uncertainty. The federal government and states relaxed many restrictions on virtual mental health treatment last year, including Medicare rules that barred patients from receiving coverage for video visits in their home.

Many states temporarily dropped their requirements that mental health providers be licensed in the same state where their patients live, a move that, for example, allowed many college students learning remotely to continue treatment with their current therapists. Several private insurers waived copays for telehealth visits, including those for mental health.

Some states have reinstated their licensing rules in recent months. Insurers including UnitedHealthcare and Aetna have largely brought back copays and coinsurance for telehealth.

Digital mental health remains popular. Aetna says that about 60% of its members’ outpatient mental health visits are currently virtual, about the same as during the period from April 2020 to December 2020. And more states are allowing psychologists to practice who are licensed elsewhere.

Some psychologists and psychiatrists see care evolving to include a variety of digital tools including apps, texting and self-help online courses, along with video and in-person visits.

These tools could reduce the cost of therapy, allow mental health professionals to treat more patients and potentially speed up treatment, something especially important in underserved areas where providers are in short supply and waits for appointments are long, says Jay Shore, a psychiatrist and professor at the University of Colorado Anschutz Medical Campus and chair of the American Psychiatric Association’s telepsychiatry committee.

Dr. Cassiday in the Chicago area says she has found that in-person sessions are more effective for many children and teens. Her practice is now seeing about 70% of patients face-to-face. But during the months when most therapy was virtual, she had experiences where children refused to talk, ran out of the room or shut the laptop.

In a few instances, children threw and broke the phone or iPad in an attempt to end treatment. “When there is any hint of the kid not being interested, this mode just doesn’t work. There are too many ways to escape,” she says of virtual therapy. Dr. Cassiday says these situations rarely come up in her office.

Mary Alvord, a psychologist in Chevy Chase, Md., has caught teens playing videogames during online therapy. She knows because the screen “changes color and it reflects off their faces,” she says.

Michi Fu, a psychologist in Los Angeles, says she now asks patients to do a 360-degree scan of their environment during sessions. She has picked up important information that way, she says, like the fact that a wheelchair-using 82-year-old with depression has a park in her apartment complex.

“I’m able to prescribe, ‘go downstairs, spend 15 minutes in the sun and say hi to three people,’” Dr. Fu says. “That helps her to combat social isolation and it also stimulates her brain.”

Dr. Cassiday says she realized that being more animated—using the slightly louder voice and exaggerated expressions she would use teaching a class—makes video sessions more effective. She has also found that she can motivate children by telling them that her dog Shiloh, a 19-pound Cavapoo, will join her on screen if they pay attention and participate.

Write to Andrea Petersen at andrea.petersen@wsj.com