A qualitative study exploring how technical friction, environmental context, and screen-mediated presence affect emotional disclosure and connectedness in online therapy.
Post-pandemic, therapy moved to screens. But the shift exposed gaps: people reported feeling less safe, less seen, and less willing to open up. This research investigated the specific mechanisms behind that gap.
The study originated from personal experience: navigating Zoom sessions with a therapist back home after moving to Seattle made me realize something was lost in translation. I brought that curiosity into HCDE's Qualitative Research course.
We began broadly: scanning public discourse: then narrowed to direct conversations with people who had lived the comparison.
Participants consistently chose the setting: online or in-person: where they felt most secure. Security wasn't just physical privacy; it was about knowing the therapist's full attention was on them.
In-person: no fear of being overheard by roommates or family. Online: participants actively scanned for signs the therapist was distracted or had other tabs open. When security felt absent, participants developed self-protective coping: becoming less focused, less engaged, less willing to disclose.
"He might be looking at something else. I'm not sure if we're both on the same Zoom page; maybe you're just looking at the camera, or maybe you have other pages open."
The physical space of in-person therapy does real psychological work. Room layout, decor, and lighting aren't incidental: they signal safety and invite vulnerability. Online sessions invert this: the client is in their own space, which can work as a comfort, but often lacks the professional cues that signal "this is a space for healing."
Therapist's physical environment communicated their humanity and professional investment. In-person: clients enter the therapist's territory, enabling two-way relational dynamic rather than pure self-exploration. Online: home comfort helps some clients, but absence of professional space cues reduces therapeutic framing.
"In person environment is very comfortable and relaxing, can't see and feel the comfortable and relaxing atmosphere online."
5 of 6 participants named technical issues as a top pain point: but the problem went well beyond connectivity. The consequences of freezes and lags are uniquely damaging in therapy: they interrupt the one thing that matters most, the train of thought mid-disclosure.
Video freezing mid-session caused loss of emotional momentum and trail of thought. Therapeutic activities and exercises that worked in-person couldn't be translated to video calls. Notification pop-ups created constant distraction: especially ironic when screen addiction was part of why someone sought therapy.
"I get distracted because notifications will pop and I am on my laptop all day or Instagram, which is half of the reason for me to be in therapy: and then also getting therapy from a screen does not seem to make sense to me."
The screen creates a unique and compounding identity problem. Seeing yourself while talking: particularly while discussing your struggles: introduces self-consciousness that actively inhibits disclosure. At the same time, the limited, lagged view of the therapist strips them of their humanity, making it easier to disengage.
One participant held back during sessions because she felt uneasy "talking about herself" while "looking at herself". Limited visibility of the therapist (head only, face frozen) removed non-verbal cues that build trust and rapport. Participants who dehumanised their therapist online were less committed and found it easier to disengage.
"Offline you have more personal connections, the person you see has temperature. That is, you can feel that she isn't a black screen when calling you."
"I sometimes don't like myself and that's why I am in therapy. So when I have to look at myself talking on Zoom, I get very self-conscious and uncomfortable."
Six platform-level interventions, grounded in the four findings, plus three research questions that should come next.