Online vs In-Person Therapy: Scheduling Considerations

TL;DR

• The Shift: 65% of sessions are now online. Scheduling must adapt.
• The Choice: Dedicate full days to In-Person vs Online (easiest for brain).
• The Trap: Back-to-back switching. You need 30m to drive/reset.
• The Fix: Clearly labeled event types "Therapy (VIDEO)" vs "Therapy (OFFICE)".

Before 2020, about 8% of my practice was telehealth. Now it's around 65%. The shift happened fast, and honestly, I wasn't ready for the scheduling chaos that came with it.

If you're offering both online and in-person sessions, you've probably discovered that it's not as simple as "same calendar, different location." There are real considerations that affect everything from no-show rates to your own sanity.

Let me share what I've learned managing a hybrid practice for the past few years.

The Core Scheduling Differences

Online Sessions

Advantages:

• No commute buffer needed
• Can schedule tighter (15-min gaps work)
• More flexible with time zones
• Lower no-show rates (surprisingly)
• Can work from anywhere

Disadvantages:

• Zoom fatigue is real
• Tech issues eat into session time
• Harder to read body language
• Some clients struggle with the format

In-Person Sessions

Advantages:

• Better therapeutic connection (for some clients)
• No tech barriers
• Easier to use physical interventions
• More "official" feeling

Disadvantages:

• Need travel buffer time
• Higher no-show rates
• Weather/traffic impacts
• Limited to local clients

How No-Show Rates Actually Differ

This surprised me. Conventional wisdom says in-person appointments have higher commitment. The data tells a different story.

A 2023 study in Telemedicine and e-Health found:

• In-person no-show rate: 18-23%
• Telehealth no-show rate: 7-11%

Why? My theory: online sessions have lower friction. Client just needs to click a link from wherever they are. No fighting traffic, finding parking, or rushing from work.

That said, last-minute cancellations are slightly higher for telehealth. Easier to book, easier to cancel.

Practical Scheduling Strategies

Option 1: Dedicated Days

Some therapists designate specific days for each format:

• Monday, Wednesday, Friday: In-person
• Tuesday, Thursday: Telehealth

Pros: Simple mental model, consistent routine Cons: Less flexible for clients, might have underbooked days

This works great if you rent office space by the day. Why pay for Tuesday office time when you're doing Zoom calls from home?

Option 2: Time Blocks

Others split the day:

• Mornings: In-person
• Afternoons: Online

Or vice versa. This matters for your energy. Some find Zoom draining and prefer it earlier. Others like ending the day from home.

Pros: Flexibility within each day, minimizes transitions Cons: Might still have gaps in the schedule

Option 3: Client Preference

Let clients choose their format session-by-session.

Pros: Maximum flexibility, client-centered Cons: Scheduling becomes chaotic, hard to plan your day

I tried this. It was a nightmare. Don't recommend.

What Actually Works (For Me)

I landed on a modified version of Option 1:

• Two full in-person days (I rent office space those days only)
• Two full telehealth days
• One flex day for overflow and admin

This cut my office rent by 60% and made my schedule predictable. Clients adapted within a month.

Setting Up Your Booking System for Hybrid

Whatever scheduling tool you use, it needs to handle:

1. Different appointment types - "In-Person Session" vs "Video Session"
2. Different availabilities - Maybe mornings only for in-office
3. Location details - Office address for in-person, video link for online
4. Clear indicators - Client should know immediately which type they're booking

Most modern tools handle this. SimplePractice, Jane, and OnlyCaly all let you create separate appointment types with different availability windows. Calendly works too but requires more setup.

The key is making it obvious to clients. I've had people show up to my office for a telehealth appointment because they didn't read carefully. Now my appointment types are named:

• "Therapy Session (IN-PERSON @ 123 Main St)"
• "Therapy Session (VIDEO - Link Will Be Sent)"

Not pretty. Very clear.

Transition Time Between Formats

This is where people mess up. You can't do a video call at 10am and have an in-person at 10:30 unless you live above your office.

Build in reality:

• Video to in-person: 30-45 min minimum
• In-person to video: 15-20 min (for mindset shift)
• Back-to-back same format: 15 min minimum

I block 45 minutes before any in-person session that follows a video session. Yes, it looks like wasted calendar space. It's not. It's sanity preservation.

Common Hybrid Mistakes

1. The "Teleportation" Schedule: Booking an in-office client at 10am when your 9am Zoom call is at home 20 mins away.
2. Confusing Clients: Not putting ALL CAPS LOCATION info in the event title.
3. Tech Fails: Assuming office Wi-Fi is as good as home Wi-Fi. Test it.

Client Communication

Be explicit about expectations for each format:

For telehealth, I send:

• Link 24 hours before (automated)
• Link 15 minutes before (automated)
• Tech requirements (stable internet, quiet space, camera on preferred)
• Backup plan (phone number if video fails)

For in-person, I send:

• Address with parking instructions
• What entrance to use
• Arrival time (5 min early)
• COVID policies if applicable

Automate everything you can. Your booking tool should handle most of this.

When to Recommend Each Format

Not every client fits every format. Here's my rough guide:

Telehealth works better for:

• Clients with anxiety about traveling
• Those with mobility issues
• Parents with childcare challenges
• People with long commutes to your office
• Follow-up sessions after rapport is established

In-person works better for:

• Initial assessments
• Clients who struggle with technology
• Those in crisis (easier to assess safety)
• Couples therapy (harder to read dynamics on screen)
• Clients who specifically request it

Some clients thrive on video. Others hate it. Ask during intake which they prefer and revisit periodically.

The Legal Stuff (Quick Version)

This varies by location, but generally:

• Telehealth requires client consent (usually a form)
• Some states require specific note-keeping for video sessions
• Cross-state licensing is complicated (client must be in state you're licensed in during session)
• HIPAA applies to your video platform (use compliant tools only)

Check your licensing board's telehealth guidelines. They've updated a lot since 2020.

Frequently Asked Questions

Do I need separate informed consent forms for telehealth?

Yes. Most licensing boards and liability insurance providers require a specific "Telehealth Consent" form that outlines risks (tech failure, privacy) and procedures for emergencies.

Can I treat a client who is on vacation in another state?

Usually, no. Psychology and counseling licenses are state-specific. You typically must be licensed in the state where the client physically is at the time of the session. Check widely, but assume "no" until verified otherwise.

Is Skype HIPAA compliant?

Standard Skype is not. Skype for Business (now Microsoft Teams) can be if configured correctly. It's safer to use dedicated telehealth platforms like Zoom for Healthcare, Doxy.me, or the built-in video tools in EHRs.

My Hybrid Schedule Template

Here's what a typical week looks like for me now:

Monday - Telehealth (9am-5pm, 8 clients) Tuesday - In-Office (10am-6pm, 6 clients) Wednesday - Telehealth (9am-3pm, 5 clients) Thursday - In-Office (10am-6pm, 6 clients) Friday - Flex/Admin (occasional telecalls, paperwork)

Total: 25 clients/week, 2 office days, reasonable energy management.

Quick Takeaways

1. Choose a scheduling model that matches your office situation
2. Create separate appointment types for each format
3. Build real transition time between formats
4. Communicate expectations clearly for each type
5. Let clients choose format but within your structural constraints
6. Telehealth often has better show rates (counter-intuitively)

Hybrid practice is here to stay. Once you nail the scheduling, it actually offers more flexibility than either format alone.

Just don't try to do both on a whim. That way lies chaos.