Unpaywalled: https://www.nytimes.com/2025/10/30/health/text-therapy-effec...

Details are bigger than sales pitch headline “Dr. Areán said many in the mental health field have lingering concerns about the text model, because the therapist is not face to face with the patient and may miss danger signs. But there were no adverse events in the trial, she said. The trial participants were more likely to drop out of video-based therapy than text-based. But at the same time, the researchers reported, the video sessions appeared to create a slightly stronger bond with therapists, who were viewed by patients as warmer and more compassionate. When some participants switched from text-based to video sessions in a second phase of the trial, the quality of the bond improved significantly. Dr. Areán said the gap in therapeutic bonding merited further research. “How do you build alliance when you can’t see the person?” she said. “How do you deal with silences when you can’t see them? Are they crying? Are they happy?”