Even advocates for online counseling agree that many mental-health problems have symptoms that cannot be properly treated without in-person services and so should automatically be precluded from online therapy. While no conclusive research has been done to date, the issues that therapists should not attempt to treat online might include sexual abuse as a primary issue, violent relationships, eating disorders, and psychiatric disorders that involve a distortion of reality.

At first glance it might seem that some people’s conditions—e.g., social phobia, avoidant personality disorder or agoraphobia--would make them good candidates for online text-based therapy since individuals who have these conditions experience such symptoms as fear of embarrassment, anxiety surrounding the missing of social cues, and the inability to risk interpersonal rejection when having to meet with someone in person. However, the solution to treating conditions characterized by social anxiety (being highly fearful of social interaction) lies central to the problem.

Repeated person-to-person encounters, beginning with the relationship of trust established with the therapist, can progressively reinforce successful social interaction for the individual and is one of the crucial means of alleviating the anxiety and thus successfully treating their condition. And so, while text-based therapy eliminates the need to experience initial uneasiness in meeting face-to-face with the therapist, it avoids the experience of person-to-person help that can be crucial to recovery.