Introduction: For in-person psychotherapy, psychotherapists make individual adaptions to meet clients' disability-related needs, for example, by providing plain or sign language. Such adaptations apply to different types of psychotherapy (e.g. psychodynamic, systemic, or cognitive-behavioral). Digital interventions, such as video psychotherapy or internet interventions, allow more flexibility in terms of design, individual preferences, and integration of text, video, or audio. Methods: This clinical perspective explores issues associated with the delivery of psychotherapy using traditional in-person sessions vs digital interventions utilizing literature related to the topic. The evidence is synthesized to build an argument of the relative merits and challenges of either approach to the psychotherapeutic encounter of people with intellectual and developmental disabilities. Results: For cognitive disabilities, the needs for in-person and digital psychotherapy interventions were comparable and focused on simple/plain language, reducing session complexity, and linear therapy structure. For motor, hearing, and visual impairments, the needs differed between the two forms of psychotherapy. Conclusion: Involving the target group in design and testing of digital interventions was considered critical.