Does online therapy work? What to expect from therapy over video

Yes, for many people online therapy works well. Research broadly suggests that therapy delivered over video can be as effective as face-to-face therapy for many common difficulties, including anxiety and depression. What matters most is much the same in both settings: a qualified, registered therapist, a trusting relationship, and a private space where you can speak freely.

Key points

• Online therapy can be as effective as in-person therapy for many common difficulties, such as anxiety and depression.
• It offers flexibility, saves travel time and widens your choice of therapist.
• It may not suit everyone, for example people in crisis or without a private space at home.
• A little preparation (privacy, headphones, a few minutes either side) makes a real difference.
• Ask your therapist how they protect confidentiality and which platform they use.

What does the research suggest?

Online therapy has been studied for many years, and interest grew considerably when so much therapy moved online during the Covid-19 pandemic. Overall, research broadly suggests that for many common difficulties, such as anxiety, depression and stress, therapy over video can be as helpful as meeting in a room together.

Many therapists, myself included, have found that a genuine therapeutic relationship can form over video. Some clients say they find it easier to open up from the familiarity of their own home. Others miss being in the same room. Both experiences are valid, and it is fine to try online sessions and see how they feel for you.

What are the benefits of online therapy?

• Flexibility. Sessions can fit around work, childcare or caring responsibilities, without travel time.
• Choice. You are not limited to therapists near where you live, which can help if you are looking for particular experience or a shared language or background.
• Accessibility. It can help if you have a disability, a health condition, social anxiety or limited mobility, or if you live somewhere with few local options.
• Continuity. If you move, travel or have a busy period, you can often keep seeing the same therapist.
• Comfort. Some people feel safer and more relaxed in their own space.

What are the drawbacks?

• Privacy at home can be hard to find if you live with others or in a small space.
• Technology can interrupt the flow: poor connections, frozen screens or audio delays.
• Less body language. Your therapist sees less of you, and you see less of them, which can make some things harder to pick up.
• No transition. Without a journey to and from the session, it can be hard to settle in or to wind down afterwards.
• Screen fatigue. If you spend all day on video calls, another one may feel tiring.

Who might online therapy not suit?

Online therapy is not the right fit for everyone or every situation. It may not be suitable if:

• You are in crisis or at immediate risk of harming yourself, when more immediate and local support is needed.
• You do not have anywhere private to talk, or you are worried someone at home may overhear or monitor your sessions, for example in situations of domestic abuse.
• You are working through some kinds of trauma where being in the same room, with more support around the session, feels safer.
• You find screens very difficult, or have no reliable internet connection.

A good therapist will talk this through with you at the start, and may suggest in-person sessions, a different service, or a mix of both. Online therapy is usually not designed as a crisis service.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

How can I get the most out of a video session?

A few practical steps can make online sessions feel more contained and more like a protected space.

Before the session

• Find a private space where you will not be overheard. Some people use a bedroom, a parked car or a quiet room at work.
• Use headphones, which helps privacy and makes it easier to hear.
• Check your connection, charge your device and close other apps and notifications.
• Have water and tissues to hand.
• Give yourself a few minutes beforehand to arrive, rather than going straight from a work call.

During the session

• Sit somewhere comfortable with your face visible and the light in front of you rather than behind.
• Agree with your therapist what will happen if the connection drops, for example switching to a phone call.
• If something about the online format is getting in the way, say so. It is useful information.

After the session

Try to leave a few minutes before your next task. A short walk, a cup of tea or a moment to jot down anything that stood out can help you move from the session back into your day.

Is online therapy confidential?

Confidentiality works in much the same way online as in person. A therapist who is a member of a professional body such as the BACP follows an ethical framework that includes keeping what you share confidential, with limited exceptions (for example, if there is a serious risk of harm), which your therapist should explain at the start.

It is reasonable to ask your therapist which video platform they use and how they keep sessions secure. Many therapists use platforms with encryption and avoid recording sessions. You can also protect your own privacy by using a device and account that others do not have access to, and by using headphones.

How I work online

I offer online therapy by video to clients across the UK and internationally, as well as in-person sessions in Farringdon, Central London. Some clients work entirely online, some in person, and some move between the two depending on what suits them. In our first conversation we can talk about which might work best for you.

If you would like to explore whether online therapy could help, you are welcome to get in touch and book an initial consultation. It is a chance to ask questions, get a sense of how I work, and see how talking over video feels.