Online Therapy: Does it Actually Work?

When you first consider online therapy, you might find yourself asking whether it is the same as meeting in person. "Is something lost through a screen?" "Is it possible to do meaningful psychological work without being in the same room as another person?" These are reasonable questions, and they deserve a considered answer.

What the evidence suggests

The research on online therapy has expanded considerably over the past decade, particularly when the Covid-19 pandemic changed the landscape and made meeting online the 'new normal'. Research findings are broadly consistent: for the majority of people and for most psychological presentations, online therapy is can be as effective as in-person work. Studies comparing the two have found no significant difference in outcomes for anxiety, depression, trauma, relationship difficulties, and a range of other concerns. The therapeutic relationship (which is the strongest predictor of outcomes in any form of therapy) forms and develops online in much the same way as it does in person.

Research also generally finds that measures of feeling understood, client satisfaction, and engagement with therapy, are similar across online and in-person therapy. 

These findings are not a complete surprise. What really makes therapy useful is not the physical configuration of the room. It is the quality of attention paid by the therapist, the therapist's consistency and attunement within the relationship, and the safety of the space. None of those things require proximity.

What online therapy makes possible

Beyond the question of equivalence, online therapy offers something that in-person work simply can't: convenience and genuine accessibility. If you are someone who lives outside of a major city, or who has a demanding or unpredictable schedule, who travels regularly, or if the logistics of attending a physical appointment are a barrier in themselves, online therapy removes layers of friction that might otherwise prevent you from starting therapy at all.

Online therapy also removes geography as a constraint on finding the right therapist for you. The decision about who to work with can be made on the basis of fit, specialism, experience and approach, rather than simply who is closest to your home, or place of work or study.

What some people find easier online

Many people find the online format actively preferable, not simply more convenient. You may appreciate the 'zero commute' aspect of meeting online, and the ability to schedule an appointment at any convenient point in your day, not just the evenings when work or study are concluded. Speaking from a comfortable, familiar environment (such as your home, or another private space that you have personally chosen) can actually make it feel safer, less self conscious, and easier to open up. The slight reduction in intensity that comes with not being physically in the same room can be exactly what allows you to speak more freely. This is particularly true if you find close proximity stressful due to a history of trauma, or finding the idea of being physically observed or enclosed in a space with a less familiar other person, in itself a source of anxiety.

Other people feel more emotionally connected when they are in the same room as their therapist They find themselves better able to focus without potential home distractions, and that they gain more comfort from their therapist's physical presence and office structure. It really depends on individual preferences.

What requires attention in online work

Online therapy works best with a degree of intentionality about the environment. A private space, a reliable internet connection, and a genuine commitment to being present (rather than fitting a session between other things) make a meaningful difference.

While the 'zero commute' can be on the pros list for online therapy, the therapeutic frame matters online just as it does in person. We have to remember that therapy is a different type of appointment scheduling. I encourage all clients to reserve some time in the diary prior to therapy sessions to pause, prepare, and arrive, and following the therapy sessions to decompress, make notes, and integrate the therapy conversation. As with in-person therapy, close attention is paid to explaining confidentiality and safety, with GP details and emergency contact details requested for all clients, as part of rigorous risk assessment protocols and procedures, so that we can keep you safe. 

There are also some presentations for which in-person work may be preferable: certain forms of trauma work, or support for severe mental health challenges, where the physical presence of the therapist or team is part of what makes the work feel safe. 

So, what really matters

Research consistently finds that what really determines the success of therapy is a combination of:

• finding a therapist that you trust

• Receiving a therapy approach that you feel fits the challenges that you bring to therapy.

• Showing up consistently for sessions

• Feeling safe enough with your therapist, to be honest.

Those factors predict therapy outcomes much more strongly than whether the therapist is sitting across from you or appearing on a screen.

Getting started

If you have been considering therapy and have been uncertain about the online format, most people find that after an initial enquiry that their questions and any reservations are answered and addressed: you notice the quality of the conversation and relational connection rather than the screen.

I offer an initial free 30 minute conversation for anyone who would like to think together about whether online therapy might be a useful step. There is no obligation, and if I am not the right fit, I will try my best to point you in the direction of other suitable options.

Dr Erin Reid is a counselling psychologist offering online, telephone and 'Walk and Talk' therapy. She works with adolescents, adults, couples, and families across the UK and internationally. Visit www.drerinreid.com to find out more.