It is a fair question, and one worth asking before you commit several months to something. Therapy has always been described as a relationship — so it is reasonable to wonder whether that relationship holds up through a screen.
This article looks at what the research has found, where online therapy tends to work well, where in-person still has the edge, and how to decide which suits you. Both are legitimate ways to do serious psychological work.
Explore sections:
- What the research shows
- Why it works better than people expect
- The advantages people notice
- Where in-person has the edge
- Common worries about video sessions
- Making online therapy work well
- How to decide
- Starting therapy with a psychologist in the UK
What the research shows
Online therapy is not new, and it is not under-studied. It has been researched for over two decades, and that body of work expanded considerably after 2020, when most therapy in the UK moved online more or less overnight.
The broad finding is consistent: for common difficulties such as anxiety, depression, panic and post-traumatic stress, therapy delivered by video produces outcomes comparable to the same therapy delivered in a room. Reviews pooling many trials have generally found no meaningful difference in symptom improvement between the two.
Two other findings are worth knowing. The therapeutic alliance — the working relationship between client and therapist — tends to be rated similarly in both formats, which surprised a good many clinicians. And drop-out rates are often lower online, most likely because attending is simply easier.
This is why NHS services, private practices and insurers all now offer video therapy as standard rather than as a substitute.
Why it works better than people expect
The mechanics of therapy turn out to transfer well to video.
The active ingredients — understanding what maintains a difficulty, noticing patterns of thinking and behaviour, learning to sit with difficult feelings, being properly listened to — are conversational and relational rather than physical. They do not depend on sharing a room.
There is also something about being in your own space that some people find helps. Home has fewer of the associations that a clinical waiting room carries. People often report reaching difficult material sooner, partly because there was no anxious journey and waiting-room build-up beforehand.
And the face is closer. On video you see expression more clearly than across a consulting room, which is often more informative than the full-body view it replaces.
The advantages people notice
No travel. For weekly therapy over several months, an hour's round trip is a real cost in time, money and energy. It is one of the most common reasons therapy stops.
Wider choice. You are not limited to practitioners within driving distance, so you can choose on specialism rather than geography. This matters most in rural areas — see our guide to finding a psychologist in Exeter and Devon.
Continuity. Therapy continues through illness, bad weather, work travel, childcare gaps and house moves, instead of stopping and restarting.
Privacy. No waiting room, and no chance of meeting someone you know on the way in — which matters more in a small town than people from cities tend to appreciate.
Easier to start. For those who find leaving the house difficult, whether through social anxiety, agoraphobia, depression or a physical health condition, online removes the barrier that would otherwise prevent therapy altogether.
Where in-person has the edge
Being straightforward about this matters more than selling the format.
If home is not safe or private. Therapy needs a space where you can speak freely. If that does not exist at home, a consulting room provides it, and that is a strong argument for in-person work.
Certain body-based approaches. Some therapies involving physical work in the room are harder to deliver by video, though many adapt well.
Higher levels of risk. Where someone is at significant risk, in-person work embedded in a local service is usually more appropriate than private online sessions. A responsible practitioner will assess this at the outset and say so.
Personal preference. Some people simply concentrate better sharing a room, and find video tiring. That is a legitimate reason, not a failure to adapt.
Common worries about video sessions
"I will not feel a proper connection." This is the most common worry and the one most often disproved by the first session. Alliance ratings online are broadly comparable to in-person, and most people stop noticing the screen within a session or two.
"The technology will fail." Occasionally it does. In practice this is a minor interruption — you reconnect, or move to phone. Agreeing a backup with your therapist in advance removes most of the anxiety about it.
"It is not confidential." Registered practitioners use secure, encrypted platforms and are bound by the same confidentiality and record-keeping standards as in a consulting room. If you want to know exactly how your information is handled, ask — a good practitioner will explain it plainly.
"I have nowhere private." More solvable than it seems. Headphones make a significant difference, and many people attend from a parked car, a garden, a room booked at a library or a quiet office. Therapists are used to this.
Making online therapy work well
A few practical things make a noticeable difference:
- Use headphones — better sound, and considerably more private
- Choose a spot where you can see the screen without holding a device
- Have water and tissues to hand, as you would in a consulting room
- Close other applications and silence notifications
- Leave a few minutes either side, rather than joining from one meeting and leaving for another
- Agree with your therapist what happens if the connection drops
Treating the session as a protected hour, rather than something squeezed between other things, is most of what makes it work.
How to decide
If you are weighing it up, these questions usually settle it:
- Do I have a private, reasonably quiet space for an hour each week?
- Would travelling to sessions realistically stop me from continuing?
- Do I want a specialist who may not be nearby?
- How do I feel about video calls generally?
There is no wrong answer, and it need not be permanent. Many people begin online and find that within a few weeks the question stops occurring to them.
Starting therapy with a psychologist in the UK
Dr Kayleigh Darch is a HCPC-registered Clinical Psychologist offering online therapy to people living in Devon and across the UK. Sessions are held by secure video, drawing on CBT, CFT, ACT and trauma-focused approaches depending on what would help.
You might like to read more about how online therapy works, working with a psychologist in Exeter and Devon, or fees and health insurance. Our earlier article on therapy in the digital age covers the wider picture, and what to expect in a first session may help if you are close to booking.
The best way to find out whether it suits you is usually to try one conversation. Get in touch to arrange a free 15-minute introductory call.
Thank you for reading.