Online therapy can sometimes sound like the budget version of “real” therapy.

You sit in front of a screen. Your counsellor is in another room—or another city. There is no waiting room, no journey home afterwards and no dramatic therapist’s office with an expensive sofa.

So does it actually work?

For many people and many common difficulties, research suggests that live online therapy can produce results broadly comparable with face-to-face therapy. This is especially well supported for structured approaches such as CBT and for difficulties including anxiety and depression. That does not mean online therapy is identical to meeting in person, or equally suitable for every client and every situation. (PMC)

The better question is not simply:

“Which format is best?”

It is:

“Which format will help me attend consistently, speak honestly and work well with this particular therapist?”

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What does the research actually say?

Studies comparing therapy by video with therapy delivered in the same room have generally found similar improvements across a range of common psychological problems.

A controlled study comparing video-based and face-to-face CBT found significant improvements in depression, anxiety, stress and quality of life in both groups, without a meaningful difference between the formats. (PMC)

A systematic review of video-delivered CBT also found that it was effective across the conditions studied, while noting that stronger evidence is still needed for some specific diagnoses. (PMC)

For depression specifically, a review of direct comparisons concluded that video-based psychotherapy was roughly comparable with in-person treatment. (PubMed)

The honest conclusion is therefore not that online therapy is always “just as good.” It is that online therapy can be highly effective, and the evidence does not support treating it as automatically inferior.

Results still depend on the therapist, the client, the problem being addressed, the quality of the relationship and whether the format suits the work.

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The screen is not necessarily the biggest factor

People sometimes imagine that therapy works mainly because two people are physically sitting together.

Being in the same room can matter. You may notice someone’s posture more clearly. Silence can feel different. The physical separation between therapy and ordinary life may help you focus.

But therapy is not created by furniture.

A counsellor does not become more insightful because there is a plant in the corner and a box of tissues on the table.

What usually matters more is whether you feel able to speak openly, whether the counsellor understands what is happening, whether they can work competently with your difficulties and whether the sessions lead somewhere useful.

Think of The Bear. Carmy can be surrounded by people in the same kitchen and still feel completely unreachable. Physical proximity does not automatically create connection.

The opposite can also be true. Two people can be speaking through screens and still have an honest, focused and emotionally significant conversation.

Online therapy can make it easier to actually attend

A theoretically perfect counselling room is not much use if getting there becomes another weekly battle.

In-person therapy may involve:

• travelling across the city

• leaving work early

• finding parking

• waiting for delayed buses

• arranging childcare

• explaining where you are going

• cancelling when you travel or move

Online therapy removes some of those barriers and can make regular attendance more realistic. Accessibility and convenience are among the main reasons remote mental-health services have expanded. (American Psychiatric Association)

For example, imagine two versions of the same Tuesday.

In one, you finish work, rush through Bristol traffic, arrive ten minutes late and spend the first part of the session trying to calm down.

In the other, you close your work laptop, make a drink, take five minutes and join from a private room.

For some people, the second version creates better conditions for therapy.

For others, staying at home means distractions, family members nearby and no mental transition into the session. In that case, travelling to a counselling room may be useful rather than inconvenient.

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Some people speak more openly online

The slight distance created by a screen can make difficult subjects easier to approach.

You may feel less watched. You may find it easier to pause, think or talk from a familiar space. BACP’s online-therapy competence material recognises that online communication can sometimes increase openness or disinhibition, although this also needs to be handled carefully. (BACP)

It is a little like the difference between sending a voice note and speaking in a crowded room.

The content may be the same, but the setting changes what you can access.

In Sex Education, many of the characters can discuss intensely personal issues once they feel they have a space where embarrassment will not immediately take over. The point is not the fictional “clinic.” It is the permission to say the thing they have been editing in their head.

Online therapy can sometimes create that permission.

It can also make avoidance easier. You may minimise the video window, check another tab or remain emotionally distant. A competent online therapist should notice how the format is affecting the work rather than pretending the screen changes nothing.

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In-person therapy offers something online cannot fully reproduce

There are genuine differences.

In the same room, a counsellor may notice more of your movement, posture and physical tension. The shared environment can help some clients feel contained and present. Leaving the house for therapy can also create a useful boundary around the session.

After a difficult in-person session, the journey home may give you time to process.

After an online session, you might close the laptop and immediately hear:

“What are we having for dinner?”

That transition can be abrupt.

This does not make online therapy ineffective. It means that the practical setup matters.

A good online routine might include:

• joining from a private room

• using headphones

• silencing notifications

• avoiding work tabs during the session

• leaving ten minutes afterwards before returning to normal tasks

You are not creating a spa ritual. You are simply giving your mind enough space to register that something important has happened.

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Online therapy is not the same as texting an app

“Online therapy” can describe several very different services.

It may mean:

• live weekly video sessions with the same qualified counsellor

• telephone counselling

• text or voice-message exchanges

• structured digital CBT programmes

• automated wellbeing tools

• large subscription platforms where therapists may change

These should not all be treated as equivalent.

The research on live videoconferencing cannot automatically be used to prove that every mental-health app or messaging service is equally effective. A 2024 trial comparing message-based psychotherapy with video therapy, for example, treated them as distinct formats rather than assuming they provided the same experience. (PubMed)

When I refer to online therapy here, I mainly mean live, confidential sessions with a consistent, professionally trained therapist.

It is closer to a normal therapy session conducted through video than to messaging a customer-service chatbot about your childhood.

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Does the therapeutic relationship still work online?

A common concern is that online counselling will feel distant, artificial or awkward.

Sometimes the first few minutes do.

You may be unusually aware of your own face in the corner of the screen. Eye contact is not perfectly aligned. Someone freezes in a strange expression because the Wi-Fi drops.

Then, usually, your attention moves to the conversation.

Research on remote therapy has generally found that a meaningful therapeutic relationship can be established online, although experiences vary and the therapist needs specific competence in working remotely. (BACP)

Think of how relationships are shown in Heartstopper. Some important moments happen face to face, but messages, calls and distance are also part of how people reveal what they cannot immediately say out loud.

The medium influences the interaction. It does not automatically make the interaction fake.

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When might in-person therapy be preferable?

In-person work may suit you better when:

• you do not have a private or safe space at home

• you find screens exhausting or emotionally distancing

• you struggle to remain engaged during video calls

• being physically present helps you feel grounded

• important non-verbal or body-based work is difficult to do online

• you need a level of care or crisis support that ordinary online counselling cannot provide

Online counselling should not be presented as suitable for everybody.

A responsible counsellor should assess whether remote work is appropriate, discuss confidentiality and emergencies, know your location during sessions when necessary and have a clear plan for technical problems. BACP’s current online and phone therapy framework sets out specific competences for safe remote practice. (BACP)

Sometimes a blended arrangement, specialist service or more intensive local support may be more appropriate.

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When might online therapy be the better fit?

Online therapy may work particularly well if:

• you travel regularly

• you live away from the therapist you want to work with

• your local options feel limited

• commuting would make attendance inconsistent

• disability, illness or caring responsibilities make travel difficult

• you feel more able to speak from your own environment

• continuity matters because you may move city or country

• you simply prefer video sessions

Preference matters more than people sometimes admit.

There is no prize for choosing the format that looks more serious.

Lorde did not need to record Melodrama in your living room for the album to reach you. Emotional impact is not always dependent on physical co-presence.

Therapy is different from music, obviously—but the underlying point stands: something can be mediated through technology without becoming emotionally meaningless.

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What makes online therapy work well?

The format is only one part of the equation.

Online therapy is more likely to be useful when:

• the therapist has appropriate training and experience

• you meet consistently rather than only when things become unbearable

• the technology is reliable enough not to dominate the session

• you have privacy

• both of you can discuss problems in the therapeutic relationship

• the counsellor does more than nod professionally at the webcam

• the work matches what you actually need

A therapist can be excellent in person and poor online.

They may struggle with silence through a screen, fail to discuss privacy or behave as though video therapy requires no additional thought.

Equally, an online therapist may be attentive, active and highly skilled at noticing changes in expression, voice, pacing and engagement.

The delivery method matters.

The person delivering it matters more.

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So, which should you choose?

Choose in-person therapy because the room, physical presence and separation from home help you engage—not because it seems more legitimate.

Choose online therapy because it suits your life and allows you to work well—not because it feels easier to cancel at the last minute.

You could ask yourself:

“Where am I more likely to speak honestly?”

“Which option can I attend consistently?”

“Do I have genuine privacy online?”

“Do I want the structure of travelling somewhere?”

“Am I choosing based on my needs, or based on what therapy is supposed to look like?”

There is no universally superior answer.

There is only the format that creates the best conditions for useful work between you and your therapist.

 

How I work

I offer counselling online rather than from a physical counselling room.

This means I can work with clients in different parts of the UK, including people whose schedules, location or lifestyle make regular in-person sessions difficult. My website describes my work as online counselling for anxiety, trauma, depression, ADHD and relationship difficulties. (counselling)

I will not tell you that online therapy is ideal for everybody.

During an initial consultation, we can discuss what you are looking for, what has or has not worked before and whether meeting online seems appropriate.

You can start with something simple:

“I’m interested, but I’m not sure whether talking through a screen will work for me.”

That is a reasonable question—not a commitment.