I was sceptical about online therapy for longer than I’d like to admit. The work I do is relational; it rests on two people in a room together, and a screen seemed like exactly the wrong place for it. Then, like most therapists, I was pushed into it whether I liked it or not, and what I found didn’t match what I’d assumed. So when people ask me whether online therapy works, I can answer from both sides of the question: the research, and several years of doing it.
What the research says
The evidence here is more settled than most people expect. Study after study, including large reviews comparing video therapy directly with in-person work, has found that outcomes are broadly equivalent for the most common reasons people seek help: anxiety, depression, stress, relationship difficulties. The therapeutic alliance, which is the strongest predictor of whether therapy helps at all, forms over video much as it does in person. Clients report similar levels of trust, similar depth of work, similar results.
That surprised researchers too, initially. The assumption was that something essential would be lost through a screen. What the data kept showing was that the essential thing isn’t the room; it’s the relationship, and the relationship turns out to be remarkably portable.
What my own practice has taught me
The research told me online therapy works in aggregate. Practice taught me something more specific: for some people, it works better.
There are clients who say things to me over video that I suspect would have taken months to surface in a room. Being in their own space, with their own mug of tea, their dog somewhere nearby, lowers something. The slight formality of travelling to an office, sitting in a waiting room, being in the therapist’s territory, all of that is gone. Some people open up faster when the setting belongs to them.
There’s also the plain practical fact of access. I work from Bude, in North Cornwall. If you live rurally, the nearest suitable therapist might be an hour’s drive away, and the therapist who’s actually right for you might be three counties over. Online work means you choose a therapist by fit rather than by postcode, and fit matters far more than geography ever did.
Who it suits less well
I’d be overselling it if I said online therapy works equally well for everyone, and the honest answer to “does online therapy work” has to include the exceptions. Some people genuinely need the ritual of going somewhere: the journey there is preparation, the journey home is digestion. Some find screens tiring or struggle to feel met through one. Where there’s significant crisis or risk, in-person support is usually more appropriate. And it depends on having somewhere private to talk, which not every home provides.
None of this makes online therapy a lesser version. It makes it a different doorway into the same work, and the right doorway depends on the person walking through it.
What matters more than the format
After several years of working both ways, my conclusion is that the format is one of the least important variables. What matters is whether you feel met. Whether the therapist is properly trained and registered; I’m registered with the NCPS, and any therapist you consider should be able to tell you who they’re accountable to. Whether the relationship feels like one in which something true could eventually be said.
If those things are present, the work happens, screen or no screen. If they’re absent, the nicest consulting room in Cornwall won’t make up for it.
I see clients in person in Bude and online across the UK. If you’re weighing up which would suit you, that’s a reasonable thing to ask me directly; it’s the kind of question a first conversation is for.
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