Five years ago, the world was shaken by a global pandemic that disrupted nearly every aspect of daily life. For therapists and their clients, this meant an abrupt transition from in-person sessions to digital platforms, where the therapeutic relationship was mediated by a screen. Initially, many were sceptical—how could therapy be effective without sharing a physical space? But as both therapists and clients adapted, online therapy not only became routine but, for many, a preferred and convenient alternative.

Despite early doubts, research has increasingly validated the efficacy of online therapy. Studies have found that virtual therapy sessions yield similar outcomes to traditional face-to-face therapy across a broad range of mental health concerns (Vitry et al., 2021; Giovanetti et al., 2022). Today, some therapists have returned to in-person practice, others have embraced a hybrid model, while many—myself included—have remained fully online.

The accessibility and flexibility of digital platforms like Zoom have made therapy more inclusive, extending support to those who might otherwise face geographical, logistical, or personal barriers. For some clients, online therapy offers a sense of safety and control that can be particularly beneficial, especially for those struggling with social anxiety or who find face-to-face interactions overwhelming.

The challenges of online therapy

While online therapy has proven effective, it does come with limitations. One of the most commonly cited concerns is whether the therapeutic alliance—the relationship between therapist and client—is as strong in a virtual setting. While studies suggest that a deep therapeutic bond can still be formed online, there are undeniable differences. The absence of certain non-verbal cues, like body language and facial expressions, requires therapists to work harder to read emotional states and pick up some of the more subtle and more nuanced moments in the room. Both anecdotal and more research-based evidence has suggested that in-person interactions might not be essential for effective therapy and that meaningful dynamics can be established online.

Another key issue to navigate is the risk of technical disruptions. Though this feels far less of a hindrance than it did back in 2020, I am mindful of the importance of internet connectivity problems, frozen screens, and audio lags that can break the flow of a session and impact the sense of presence and engagement. If these limitations do emerge, they can still provide useful conversational material. 

Additionally, ensuring that a client has a private and secure environment for therapy is crucial. Clients may face interruptions from family members, phone calls, or even doorbells ringing—distractions that wouldn’t typically occur in a professional therapy office. Again, I discuss this with clients and to date, it has rarely been an obstacle. 

A therapist does however have the client’s ‘world’ much closer to them so I have on occasions found it useful to respond to a client wanting to refer to something visible on the screen (e.g. a cat, a picture) or they might choose to bring something to me which can be a useful vehicle for our work.  Finally, confidentiality is another greater concern, requiring both therapist and client to take precautions to maintain privacy.   

When I work with clients, I will always speak to them as part of the initial consultation about the work and how it might not suit all.  If we do work together, we will think about the importance of being able to identify a quiet, private space where they feel safe to open up, the use of headphones and reliable devices with a stable internet connections. 

As part of my work, I will also review with clients as to how online therapy is working. Some clients work in a hybrid way so that there will be face to face sessions every now and again which can be helpful in enhancing the alliance. 

Adapting to the digital space

To make online therapy as effective as possible, both therapists and clients must be intentional about their virtual environment. Some best practices include:

• Creating a private, quiet space: Clients should ensure they have a confidential setting where they feel safe to open up.
• Using headphones and stable internet connections: This minimises external distractions and ensures clear communication.
• Setting boundaries: Just as in-person sessions have expectations around punctuality and attentiveness, online sessions should maintain similar professional standards.
• Utilising digital tools: Platforms like Zoom offer features such as screen sharing and interactive whiteboards, which can enhance the therapeutic process.

When online therapy may not be ideal

While online therapy is a valuable resource, it’s not a one-size-fits-all solution. Some clients may struggle with the format, whether due to discomfort with technology, difficulty engaging emotionally through a screen, or the need for more immediate in-person support—particularly in crisis situations. In cases of acute distress, online therapists may need to explore alternative methods, such as follow-up calls or additional support networks.

A blended approach: Finding what works

For some clients, a hybrid approach—combining online and occasional in-person sessions—can be a beneficial compromise. Meeting face-to-face periodically can help strengthen the therapeutic relationship while maintaining the flexibility of digital sessions.

Ultimately, the effectiveness of therapy—whether online or in-person—depends on the individual’s needs, preferences, and the strength of the therapeutic alliance. As digital therapy continues to evolve, it offers an accessible, adaptable, and often highly effective option for mental health support.  Online therapy does have a safety in that it can make it easier for those clients who struggle with the intensity of face-to-face work. Indeed, it will reduce social anxiety for many and might feel less overwhelming.  

The shift to online therapy was born out of necessity but has since become a legitimate and lasting option for many. While it may not replace traditional therapy entirely, it provides a valuable alternative that meets the needs of clients including younger ones, in particular millennials and those in Gen Z, whose lives are so digitally dominated.  

As technology advances and our understanding of virtual therapeutic relationships deepens, online therapy will likely continue to play a significant role in mental health care.

Whether therapy happens in a clinic or through a screen, what truly matters is the connection, trust, and work that takes place between therapist and client.

References

Giovanetti, A. K., Punt, S. E., Nelson, E. L., & Ilardi, S. S. (2022). Teletherapy versus in-person psychotherapy for depression: a meta-analysis of randomized controlled trials. Telemedicine and e-Health, 28(8), 1077-1089.

Vitry, G., Pakrosnis, R., Brosseau, O. G., & Duriez, N. (2021). Effectiveness and efficiency of strategic and systemic therapy in naturalistic settings: Preliminary results from a Systemic Practice Research Network (SYPRENE). Journal of Family Therapy, 0(0), 1–2. https://doi.org/10.1111/1467-6427.12343