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Online Therapy - are you missing out on anything compared to in-person therapy?

Updated: Nov 11, 2020

Online therapy has gained popularity over the past few years and can be beneficial in many ways. This post outlines some research into the topic to date and the benefits to clients, I also briefly cover text-based interventions and telephone therapy as well.

Research is consistently showing that online therapy is as effective as in person therapy (links below) and so I am proud to offer this option as part of Sophie Wild Robin. Research has suggested that clients of online therapy show more stability with treatment outcomes (the benefits to therapy) over time. Studies are being conducted that compare the effectiveness of the different components of therapy which are considered central to its success. Current research has provided confidence that there are no detriments to therapies success and components like working alliance (ability to build rapport, share issues and openly communicate) when receiving therapy online. Various case studies have suggested that video-conferencing counselling can be an effective means of treatment delivery (Simpson, 2009).

I offer psychotherapeutic counselling online via secure video conferencing to your home, office or wherever you feel safe and is private. You only need a good internet connection (streaming video without issue is a good gauge) and a computer, laptop, tablet or smartphone. Using headphones or earbuds increases the feeling of privacy and improves sound quality for us both. So what are the benefits to you:

  • You can have therapy anywhere that is comfortable and convenient for you

  • You are not having to add travel time or costs into the equation

  • You have a greater choice of therapists than if you were restricted by location

  • Having fewer visual distractions often encourages focus and concentration

  • You may find that you are more comfortable online or that it is easier to talk from somewhere you know

  • I am able to provide continuous support even if either of us relocates or you go on holiday or a business trip abroad

  • I can be more flexible with scheduling than I could for my services in-person, meaning that it is easier for me to work around your schedule (just ask if a slot you want isn't available, I might be able to open one for you)

  • Depending on the platform used, I can instantly share handouts and further information with you to support what we are looking at/working on (this is possible in Skype)

  • If there is something you are struggling to verbalise, you have the option to type-out in the 'chat' function, which can be liberating for you (especially if you feel your handwriting is poorly read)

  • All remote therapies have added confidentiality to the client by way of not needing to attend a centre for therapy which some people find limits the confidentiality they have in-case they are seen by someone they know

Text-based online counselling: Research evaluating text-based online counselling generally tends to support the effectiveness of the interventions (Barak and Grohol, 2011; D’Arcy et al., 2015). In their meta-analysis comparing face-to-face and online therapy (based on 14 studies and 9764 clients), Barak et al. (2008) found no significant differences between therapy delivered face-to-face and online. Some evidence based on qualitative research suggests that online counselling might be a more comfortable and less threatening experience than a face-to-face session, which could be especially relevant for clients who experience social anxieties (Suler, 2010; D’Arcy et al., 2015).

In text-based online counselling, clients can benefit from the sole focus on writing/typing about thoughts and feelings, as suggested by the research literature on the therapeutic effects of expressive or reflective writing (Stuckey and Nobel, 2010; Goss, 2013). Research shows that expressive writing has the potential to alleviate stress and anxiety, and improve wellbeing and understanding of oneself, which can be explained by emotion regulation processes (Koole, 2009).

Writing about difficult experiences seems to help clients to reflect on deep thoughts and feelings, and to articulate interior processes (Rimé, 2009), thus facilitating one’s ability to cope with challenging experiences (Gortner et al., 2006). In text-based online counselling, we can utilise these benefits of reflective, focused writing by helping a client to explore and express their feelings (Wright, 2002).

You also have the ability to self-monitor what you have written before you send it which isn't possible with other methods.

Phone-based therapy: Has been shown to be effective (Leach and Christensen, 2006), and client satisfaction and acceptance of telephone psychotherapy has also found to be high (Reese et al., 2006; Bee et al., 2008). Irvine et al.’s (2020) review of research on interactional aspects of phone-based counselling found little evidence of difference between phone/audio-only and face-to-face counselling in terms of therapeutic alliance, disclosure, empathy, attentiveness or participation.

Links to research:


Andersson, G. (2018) ‘Internet interventions: past, present and future’, Internet Interventions, vol. 12, pp. 181–8.

Anthes, E. (2016) ‘Mental health: there’s an app for that’, Nature, vol. 532, no. 7597, pp. 20–23 [online]. Available at: news/ mental-health-there-s-an-app-for-that-1.19694[Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] (accessed 31 March 2020).

Association for Counselling and Therapy Online (ACTO), (accessed 31 March 2020).

Backhaus, A., Agha, Z., Maglione, M.L., Repp, A., Ross, B., Zuest, D., Rice-Thorp, N.M., Lohr, J. and Thorp, S.R. (2012) ‘Videoconferencing psychotherapy: a systematic review’, Psychological Services, vol. 9, no. 2, pp. 111–31.

Balick, A. (2014) ‘How to think about psychotherapy in a digital context’, in Weitz, P. (ed.) Psychotherapy 2.0: Where Psychotherapy and Technology Meet, London: Karnac.

Barak, A. and Grohol, J.M. (2011) ‘Current and future trends in Internet-supported mental health interventions’, Journal of Technology in Human Services, vol. 29, no. 3, pp. 155–96.

Barak, A., Hen, L., Boniel-Nissim, M. and Shapira, N. (2008) ‘A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions’, Journal of Technology in Human Services, vol. 26, nos. 2–3, pp. 109–60.

Bee, P.E., Bower, P., Lovell, K., Gilbody, S., Richards, D., Gask, L. and Roach, P. (2008) ‘Psychotherapy mediated by remote communication technologies: a meta-analytic review’, BMC Psychiatry, vol. 8, p. 60.

Bennion, M.R., Hardy, G., Moore, R.K. and Millings, A. (2017) ‘E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services’, BMJ Open, vol. 7, no. 1, e014844.

Berger, T. (2016) ‘The therapeutic alliance in internet interventions: a narrative review and suggestions for future research’, Psychotherapy Research, vol. 27, no. 5, pp. 511–24.

British Association for Counselling and Psychotherapy (BACP) (2016a) ‘Telephone and e-counselling’ [online]. Available at: media/ 2045/ bacp-competences-for-telephone-ecounselling.pdf (accessed 30 March 2020).

British Association for Counselling and Psychotherapy (BACP) (2016b) Telephone and E-counselling Training Curriculum, Lutterworth: BACP [online]. Available at: media/ 2046/ bacp-telephone-ecounselling-training-curriculum.pdf (accessed 30 March 2020).

British Association for Counselling and Psychotherapy (BACP) (2018) Ethical Framework for the Counselling Professions, Lutterworth: BACP [online]. Available at: media/ 3103/ bacp-ethical-framework-for-the-counselling-professions-2018.pdf (accessed 30 March 2020).

British Association for Counselling and Psychotherapy (BACP) (2019a) The General Data Protection Regulation (GDPR) Legal Principles and Practice Notes for the Counselling Professions, Good Practice in Action 105, legal resource, Lutterworth: BACP [online]. Available at: wp-content/ uploads/ 2019/ 03/ bacp-gdpr-legal-resource-gpia105-feb19.pdf (accessed 31 March 2020).

British Association for Counselling and Psychotherapy (BACP) (2019b) Using Digital Technology in the Counselling Professions, Good Practice in Action 107, research overview, Lutterworth: BACP.

British Association for Counselling and Psychotherapy (BACP) (2019c) Working Online in the Counselling Professions, Good Practice in Action 047, fact sheet, Lutterworth: BACP [online]. Available at: media/ 2162/ bacp-working-online-supplementary-guidance-gpia047.pdf (accessed 30 March 2020).

British Association for Counselling and Psychotherapy (BACP) (2020a) ‘Using online counselling platforms: example client information sheets’, 27 March [online]. Available at: news/ news-from-bacp/ coronavirus/ online-counselling-client-information-sheets/ (accessed 31 March 2020).

British Association for Counselling and Psychotherapy (BACP) (2020b) ‘Working online: resources for members’, 30 March [online]. Available at: events-and-resources/ working-online-resources/ (accessed 31 March 2020).

British Association for Counselling and Psychotherapy (BACP) (2020c) ‘FAQs: Coronavirus and counselling services’, 1 April [online]. Available at: news/ news-from-bacp/ coronavirus/ coronavirus-and-counselling-services/ (accessed 1 April 2020).

Buckingham, D. (2013) ‘Making sense of the “digital generation”: growing up with digital media’, Self & Society, vol. 40, no. 3, pp. 7–15.

Carlbring, P., Andersson, G., Cuijpers, P. Riper, H. and Hedman-Lagerlöf, E. (2018) ‘Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis’, Cognitive Behaviour Therapy, vol. 47, no. 1, pp. 1–18.

Cipoletta, S., Frassoni, E. and Faccio, E. (2018) ‘Construing a therapeutic relationship online: an analysis of videoconference sessions’, Clinical Psychologist, vol. 22, no. 2, pp. 220–29.

D’Arcy, J., Reynolds, W., Stiles, W.B. and Hanley, T. (2015) ‘The online calming effect: does the internet provide a more comfortable modality for conducting psychotherapy?’, in Riva, G., Wiederhold, B.K. and Cipresso, P. (eds) The Psychology of Social Networking: Identity and Relationships in Online Communities, pp. 17–28, Warsaw/Berlin: De Gruyter Open.

Ersahin, Z. and Hanley, T. (2017) 'Using text-based synchronous chat to offer therapeutic support to students: a systematic review of the research literature', Health Education Journal, vol. 76, no. 5, pp. 531–43.

Fenger, M., Lindschou, J., Gluud, C., Winkel, P., Jørgensen, L., Kruse-Blinkenberg, S. and Lau, M. (2016) ‘Internet-based self-help therapy with FearFighter™ versus no intervention for anxiety disorders in adults: study protocol for a randomised controlled trial’, Trials, vol. 17, no. 1, p. 525.

Fletcher-Tomenius, L. and Vossler, A. (2009) ‘Trust in online therapeutic relationships: the therapist’s experience’, Counselling Psychology Review, vol. 24, no. 2, pp. 24–34.

Gibson, K. and Cartwright, C. (2014) ‘Young people's experiences of mobile phone text counselling: Balancing connection and control’, Children and Youth Services Review, vol. 43, pp. 96–104.

Gortner, E., Rude, S.S. and Pennebaker, J.W. (2006) ‘Benefits of expressive writing in lowering rumination and depressive symptoms’, Behaviour Therapy, vol. 37, no. 3, pp. 292–303.

Goss, S. (2013) ‘Research review: therapeutic writing’, TILT [Therapeutic Innovation in Light of Technology] Magazine, vol. 3, no. 4, pp. 10–12.

Hanley, T. (2012) ‘Understanding the online therapeutic alliance through the eyes of adolescent service users’, Counselling and Psychotherapy Research, vol. 12, no. 1, pp. 35–43.

Hanson, M. (2020) ‘Zoom finally gets a much-needed security feature – but there’s a catch’, TechRadar, 14 April [online]. Available at: news/ zoom-finally-gets-a-much-needed-security-feature-but-theres-a-catch (accessed 15 April 2020).

Huang, P. (2020) ‘COVID-19 self care: tips from the World Health Organization’, National Public Radio, 26 March [online]. Available at: sections/ coronavirus-live-updates/ 2020/ 03/ 26/ 822114301/ covid-19-self-care-tips-from-the-world-health-organization (accessed 30 March 2020).

Information Commissioner’s Office (n.d.) ‘Data protection and coronavirus: what you need to know’ [online]. Available at: for-organisations/ data-protection-and-coronavirus/ (accessed 31 March 2020).

Inter-Agency Standing Committee (2020) Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak, Interim Briefing Note, version 1.5, February [online]. Available at: iasc-reference-group-mental-health-and-psychosocial-support-emergency-settings/ interim-briefing (accessed 31 March 2020).

Irvine, A., Drew, P., Bower, P., Brooks, H., Gellatly, J., Armitage, C.J., Barkham, M., McMillan, D. and Bee, P. (2020) ‘Are there interactional differences between telephone and face-to-face psychological therapy? A systematic review of comparative studies’, Journal of Affective Disorders, vol. 265, pp. 120–31.

JISC (2014) ‘Evaluating digital services: a visitors and residents approach’, 7 May [online]. Available at: full-guide/ evaluating-digital-services (accessed 14 April 2020).

Koole, S.L. (2009) ‘The psychology of emotion regulation: an integrative review’, Cognition and Emotion, vol. 23, no. 1, pp. 4–41.

Leach, L.S. and Christensen, H. (2006) ‘A systematic review of telephone-based interventions for mental disorders’, Journal of Telemedicine and Telecare, vol. 12, no. 3, pp. 122–9.

Martinez, C. and Farhan, I. (2019) Making the Right Choices Using Data-driven Technology to Transform Mental Healthcare, London: Reform Report.

NHS (n.d. 1) ’10 tips to help you if you are worried about coronavirus’, One You [online]. Available at: oneyou/ every-mind-matters/ coronavirus-covid-19-anxiety-tips/ (accessed 31 March 2020).

NHS (n.d. 2) ‘Mental health apps’, NHS Apps Library [online]. Available at: apps-library/ category/ mental-health/ (accessed 30 March 2020).

Norwood, C., Moghaddam, N.G., Malins, S. and Sabin‐Farrell, R. (2018) ‘Working alliance and outcome effectiveness in videoconferencing psychotherapy: a systematic review and noninferiority meta‐analysis’, Clinical Psychology & Psychotherapy, vol. 25, no. 6, pp. 797–808.

OCLC Research (2020) ‘Digital visitors and residents: what motivates engagement with the digital information environment?’ [online]. Available at: research/ themes/ user-studies/ vandr.html (accessed 14 April 2020).

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Proctor, B.J., Moghaddam, N., Vogt, W. and Das Nair, R. (2018) ‘Telephone psychotherapy in multiple sclerosis: a systematic review and meta-analysis’, Rehabilitation Psychology, vol. 63, no. 1, p. 16.

Reese, R.J., Conoley, C.W. and Brossart, D.F. (2006) ‘The attractiveness of telephone counseling: an empirical investigation of client perceptions’, Journal of Counseling & Development, vol. 84, no. 1, pp. 54–60.

Rimé, B. (2009) ‘More on the social sharing of emotion: in defense of the individual, of culture, of private disclosure, and in rebuttal of an old couple of ghosts known as “cognition and emotion”’, Emotion Review, vol. 1, no. 1, pp. 94–6.

Russel, G.I. (2015) Screen Relations, London: Karnac.

Scharff, J. (2012) ‘Clinical issues in analysis over the telephone and internet’, International Journal of Psychoanalysis, vol. 93, no. 1, pp. 81–5.

Simpson, S.G. (2009) ‘Psychotherapy via videoconferencing: a review’, British Journal of Guidance and Counselling, vol. 37, no. 3, pp. 271–86.

Simpson, S.G. and Reid, C.L. (2014) ‘Therapeutic alliance in videoconferencing psychotherapy: a review’, The Australian Journal of Rural Health, vol. 22, no. 6, pp. 280–99.

Stuckey, H.L. and Nobel. L. (2010) ‘The connection between art, healing and public health: a review of the current literature’, American Journal of Public Health, vol. 100, no. 2, pp. 254–63.

Suler, J. (2004) ‘The online disinhibition effect’, Cyberpsychology & Behaviour, vol. 7, no. 3, pp. 321–6.

Suler, J. (2010) ‘The psychology of text relationships’, in Kraus, R. Stricker, G. and Speyer, C. (eds) Online Counseling: A Handbook for Mental Health Professionals, pp. 22–53, San Diego, CA: Elsevier.

Tao, L. (2015) ‘Teleanalysis: problems, limitations, and opportunities’, in Scharff, J. (ed.) Psychoanalysis Online 2, London: Karnac.

Vincent, C., Barnett, M., Killpack, L., Sehgal, A. and Swinden, P. (2017) ‘Advancing telecommunication technology and its impact on psychotherapy in private practice’, British Journal of Psychotherapy, vol. 33, no. 1, pp. 63–76.

Weitz, P. (ed.) (2014) Psychotherapy 2.0. Where Psychotherapy and Technology Meet, London: Routledge.

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Wright, J. (2002) ‘Online counselling: learning from writing therapy’, British Journal of Guidance and Counselling, vol. 30, no. 3, pp. 285–98.

I follow the BACP and ACTO guidelines for working online and in-person as a therapist.

Hope this has been informative,


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