Connecting Through the Screen: A Real-World Guide to Online Therapy

If you're still unsure about whether online therapy is for you, read on...

How it all started:

My own journey into the realm of online therapy began in 2011, long before the term 'Covid-19' became a household name. Back then, gaining qualifications in online counselling was quite a pioneering step, but also mandatory for anyone wanting to provide therapy over the internet. That's right, we actually needed to complete additional training courses in order to be allowed to practice online, especially those of us who worked with health insurance providers. We had separate contracts for our online work as well as different billing codes. 

Today, I work exclusively online, and in this blog post, I'd like to share some of the pros and cons of online therapy, along with some of the key considerations for anyone thinking about starting therapy online. 

Here's how Online Therapy can benefit you: 

Accessibility and Convenience: One of the most significant advantages of online therapy is its accessibility. Clients can access support from the comfort of their own homes, eliminating the need for travelling to your therapist's office. This is especially beneficial for clients with mobility issues or those living in remote area. It's of course also a great time saver - no more sitting in traffic, navigating public transport, or cancelled taxis because it's raining (yep, that has actually happened to several of my clients who had to rely on rebooked taxi services!)

Flexibility: Online sessions can be more easily scheduled around both clients' and therapists' busy lives. This flexibility supports a much better work-life-therapy balance. I have found that since I've been working exclusively online, I can see more clients and schedule appointments more flexibly, all while keeping my own work-life balance at a much better place than where it used to be before. I now see more clients than I used to when I worked from an external clinic. I'm also much more willing to squeeze in an extra appointment at short notice as a one off if needed, whilst still feeling that I do roughly the same amount of work as before. 

Comfort and Familiarity: Being in a familiar environment can help clients feel more at ease, potentially leading to more open and honest conversations. As you're in control of your immediate environment, you can make sure that you have everything you need to feel comfortable. Want to wrap yourself in a blanket? Go ahead! And yes, sometimes clients even bring their plushies to the session and introduce them to me.  

Broader Range of Therapists: When you choose to work online, you aren't limited to therapists in your geographic location, allowing you to find a therapist who truly suits your needs and preferences. It also means that it is much easier to get access to a therapist who specialises in a certain field or practices in a very specific way. It also means that you can continue to see your regular therapist, should you move or travel for work. 

Privacy: Online therapy offers a degree of anonymity and privacy that some clients might prefer, especially those hesitant about visiting a traditional therapy office. Especially Cambridge, where I've been practicing since 2005, can feel very "small" since Cantabrigians are connected through so many different groups and societies. When I did used to work face to face, I very regularly had clients who would remark: "I know someone who works in this building" and it wasn't uncommon at all for clients to ask to use the side entrance, bypass reception, or ask to avoid walking through certain corridors, because they knew someone who worked there. 

It's not all that straightforward though, and here's what you need to be aware of though: 

Technology Reliance: Online therapy requires a stable internet connection and a suitable device, including a working camera and good quality microphone.

What you need to consider: Do you have the right kit? Make sure you have reliable technology and a backup plan, such as potentially reverting to telephone sessions, in case of technical issues. I usually asks my clients to provide me with a mobile phone number that I can reach them on to continue our session, in case the internet ever drops out completely. Keep in mind that your internet speed might wary, depending on what other household members are doing. Some browsers require you to authorise camera and microphone access within your system settings. Make sure that you do all of this in good time before your first appointment. Depending on your therapist and the type of therapy you're having, you may need to install Telehealth software on your machine, make an account, or simply have the correct access link. I usually send clients a reminder the day before the appointment, suggesting they set everything up well in advance. 

Interpersonal Distance: The lack of physical presence can sometimes make it harder to build a therapist-client rapport.
What you need to consider: Use video calls to create a more personal connection and establish strong communication practices from the start. Having said that, I do have several clients who prefer phone calls, especially if they have already spent a great deal of their day attending video meetings for work. Make sure you treat your therapy session in the same way you would a face to face session, even if you're talking on the phone. This might sound obvious, but avoid boiling the kettle or start clattering around in the kitchen - you'd be surprised how often that does happen! If you find that you get too easily distracted by your home environment, then going for a walk during your session might be an option. 

Privacy and Confidentiality Concerns: Ensuring privacy at home and data security online is crucial. What you need to consider: You will need to find a private space for your appointments.  Your therapist should insist on using use secure, encrypted Telehealth platforms for your sessions. Ask yourself whether you'll feel comfortable if there are other people in the building. Where client wear in-ear headphones, I sometimes suggest they take out on of them, so they feel more in control of the volume of their voice and can feel reassured that their not talking so loudly that others can overhear them. Make sure you tell everyone in your household that you must not be disturbed during your meeting (no need to tell them you're having therapy, if you'd rather not). You may even want to post a 'do not disturb' sign to your door, to ensure no-one comes in to ask you if you'd like a cup of tea. And even if you feel like you don't have any secrets from your partner of family, it goes without saying that you must be on your own and can't have someone else in the room with you, unless this has been explicitly agreed on with your therapist before the session!

Limitations with Certain Client Groups: I don’t see children or young people online, and it’s important to acknowledge that online therapy may not be suitable for everyone.
What you need to consider: Face-to-face therapy may be your only option if you cannot find a therapist willing to take you on. The reason I don't typically work with children or young people online is due to safeguarding issues that can arise when working remotely. I simply cannot guarantee that there isn't a hidden parent standing off screen listening in or coaching the client on what to say. 

So here's what you may want to consider before starting online therapy

Assess Your Individual Technological Needs: Check if you have the necessary technology, such as a smartphone, computer or tablet, with a working webcam and stable internet connection.

Create a Private Space: It's essential to have a confidential and quiet space where you can talk freely without interruptions.

Understand the Therapy Process: Find out how online appointments will work in practice, including session duration, communication methods, and emergency protocols.

Set Realistic Expectations: Keep in mind the potential limitations and advantages of online therapy and set realistic expectations for your therapeutic journey.

If you're still unsure, give it a try to see if you like it! 

Online therapy, while of course different from traditional face-to-face therapy, offers a flexible, accessible, and effective alternative for mental health support. As an experienced clinical psychologist, psychotherapist, and mental health coach, I specialise in providing comprehensive online therapy services. My qualifications and expertise, gained over years of practice and continuous learning, equip me to offer effective and empathetic support, helping clients navigate their mental health journeys with confidence and resilience. I am extremely enthusiastic about online therapy and remain committed to providing the highest quality of care, tailored to the unique needs of each client in the digital age.