If you’re thinking about starting therapy, one of the first questions is often whether to meet your therapist on a screen or in a room. I offer both, and I don’t think either one is better for everyone. In this post, I’ll go through what each format does well, what the research says, and a few questions to help you decide.
What the research says about effectiveness
Online therapy became far more common during the pandemic, and many people worried it wouldn’t work as well. Research so far is reassuring. A 2018 review and meta-analysis found that symptom improvement from video therapy was comparable to face-to-face therapy, and a 2024 meta-analysis found no significant difference in how strongly clients and therapists rated their relationship, which matters because, according to research, the quality of that relationship is one of the best predictors of how therapy goes.
The research mostly tells us about averages, though, and you aren’t an average. Most studies also focus on specific approaches and diagnoses, and they can’t tell us much about how it feels for you to sit in a particular room, or to sit in your own living room with a laptop. That’s where the two formats differ.
Where online therapy can help
It widens who can access therapy. Where you live shouldn’t decide whether you can find a therapist who suits you. Some areas have few therapists, and even fewer with expertise in a particular issue, language or culture. Online therapy lets you look beyond your postcode. In my view, finding someone who understands your background can matter more than finding someone close by.
It can make therapy possible when leaving the house is hard. For disabled people, or people living with agoraphobia or sensory sensitivities, travelling to an unfamiliar building can be a barrier, whether because of how accessible the space is, how overwhelming it feels, or the journey itself. Meeting from a familiar, comfortable space can remove it.
It can make the first step feel smaller. Many people find it easier to start therapy from home, and that matters, because the hardest part is often getting started. I’ve seen people who might never have walked into a therapy room feel able to book an online session.
Where in-person therapy can help
It gives therapists more to work with. Over a screen, I usually see your face and shoulders. In person, I can notice posture, breathing, small movements, and how you hold tension. Much of what we communicate happens beyond words, and the more I can see, the better I can respond to you.
It offers a private space. If you live with others, it can be hard to speak openly at home, even with headphones on. Having a dedicated space, away from your daily life, can make it easier to say what you haven’t said before.
It can be safer when things are very difficult. If you’re in a severe mental health crisis or working with trauma, it can be important that I’m physically with you. If you become overwhelmed, I can respond to what I see in the room, and I can make sure you leave in a settled state, rather than closing a laptop and being on your own. Many people do trauma work online successfully, but it needs careful planning.
So which one is right for you?
There’s no universal answer, and I’d be wary of anyone who claims there is. These questions might help:
Is there a therapist near you with the experience, language, or cultural understanding you’re looking for?
Is getting to a session a barrier for you, because of anxiety, sensory needs, mobility, time or cost?
Do you have a private, quiet space at home where you can speak freely?
Do you tend to open up quickly with distance, or do you feel safer with someone in the room?
Are you dealing with something very distressing, like a recent crisis or trauma?
Your answers can change over time, and so can your choice. Some people start online and move to in-person once they feel more settled, and some combine both.
Both formats can work well, and the research suggests that the relationship matters more than the medium. Online therapy opens doors for people who can’t easily reach a therapist or who find the first step daunting. In-person therapy offers a physical presence that can support deeper work, especially when things are very difficult. I’d encourage you to choose what feels safest and most workable for you right now, and to stay open to changing your mind.
If you’re not sure, that’s completely fine. Many first conversations are about working out what will suit you best, and you’re welcome to get in touch to talk it through.