Online therapy

Online psychotherapy can be a helpful option for people who cannot make it to face to face appointments. Some people might live far from therapists (or the therapists or therapy approach they would like to try working with), or their schedule makes it hard to commit to regular in-person appointments. Sometimes people might have a reason that makes it hard to leave the house, such as a health or mobility issue, or caring commitments. And others might simply find the idea of connecting and communicating through a different medium like text or email an easier way to open up about the things they would like to discuss. 

Some important things are exactly the same as working face to face. For example, as your therapist, I am guided by the same ethical, professional, and legal frameworks as when working in person. We would still have a therapy agreement, and will make a commitment to working together collaboratively. And the same theoretical framework would underpin and inform the therapy process. 


There are of course some important differences when working online. The main difference is that we are not in the same room together, and in the case of email, we are not meeting at the same time. That means we don't have the full range of information we would have if we were meeting in person. With less non-verbal information, there is potentially more chance of misunderstandings, but we can manage this by seeking clarification and asking questions.

It must be noted that due to the nature of online therapy, some issues are not suitable for online work. These include issues of significant risk, such as active suicidal thoughts, psychosis, mania, some trauma issues, and some addiction issues. If you are not sure if this might apply to you, feel free get in touch to discuss. 

Lastly, there are some practical issues that must be arranged in advance. You must have access to and be able to operate the required technology (e.g. a fully working, updated and secure computer or smart phone or tablet), have internet access for the time of the appointment, and a place to conduct the appointment that is private and confidential. 



This is perhaps the closest to face to face therapy; sessions are synchronous (they happen in real time) and the client and therapist can see and hear each other. Sessions are 50 minutes and usually happen at the same time each week. However, only the head and shoulders can usually be seen on screen, which means there is less non-verbal communication available. 

We meet using a secure end-to-end encrypted video conferencing tele-medicine platform that meets HIPAA requirements. 

Choosing your online therapy: webcam, voice only, instant message or email

Each option has pros and cons (as do in-person face to face sessions). Have a read through the descriptions below, and if you find you are drawn to one approach in particular, you could trust that instinct and give it a go.   

You would be encouraged to try to give the medium a chance, rather than switching from one to another. But if after working with a particular medium for a while you feel it is not working for you, we can always have a review and consider trying a different medium.


Voice only

This is similar to webcam sessions, only without the webcam image. Sessions are synchronous (they happen in real time) and the client and therapist can only hear each other speaking. Sessions are 50 minutes and usually happen at the same time each week.


We don't have visual information in a voice only session, such as facial expression or body posture, and so we might need to check in sometimes to clarify meaning or a pause.


Some people prefer this medium to webcam and find they are better able to focus when they are just speaking and listening. 


Instant Message

Instant Message (IM) sessions involve meeting for 50 minutes online, typically once per week, and communicating via text message in real time using a secure platform. This can be a surprisingly useful way of conducting your therapy.

Whilst this medium doesn't appeal to everyone, the absence of visual and auditory information can actually make it easier for some people to open up, thereby getting quite quickly to the issues that are most pressing. 

These exchanges only take place during the pre-arranged appointment time. It is not possible to engage in therapeutic use of IM between scheduled appointments.



In this medium the sessions take place by email. You compose and send one email per week using a secure email platform with end-to-end encryption. We agree the day in the week in advance. I will then devote one therapy hour to reading and responding to your email, and will send you a reply within 48 hours. 

This medium is also entirely text based, but unlike the other options, it is asynchronous. That is, our communication is not live and our exchanges are not happening in real time. Some people really like this medium, and some think of it as being like journalling, only this time it is like your journal replies back to you!

It is up to you how you organise your time to write your email. You can write your thoughts down from time to time over the week, or you can devote an hour once per week, like a therapy appointment.