Online therapy is no longer a fringe idea. Video-conference psychotherapy, guided internet CBT, and digitally enabled talking therapies have been studied in systematic reviews, health-technology guidance, public health systems and specialist services. The important question is not whether online therapy is always better or worse than meeting in person, but for whom it is suitable, what kind of therapy is being offered, and what safety arrangements are in place.
Sources checked May 2026. This page is educational and service-orienting. It does not diagnose, replace an individual clinical assessment, or provide crisis care. If you are in immediate danger, contact local emergency services or a recognised crisis service. Medication decisions need to be discussed with a qualified prescriber.
Short answer
Research broadly suggests that online and video-based therapy can be a useful way to deliver psychological help for many people, especially when it improves access, continuity, privacy, or travel practicality. It should still begin with clinical judgement: privacy, risk, technology, location, local emergency support, and the nature of the problem all matter.
What systematic reviews suggest
- Backhaus and colleagues reviewed videoconferencing psychotherapy studies and found it had been used across formats and populations, with generally good satisfaction and broadly similar clinical outcomes to in-person psychotherapy, while noting the need for larger trials.
- Thomas and colleagues reviewed adult videoconferencing psychotherapy and reported an established evidence base for some behavioural and cognitive therapies, especially PTSD and depression, while also noting practical issues such as reading non-verbal feedback.
- Berryhill and colleagues reviewed videoconferencing psychotherapy for depression and found many studies reported reduced depressive symptoms, with most controlled comparisons showing no statistical difference from the same intervention delivered in person.
- Andersson and colleagues compared guided internet CBT with face-to-face CBT across psychiatric and somatic conditions and found equivalent overall effects in the included trials, while cautioning that the evidence base varied by condition.
- Seuling and colleagues reviewed therapeutic alliance in videoconferencing psychotherapy compared with in-person psychotherapy, which is important because the working relationship is one of the things many people worry about before trying video therapy.
What public health and guideline sources add
- NICE guidance on digitally enabled therapies for anxiety disorders treats selected digital therapies as a possible access route in NHS Talking Therapies, while asking for further evidence on recovery, deterioration, relapse, experience and stepped-up care.
- NICE guidance on digitally enabled therapies for depression similarly emphasises flexible access and potential symptom benefit, but also keeps assessment, risk and evidence generation in view.
- NHS England describes digital talking-therapy options including therapy by video call and online programmes with therapist support.
- HSE information on free and low-cost talk therapy lists Irish routes including guided digital CBT, counselling/psychotherapy, and online or community services.
- The American Psychiatric Association and American Telemedicine Association provide best-practice guidance for synchronous videoconferencing-based telemental health.
- The VA National Center for PTSD summarises evidence and practical precautions for PTSD treatment by clinical video teleconferencing, including emergency protocols and confirming the person’s location at each session.
What this means for a person considering therapy
The research is encouraging, but it does not remove the need for a careful first conversation. Online therapy can be a good fit when the person has a private space, a reliable connection, enough emotional safety for the work, and access to local support if urgent help is needed. It may be less suitable, or may need extra planning, if there is immediate risk, severe crisis, safeguarding concern, unstable privacy at home, high substance-use risk, psychosis, mania, complex medical risk, or a need for a local multidisciplinary service.
Video therapy is not just an app
A live video session is different from a self-guided app or an anonymous chat. In psychotherapy by video, the therapist and client meet in real time. There is room for pauses, emotion, uncertainty, questions, practical planning, and the therapeutic relationship. Good online work still needs the same professional boundaries as in-person therapy: confidentiality, suitability, fees, cancellation, crisis arrangements, privacy, and clarity about what the therapist can and cannot offer.