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How Does Online Therapy Work?



Friday, 3rd April 2020

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Whether you have had face-to-face therapy in the past or this is the first time you are considering therapy, you will find that accessing therapy during the Coronavirus crisis is generally limited to online or telephone.

But don't think that online therapy is a poor substitute; there is increasing evidence claiming that online therapy can be just as effective as face-to-face.

Many therapists have been working online for years and it is growing in popularity. Nonetheless, it is a different experience than face-to-face and will not be suitable for all.

In this post, we'll help you understand whether it's for you as well as how to get going with it!

What is online therapy?

Terms like cyber therapy, e-therapy, online counselling, teletherapy and telemental health are interchangeable.

Whatever the terminology, there are a variety of online options available. Though you do not have to be tech-savvy, being comfortable with technology will make things easier.

Video therapy is the most popular form of online therapy and is usually conducted via Skype, Zoom, WhatsApp, or FaceTime, etc. Some therapists only use one platform, whilst others will be more flexible. This is the most similar to face-to-face as you and your therapist can see each others faces.

Telephone counselling also works similarly to face-to-face, but via the telephone.

Using instant messaging or text, you and your therapist arrange a time to start a chat, and work in the same way as you would face-to-face. Some services work asynchronously.

This is an asynchronous method of therapy, meaning that, there will be a series of email messages exchanged between you and your therapist, responding at a time convenient, usually within 24-48 hours of receipt, but there will be no fixed time for the session as with video, telephone and messaging.

Some therapists only work online via video/webcam, some will additionally offer sessions via telephone, whilst email and messaging are not as mainstream.

How to find an online therapist

Some therapists only work face-to-face as a rule, and only work online if, for instance, their clients are away on business. More and more, however, therapists are embracing the online platform and with the current situation many are engaging with a new way of working.

As such, you're generally working with the same therapists as you would if you were doing therapy face-to-face.

If you want to find an online therapist, a good percentage of the therapists on Timewith work online, which you can find here. You can change therapist at no extra cost if you don't find the right person.

In general, therapists will indicate on their websites and online profiles that they offer online therapy, and how they provide it.

How do sessions differ from face-to-face?

Sessions work in much the same way. You will have a scheduled appointment time and the framework for face-to-face therapy will apply.

It might be a good idea to see if your therapist will offer a brief telephone conversation initially. Alternatively, this can all be done via email.

The first session, whichever medium you choose, will be similar to an initial session face-to-face. You will agree who will contact who (or initiate the chat), so that you are not both trying to reach each other at the same time, and what to do in case of interruptions in service.

Clients working with video will need to remember that although they are in their own home, the same boundaries apply. For instance, you wouldn’t arrive to your therapist’s office in your pajamas or be eating your breakfast, would you?!

The point here is that you do not take calls during your session and try to limit any distractions.

Tips for starting online therapy

You will need adequate internet connection to minimise connection difficulties. Make sure you have a landline or good mobile phone connection, even if you intend to use video calling. You may need this as a backup.

A computer is recommended if using video calling as this will replicate face-to-face more closely and feel more familiar. Check that your connection is adequate and that your camera (computer or separate webcam) show your face and shoulders and that the sound works. You may need to download software such as Skype; your therapist will discuss this with you prior to your first session.

Before the session
Take a few minutes before the session to get comfortable and take a few deep breaths.

Make sure that you are in a quiet room where you feel comfortable and where you will not be overheard if you are using video or phone.

For more general advice on starting therapy, read our blog on how to prepare for you first therapy session.

During the session
Let your therapist know if you do not hear or understand something. It is really important as they may not immediately pick up on this as the visual cues may be missing.

After the session
Take some time for yourself directly after the session before launching back into your world. If you share a computer or device, ensure that you close or delete any relevant pages from your session to maintain your privacy.

What are advantages and disadvantages of online therapy

There are benefits to online therapy, and there are significant differences as well.

Firstly, you are not limited to therapists practicing in your area. This is a game-changer.

If there is a particular approach you like, or you require specific expertise, you can access that therapist easily, no matter where they are located.

Furthermore, online counselling is accessible for clients who are physically disabled, unable to leave their home or who live in a remote area.

Flexibility and convenience
As there is no travel time, you save time and do not have to concern yourself with getting there and back on public transport, on foot, or by car.

Furthermore, both you and your therapist will have more flexible availability. You can arrange the same time each week, but equally if your work schedule is not consistent, it is easier to vary days and times each week. This can make it easier to get the habit to stick.

Some clients find it easier to talk and are more comfortable with one of the online options. You may find that you share sensitive information more quickly than face-to-face, or conversely, it may take longer. Do communicate any concerns with your therapist as they come up so that they can support you.

Online therapy also may be especially suited to children or teenagers who may be used to expressing themselves online and find this easier than speaking face-to-face, as well as adults with anxiety and agoraphobia, for example.

There are also some disadvantages to be aware of.

Non-verbal communication
Subtle visual cues, such as body language, are limited with video calling, and are completely absent in text and phone therapy. This is not to say it is an inferior way of working, it is just different. It might take some time to adjust, especially if you are used to face-to-face therapy.

Technology glitches
These can disrupt the flow of a session, which can then be difficult to settle back in to. However, you and your therapist will always have a contingency in place and will attempt to minimise any disruption.

Online therapy may be your only choice of therapy right now, but it is not suitable for everyone. Discuss any concerns with the therapist so they can best advise how to support you. As with face-to-face therapy, your therapist should have your GPs details as well as an emergency contact, together with your consent to waive confidentiality if they consider you to be at risk.

Security and confidentiality
You may be aware of the discussion in the media recently around which video platforms are safe. Although the advice here is changing daily at the moment, professional organisations are monitoring the situation and are advising therapists accordingly. Generally speaking, online therapy is safe and therapists are subject to GDPR guidelines and take client confidentiality and privacy very seriously. Your therapist will discuss the risks and any concerns you may have.

How much does online therapy cost?

Some therapists charge slightly less for online therapy as they will not be paying room rent, but generally it is the same. Therapists are still providing the same amount of time, and often involved with more preparatory work, as well as after the session, requiring more gaps between sessions.

Typically, you can expect to pay between £40-£80 per session with the average being £63. Some therapists will offer concessions (do ask if you are on a low income), starting from £20 per session, whilst clinical psychologists often charge up to £150.

Cost of Online therapy 2020 part 1


For more information, see our blog on the cost of therapy.

Is online therapy effective?

Yes! Deeply meaningful therapeutic relationships develop online and can support change and healing. A number of recent studies indicate that online therapy can be as effective as face-to-face. NICE, the National Institute for Health and Care Excellence, provide a list of research studies if you are interested in reading about this further.

One person’s experience is unique to them, so as in face-to-face therapy, what works well for one individual may not work for another. If you are not sure, find a therapist that works with a variety of different platforms and options.

Always bear in mind that the therapist needs to be right for you too. Although therapists abide by the same or similar guidelines and may have similar training and approaches, they are unique individuals too. If you think they are not for you, try another. Some clients like to try a session with a few different therapists before they decide.

Give it a try, and think about what might work best for you.