Online therapy: how a video session works and whether it helps

Not long ago, seeing a psychologist online seemed like a stopgap. Today it is an ordinary choice for many people: you can talk in your own language from another country, skip an hour of travel and avoid hunting for someone to watch the children. Here is how a video session with a psychologist or psychotherapist works, what research says about it and how to choose someone online.

How a video session works

You choose a time on the site, and it is shown in your own time zone, wherever you are. Before the session you get a link to the video call. You usually do not need to install anything: a phone, tablet or computer with a camera and a stable connection is enough.

The session itself is not very different from meeting in person. We see each other and talk, I ask questions, and sometimes we do exercises for breathing, for noticing sensations in the body or for working with thoughts. Many breathing and body-based techniques work well through a screen.

We agree in advance what to do if the connection drops: for example, I call you back by phone or we switch to another app.

Does online therapy help?

This is the question I hear most. A large 2021 review compared dozens of studies in which the same help was given by video and in person. Overall, the results were comparable. The authors note honestly that there are still few strict randomised trials, so the final word has not been said.

Your relationship with the psychologist matters too: a trusting working relationship is linked to better results in therapy. A review of studies on video therapy found that this connection does form through a screen, and clients rate it at least as highly as in face-to-face sessions.

This does not mean online suits everyone, every time. But for anxiety, low mood, stress, crises and relationship difficulties, many people find it a fully fledged option in its own right, not a last resort.

How to keep your sessions private

The most important condition for an online session is that you feel at ease and no one can overhear you. A few tips:

• Choose a room with a door that closes. If the whole family is at home, a car parked somewhere quiet can work too.
• Wear headphones, so the people at home cannot hear what I say and you can speak more freely.
• Ask your family not to come in. Music or a fan outside the door helps muffle voices.
• Turn off notifications while the session lasts.
• If there is truly nowhere to talk at home, tell me. We will find a solution together: another time, another place or meeting in person.

There are rules on my side too. I hold sessions alone, in a closed room, and I do not record them. Messages and my working notes on the site are stored encrypted, and reminder emails say nothing about what we discuss.

Who online suits, and when in person is better

Online is often chosen by:

• Armenians abroad and people who have recently moved. Wherever you live, you can talk in your own language with someone who understands your background.
• Parents of young children who find it hard to leave home.
• People who work long hours or travel a lot.
• People in small towns and villages, where there is no psychologist nearby or everyone knows everyone.
• People who find it easier to open up in familiar surroundings.

Meeting in person may be better if:

• you have no place at home where you are alone and can talk freely;
• you find it hard to concentrate in front of a screen, or the technology itself makes you anxious;
• you prefer body-oriented work face to face;
• things are very hard right now and you need help close by: a doctor, family, a specialist in the room.

If you are in danger or thinking about harming yourself, an online session cannot replace urgent help. Get help the same day, and call 911 if the danger is immediate.

I see clients in person in Yerevan. You can start in one format and switch to the other later.

How to choose a psychologist online

A few things to look at when you choose:

• Training. A degree in the field and training in specific methods, such as cognitive behavioural therapy (CBT) or EMDR. It is perfectly normal to ask where someone trained.
• Supervision. A good psychologist regularly discusses their work with a more experienced colleague.
• Clear rules. How long a session lasts and what it costs, how to cancel or reschedule, what happens if the connection drops. Prices should be published openly, not only shared in private messages.
• Data protection. Where your messages and records are kept, who can see them, whether sessions are recorded.
• Language. It is easiest to talk about feelings in your first language.

Many people look for an “anonymous” psychologist. Full anonymity is rarely possible in therapy: a psychologist needs to know your name and how to reach you, if only for your safety. What you do have is confidentiality: what you say stays between you and your psychologist, apart from a few narrow cases that should be explained at the start. I write about this in more detail in the article on the first session.

A free first conversation

If you would like to see whether online sessions suit you, book a free 15-minute intro video call with me. We can check the sound and picture, you can ask your questions, and we will decide whether to work together. Session fees are listed on the site, and you pay nothing when you book. My sessions are held in Armenian or Russian only, online from any country or in person in Yerevan.

Before the call, you can also take the free WHO-5 wellbeing test or the PHQ-9 mood questionnaire on this site. They take a few minutes, and you can show me the result when we meet.