Psychotherapy

When someone says “counselling” or “psychotherapy”, most people immediately picture a patient lying on a couch or sitting in a comfortable armchair, while the therapist is ensconced in another. With that image serving as a backcloth, it might be hard to imagine what video therapy looks like and, quite naturally, whether it’s going to be effective. You’ve decided to try therapy — but through a screen? Many people wonder whether video sessions can really work. The research is clear: they can, and under certain circumstances even more so. With the right expectations and a few adjustments, the experience can feel surprisingly natural and over time even become a preference.

Does video therapy actually work?

The short answer is yes. Multiple studies — across anxiety, OCD, PTSD, insomnia, and general psychotherapy — have found that video therapy is as effective as face-to-face sessions (Bisson et al., 2022; Lundström et al., 2022; Weidle et al., 2024). That’s also true for psychodynamic therapy and hypnosis, both relying heavily on non-verbal cues and the subtleties of the therapeutic relationship (Weinberg & Rolnick, 2019).

That said, it does feel different: body language is reduced, eye contact works differently, and your environment is your own rather than a therapist’s office. None of that makes the work less real. But it does mean both of us need to be intentional about how we set things up. I’ll be responsible for adjusting my video space for you to feel comfortable and connected. For example, I’ll make sure the camera height is right, I sit close enough, no glare, and a backup plan. All you need to care about from your side is making the session comfortable and confidential on your end. Please continue reading to find out exactly how.

Setting up your space

In face-to-face therapy, the therapist takes care of the room. Online, you get to create your own. That can actually be an advantage — you’re somewhere familiar and comfortable. This can also make it harder to tune out from the session.

A few things that help.

Find a private spot. Confidentiality matters. If you can’t guarantee that no one will overhear, it’s better to reschedule than to hold back in session.

Minimise distractions. Close other tabs, silence your phone, and let the people you live with know you need uninterrupted time. It’s easy to underestimate how much a notification can pull you out of a moment that matters. In face-to-face practice though, similar interruptions still need to be accounted for.

Get your lighting right. Sit facing a window or light source so your face is clearly visible. This makes it easier for both of us to read facial expressions — which carry a lot of the emotional work in therapy. You don’t always have to say something — very often what isn’t said but unconsciously shown matters tons more.

Make it yours. Adjust your seating, your screen angle, whatever you need to feel settled. This is your space. Own it.

What stays the same

The core of therapy doesn’t change because of a screen. We still talk. We still sit with difficult feelings. I still pay close attention to what you say — and what you don’t.

In psychodynamic work, some things actually become more available online. With only part of the therapist’s environment visible, there’s more room for the imagination — for fantasies, projections, and the kind of unconscious material that psychodynamic therapy is especially interested in (Weinberg, 2021). The frame is different, but the depth doesn’t have to be.

What I notice in sessions is that the adjustment period is usually short. The first few minutes might feel slightly odd — the slight delay, the framing, the unfamiliarity of talking to a screen. But once we’re in the work, the screen tends to fade into the background.

It’s important to keep in mind that the main (and perhaps the only) reason therapy has traditionally been conducted face-to-face is that the first psychotherapist (S. Freud) set the practice up in the likeness of a doctor’s appointment — because he himself was one, and because Freud didn’t have a computer. Had psychotherapy emerged when screens were already dominating our world, the therapeutic space might have become something different from the very start. As with everything, we have to know the limitations and advantages.

What to do if something feels off

If the video format is bothering you — if you feel disconnected, distracted, or like something isn’t quite working — say so. That’s not a complaint; it’s material. In psychodynamic therapy, how you feel about the process is always worth exploring.

Sometimes the desire to turn the camera off, or the difficulty settling in, or the feeling that “this isn’t real therapy” connects to something deeper. It might be about vulnerability, about being seen, about what it means to let someone in from the comfort of your own home. These are exactly the kinds of things we can work with.

Practical checklist

To make sure the first awkward moments are as short as possible, before your first session:

Test your internet connection and have your phone nearby as a backup.
Please test Google Meet beforehand! A few people experience technical difficulties when they first use it (especially on Windows machines). You might have to grant it camera and microphone permissions on the first use and restart your browser. Consider downloading the Google Meet app on your phone as a backup if this fails or your computer isn’t working properly.
Find a private, quiet space where you won’t be interrupted.
Position your camera at roughly eye level.
Ensure good lighting on your face.
Close unnecessary tabs and silence notifications.
Have water nearby and tissues if you need them.
Give yourself a few minutes before and after the session — don’t rush straight from or into something else.

References