Online psychotherapy means that psychotherapy sessions are conducted over the internet, usually through a protected video-conferencing platform. The basic framework of the work does not change: the client and therapist meet at an agreed day and time, sessions are conducted on the basis of confidentiality and ethical principles, and the topics addressed are considered according to the person’s reason for seeking support and needs.
The NHS notes that talking therapies can be delivered in person, through a video or phone call, or as an online course; NIMH treats sessions conducted with a therapist’s remote support separately from programs and apps used without a therapist. This article addresses sessions held with a therapist; What Is Psychotherapy? and What Is Individual Psychotherapy for Adults? describe the general framework and the individual work carried out with adults.
How does online psychotherapy begin and how do sessions proceed?
The process generally begins with a first session. In this session, the person’s reason for seeking support, difficulties, expectations, and life circumstances are considered, along with whether online sessions suit the person; then the frequency, length, and goals of the work are clarified together (How Are Session Frequency and Length Determined?).
The topics addressed need not differ from those in in-person psychotherapy; anxiety, stress, relationship difficulties, loss and grief, or a wish to understand oneself can be worked on in online sessions as well. Within a Cognitive Behavioral Therapy framework, cycles of thoughts, emotions, bodily reactions, and behaviors can be addressed; within a psychodynamic psychotherapy framework, past experiences and recurring relationship patterns. The aim is not to offer quick, ready-made solutions but to help the person make sense of their difficulties and develop more functional ways of coping.
What does research show about online psychotherapy?
The findings of peer-reviewed reviews comparing video-based and in-person psychotherapy can be summarized as follows:
- A meta-analysis of randomized controlled trials comparing video-based and in-person psychotherapy for depressive symptoms (Giovanetti et al., 2022) found no significant difference between the two formats in efficacy or dropout; the authors note that more research is needed.
- A broader review (Fernandez et al., 2021; 56 within-group and 47 between-group studies) reported that video-based psychotherapy performed significantly better than wait-list controls and differed only negligibly from in-person psychotherapy; according to the authors, improvement was greater in CBT and in studies targeting anxiety, depression, and post-traumatic stress symptoms.
These findings may not apply to every person or situation; the studies were conducted under particular conditions and with particular samples. They therefore do not mean that online psychotherapy suits everyone.
Can a therapeutic relationship be built in online sessions?
The therapeutic relationship (therapeutic alliance) is considered one of the important elements of psychotherapy; NIMH likewise states that rapport and trust are essential. A meta-analysis covering 18 publications (Seuling et al., 2024) found no significant difference in therapeutic alliance between video-based and in-person psychotherapy, as rated by either clients or therapists; the authors stress that the mechanisms behind alliance need further research.
In which situations may in-person evaluation also be considered?
The suitability of the online format varies with the person and the situation. The telepsychology guidelines of the American Psychological Association (APA) call for assessing suitability before services begin, and note that factors such as medical conditions, mental status and stability, psychiatric diagnosis, substance use, treatment history, therapeutic needs, and the technological competence of both the person and the psychologist may be considered. The guidelines also point out that in-person services may be appropriate if a person repeatedly experiences crises.
In particular, in intense crisis situations, when there is a risk of harm to oneself or others, in severe psychiatric symptoms, in serious substance use, or in situations requiring urgent medical or psychiatric evaluation, online sessions alone may not be sufficient; in-person evaluation or other mental health services may be needed. Whether online sessions suit the person is assessed together in the first session (What Is Covered in the First Session?).
How can one prepare for an online session?
NIMH and the APA guidelines draw attention to the practical conditions of online sessions:
- Privacy: holding the session in a quiet place where others cannot hear or see; NIMH notes that a session may feel less private if people nearby can see or overhear it.
- Technical conditions: an adequate internet connection and a working device; NIMH notes that a poor connection or malfunctioning device can disrupt a session.
- Risk of interruption: because the psychologist cannot control the remote environment, the APA guidelines recommend discussing at the outset the person’s role in keeping sessions uninterrupted.
- Comfort with the camera: some people may feel uncomfortable using a camera at home (NIMH); this can also be raised in the first session.
How are privacy and personal data protected in online sessions?
Confidentiality and privacy principles are also maintained in online sessions. The ethical rules of the Turkish Psychological Association state that all ethical rules remain fundamental in telephone, e-mail, chat, and video settings as well, and that the person must be informed about benefits, risks, and possible precautions. While the APA guidelines recommend sharing technology-related confidentiality risks with the person, NIMH points to the use of a platform that protects privacy. Sessions are not audio- or video-recorded unless explicit consent has been given in advance. The article How Are Confidentiality and Ethics Protected? gives more detail.
What happens in case of technical problems or an emergency?
Which channel will be used for contact if the connection drops is among the topics to be discussed at the start of sessions. The APA guidelines recommend identifying the emergency resources in the person’s local area at the outset and sharing clear instructions on what to do in an emergency. If a person has thoughts of harming themselves or there is an immediate danger, emergency services in the person’s location should be contacted without waiting for a session.
Expert note
In online sessions, the core of the work does not change: trying to understand the person’s experience, and doing so within a safe framework. The fact that the setting is provided by the person can make it even more important to discuss privacy and technical preparation at the outset.
From a perspective that draws on cognitive behavioral and psychodynamic psychotherapy theories, whether the online format suits the person is also one of the topics of the initial assessment. The information in this article is general in nature and does not replace a personal assessment.
Clinical Psychologist Özgün Emre Yaylacı
Frequently asked questions
Is online psychotherapy different from in-person psychotherapy?
The topics addressed need not differ; the format is conducted over the internet, usually through a video-conferencing platform. The fact that the setting is provided by the person can make privacy and technical preparation more important.
Is online psychotherapy as effective as in-person psychotherapy?
A peer-reviewed meta-analysis found no significant difference between video-based and in-person psychotherapy for depression, and a broader review found the difference to be negligible. These findings were obtained under particular conditions and may not apply to every person.
Can a bond with the therapist be built in online sessions?
A meta-analysis covering 18 publications found no significant difference in therapeutic alliance between video-based and in-person psychotherapy. The authors state that more research is needed in this area.
Is online psychotherapy suitable for everyone?
Suitability varies with the person and the situation and can be assessed together in the first session. In some situations, in-person evaluation or other health services may also be needed.
Are sessions recorded?
Permission must be obtained before audio or video recording; sessions are not audio- or video-recorded unless explicit consent has been given in advance.
Sources
This article is intended for general information. The following sources were consulted in its preparation:
- Giovanetti et al. (2022), Telemedicine Journal and e-Health: Teletherapy Versus In-Person Psychotherapy for Depression
- Fernandez et al. (2021), Clinical Psychology & Psychotherapy: Live psychotherapy by video versus in-person
- Seuling et al. (2024), Journal of Telemedicine and Telecare: Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person
- American Psychological Association (APA): Guidelines for the Practice of Telepsychology (2013)
- NIMH (U.S. National Institute of Mental Health): Getting Mental Health Support Virtually
- NIMH: Psychotherapies
- NHS (UK National Health Service): NHS talking therapies
This article was prepared by Clinical Psychologist Özgün Emre Yaylacı. Last updated: October 23, 2026. The content is for general information only and does not constitute diagnosis, treatment or personal guidance.
