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On-line Therapy

SIGMUND FREUD was not only the Father of psychotherapy but also a great innovator. Although much of his theory and research has since been discredited, he wasn’t afraid to challenge the status quo. I am in little doubt that if he were formulating his ideas and practicing his skills now, instead of in the late nineteenth century, he would be using all of the technology available to him.

He would be sharing ideas with colleagues using email, Skype and WhatsApp as well as texting and calling on his mobile. Documents would be shared using “cloud” services and collaborations would be enabled using Microsoft “Teams”. I think that he would almost certainly be meeting some of his clients online and conducting therapy sessions remotely.


There are many traditions around how psychotherapy sessions should be conducted that have arisen largely because the discipline arose in the late 19th Century. Traditions such as: sessions should always be held weekly, in the therapists consulting room, sitting in the same chairs, lasting the therapeutic hour (whether it is needed or not), and with no contact in between sessions. The extension of this is that self-help, telephone, email or video sessions are inferior to face-to-face sessions between client and therapist. Little if any of this is supported by research evidence on the effectiveness of different types of therapy delivery. But a reluctance to try new things persists for us all.


I have been conducting psychological therapy via Skype, Zoom and telephone for many years; it works. My observations of what my clients experience matches the feedback that I receive from them. It is overwhelmingly positive.

The Coronavirus pandemic has brought questions of how we work to the forefront; not least, how therapy is delivered. We are faced with two principal choices: to conduct therapy remotely, or not to have therapy at all. I think that we should all try remote therapy at least once before dismissing it out of hand. Here are some tips for therapist and clients to make the experience positive and the outcomes successful.


  1. Treat your online sessions as if you are physically meeting each other. This is real life therapy. It is face to face. It is not a poor substitute.
  2. Ensure that your computer/tablet/phone is in a quiet place where you can be alone and private and without interruptions.
  3. Ensure that you have a good Wi-Fi signal in that space. If there is anyone in your house with you, ask that they respect your privacy and keep away from your “therapy” room and keep the noise down. You might need to arrange childcare for the duration. Or this might happen:
  4. Get dressed.
  5. Be on time.
  6. Set up your device pointing away from windows and bright lights that might make the screen glare. Use plug in headphones or ear buds. This makes for better quality sound and goes some way towards ensuring privacy.
  7. Try not to munch your way through a session and leave your glass of wine outside the door!!
  8. If you have questionnaires to complete, they should be emailed before the session starts so that you both have a copy in front of you. Zoom and some other platforms allow for document sharing, so this may not be necessary.
  9. Be prepared for things to go wrong. The WiFi will go down, the screen will freeze and the microphone will stop working. Children or other family members will forget that you are having therapy and will barge in. Always have your mobile handy and share the number with your therapist as an emergency backup.
  10. Have some tissues handy so that you do not need to leave the room during the session, also go to the loo beforehand.
  11. It’s fine to have pets around and I know that some clients find this particularly comforting. Just try to make sure that they are not too bouncy and noisy, or sit on the computer keyboard, as my cat likes to do.
  12. Be prepared to have slightly shorter sessions. It’s quite difficult to maintain concentration with a screen for a long time.
  13. Especially if you are doing trauma work, enrol another person who is in your house to be available to help you if you become overly distressed.
  14. Provide feedback to each other on the experience: how was the lighting/sound, how did the session feel, what was good, what was difficult, and be prepared to make adjustments for next time.


With adequate preparation and a willingness to be curious, therapists and clients can both benefit from this different way of working. In times such as these when it is as important as ever to maintain our psychological well being, we will be better served if we embrace technology rather than rejecting it out of hand.













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