What is online psychotherapy?

Karolina Fotyga

This piece was a long time coming because questions about teletherapy (online therapy – video sessions – telehealth) are on many people’s minds.

Since I have an online presence – and I use my IG account to talk about my work –  every now and then I get some questions about how it actually works. I thought that instead of replying to DMs on Instagram I should write a proper text here. So here it is – a short text about teletherapy = psychotherapy online.

I’ve been using video sessions with most of my clients for years now.

It is a new concept – that’s for sure, but it actually works great. Especially that for some people it’s the only way to get the support they need.

What is online psychotherapy?

Online psychotherapy (otherwise known as e-therapy, distance therapy, web therapy or teletherapy) is still uncharted territory in this digital era of ours. Those who go through the process can easily tell all the pros and cons. On the other hand, those who’ve never been to ’teletherapy’ couldn’t know where to start and if it’s even worth it. So let me tell you about it a little more.

First of all, we use the term ‘teletherapy’ to describe the form of psychotherapy that will be conducted over the video call. I prefer Zoom over the other systems since it’s very secure, there are others like that – I wouldn’t use Skype or FaceTime for therapy though.

You will experience the same setting, the same techniques, and process as in a session you’d have in an office. There are some differences and I’ll get to them in a moment.

Let’s talk about therapy in general.

It’s safe to say that psychotherapy, in general, might still be somewhat a mystery for some. It can be thought of differently in different countries and cultures. All in all though – psychotherapy – be it online or in an office – is all about taking care of your mental health and your personal growth. Some people are more accustomed to this idea while others might still not see much point in talking to a stranger about what’s bothering them.

How to find a good therapist?

The first thing to think of when you look for psychotherapy online – is to make sure your therapist is well educated in the area of mental health. They should hold a valid certificate or a license– depending on the country they received their credentials. Different countries have different rules and regulations, sometimes this profession is not regulated at all. The rule of thumb is to seek the help of those who are qualified to do so. If anything goes wrong you then have access to further steps concerning any misconduct or other. Not that it would happen often with a mental health profession – but it’s crucial to have this option available.

So when you browse through the therapists’ websites, you should be able to find links to all the institutions that have granted them their credentials. Sometimes, there will be online lists of certified psychotherapists where you can look up the person you consider working with.

Some countries despite not having this profession fully regulated will recognize certified psychotherapists and your mandatory/premium insurance might cover all or part of the cost of your sessions.

Make sure your psychotherapist is undergoing supervision– which is a process all therapists should be engaged in. It’s talking their work through with experienced colleagues.


What is modality?

Aside from that – there is also a matter of modality. In other words – the theory/school of thought the therapist was educated in. When we say modality – we mean the set of theories, techniques, and tools used to understand, describe and work with certain disorders and conditions people experience.

Of course, this is not something specific for online therapy (teletherapy), but when you’re browsing through the therapists’ websites you might as well check this one thing. You can make sure whether this approach is something you feel comfortable with. Not all approaches have to do with understanding the past and your childhood, for some it’s necessary to only focus on the present. Some approaches work mostly on symptoms – some – uncover the underlying cause. Some therapists will give you ‘homework’, some will want you to be ‘here and now’ in understanding what’s going on and how what you think impacts what you feel and so on. Make your research, ask people who know more and decide what modality feels right for you.

Modalities influence what that happens throughout therapy, how the therapy is conducted. The whole range of methods and techniques used in the process, as well as interpretation, setting, length of the session or the number of them, originate in the school of thought the therapist is educated in. They can also work in an integrative way – using two or more modalities.

An online meeting. What, where, how?

When you’ve found a certified, well educated mental health professional – an online formula should then be a full quality therapeutic process. Because of the medium used (internet), there are some specifics that make it a slightly different experience you’d get in a regular office-based session.

I’d say the whole process seems comparable. I’ve had clients who transferred to an online process from an office setting where they would come once or twice a week and see me in person. I’ve also had those who have already been consulted online. Let me tell you a bit about how the whole process looks from beginning to end.

The logistics of online consultation.

When you want to set up your first appointment you will usually use an online form or call the person you’d like to work with. There will be information on the site. That first meeting is called a consultation. Consultation, in general, may last somewhere between 1 and 3 meetings and is necessary to assess what the matter is, what kind of help the person needs and if the therapist and the client are compatible.

It’s a time for the therapist to be able to diagnose if the problem the patient/client is experiencing is in the scope of their expertise. I, for example, don’t work with substance abuse. If a person reveals they have severe problems in this area I will refer them to some other specialist. The consultation also helps to clarify the problem the client is sometimes not aware of him/herself.  It is also a time for the patient to see if they feel they can trust the therapist if they feel comfortable talking about conflicting, often intimate issues with them. And so this whole process takes place online – using a video call. I use Zoom as it’s one of the best in the category – it’s safe – above all.

By the end of the consultation, the therapist and the client agree on the scope of the help and the length of the therapy, as well as details of payments, the cancellation policy, insurance details – if needed – and so on. We call it -the contract.

As you can see so far – the whole process is basically the same as with the appointment you would have in an office.

What’s different is if you go to a physical office – you’d be there a couple of minutes before your scheduled time, and the therapist would simply invite you in when the time came.

With online therapy, you as a patient call the therapist at the scheduled time. If you’re using Zoom – you go to your virtual meeting room and at the scheduled time your therapist comes in to welcome you.

The session.

The biggest difference is about the session itself. In an office you get to see each other in person – the whole person – which is pretty obvious. In an online meeting, it’s usually the waist-up frame. Otherwise, you’d get a tiny person on the screen, and you don’t want that.

You will also need a stable wifi connection to be able to have a high-quality audio and video image. All so that the mimics, the moments of silence, the tears, the sighs – can be noticed, interpreted and understood better.

The default camera and microphone you have on your computer or a tablet are enough.

And that’s it – you’re all set.

The things to pay attention to.

One thing from the logistics spectrum is for sure the wifi problems. Rarely, but it happens, that the connection is so slow that it’s virtually impossible to hold a real conversation. Once or twice my internet provider had some technical issues and I had to reschedule a couple of sessions.

Something I had to touch on a couple of times with my clients/ patients was the rules and boundaries that otherwise don’t often need much explaining. There was a time for example when a patient called me wearing her pajamas, with wet hair – straight out of the shower. This would never happen in an office, but somehow it seemed appropriate to her – given the flexibility of the setting. Some other time another patient thought she’d use the time for the session to have lunch.

Of course, these are just examples that we still use and integrate within the material of the therapy – to understand and work with it.

Who is the online psychotherapy for?

This is the question that is as frequent as the question about what is depression. “Who can benefit from an online therapy process?”.

My answer is – pretty much everyone who needs this kind of flexibility.

I’ve worked with clients/patients who:

  • are so-called – ‘digital nomads’,
  • expats – not finding local psychotherapists speaking their language,
  • very (VERY) frequent travelers,
  • living in a city/country with psychotherapy services not available easily,
  • people with an extremely busy schedule.
  • people with extreme cases of anxiety or other mental disorders that make it difficult for them to leave the house.

Some circumstances would call for a regular in-the-office or rather in-patient treatment. Those would be:

  • severe psychiatric condition (for example – psychotic episodes, severe clinic depression)
  • suicidal tendencies

Is psychotherapy online effective?

More and more research shows that the most important aspect of the therapy and its effectiveness is the patient/client’s motivation and the relationship (rapport) – between the client and the therapist.

Taking that into account – it feels less important whether you see each other in person or on the screen. The connection – no pun intended – is the most impactful factor.

Having said that – I do find it refreshing to see my online clients – OFFLINE – from time to time. In an ideal world, I would probably prefer to see them in person more often. It’s still a matter of personal preference more than it is a matter of effectiveness.

Here you can find an article on how to prepare for an online psychotherapy session, and below I’ll attach some links if you feel you want to read more about the effectiveness of online psychotherapy:

Does online therapy works? What does the science say?



Two studies explore the effectiveness of online therapy.

Online psychotherapy. Meta-analysis interventions.


As you can see – there are differences between an office and an online setting. All in all, it really is pretty comparable when it comes to results.

If you feel I haven’t touched on something that you think is important – let me know in the comments.