In brief: Yes, online therapy can still be helpful if you are unsure about opening up. Feeling cautious or self-conscious at the beginning of therapy is not unusual, and it may take time to become comfortable enough to talk freely and share deeply personal information. Research also suggests that a good therapeutic relationship can develop through live video appointments.
Here, online therapy means a live video appointment with a Clinical Psychologist.
Can a good therapeutic relationship develop online?
One understandable concern about online therapy is whether talking through a screen will make it harder to feel connected to your Clinical Psychologist.
The research is reassuring, although it does not suggest that online therapy will suit everyone equally.
A systematic review and meta-analysis examining 18 publications found no statistically significant difference between video and in-person psychotherapy in ratings of the therapeutic alliance provided by either clients or therapists. A meta-analysis is a study that combines findings from a number of studies.
More recently, a 2026 study involving 1,175 adults receiving psychotherapy also found comparable ratings of the therapeutic relationship in in-person and video-call sessions.
Evidence: The therapeutic relationship in in-person, video call, and telephone psychotherapy sessions
There is also evidence for the effectiveness of particular psychological therapies delivered by video. For example, a systematic review and meta-analysis of video-call Cognitive Behavioural Therapy (CBT) found no significant difference in symptom reduction compared with in-person CBT across the studies included.
These findings do not mean that every person, psychological difficulty or type of therapy will feel exactly the same online and in person. They do, however, suggest that meeting by video does not in itself prevent a useful therapeutic relationship from developing.
Why might some people find it easier to talk online?
For some people, speaking from their own environment may feel less socially demanding than sitting in the same room with someone they have only recently met.
One possible explanation is related to what researchers call the online disinhibition effect. This describes how some people communicate or reveal more about themselves through digital communication than they might in person.
Evidence: Suler J. The Online Disinhibition Effect
However, the theory was developed to explain online communication more broadly, rather than live video psychotherapy. Some of its proposed mechanisms, such as invisibility, are much less relevant when you and your Clinical Psychologist can see and hear one another in real time.
It is therefore best understood as one possible explanation for why some people find online communication easier, rather than evidence that people will automatically open up more during online therapy.
Many people use video calls to friends and family, and so this familiarity may help with your remote meetings with a Clinical Psychologist.
What if I still find myself holding back?
Other people have the opposite experience and initially find video appointments quite exposing.
You may notice that you are watching your Clinical Psychologist closely for a reaction, thinking about how you are coming across, or choosing your words very carefully. You may simply need more time before you feel comfortable discussing personal experiences.
There is no requirement to tell your whole story during the first appointment. Some people worry afterwards that they may have said too much too soon, while others are surprised by how freely they have been able to talk. Either reaction can be discussed with your Clinical Psychologist.
You can also tell your Clinical Psychologist if talking openly feels difficult. That in itself can be useful information. Together, you can consider what is making the conversation difficult and what might help you feel sufficiently comfortable to engage with the therapy.
The pace can then be considered with you, rather than assuming that important subjects have to be discussed immediately.
Try hiding your self-view
There is also a simple practical adjustment worth knowing about.
During most video appointments, you can see both your Clinical Psychologist and a small live image of yourself. If you find your attention repeatedly being pulled towards your own face, you can usually hide that image without switching your camera off.
On Zoom, the setting is called Hide Self View. Your camera remains on and your Clinical Psychologist can still see you; only your own image disappears from your screen. Other video platforms may offer a similar option.
Zoom guidance: Showing and hiding your video in a meeting — Hide Self View
This can be useful if you notice yourself checking your appearance, facial expression or emotional reactions instead of attending to the conversation.
An in-person therapy session does not ordinarily give you continuous visual feedback of your own face! Removing that additional source of information may therefore make the video appointment feel less distracting for some people.
In clinical practice, some people describe their own image as an additional source of self-consciousness, particularly when they are struggling with low self-esteem or concerns about their appearance.
Research into videoconferencing (not specifically psychological therapy) supports being cautious about constant self-view. Studies have linked concerns about one’s own facial appearance (facial dissatisfaction) with greater videoconference fatigue.
More recently, experimental research in online education found that turning self-view off reduced cognitive load and fatigue.
That does not establish that hiding self-view improves psychotherapy outcomes, but it does provide a reasonable evidence-based basis for trying the adjustment if watching yourself is getting in the way.
Can EMDR therapy work online for PTSD?
There is also encouraging research specifically on online EMDR.
A UK traumatic-stress service evaluation compared online with in-person EMDR for PTSD: 45 people received online EMDR and 33 received in-person EMDR. The evaluation found no evidence of differences in treatment completion, dropout or adverse events between the two formats. PTSD outcomes among those completing treatment were also encouraging. However, because participants were not randomly allocated to online or in-person treatment, further randomised research is needed before concluding that the two formats are equivalent.
Additional supporting evidence: An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid-19 pandemic
You do not have to decide about a whole course of therapy immediately
Being unsure about online therapy does not require you to make a decision about months of appointments before you have experienced one.
An initial appointment gives you an opportunity to meet your Clinical Psychologist, experience the video format and notice how easy or difficult it feels to talk together.
You can discuss what worked, what felt uncomfortable and whether anything could be adjusted. You can then consider, together with your Clinical Psychologist, whether online psychological therapy appears to be a workable option for you.
Considering online therapy?
If you are thinking about online therapy but are unsure whether it would suit you, you are welcome to contact National Clinical Psychology Service for a free, no-obligation consultation.
We can discuss what you are looking for and help you consider which Clinical Psychologist may be a suitable match.
Research referred to in this article
Seuling PD, Fendel JC, Spille L, Göritz AS & Schmidt S. Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person: a systematic review and meta-analysis. Journal of Telemedicine and Telecare.
Stefana A, Fazia T & Nova A. The therapeutic relationship in in-person, video call, and telephone psychotherapy sessions. British Journal of Clinical Psychology.
Ebrahimjee A and colleagues. Video call-based cognitive behaviour therapy for adults with common mental health conditions: a systematic review and meta-analysis. The Cognitive Behaviour Therapist.
Suler J. The Online Disinhibition Effect. CyberPsychology & Behavior.
Ratan R, Miller DB & Bailenson JN. Facial Appearance Dissatisfaction Explains Differences in Zoom Fatigue. Cyberpsychology, Behavior, and Social Networking.
Basch JM, Albus P & Seufert T. Fighting Zoom fatigue: Evidence-based approaches in university online education. Scientific Reports.
Strelchuk D, Turner KM, Smith S, Bisson JI, Wiles NJ & Zammit S. Provision of online eye movement and desensitisation therapy (EMDR) for people with post-traumatic stress disorder (PTSD): a multi-method service evaluation. European Journal of Psychotraumatology.
McGowan IW, Fisher N, Havens J & Proudlock S. An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid-19 pandemic. BMC Psychiatry.
Dr Jurai Darongkamas
Consultant Clinical Psychologist
National Clinical Psychology Service
Published: 12 August 2026
