Online therapy: does it work as well as in-person therapy?

"Does therapy by video call actually work?" It is one of the questions I am asked most often by people considering therapy who cannot, or would rather not, come to the practice. Behind it there is usually a reasonable suspicion: that something important gets lost through a screen.

The short answer is that, for many people, online therapy works as well as in-person therapy. The full answer has some nuances, and they are worth knowing before you decide.

What online therapy actually is

It is not a reduced version or an emergency substitute. It is the same therapeutic process, with the same session length, the same structure and the same work between one session and the next. The only thing that changes is the medium: instead of sitting in the consulting room, we talk by video call from wherever you are.

In practice, it feels very much like a face-to-face conversation. We see and hear each other, and the pace of the session is the same. You can read how it works in my practice on the online therapy page.

Does it work as well? What the evidence says

The available research indicates that, for many of the most common reasons people seek help —such as anxiety, stress or low mood—, therapy by video call achieves results comparable to in-person therapy.

What matters most for therapy to help is not the screen but the working relationship between patient and therapist, commitment to the process, and an approach adapted to your situation. All three are entirely possible at a distance. As with any format, though, nobody can guarantee you a particular result or timeframe.

What does change

The space changes. In the consulting room the setting is prepared for the session; at home, you prepare it. You need a quiet, private place where you can talk without being overheard, and a stable connection. For some people, finding that spot at home is the biggest challenge.

Some details of communication also change: less of the body is visible, and silences can feel different at first. It usually takes only a few sessions to get used to it. And some people find the opposite: that talking from their own surroundings is easier than doing it somewhere unfamiliar.

Who it tends to suit

If you live outside Barcelona, or in the city but far from the practice. If your schedule makes adding travel time impossible. If you travel often and want to keep continuity. If you have mobility difficulties. Or if you simply feel more at ease starting from home.

Online therapy is available across Spain, so distance is no longer a reason not to start.

When in-person sessions are better

There are situations where in-person sessions are the better choice: when there is no way to have privacy at home, when the technology causes more stress than it relieves, or when someone feels they need to leave their surroundings to be able to talk. In those cases, in-person individual therapy at the Barcelona practice usually fits better.

And there is something no form of therapy replaces: if you are going through a crisis and feel your safety is at risk, do not wait for an appointment. In Spain, call 112, or 024, the free suicide-prevention line, available 24 hours a day.

Fees and the first session

In my practice, online therapy costs the same as in-person therapy, because the work is the same. The details are on the fees page.

The first session is the same too: we get to know each other, you tell me what brings you, and we consider how to approach the process. If you are wondering what it will be like, I go into it in more detail in what happens in a first therapy session.

If you are unsure whether online therapy is right for you, the simplest thing is to ask before starting. You can write to me and we can talk it through, with no obligation.