I’m a therapist currently based in Vilnius, Lithuania, while working online with clients around the world. Every now and then, people ask me: Why online? Isn’t it different from meeting in person? Does it really work? And who actually wants to do therapy online?
To be honest, there are times when I miss meeting people face to face. There is something special about sharing the same physical space. But over time, I’ve also discovered just how much meaningful work can happen online.
And it’s not just my experience. A 2024 systematic review and meta-analysis published in the Canadian Medical Association Journal, which included 54 randomised controlled trials and over 5,400 participants, found little to no difference in effectiveness between therapist-guided remote and in-person cognitive behavioural therapy (CBT) across a range of conditions (Zandieh et al., 2024).
Research also suggests that a meaningful therapeutic relationship can develop through videoconferencing: a 2024 systematic review and meta-analysis of 18 publications found no significant difference in therapeutic alliance, the quality of the working relationship between therapist and client, between videoconferencing and in-person therapy, whether rated by clients or therapists (Seuling et al., 2024).
Of course, online therapy isn’t the right fit for everyone or every situation, but it can be a valuable way of accessing psychological support.
So, who are the people choosing online therapy?
As a former humanitarian aid worker, I work with clients in the humanitarian sector who live and work in challenging contexts. Some are based in hardship duty stations or highly insecure environments, where in-person therapy may be unavailable or difficult to access due complicated security clearances and restrictions on movement.
As a Lithuanian citizen and native Lithuanian speaker, I also work with Lithuanians living abroad. While many of us speak other languages, there is something important about being able to express our feelings, experiences and most complicated thoughts in our native language. Finding a therapist who speaks that language abroad isn’t always easy.
Some of my clients are people whose lives cross borders frequently. They travel frequently for work, relocate between countries or move around the world because of family or professional commitments. For those clients, online therapy has been the only practical way to maintain continuity with the same therapist while their lives and locations keep changing.
For some people, particularly those who are well-known or easily recognisable in their communities, such as politicians, government officials or senior business executives, it might feel uncomfortable to visit a therapist’s office. Others live in small towns, villages or communities where people might have concerns about confidentiality and be reluctant to seek support as a result. I’ve also worked with someone whose cultural and community expectations made attending in-person therapy particularly challenging. In such circumstances, online therapy was a more discreet way to seek support.
Finally, I’ve worked with people juggling demanding schedules: parents of young children, people in senior management positions and others whose days are already packed with responsibilities. For them, finding time for a therapy session can be challenging enough, let alone finding the additional time to travel to and from a therapist’s office.
In over two years of practice, I’ve had the privilege of working with people from many parts of the world, including many European countries, Palestine, Afghanistan, South Africa, Bangladesh, Kenya, China and others. Each person has brought a different story and reason for seeking support. And that, perhaps, is what I appreciate most about working online: it allows us to connect across geographical distances.
I don’t think online therapy should replace in-person therapy. Rather, I see it as another way of making psychological support accessible to people who might otherwise struggle to find it. In this case, the most important thing isn’t where the conversation takes place, but whether someone has the opportunity to have it at all.
References
Zandieh, S., Abdollahzadeh, S. M., Sadeghirad, B., Wang, L., McCabe, R. E., Yao, L., Inness, B. E., Pathak, A., Couban, R. J., Crandon, H., Torabiardakani, K., Bieling, P., & Busse, J. W. (2024). Therapist-guided remote versus in-person cognitive behavioural therapy: A systematic review and meta-analysis of randomized controlled trials. Canadian Medical Association Journal, 196(10), E327–E340.
Seuling, P. D., Fendel, J. C., Spille, L., Göritz, A. S., & Schmidt, S. (2024). Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 30(10), 1521–1531.