Why Online Therapy could be the Way Forward for Mental Wellness in the Modern World

Online therapy has become a powerful alternative to face-to-face sessions, and Zoom is one of my most preferred platforms due to its reliability and user-friendly features. With the right setup and preparation, virtual therapy can be just as impactful as in-person sessions.

A Shift in Perspective: Embracing Online Therapy

I never would have expected this before, but COVID-19 completely changed my perspective on delivering online therapy and its effectiveness. In both my private practice and my work with the NHS, I specialise in trauma therapy. Initially, I was sceptical about how well it could be delivered remotely and whether it would truly benefit my clients. However, over time, I realised that my reservations stemmed from a lack of confidence in the tools available. By learning to navigate teletherapy platforms effectively, reviewing research on its efficacy, and witnessing first-hand how well it works for my clients, my mindset shifted. This journey of adaptation and growth—especially during and after the pandemic—has shown me that online therapy is not only feasible but highly effective. Today, I successfully provide EMDR and other trauma-focused therapies online, and I can confidently say that it works. While I had provided online therapy before, the pandemic made it the primary mode of treatment, significantly shifting my perception. As a result, I have incorporated it into my private practice in a much more substantial way. Over time, I pursued further training and became more technologically proficient, which helped me build confidence in the services I offer. I quickly recognised the advantages of online therapy for both myself and my clients. Clients can access therapy from the comfort of their own homes, which often helps them feel more at ease. It also eliminates the need for commuting, making therapy more time-efficient and cost-effective. Additionally, online therapy broadens access to a wider range of therapists, removing geographical limitations and allowing clients to find the right professional for their needs. These benefits often outweigh any potential drawbacks, making online therapy a valuable option for busy mums, working professionals, children and adolescents, couples, and those in remote areas who need flexibility in their schedules. Another significant advantage of online therapy is the anonymity it provides, which can help reduce stigma associated with seeking mental health support. Some individuals may feel hesitant to attend in-person sessions due to concerns about being judged or recognised, especially in small communities or workplaces. Virtual therapy allows them to seek help discreetly, creating a safer and more comfortable environment for those who might otherwise avoid treatment. Research has shown that many therapists faced significant professional challenges during the early phase of the pandemic, particularly in relation to their confidence in online therapy and its effectiveness compared to in-person sessions. Initially, concerns about the therapeutic relationship and the efficacy of virtual therapy were common. However, over time—typically within a few months—these concerns lessened as therapists gained more experience and familiarity with the format. This shift aligns with pre-pandemic findings that initial scepticism towards online therapy often decreases once practitioners have the opportunity to use it in practice (Connolly et al., 2020). While existing evidence suggests that online therapy can be just as effective as face-to-face treatment (Marchand et al., 2011; Fernandez et al., 2021), many therapists at the start of the pandemic lacked training or prior exposure, which contributed to their initial doubts. My own journey mirrors these findings—I, too, had reservations at first, but with time, training, and direct experience, I have come to see the real value of online therapy in supporting clients effectively. Further supporting this, Fisher (2021) found that the standard EMDR protocol can be effectively delivered remotely, provided that the right adaptations are made at each stage of therapy. This ensured that clients could continue to benefit from EMDR even during the global health crisis and beyond, allowing them to access essential trauma therapy without disruption. The flexibility of remote EMDR has since become a core aspect of my practice, reinforcing that virtual therapy is not just a temporary solution but a sustainable and effective model for mental health care post-COVID-19.

When Face-to-Face Therapy Might Be Better

While online therapy offers numerous advantages, it may not be the best fit for everyone. Some individuals benefit more from in-person human connection, particularly those who find digital interaction impersonal or disengaging. In cases where a client requires intensive, hands-on treatment, such as severe trauma or crisis intervention, face-to-face therapy can offer the immediacy and physical presence needed for effective support. The choice between online and face-to-face therapy ultimately depends on the individual’s needs, comfort level, and the nature of their mental health challenges.

Optimizing Your Online Therapy Setup

1.       Camera Position & Eye Contact 🎥

1. • Position your laptop, computer, or smartphone at eye level to maintain natural eye contact.
   • Avoid angles where you’re looking up or down at the client, which can feel unnatural.

2.       Lighting & Visibility 💡

2. • Ensure that neither you nor the client has a light source behind your head, as this can darken the face.
   • Sit at a comfortable distance so the client can see your upper body, not just your face.

Bilateral Stimulation (BLS) in Online Therapy

• Tapping techniques can be adapted for virtual sessions.
• The butterfly hug is highly effective, allowing clients to self-administer tapping.
• I encourage clients to watch a BLS tutorial video and dedicate a session to practice, ensuring they are comfortable with the technique.
• There are also digital tools available, such as light bars or moving dots, to facilitate eye movement desensitization.

Creating a Safe and Structured Space

• Clients should ensure doors are closed, tissues are nearby, and they won’t be disturbed during the session.
• Online therapy can evoke strong emotions just like in-person therapy, so preparation is key.
• For dissociation and abreaction, the approach remains similar to face-to-face work, and I have not encountered additional challenges with proper precautions in place.

Enhancing the Therapeutic Experience with Zoom

1.       Virtual Backgrounds

1. • A clean, non-distracting background enhances focus.
   • I prefer a bookshelf image or a peaceful scene to replace my office background.
   • Zoom allows for digital backgrounds with or without a green screen—worth experimenting with!

2.       Session Recording & Screen Sharing

2. • With client permission, recording sessions can be beneficial for reinforcement and self-reflection, creating a double exposure effect in therapy.
   • Zoom’s screen sharing feature is great for sharing assessments (like ITQ or PCL-5) and videos.

Technical Considerations & Backup Plan

• A strong internet connection is crucial—both therapist and client should have a stable setup.
• Keep a mobile phone handy in case of a connection drop.
• Despite Zoom’s reliability, occasional issues arise, so having a contingency plan is essential.

Ending Sessions Thoughtfully

• When working with vulnerable clients, ensure sessions are concluded properly so they don’t feel emotionally stuck between sessions.
• Techniques like container and vault exercises should be carefully handled to avoid leaving unprocessed emotions locked away.

Final Thoughts

With proper structure, preparation, and use of technology, online therapy can be just as effective as in-person sessions. By optimizing your setup, leveraging Zoom’s tools, and maintaining a secure therapeutic space, virtual sessions can provide meaningful and transformative experiences. However, for those who require intensive, hands-on support, face-to-face therapy may still be the better choice. Ultimately, the key is finding the right approach that meets the client’s needs and comfort level, ensuring they receive the best possible care.

References

Békés V, Aafjes-van Doorn K, Luo X, Prout TA and Hoffman L (2021) Psychotherapists’ Challenges With Online Therapy During COVID-19: Concerns About Connectedness Predict Therapists’ Negative View of Online Therapy and Its Perceived Efficacy Over Time. Front. Psychol. 12:705699. doi: 10.3389/fpsyg.2021.705699

 

Fisher, N. (2021). Using EMDR therapy to treat clients remotely online. Journal of EMDR Practice and Research, 15(1)

 

Schubert, S., & Brown, P. (2020). Online remote EMDR. Retrieved from https://cloudemdr.com