Online vs In-Person Therapy: How the Pandemic Changed Things

One of the first practical questions people ask me is a simple one: would it be better to meet in person, or online? It is a good question, and the honest answer is that there is no single right one — only what fits your life, your temperament, and the work you want to do. But the way I answer it now is very different from how I would have answered it a few years ago, and that change is worth telling.

Before 2020, I was a sceptic

For a long time, many therapists — myself among them — quietly assumed that real therapy happened in a room. There was a feeling that something essential would be lost through a screen: the shared silence, the small shifts in posture, the sense of two people breathing the same air. Online work was thought of, if at all, as a lesser substitute for when someone travelled or moved away.

Then, almost overnight, that assumption was put to the test.

The experiment we were all forced to run

When the pandemic arrived in 2020 and consulting rooms closed, therapists and clients had no choice but to move online more or less at once. It became, in effect, the largest experiment in remote therapy ever conducted — not by design, but by necessity.

What we learned surprised many of us. The work did not collapse. People kept turning up, kept going deep, kept getting better. For a great many clients, therapy over video proved every bit as meaningful as therapy in the room — and the research that has followed largely bears this out, finding online therapy to be comparably effective for common difficulties such as anxiety and depression. The screen, it turned out, was far less of a barrier than we had feared.

The relationship, not the room, is what carries the work. That was true before the pandemic; it simply took a crisis to prove it.

The pandemic also changed something in clients. Video calls became ordinary. Meeting a therapist from your own sofa stopped feeling strange, and for many people the convenience opened a door to therapy they might otherwise never have walked through.

What online therapy does well

Working online has genuine strengths, and for some people it is not a compromise at all but the better choice:

• Access. No commute, no waiting room, no time taken out of a working day. You can be seen from wherever you are.
• Comfort. Some people find it easier to be honest from a familiar space of their own, with a pet nearby or a favourite chair beneath them.
• Continuity. Travel, illness, a house move or a hectic week need no longer interrupt the work.
• Reach. It removes geography entirely — useful if you live somewhere rural, have limited mobility, or simply want to choose a therapist who feels right rather than one who happens to be nearby.

What the room still offers

And yet in-person work has qualities that are harder to replicate through a screen, and for some people they matter a great deal:

• The room as a container. There is something steadying about a dedicated, private space set apart from ordinary life — a place that is only for this.
• Full presence. In person we take in the whole person, not a framed head and shoulders. Silences can feel more spacious, and some people find it easier to reach difficult feelings when they are physically in the room with another.
• A boundary around the work. The small ritual of leaving home, travelling, and returning can help mark therapy off from the rest of the week.
• Fewer distractions. No notifications, no temptation to glance elsewhere, no broadband cutting out at the wrong moment.

It need not be either / or

In practice, the choice is rarely all-or-nothing. Many of the people I work with blend the two — mostly online, with occasional sessions in person, or in-person work that moves online during a busy stretch or a bout of illness. What matters far more than the medium is the relationship itself: whether you feel safe, understood, and able to be honest. That can grow in either setting.

How to choose what suits you

A few questions can help you sense which way you lean:

• Do you have a private, uninterrupted space where you could speak freely at home?
• Do you tend to open up more easily in your own surroundings, or when you are physically with someone?
• Would the practical ease of online make therapy more sustainable for you — or would the journey to a room help you arrive ready to work?

There is no wrong answer, and nothing is fixed. We can begin one way and change if it is not serving you. One note of care: if you are in crisis or at risk of harming yourself, please treat that as more urgent than a preference about format — contact your GP, call 999, or reach the Samaritans free on 116 123 at any time.

Where I stand now

The sceptic in me has been thoroughly won over. I now work both ways — online with clients across the UK, and face to face in Richmond, West London and Surrey — and I no longer think of one as the real thing and the other as a stand-in. They are two doors into the same room. What matters is that you find the one that lets you walk in.