Diana Tutschek is a psychologist and a licensed psychological counsellor offering online and in-person individual counselling and couples therapy. She holds a master’s degree in psychology and mental health from King’s College London, complemented by a master’s study at the University of Vienna (Institute of Clinical and Health Psychology), and she is currently pursuing a PhD in Clinical Psychology. She has years of supervised practice and more than a decade of experience counselling couples and individuals worldwide.
On the Effectiveness of an Online Setting for Individual and Couples Therapy, Counselling and Coaching in Addressing Relationship Problems, Depression, Anxiety, Trauma, Procrastination and Other Conditions
Is online counselling or therapy for depression, anxiety, ADHD, trauma and other mental health conditions, as well as for non-clinical issues, such as relationship crises and procrastination, as effective as an in-person setting? Many people new to counselling or switching from an in-person to online setting might doubt the effectiveness of online treatment.
The reason is often that “traditional” or “real” therapy and counselling are viewed as an intervention delivered in an in-person setting. Indeed, the efficacy of different types of in-person treatment for various clinical and non-clinical issues is well established through research evidence.
Yet, the notion that “real” therapy is only possible in an in-person setting has been increasingly challenged since the pandemic. The pandemic-driven global shift has made the online setting the option for a prolonged period. Numerous clinical studies examined the effectiveness of online treatment for various conditions.
So, does online therapy work?
Research evidence points out that online therapy is just as effective as in-person treatment for various mental health and relationship issues.
What conditions may online therapy help with?
Remotely delivered counselling may provide essential support and tools to help individuals with
- post-traumatic stress disorder (PTSD) and consequences of psychological trauma, including childhood trauma,
- mood disorders such as depression and anxiety,
- neurological conditions such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders,
- relationship distress and marriage crisis.
Research indicates that it is not the setting—whether online or in person—that determines the effectiveness of therapy
So, what are the factors that contribute to the effectiveness of therapy or counselling?
- Therapeutic Alliance
It is simply the relationship between the client and the therapist, including trust, connection and cooperation. - Client Factors
What do you, as a client, bring to the table? This may include factors such as your goals, openness to therapy, readiness to change and motivation. - Expectations
These include your (as a client) belief in the usefulness of therapy and its positive effects. - Therapist-Related Factors
These are therapist qualities that include the therapist’s proficiency, empathy and cultural competence. - Specific therapy factors refer to the therapeutic techniques or approaches used in treatment, such as cognitive behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), dialectical behaviour therapy (DBT), emotion-focused therapy (EFT), and psychoanalytic therapy, among others.
Interestingly enough, a specific technique or modality (e.g. CBT, psychodynamic, EMDR, DBT, EFC, MBT, etc.) influences around 15% of therapy outcomes. Moreover, according to the “Dodo bird hypothesis”, no particular therapy has greater effectiveness than any other. On the other hand, common factors that are not therapy-specific—such as the therapeutic alliance, client factors, and expectations—account for about 70% of therapy outcomes, with the therapeutic alliance alone contributing around 30%.
Effective therapy concentrates on the client’s strengths and resources and employs an approach tailored to the client’s specific needs and targets.
What are the benefits of an online therapy setting?
- Better Accessibility
A physical location can limit access to in-person therapy, individual or couples counselling. Online therapy removes that barrier, connecting clients with licensed professionals regardless of location—particularly helpful for those in underserved or rural areas. - Wider Choice of Therapists
Geography no longer limits therapist selection. Clients can access professionals with expertise in specific areas, such as trauma, anxiety, depression, ADHD or marriage difficulties. - Convenience
Therapy sessions can be joined from home, work, or any private space, removing the need for travel and allowing appointments to fit easily into everyday routines. - Greater Flexibility
Online platforms often offer more flexible scheduling. Some also provide additional support, such as secure messaging, to maintain therapeutic contact between sessions. - Increased Privacy
The stigma around mental health care still prevents some people from seeking help. Online therapy allows for more discretion, enabling clients to speak openly from the comfort of their own space. - Reduced Costs
Virtual sessions can be more cost-effective by eliminating travel expenses and minimising the need to take time off work. In some cases, online fees may also be lower. - Comfortable Environment
Attending therapy in a familiar space can reduce anxiety and encourage openness—particularly helpful when discussing personal or sensitive topics. - Varied Communication Formats
Many online services offer video, phone, or written communication. This flexibility allows clients to choose the method that best suits their comfort and needs.
While online therapy offers many benefits, it may not be the right fit for everyone
- Technical Issues
A stable internet connection is essential. Poor connectivity or audio/video problems can interfere with the therapeutic process. - Licensing Restrictions
Therapists may only be permitted to work with clients in specific countries or regions. - Unsuitability for Certain Conditions
Severe psychiatric issues—such as psychosis or extreme suicidal thoughts—may require in-person intervention or crisis care. In such cases, emergency support and follow-up with local services are vital.
To decide if online therapy is right for you, consider the following:
Comfort with technology – Are you familiar with using video conferencing or messaging tools?
Privacy – Can you find a quiet, confidential space to attend sessions undisturbed?
Therapist access – Does online therapy offer access to specialists suited to your needs (e.g., for depression, trauma, or couples counselling)?
Affordability – Do online therapy costs fit your budget? Is it covered by your insurance?
Personal preference – Do you feel you can emotionally connect and engage well in an online format?
Crisis support – In emergencies, online therapy or counselling may not be the right option. If you’re in a high-risk situation, experiencing an emergency, or need immediate help, online therapy may not be the most appropriate first line of care.