Is online counselling effective?

For many people, yes. Meta-analyses comparing therapy delivered live by video with face-to-face therapy have found little or no difference in outcomes on average. But most of the studies tested structured therapies such as CBT, some weren't randomised trials, and an average across thousands of people can't predict how online counselling will feel for you.

What does the research say about online counselling?

The strongest evidence comes from meta-analyses, which pool the results of many studies. Three recent ones are worth knowing about, because they ask the same question in slightly different ways.

Fernandez and colleagues (2021) looked at therapy delivered live by video. They found 56 studies measuring change within video therapy and 47 studies comparing it with in-person therapy or other groups, with 3,564 participants in the comparison studies. People improved substantially from the start to the end of video therapy, and the difference from in-person therapy was negligible. The authors concluded that therapy is no less efficacious by video than in person.

Batastini and colleagues (2021) pooled 43 studies of treatment outcomes, covering 4,336 clients and 281 individual outcomes. Video sessions produced effects that were largely equivalent to in-person sessions.

Greenwood and colleagues (2022) included only randomised controlled trials, 12 of them with 931 patients, focusing on less common conditions. Most delivered telehealth by video, some by telephone. They found no significant differences in symptom severity between telehealth and face-to-face therapy straight after treatment or at later follow-ups.

So three teams, using different methods and different sets of studies, reached a similar answer. That consistency is the main reason the finding is taken seriously.

Can you build a real relationship over video?

This is the question that matters most for person-centred counselling, where the relationship between you and your counsellor is the heart of the work. If you'd like to read more about why, the glossary explains the therapeutic relationship.

A review by Simpson and Reid (2014) looked at 23 studies that measured the therapeutic alliance in video therapy. The studies overwhelmingly supported the idea that a good alliance can develop by video. Clients rated their bond with the therapist, and their sense of the therapist's presence, at least as strongly as clients seen in person.

One detail is interesting. Therapists sometimes rated the alliance a little lower than their clients did, early in treatment. It may be that practitioners worry more about the screen than clients do.

What doesn't the research show?

Being precise about the limits is part of taking the evidence seriously.

• It's mostly about CBT. Most studies tested cognitive behavioural therapy. In Fernandez's analysis, the largest improvements came from CBT, and the effect for other therapies was smaller. There is much less research testing person-centred counselling by video specifically. The evidence for this approach is encouraging, not settled.
• Many studies weren't randomised. Batastini and colleagues flagged the relatively small number of randomised controlled trials, and incomplete reporting in many studies, as their biggest concern.
• Publication bias. Fernandez and colleagues adjusted for the chance that positive studies are more likely to be published. The overall effect of video therapy shrank after that adjustment, though it stayed meaningful.
• Averages hide individuals. "No difference on average" can include people who did better online and people who did worse.
• "Online" isn't one thing. These studies are mostly about live sessions with a practitioner. They don't tell you much about apps, text chat or self-guided programmes. My page on private counselling versus therapy apps looks at that difference.
• It doesn't promise outcomes. No study can tell you counselling will fix a particular problem, online or in person.

What does this mean for person-centred counselling?

Person-centred counselling doesn't rely on worksheets or techniques that might work differently on a screen. It relies on the relationship: being listened to closely, accepted, and met honestly, which Rogers described as the core conditions. The alliance research is the most relevant evidence here, and it's reassuring. The honest summary is that video counselling looks comparable to in-person work on average, that the relationship can form well over video, and that direct trials of person-centred counselling by video are still scarce. My page on person-centred counselling explains the approach.

Why might online counselling suit some people better?

Some of the advantages are practical. There's no travel, it's easier to fit around work or children, and you can keep the same counsellor if you move countries. For people living abroad, it can mean talking in your own language with someone who shares some of your cultural references. My page on online therapy for expats explains how that works.

Others are more personal. Some people find it easier to say difficult things from their own sofa. A screen can give a little distance that makes honesty feel possible.

When might in-person or local help be better?

Online counselling isn't the right fit for everyone or every moment.

• In a crisis, you need services where you are. If you're in danger, call 112 anywhere in the EU or 999 in the UK. The helplines directory lists verified crisis lines by country.
• Without a private space, it's hard to speak freely. If someone at home monitors your phone or computer, online sessions may not be safe.
• With an unreliable connection, frozen screens can break the thread of what you're saying.
• If you simply prefer it. Wanting to be in the same room as someone is a good enough reason.

I don't work with active suicidal crisis, psychosis, eating disorders or addiction, online or in person, and I'll help you look for the right local support if that's what you need. My guide on how to find a therapist abroad explains how to look locally.

How can you give online counselling a fair try?

Treat the first few sessions as an experiment. Sit somewhere you won't be overheard, use headphones if you can, and close other apps so messages don't pull you away. Notice whether, after a session or two, you feel heard. That feeling is a better guide than any statistic. The guide to what to expect in your first counselling session explains how those early sessions usually go, and the understanding therapy resources collect independent reading.

If you're unsure, my short reflection tool, is online counselling right for me?, may help you think it through. You might also want to read is online counselling confidential? before you start.

I'm a trainee person-centred counsellor and BACP student member, working under supervision. Sessions are online by secure video from the UK, and you can book a session when you're ready.