Online Counselling, Wherever You Are

Is Online as Good as Being in the Room

For most people, most of the time, yes. Not because the two are identical, but because the thing that actually does the work turns out to travel.

What people are really asking is narrower than they think. They are not asking whether video is as pleasant. They are asking whether you can build a proper working relationship with someone through a screen, because they have worked out, correctly, that the relationship is the part that matters.

That question has been looked at directly. A review of 24 studies found clients rating the bond and the sense of being present with their therapist at levels comparable to in-person work. The detail I find most telling is that clients consistently rated the connection higher than the therapists did. The people worrying about this most are the therapists.

The same authors are clear that it does not suit everyone, and they name digital access and confidence with the technology as real barriers rather than excuses.

Where I would push back on the usual claim is the evidence for equivalence of outcome. The strongest head-to-head work, twenty studies and 1,418 people, found effectively no difference between delivering therapy over the internet and face to face. But it is about CBT, a structured protocol you can hand over in a fixed number of sessions. That is not what I do, and I am not going to borrow somebody else's evidence and let you assume it covers me.

Telephone Counselling, If You Would Rather Just Talk

Not everyone wants to be on camera, and I do sessions by phone as well.

It is worth saying plainly that this is not the poor relation. Some people find the absence of a camera makes it easier to say the difficult thing, because they are not also managing their own face in a little box. Some people have a connection that will carry a voice and not a video. And some people simply talk better while walking around the kitchen than while sitting still in front of a laptop.

The research here is thinner than for video, and it is mostly about depression rather than everything people bring. A 2019 review of ten trials and 1,392 people found telephone-delivered therapy clearly better than no treatment, and across the four studies that compared it directly with face to face, no significant difference. Two honest caveats: the effect varied a great deal between studies, which the authors report rather than hide, and on average about a quarter of people did not complete the sessions they signed up for.

What I take from that is not that phone beats video. It is that phone is a real option rather than a fallback, and that the right format is the one you will actually turn up to.

When I Would Tell You to Come to Wolverton Instead

Nobody writes this bit down, so here it is.

If you have nowhere in your home you can speak freely, online is going to work against you. Someone spending fifty minutes being careful about volume is not doing the work, they are managing the room. Sitting in your car in a car park is better than that, and plenty of people do exactly that, but it is worth being honest with yourself about which one you have.

If the thing you want help with is going to be hard to look at, some people find the screen makes it easier and some find it lets them keep a distance they would not manage in person. I cannot tell you which you are in advance. I can tell you it is worth naming early, so we watch for it.

And if you live near enough to get here without it being a production, come here. Not because online is a lesser thing, but because turning up somewhere, sitting down and then leaving again does something on its own, and you lose that when the session ends and you are still in the kitchen.

Everyone else, and that is most people who ask me about this, is fine online. If you are in Aberdeen or Cornwall or on a rig, the alternative is not in-person work with me. It is nothing, or it is starting again with a stranger, and online beats both.

You Do Not Have to Be in the UK

This page used to say anywhere in the UK. That was smaller than the truth.

I have worked with people outside the UK, in Europe and in the United States, alongside clients all over Britain and Ireland. Online work is not bounded by geography, and if the connection holds and the hours can be made to meet, distance turns out to be less of an obstacle than people expect.

Two practical things if you are not in the UK. Say where you are when you first get in touch, because it occasionally matters for reasons that have nothing to do with the therapy. And be honest with yourself about the time difference rather than optimistic: a session booked at an hour when you are exhausted is not the same session.

How Working With Me Online Is Different From an App

The large online therapy services match you with somebody from a pool. If that person leaves, or your hours change, or the algorithm reshuffles, you get somebody else and you start again.

There is no pool here. You send a message, I am the person who replies, and I am the person on the screen. Same counsellor in session one and session twenty. That is not a policy I have adopted, it is that I am the only person here.

I have been in practice since 2013. I am an integrative therapist, which means I trained across several approaches rather than one, and I do not try to fit every person into the same model. I also tutor counselling and hypnotherapy students at RQF levels 3 to 6.

Online and telephone sessions are the same length as in-person ones and cover the same ground. If you want the detail of what a first session involves, it is set out on the contact page, and it does not change because we are on a screen.

You can also switch. People move between the three depending on the week they are having, and that is normal rather than a decision you have to make once and stick to. If you are within reach of Wolverton, the rest of my counselling and psychotherapy work happens there in person.

What About the Free Route

If you are in England, NHS Talking Therapies runs online too, it is free, and you can refer yourself without going through your GP as long as you are registered with one and you are 18 or over, or 16 in some areas. Elsewhere in the UK and abroad there is usually an equivalent, and it is worth finding out what yours is.

I would rather you knew that than found it out after paying me. Some people want to choose who they see, or have been through it already, or would rather it was not on their record. Those are all reasonable, and so is trying the free route first.