Is Online Therapy Effective? What Happens in Online Counselling and Your First Therapy Session
- Paul Madden
- Mar 29
- 5 min read
Updated: 5 days ago
Many people considering therapy ask the same questions:
“Is online therapy effective?”
“What happens in online counselling?”
“Is online therapy as good as face-to-face counselling?”
“What happens in a first therapy session?”
“Will online counselling feel awkward or impersonal?”
These concerns are completely understandable. Starting therapy can feel like a big step, especially if you’ve never spoken to a counsellor before.
The good news is that online counselling is now a well-established and evidence-based form of psychological support. Research and professional guidance from organisations such as the NHS, BACP (British Association for Counselling and Psychotherapy) and NICE (National Institute for Health and Care Excellence) increasingly recognise online therapy as an effective way to access mental health support.
This guide explains:
how online counselling works
what happens in your first therapy session
the benefits of online therapy
how online therapy compares with in-person counselling
what professional standards say about online counselling
If you’re new to counselling, you may also find my article on what happens in your first therapy session helpful: What Happens in Your First Therapy Session?
What Is Online Counselling?
Online counselling is therapy delivered remotely using secure platforms such as:
video sessions
telephone counselling
secure online communication platforms
Online therapy allows people to access professional mental health support from their own home or another private space.
Many people seek online counselling for:
anxiety
depression
stress and burnout
grief and bereavement
relationship difficulties
low self-esteem
identity and sexuality concerns
emotional overwhelm
Online therapy is not considered a lesser form of therapy. For many people, it is a highly effective and accessible way to receive support.
Is Online Therapy Effective?
Research consistently shows that online therapy can be effective for many common mental health concerns, particularly anxiety and depression.
The NHS guidance on counselling and talking therapies recognises online therapy as part of modern mental health support services.
Research reviewed by NICE has found that online therapeutic approaches, including online CBT, can produce outcomes comparable to face-to-face therapy for many people experiencing mild to moderate mental health difficulties.
According to the BACP guidance on online counselling, online therapy can provide a safe, ethical and effective therapeutic space when delivered by a qualified professional.
Importantly, psychotherapy research consistently shows that one of the strongest predictors of positive therapy outcomes is the quality of the therapeutic relationship itself.
In other words, feeling safe, understood and supported matters more than whether therapy takes place in a physical room or online.
What Happens in Your First Online Therapy Session?
Your first counselling session is usually called an initial assessment.
This first session is an opportunity for:
you to talk about what has brought you to therapy
the therapist to understand your needs
both of you to decide whether working together feels like a good fit
The first session is not:
a test
a diagnosis
an interrogation
a commitment to long-term therapy
You do not need to arrive with everything figured out.
Many people begin by saying:
“I don’t know where to start.”
“I just feel overwhelmed.”
“Something doesn’t feel right.”
“I’m not really sure why I’m here.”
That is completely normal.
What Will a Therapist Ask in the First Session?
The first therapy session is usually a calm, structured conversation.
A therapist may ask about:
what has brought you to therapy
how you have been feeling recently
stress, anxiety or low mood
relationships and support systems
important life experiences
physical or mental health history
what you hope therapy might help with
The aim is not to judge or analyse you. It is simply to begin understanding your experiences and how therapy may support you.
Confidentiality in Online Counselling
Professional bodies such as BACP place strong importance on confidentiality, informed consent and safe therapeutic practice.
At the beginning of therapy, your therapist should explain:
how confidentiality works
the limits of confidentiality
how notes and information are stored
what happens in situations involving serious risk of harm
your right to ask questions at any point
Qualified online therapists use secure platforms and work within professional ethical standards.
Benefits of Online Counselling
Online counselling has become increasingly popular because it removes many practical barriers that can make therapy difficult to access.
Online Therapy Is More Accessible
Online counselling allows people to access therapy regardless of location.
This can be especially helpful if you:
live in a rural area
have mobility or health difficulties
travel frequently
have childcare responsibilities
struggle with commuting
For many people, online therapy makes support possible where it may otherwise have felt inaccessible.
Online Counselling Offers Greater Flexibility
Online therapy can fit more easily around:
work schedules
shift work
parenting responsibilities
travel
busy lifestyles
This flexibility can help people engage with therapy more consistently.
Many People Feel More Comfortable at Home
Some people find it easier to open up emotionally when they are in familiar surroundings.
Being at home can:
reduce anxiety
increase emotional safety
help people feel more grounded
make difficult conversations feel less intimidating
For clients discussing sensitive issues such as grief, sexuality, trauma or relationship difficulties, this added comfort can make a significant difference.
Online Therapy Allows Continuity of Support
Online counselling allows therapy to continue during periods of change, including:
relocation
travel
illness
changing work circumstances
Consistency and continuity can be important parts of effective therapeutic work.
Online Therapy vs In-Person Therapy
Many people wonder whether online therapy is “better” than face-to-face counselling.
In reality, both online and in-person therapy can be highly effective.
The right choice depends on:
your comfort level
your lifestyle
your environment
your preferences
the kind of support you are seeking
Some people prefer:
the flexibility of online counselling
the privacy of attending sessions from home
avoiding travel and waiting rooms
Others prefer:
being physically present in a therapy room
a clearer separation from home life
face-to-face interaction
There is no universal “best” option. What matters most is finding a therapeutic environment where you feel safe enough to talk openly.
Common Concerns About Online Therapy
“Will online therapy feel impersonal?”
Many people are surprised by how connected and personal online counselling can feel once the conversation begins.
“What if I cry during therapy?”
Crying is common and completely accepted in therapy.
“What if I don’t know what to say?”
You do not need to prepare perfectly. Therapists are trained to help conversations develop gently and naturally.
“Is online counselling confidential?”
Qualified therapists follow ethical and legal standards regarding confidentiality and data protection.
“What if I decide therapy is not right for me?”
There is no obligation to continue after an initial assessment. The first session is also your opportunity to decide whether the therapist feels like the right fit.
What Makes Therapy Effective?
Research across decades of psychotherapy consistently highlights several factors linked to positive outcomes:
feeling heard and understood
trust and emotional safety
consistency in sessions
a strong therapeutic relationship
openness within the process
These factors matter more than whether therapy takes place online or in person.
When Might Online Counselling Help?
Online therapy may help if you are experiencing:
anxiety
depression or low mood
stress and burnout
grief and bereavement
emotional overwhelm
relationship difficulties
low self-esteem
feeling emotionally stuck or disconnected
You do not need to wait until things become severe before reaching out for support.
Online Counselling Across the UK
I’m a BACP-accredited therapist offering confidential online counselling across the UK.
If you’re considering therapy and wondering whether online counselling is right for you, an initial assessment gives us space to explore what’s been happening and whether this approach feels supportive and appropriate for your needs.
You do not need to have everything figured out before reaching out. Sometimes beginning the conversation is enough.
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