Does Online Counselling and Psychotherapy Really Work? What the Research Says — What I've Noticed

This morning I went for a walk in the inner city of Sydney, NSW.

I picked wild jonquilles growing through the cracks in the footpath. Small, stubborn, improbably beautiful. I thought about the cabin I once lived in Colorado, surrounded by mountain lions and bears, and wildflowers so abundant you could lose yourself in them. I try to get into the Australian wilderness once a month. There is nothing quite like it.

And yet.

The jonquilles were real. The morning was real. The quality of attention I brought to that walk, the noticing, the slowing down, the willingness to see what was there, made it nourishing in the same way the wilderness does.

It is often a matter of what we decide to see.

I have been reflecting about this in relation to online therapy. Because the question I am asked most often, sometimes with genuine curiosity, sometimes with barely concealed scepticism, is: does it really work?

The short answer is yes. The longer answer is even more interesting.

What the research says

The evidence for online therapy is now substantial and growing. Multiple meta-analyses, studies that pool the results of many individual studies, have found that online counselling and psychotherapy produce outcomes comparable to in-person therapy across a wide range of presentations, including depression, anxiety, grief, trauma, and PTSD.

A landmark review published in the Journal of Anxiety Disorders found that internet-delivered cognitive behavioural therapy was as effective as face-to-face delivery for anxiety and depression. More recent research has extended these findings to grief-specific interventions, trauma processing, and existential work.

The therapeutic alliance, the quality of the relationship between therapist and client, which is one of the strongest predictors of therapy outcomes, has been shown to be just as strong in online sessions as in person. Clients report feeling heard, understood, and genuinely connected to their therapist, regardless of the medium.

In short: the screen does not get in the way of the work.

What I have noticed in my own practice

Research is one thing. But I want to speak honestly about what I have actually experienced, because statistics can only tell you so much.

What I notice, working with clients online, is that the intimacy of a session is not diminished by the screen. If anything, there is something particular about being received in your own space, in your own home, your own chair, your own familiar surroundings, that can create a different kind of safety. You are already on your own ground. You do not have to travel to vulnerability. It comes to meet you where you are. Literally.

I have sat with people in acute grief, in deep existential crisis, in moments of profound realisation, all through a screen. The tears were real. The breakthroughs were real. The relationship was real.

What makes therapy work is not the room. It is the quality of presence, the quality of attention, the quality of the relationship. These things travel.

The wilderness and the footpath

This is where my morning walk comes back to me.

There is nothing quite like being in the wilderness, in the full sensory immersion of nature, far from the city, surrounded by something vast and indifferent and alive. I would not trade it. I seek it out as often as I can.

But this morning, picking jonquilles from the cracks in a Sydney footpath, I was nourished too. Not less. Differently, perhaps. But genuinely.

The quality of the experience depended not on the location, but on the attention I brought to it. On what I decided to see. And I decided to see beauty, I let the feelings take over me.

Online therapy is a little like this. It is not the wilderness. But it is not nothing, either. With the right presence, on both sides of the screen, it can be profoundly real. And sometimes this reality can be as intense or emotional, if not more. Because we are home, safe, grounded withing our own territory.

What online therapy makes possible

Beyond the question of whether it works, there is a question worth asking: what does it make possible that wouldn't otherwise exist?

For many people, the answer is significant.

Online therapy means:

• Access regardless of location: whether you live in regional Queensland, rural Western Australia, or a city where the right therapist simply isn't available nearby

• No travel time: which matters enormously when you are already exhausted, grieving, or managing a busy life

• Sessions from your own space: which for some people, particularly those processing grief or trauma, feels safer and more manageable than a clinical setting

• Continuity: therapy doesn't have to stop when you travel, relocate, or move interstate

• Choice: you are not limited to whoever happens to practice within driving distance. You can find the right fit, wherever they are

For my French-speaking clients across Australia, online therapy is often the only way to access support in their own language. For people navigating migration, relocation, or displacement, whose lives are already defined by the tension between where they are and where they belong, therapy that travels with them matters deeply.

What online therapy is not

I want to be honest about this too.

Online therapy is not for everyone in every circumstance. For some people, particularly those in acute crisis, those with significant dissociation, or those who find the screen genuinely distancing and lacking human warmth or physical cues, in-person support may be more appropriate, at least initially.

There are also practical realities: you need a stable internet connection, a private space, and a willingness to show up to the screen with some intentionality. A session taken from the car or the office during a lunch break is not the same as one taken from a quiet corner of your home with a cup of tea.

The container matters. Not the room, but the container you create around the session.

A note on presence

I also want to say one more thing about presence, because I think it is the heart of this question.

The fear beneath "does online therapy work?" is often really a fear about whether genuine human connection is possible through a screen. Whether you can truly be met, seen, understood, accompanied, by someone you have never been in the same room with.

I understand that fear. And I would answer it this way:

Presence is not a function of proximity. Some of the most profound moments of human connection happen across great distances, in letters, in phone calls, in a video call late at night when someone finally says the thing they have never been able to say.

What makes therapy work is not the air you share. It is the attention, the care, the willingness to show up fully, on both sides of the screen.

That, I can offer. Wherever you are.

Sandrine Lonchampt is a grief counsellor and psychotherapist at Colibri Counselling & Psychotherapy, offering online sessions across Australia, in English and French.

If this resonated with you, I offer a free 25-minute consultation. Book a Free Consultation.

Online Counselling and Psychotherapy

References

Andersson, G., Rozental, A., Riper, H., & Cuijpers, P. (2017). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1–18. https://doi.org/10.1080/16506073.2017.140111

Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorp, N. M., Lohr, J., & Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111–131. https://doi.org/10.1037/a0027924

Chi, D., Zhang, Y., Zhou, D., Xu, G., & Bian, G. (2022). The effectiveness and associated factors of online psychotherapy on COVID-19 related distress: A systematic review and meta-analysis. Frontiers in Psychology, 13.https://doi.org/10.3389/fpsyg.2022.1045400

Fischer-Grote, L., Fössing, V., Aigner, M., Fehrmann, E., & Boeckle, M. (2024). Effectiveness of online and remote interventions for mental health in children, adolescents, and young adults after the onset of the COVID-19 pandemic: Systematic review and meta-analysis. JMIR Mental Health, 11. https://doi.org/10.2196/46637