Is Online Therapy Right for You? A Therapist's Honest Take
I get asked this a lot. Usually by women who've tried virtual therapy and suspect it isn't working for them, or by women new to therapy who don't know where to start.
Here's the short version: for most of what I work with, online therapy works. The research is fairly settled on that, and after years of doing it both ways I'd say the same from experience. But it isn't the right choice for everyone, and I'd rather tell you that up front than have you spend three months in a format that doesn't suit you.
So here's an honest look at both sides.
What the Research Actually Says
Over the past decade a good deal of research has compared therapy delivered by video with therapy delivered in a room, mostly for things like depression and anxiety. The general finding has been that outcomes are broadly comparable. Not identical in every study and not for every presentation, but close enough that format is rarely the deciding factor.
What consistently matters more is the relationship. Whether you trust the person. Whether you feel understood. Whether you can be honest with them. That's been the strongest predictor of whether therapy helps for as long as anyone has been measuring it, and it doesn't depend much on whether you're breathing the same air.
When Online Therapy Works Well
When the drive is the thing that would make you cancel. This is the big one. I've watched a lot of women schedule in-person therapy with real intention and then cancel three weeks running because a kid got sick, a meeting ran over, or getting back in the car after the day they'd had was simply beyond them. The best format is the one you'll actually attend.
When your free hour is short and specific. A lunch break. A nap time. The forty minutes after bedtime before you fall asleep on the couch. Those windows don't accommodate a round trip.
When travel is unpredictable for health reasons. If you're managing a chronic illness, chronic pain, or fatigue, you already know that leaving the house isn't a neutral act. Video removes the part of therapy that was costing you the most.
When childcare is the actual obstacle. Arranging childcare so you can go and talk about how depleted you are by childcare is a particular kind of absurd. Video means a session while the baby naps in the next room.
When you live somewhere without many options. If the nearest therapist who works with what you're dealing with is an hour away, telehealth isn't a compromise. It's access.
When Online Therapy Doesn't Work As Well
When you need to physically leave in order to stop being on duty. Some women can't drop into it at home. The house is a to-do list. Even behind a closed door, part of your brain is still tracking the dishwasher. If that's you, the drive isn't a cost. It's part of the treatment.
When you've been on video all day already. If your job is eight hours of calls, a ninth isn't therapeutic. Screen fatigue is real and it's a perfectly good reason to come in.
When there's genuinely nowhere private. This is the most common real barrier, and it deserves its own section.
When more support is needed than weekly video sessions can offer. If you're in an active crisis, having thoughts of harming yourself or others, managing an eating disorder or substance use that needs closer monitoring, or at a point where a higher level of care would serve you better, online individual therapy on its own may not be enough. That isn't a judgment. It's about matching the support to what's actually happening, and it's something we'd talk through honestly on a consultation call.
So what can make virtual therapy more effective?
If you live alone and have a flexible job, virtual therapy tends to feel more accessible. If you have a partner who is working from home, a noisy house full of kids, or thin walls where everyone knows everyone’s business, then it can make online therapy a little more difficult.
Below are a few things I’ve seen clients try to help make virtual therapy more effective:
Do sessions in your car. I'm serious. Plenty of my clients do sessions parked in the driveway, in a work parking lot, or in the garage once everyone's asleep. It's private, it's quiet, and nobody looks twice at a woman sitting in a parked car.
Use headphones. They mean only half the conversation is audible from outside the room, which changes things considerably.
Turning on a fan or white noise machine outside a closed door. Cheap, and more effective than you'd expect.
Being more intentional about timing. Early morning before the house wakes up. During a school run somebody else is doing. On a lunch break from work. While finding an ideal time isn’t always realistic, it can help alleviate some stimulation.
And if the honest answer is that there's nowhere to go and no time to fit in therapy, that's useful information too. It may mean meeting for therapy in-person is the better call, or that your existing thought patterns are keeping to stuck in a life that regularly put others needs before your own (which we can process together!).
How To Setup Your Space
You don't need much. A phone, tablet or laptop, a connection that mostly holds, and somewhere to prop the device so you're not holding it for fifty minutes. Once setup, I recomend putting the camera at eye level rather than looking down or up at it (your neck will thank me later).
You’re also welcome (and encouraged) to have comfort items within easy reach so you're not having to get up and find them mid-sentence or thought. A glass of water, a box of tissues, a warm cup of tea, a small snack, a cozy blanket, a favorite fidget toy.
Frequestionly Asked Questions
What if my connection drops?
It happens, and it isn't a problem. We reconnect, or finish the session by phone. It's never counted as a missed session and you're not charged for time we lost to a bad signal.
What if I try it and don't like it?
Give it three or four sessions before deciding. The first session feels strange in any format and video amplifies that, so it's worth letting the initial awkwardness pass.
If a month in it still feels like you're performing rather than talking, tell me. We'd look at whether coming into the Crystal Lake office is realistic for you, and if it isn't, I'll help you find someone closer to home. I'd much rather you end up somewhere that works than stay somewhere that doesn't out of politeness.
Do I need to download anything?
It depends. You'll get a link before your session that opens in your browser. If you’d prefer to use your phone, then I’d recomend downloading the Telehelaht by Simple Practice moblie.
Is it actually confidential?
Yes. Sessions run on a secure, HIPAA-compliant platform, the same confidentiality rules apply as they would in a room, and nothing is recorded. The one piece I can't control is your end. If you're somewhere people might overhear you, or where someone could walk in, that's worth sorting out before we start. It's a big part of why I spend time with clients figuring out where they'll actually take the call.
Is online therapy covered by insurance?
Usually, though it's worth confirming with your plan. I'm in network with Blue Cross Blue Shield PPO and Blue Choice, and I can provide a superbill if you're out of network.
What if I'm out of state that day?
In most cases, we'd need to reschedule. I'm licensed in Illinois, which means I can only see you when you're physically in the state. If you're moving, I'll help you find someone licensed where you're going.
Still not sure if virtual therapy is right for you? Let’s connect!
If you live near the Crystal Lake office, you don't have to choose one or the other. Plenty of my clients come in when they can and switch to video the weeks they can't. Some do winter online and summer in person. Some come in once a month and do video the rest of the time. The format can flex around your life.
And if you're further away and in person isn't realistic, but you're still unsure whether video would work for you, let's talk it through. Fifteen minutes, no cost, and we can figure out what would actually work given your week, your house, and what you're bringing in.
