What online therapy is like, and what to set up first

Therapy online can happen by real-time video, by phone, or by messaging that is asynchronous. Each has trade-offs. Video gives more visual cues and can feel closer to an in-person visit. Phone removes visual pressure and can be easier if your internet is unreliable. Messaging lets you write when it suits you and can be helpful if you process better in words, but it is not immediate.

Think about privacy in your own space, how comfortable you are with technology, and how you like to communicate. A therapist who is licensed or registered where they practise may offer one or more of these formats. If you are looking for a therapist on this site, see /therapists/ and our guidance on choosing at /how-to-choose/.

Choose a place where you will not be interrupted for the length of the session. That may mean telling a housemate you need private time, putting a note on a door, or using a parked car for brief calls. If you use a shared living area, plan how to signal to others you should not be disturbed.

Have basic comforts ready - water, tissues, a charged phone or computer, and headphones if that helps you hear better or feel less exposed. For some kinds of work, having a little time afterward without obligations matters more than usual. Try to avoid scheduling directly before an appointment where you must rush off to other responsibilities.

For video, test camera, microphone and speakers in advance. Close other apps that use bandwidth. If you use headphones, check that the volume and mic are comfortable. For phone calls, check battery level and signal strength. For messaging, make sure you know how and when your messages will be delivered and read - therapists differ in how they manage written contact.

Agree in advance with your therapist what backup you will use if technology fails. Many people arrange a phone number to call if a video session drops, or an agreed time to reconnect if messaging is delayed. Confirming this before a session reduces stress if things go wrong.

Video: You can see facial expressions and body language. That can help the flow of conversation. It may also feel more exposing for some people. Lighting and camera angle matter less than being able to see and hear each other clearly.

Phone: Without visual cues, words and tone carry more of the interaction. Some people find phone sessions easier to relax into. Others miss the nonverbal information. Phone is often more resilient on low bandwidth.

Messaging: Written sessions let you compose thoughts and may feel useful if you find it hard to speak about things in the moment. Messaging is typically not immediate and it is not a substitute for urgent help. Ask how your therapist handles response times and record keeping for written exchanges.

Plan a backup before you start. Agreeing on a phone number to call, a messaging fallback, or a time to try reconnecting can stop a dropped connection from becoming an obstacle. If you get cut off, try to rejoin the agreed method after a short pause.

If you are interrupted at home, pause and let your therapist know. You and your therapist can decide to extend, reschedule, or end early depending on what feels safe and practical. For some people doing trauma-related work, interruptions can feel more distressing. If that applies to you, mention it to the clinician so they can agree a specific plan for reconnection or immediate next steps.

Give yourself a few minutes to settle. This might mean a short walk, a drink, a few moments of quiet, or checking in with someone you trust if you planned that in advance. People often find that the minutes after a session matter more when the session covered difficult material, so avoiding immediately demanding activities can help.

Decide whether you want to make a brief note about anything to follow up, whether to schedule a next appointment, and whether you need to tell anyone else about what happened during the session. Your therapist can advise on practical next steps during the session itself.

Some therapists on this directory name EMDR among their approaches. Naming an approach on a profile is not evidence of specific training or competence in it. This directory checks no training records. If a particular approach matters to you, ask any therapist you contact about their training, experience and how they work with that method. A therapist who is licensed or registered where they practise can speak with you about suitability in a one-on-one conversation.

Because trauma-related work can sometimes bring up strong feelings, plan with your clinician how you will be supported if that happens during or after an online session. That plan may include a grounded follow-up, a check-in with a friend, or a clear agreement about how to resume the session if technology interrupts it. Your clinician who is actually talking to you is the person who can say what is appropriate for your situation.

If you are in immediate danger, call local emergency services - 911, 999 or 000. If you are feeling unable to keep yourself safe but it is not immediately life-threatening, use crisis resources for support: 988 in the US (call or text), 116 123 in the UK (Samaritans), 13 11 14 in Australia (Lifeline). If you are worried about crisis or self-harm, bring this up with a clinician before doing any emotionally intense work online so you can agree a plan together.

This article does not provide medical advice or diagnosis. A clinician who is actually talking to you can say what is needed for your care.