Is online therapy effective? What the research says

What the research shows

Researchers have compared online and in-person therapy for years. The strongest evidence comes from systematic reviews that combine many randomized controlled trials, where people are randomly assigned to one format or the other.

A 2026 review looked only at trials of live video therapy for adults. Across 12 trials with 900 participants, covering conditions such as PTSD, depression, obsessive-compulsive disorder, and generalized anxiety, it found no significant difference in symptom reduction between video and face-to-face therapy^{Source [1]}. A 2024 review of 54 trials with more than 5,400 adults reached a similar conclusion for cognitive behavioral therapy guided by a therapist by video or phone: little to no difference compared with in-person sessions^{Source [2]}.

Earlier reviews point the same way. One concluded that therapy is no less effective when delivered by video than in person^{Source [3]}. Another, covering 57 studies and more than 4,000 clients, found treatment effects that were largely equivalent^{Source [4]}. The National Institute of Mental Health also states that virtual care can be effective for anxiety, depression, PTSD, and other conditions^{Source [5]}.

Can you build a real connection over video?

Many people worry that a screen will make it hard to feel understood. The research is reassuring. A review of 18 studies found no significant difference in the therapeutic alliance, the working relationship between client and therapist, between video and in-person therapy, whether clients or therapists rated it^{Source [6]}.

That relationship matters. Across hundreds of studies, a stronger alliance is linked to better results in therapy^{Source [7]}. So the most useful question is often less about the screen and more about whether you feel heard and respected by the person on the other side of it.

Where the evidence is limited

An honest answer includes the limits. Most trials studied cognitive behavioral therapy for depression, anxiety, and PTSD, mostly in Western countries, and the authors of the 2026 review call the evidence limited in size and scope^{Source [1]}. There is little research so far on some serious conditions, such as schizophrenia and bipolar disorder^{Source [8]}.

Online therapy also depends on things outside the session: a reliable internet connection, a device, and a private place to talk. The NIMH notes that virtual visits can feel less private if people nearby can see or overhear the conversation^{Source [5]}. Ethics guidance for counselors says that when distance counseling is not working, counselor and client should consider face-to-face care, and the counselor should help the client find appropriate services if needed^{Source [9]}.

Online therapy may not be the best fit if:

• You are in crisis or need emergency care. Call or text 988, or call 911.
• You have no private place to talk where others cannot overhear.
• Video still makes it much harder for you to open up after a few sessions.

Online therapy is now a common choice

If you choose online therapy, you are far from alone. A national study of US adults in outpatient mental health care found that about 28 percent received all of their care through telehealth, and about 22 percent combined telehealth with in-person visits. People in therapy without medication were among the most likely to use telehealth only^{Source [10]}.

How to get the most from online sessions

A little preparation helps sessions feel private and focused. Federal telehealth guidance suggests a few simple steps^{Source [11]Source [12]}:

• Find a quiet, private room where no one can overhear. Headphones can help.
• Use your own device and a password-protected home network rather than public Wi-Fi.
• Test your camera, microphone, and connection, and sign on a few minutes early.
• Close other apps and silence notifications.
• Write down what you want to talk about.
• Never join a session while driving.

Signs it may be time to talk to someone

You do not need to wait until things feel unbearable. It may help to reach out if:

• Worry, sadness, or stress has lasted for weeks and is not easing.
• It is getting harder to keep up with work, school, or relationships.
• You are sleeping, eating, or connecting with people differently than usual.
• You have been coping on your own and are tired of carrying it alone.

How we can help

At Choosing Hope, every session takes place online on a secure video platform, so you can meet with us from home or another private place anywhere in New York State. We offer individual therapy for adults 18 and over and couples and family therapy, in English or in Spanish.

Your first session is an intake assessment, where we get to know you and what you want to work on. If you are unsure whether online therapy suits you, we are happy to talk it through before you begin. You can also read what to expect in your first therapy session.

Because of state licensing rules, you need to be physically located in New York State during each session. We keep a limited number of sliding scale spots for people facing financial hardship and for full-time college students. Our pricing page explains how it works.

Common questions

References

1. Meyer-Keirath C, Wallis H, et al. Journal of Medical Internet Research (2026). Comparing Video-Based and Face-to-Face Psychotherapy: Systematic Review and Multilevel Meta-Analysis Across Mental Disorders
2. Zandieh S, et al. CMAJ (2024). Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials
3. Fernandez E, et al. Clinical Psychology and Psychotherapy (2021). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment
4. Batastini AB, et al. Clinical Psychology Review (2021). Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice
5. National Institute of Mental Health (2025). Getting Mental Health Support Virtually
6. Seuling PD, et al. Journal of Telemedicine and Telecare (2024). Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person: A systematic review and meta-analysis
7. Flückiger C, Del Re AC, Wampold BE, Horvath AO. Psychotherapy (2018). The alliance in adult psychotherapy: A meta-analytic synthesis
8. Greenwood H, et al. JMIR Mental Health (2022). Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials
9. American Counseling Association (2014). 2014 ACA Code of Ethics
10. Olfson M, et al. JAMA Psychiatry (2026). Telemental Health, Hybrid, and In-Person Outpatient Mental Health Care in the US
11. U.S. Department of Health and Human Services, Telehealth.HHS.gov (2025). What should I know before my telehealth visit?
12. U.S. Department of Health and Human Services, Telehealth.HHS.gov (2024). How do I protect my data and privacy?