A common question I hear from people considering therapy is some version of: "Does it actually work if it's not face to face?" It is a fair question, and it deserves a direct answer grounded in evidence rather than reassurance.
The short answer is yes. A growing body of research, including a 2025 meta-analysis published in JMIR Mental Health, found that 86% of clients showed equal or better progress in online therapy compared to in-person treatment. That is not a marginal finding — it reflects a consistent pattern across hundreds of studies. Online therapy works, and for many people it works exceptionally well. What matters is not the medium; it is the quality of the therapeutic relationship and the depth of the work itself.
What the Research Actually Says
The evidence base for online therapy has grown substantially over the past decade and accelerated sharply after 2020. What was once considered a contingency measure is now recognised as a legitimate, well-studied mode of care.
Key findings from recent research:
- A 2025 meta-analysis in JMIR Mental Health found that 86% of clients showed equal or better outcomes in online therapy compared to in-person treatment — across a range of presentations including depression, anxiety, and trauma.
- A randomised non-inferiority trial published in Trials (PMC) specifically tested the hypothesis that online therapy via video call is not inferior to in-person therapy for symptomatic and societal recovery — and found exactly that.
- A study in Frontiers in Psychology demonstrated that skilled use of teletherapy-specific interventions is positively related to strong therapeutic alliance, genuine relational connection, and therapeutic presence — the same process variables associated with good outcomes in any modality.
- Research published in the Journal of Psychiatric Research comparing matched samples of patients receiving in-person versus telehealth intensive treatment found no significant differences in depressive symptom reduction or quality of life improvement across both groups.
The broader landscape confirms this direction. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the proportion of mental health facilities offering telehealth services rose from 38% in 2019 to 68% by 2020 — and has remained elevated since. The global online counselling market is projected to reach $3.83 billion in 2026, reflecting sustained demand from both clients and practitioners.
This is not a niche movement. Online therapy has become a mainstream clinical practice with a substantial evidence base behind it.
Why Online Therapy Works Well for Depth Work
One of the more interesting questions I sit with as a practitioner working within the tradition of Lacanian psychoanalysis is whether the screen changes the nature of the work. My experience — and the emerging clinical literature — suggests it does not diminish it, and in some respects it introduces conditions worth taking seriously.
In Lacanian terms, the unconscious speaks through language, through the gaps in speech, through what is said and what is not said. None of that requires physical proximity. The work of speech — the process through which a person begins to locate themselves differently in relation to their history, their desires, their symptoms — happens just as readily through a screen as in any other setting.
Some clients report that being in their own space during sessions actually lowers their guard in productive ways. The "democratising" effect noted in the teletherapy literature — where clients occupy their own territory rather than entering the therapist's institutional space — can shift the power dynamic in ways that are clinically useful. Certain defences relax. Certain truths emerge more readily.
What matters is the quality of listening and the depth of engagement with what the client brings. Those things are not bounded by a room.
What a Typical Online Session Looks Like
Sessions take place via a secure video platform. The technical setup is simple: a stable internet connection, a private space, and a device with a camera and microphone. Most clients use a laptop or desktop; some use a tablet.
A session runs for fifty minutes. The structure is open-ended rather than structured around exercises or homework. The client speaks; I listen carefully and respond to what I hear — not just the content, but the way things are said, what gets repeated, what gets avoided.
There is nothing "reduced" about this format. The attentiveness is the same. The silences matter just as much. What shifts over time — a gradual change in how a person relates to a recurring difficulty, a loosening of a fixed pattern of thought, a shift in what feels possible — is the same kind of shift that happens in any serious therapeutic work.
Confidentiality is maintained through an encrypted platform. Sessions are not recorded.
Who Online Therapy Suits
Online therapy is well-suited to a wide range of people and presenting concerns. In my practice, I work with clients who are dealing with:
- Anxiety, depression, and persistent low mood
- Difficulties in relationships — patterns that keep repeating
- Questions about identity, meaning, and direction
- Unresolved experiences from earlier in life
- Work-related stress, burnout, and a sense of being stuck
The research bears this out. A large study drawing on data from over 17,000 clients found that client characteristics — including symptom severity, demographics, and treatment history — accounted for only 1% of the variability in outcomes between telehealth and in-person therapy. In other words, the modality made almost no difference regardless of who the client was.
There are some situations where online therapy may not be appropriate — acute psychiatric crises, certain presentations requiring close medical monitoring — and in those cases a referral to a more intensive level of care would be warranted. But for the vast majority of people seeking therapy for the concerns listed above, online sessions are a clinically sound option.
Online therapy is particularly useful for people who:
- Have demanding schedules and limited flexibility during business hours
- Live in areas without easy access to specialist practitioners
- Find travel time a genuine barrier to consistency
- Feel more comfortable in their own environment
- Have previously had difficulty committing to regular attendance
Consistency is one of the most important predictors of progress in therapy. Anything that makes it easier to show up reliably is worth considering.
Common Concerns, Addressed Directly
"Can a therapist really get a sense of me through a screen?"
Yes. Most of what a therapist attends to in sessions — the content of speech, the rhythm of language, the quality of engagement, what gets avoided — is fully accessible online. Some practitioners report that the genuine quality of the therapeutic relationship can actually be higher in teletherapy than in traditional in-person settings.
"What about privacy? I live with other people."
This is a practical matter worth planning for rather than a reason not to proceed. Most clients arrange a time when they have the house to themselves, sit in a car, use headphones, or find another solution. I work with clients at the start to identify what works for their situation.
"Is it as secure as in-person therapy?"
Sessions take place via an encrypted, healthcare-grade video platform. The ethical obligations around confidentiality apply exactly as they would in any other setting.
"I've never done therapy before. Does online make it harder to get started?"
If anything, the lower logistical barrier can make it easier to take a first step. There is no waiting room, no travel, no navigating a new building. Many people find that the relative comfort of their own space makes it easier to speak openly from early sessions.
Conclusion
The question of whether online therapy "really works" is well-settled in the research. It does — for most people, for most presentations, most of the time. The 86% equivalence finding from the 2025 JMIR Mental Health meta-analysis is consistent with what accumulates across dozens of other studies: the therapeutic relationship and the quality of clinical work are what drive outcomes, not the physical arrangement of the room.
In my practice, working within Lacanian psychoanalysis, I have found that the conditions for depth work — careful listening, genuine engagement, sustained attention to what is said and how — transfer entirely to the online setting. The unconscious does not need a couch.
If you are considering therapy and have been wondering whether online sessions can genuinely support the kind of change you are looking for, the answer is that they can.
You are welcome to read more about how I work and get in touch at counsellingtherapymelbourne.com.au.