The Screen Was Never the Obstacle You Thought It Was
There is a quiet assumption many people carry, even people who are otherwise fully convinced they want to try therapy, that whatever happens through a screen is a lesser version of the real thing. That presence requires a shared room. That something essential gets lost in the gap between two cameras.
It is worth taking this seriously rather than dismissing it, because it points to something true. Presence does matter enormously in this work. The question worth asking is not whether presence matters, it does, but whether presence actually requires physical proximity to exist. I don't think it does, and I want to explain why, rather than simply assert it.
What the research actually says
Online and remote-delivered psychotherapy has now been studied extensively, not as a pandemic-era improvisation but as a genuine field of its own. Reviews of the evidence, including guidance referenced by the NHS on remote talking therapies, have generally found that therapy delivered online can be as effective as in-person therapy across a range of presentations, including anxiety and depression. This is not a marginal or contested finding at this point; it is closer to an established one.
This matters because it shifts the question. If outcomes are broadly comparable, then whatever is "lost" in an online format is not the thing that actually determines whether therapy works. Something else is doing the work, and it isn't the room.
What actually determines whether therapy works
As I've written about elsewhere, the research is fairly consistent that the strongest predictor of good therapeutic outcomes is the quality of the relationship between client and therapist, the therapeutic alliance, rather than the specific modality, and, it turns out, rather than the medium through which it is delivered either.
A therapeutic alliance is built from attunement, consistency, being met accurately over time, a sense of being held in mind between sessions. None of these require two bodies in the same physical square metre of space. They require a therapist who is genuinely paying attention, session after session, and a client who feels safe enough to be honest. A screen does not prevent either of these. It simply changes their shape slightly.
What actually changes online, and what doesn't
Some things genuinely do shift in an online format, worth naming honestly rather than glossing over. You lose certain subtle physical cues, the quality of silence in a shared room, some peripheral information a body gives off that a camera doesn't fully capture. These are real, if usually smaller, differences.
What doesn't disappear: the capacity to be truly listened to. The therapist's attention, consistency, and care, which were never located in the room itself but in the relationship built within it. And, specific to this work, the creative process translates online with remarkably little loss. Working with art materials at home, on your own table, in your own space, can in some ways deepen rather than dilute the process, because you are creating within your actual environment, the place where your life is lived, rather than a clinical room you leave behind at the end of the hour.
There is also something worth naming about accessibility itself. For many people, particularly those managing anxiety, chronic illness, geographic distance from a suitable therapist, or simply the demands of a full life, online therapy is not a compromise version of the real thing. It is the version that actually becomes possible. A process you can attend consistently, from home, without the added burden of travel or logistics, often outperforms a theoretically "purer" in-person process you can only attend sporadically, or not at all.
What I'd ask you to trust instead
Not the medium. The relationship. If, after a few sessions online, you find yourself feeling met, thought about, held in the way this work requires, that is the actual signal worth trusting, far more than any assumption about what a screen supposedly cannot do.
I work with clients online across time zones and borders, in English, Spanish, or Swedish. If you've hesitated because it didn't feel like "real" therapy, I'd invite you to test that assumption directly, in a free 30-minute introductory call.