Does online therapy work as well as in person?

Kasia Staniaszek, Psy.D. · August 14, 2026

Yes. People get better at the same rate on video as they do in an office, and the evidence for online therapy is now a decade deep. A review of the trial literature found video treatment non-inferior to in-person treatment for post-traumatic stress, depression and anxiety. Non-inferior is a cautious word for a simple result. The two settings produce the same improvement.

Video therapy is not a lighter version of the real thing. It is the real thing, delivered somewhere more useful. It is also how I work: telehealth, with adults, anywhere in New York State.

The reason people actually choose it

Almost nobody picks telehealth because of the research. They pick it because it fits into a life that already has too much in it.

There’s no travel at either end. No parking, no train, no lobby, no hour of your afternoon spent getting to and from the hour that matters. You close a door a few minutes before we start and you’re back in your day right after. For anyone with young children or a job that will never hand out a two-hour block on a Tuesday, that is the difference between starting therapy and meaning to.

It holds up through the rest of your year, too. A work trip, a sick kid, a week upstate, a move to a different part of New York. None of that has to interrupt the work, and the weeks people used to lose to logistics were the weeks treatment quietly ended.

Scheduling gets easier in a way that’s hard to picture until you’ve done it. An appointment that costs you one hour instead of three will fit into a lunch break, or the first slot of the workday, or the gap after a school drop-off. Plenty of people who tried therapy years ago and let it go over logistics come back to it this way and stay.

Nobody watches you arrive

Privacy comes up more often than people expect it to, usually as an aside and usually with some relief. There’s no building anyone can see you walk into. No shared waiting room where you sit across from someone else’s Thursday. No receptionist who learns your name and your standing time. You talk from a room you already trust, and the fact that you’re in therapy stays yours to tell or not tell.

The relationship question

This is what people mean when they ask whether it really works. Not symptom scores. Whether something genuine can grow between two people who have never been in the same room.

It can. What convinces me is that researchers have gone looking for the gap for years and keep coming back without one. A systematic review of controlled studies found the working relationship comparable to face-to-face therapy, and in one of those studies patients rated it higher on video.

The strongest design measured the same people before a switch to online sessions, during it, and after. The strength of the relationship did not change. Clients also rated that relationship significantly higher than their own therapists did, which fits what I see. The person worried about what a screen costs is usually the clinician rather than the client.

Even eye contact turns out to be doing less work than people assume. Researchers deliberately moved the camera to break the gaze angle, then asked how understood people felt. The ratings stayed high either way. We read warmth in a face, a voice and a change in posture, and those all arrive intact.

There’s a gain here that rarely gets named. People say hard things sooner from their own space. The sentence someone might circle for a month in an unfamiliar office often comes out in the second or third session at home, because the room is already safe and only the conversation is new.

What a telehealth session is actually like

Undramatic, which is rather the point.

A private link reaches you before we meet. You sit somewhere with a door, ideally with headphones, and we talk. The platform is a proper telehealth one, built to keep health information private, rather than whatever video tool your employer uses for meetings.

The first session is mostly you telling me what brought you here and me asking questions about it. You don’t need to arrive organized or with a tidy account of your childhood. Two small things are worth agreeing on early: what we do if the connection drops in the middle of something hard (I call you, and we settle that in advance), and where you’ll be each week. Parked cars count. So do closets, stairwells and one memorable laundry room. Nobody needs to apologize for the room they found.

After that it settles into a rhythm fast. Most people become comfortable with the screen before the first session is complete. Rarely do people quit just because of the screen. What’s left is a standing appointment where you say the things you don’t say anywhere else.

Choosing a psychologist by fit, anywhere in New York

Here is the part I think matters most. Telehealth across New York means your options are the entire state instead of the handful of offices near your train line. You choose a psychologist for their training, their approach, and whether talking to them feels like something you could keep doing.

That matters most when what you need is specific. General psychotherapy is available almost everywhere. Someone who works in depth with attachment patterns, with why the same fight follows you from one relationship into the next, is much harder to find, and for a long time you either happened to live near that person or you went without.

The outcomes hold. The relationship holds. And you get to pick the person rather than the address.

Related: what your attachment style is, and what it isn’t, can attachment styles change, and how long does therapy take.