It is one of the most common doubts before starting, and a reasonable one. People picture therapy as a room, two armchairs and a box of tissues, and a video call looks like a watered-down version of that. Here is what research says, what really changes and when the format does matter.
What the evidence says
Therapy by video call is not a pandemic invention. It has been studied for more than twenty years; what happened in 2020 is that thousands of therapists and patients suddenly started doing it, and the studies multiplied.
Two 2021 meta-analyses sum it up well. Batastini and colleagues pooled 43 studies on treatment outcomes, with more than 4,300 patients, and concluded that the effects of therapy by video call were, overall, equivalent to in-person therapy. Fernandez and colleagues compared 47 studies across the two formats and found a negligible difference; improvement was especially clear for anxiety, depression and post-traumatic stress.
It is worth being honest about it: equivalent does not mean identical. It means that, overall, nobody has been able to show that one format is better than the other. The authors themselves warn that there are still few randomised trials and that many studies report their methods poorly. And what predicts whether therapy works is still the same as ever: the relationship with the therapist, a method with support behind it, and the person doing something different between sessions.
Why it fits the way I work
I work with a systemic and strategic approach, and with acceptance and commitment therapy. These are focused therapies, in which the session is a small part of the treatment and what happens between sessions is the big part. For that, the format matters little: what is needed is to be able to talk calmly for an hour and then go out and live and try things.
What does change
Three things change, and none of them is effectiveness.
Logistics. No commute, no parking, no waiting room. It sounds like a detail and it is not: keeping a fixed hour every week with travel on top is hard. On the Costa del Sol, with the A-7 in the way and seasonal jobs, even more so.
Continuity. If you travel, move or spend part of the year away, the process continues with the same therapist. With a physical office, that breaks.
Privacy. In a small town, walking into a psychologist's office means bumping into people. From home you bump into nobody. And with couples or families, each person joining from wherever they are allows sessions that would be hard in an office: separated parents living in different towns, or a son or daughter studying away.
When it is not the first option
There are situations in which the online format is not the right choice, or not without further support:
- When there is a risk to your own life or to others. Then in-person and, if needed, urgent care comes first: in Spain, 024 (suicide prevention line) and 112 are there for that.
- When there is no space to talk without being overheard. Therapy needs privacy; if you do not have it at home, another solution has to be found before starting.
- When an assessment requiring physical presence is needed, or a severe disorder calls for close coordination with other professionals.
That is why we talk on the phone before the first session. In those ten minutes you tell me what is going on and we see together whether this format is the right one. If it is not, I tell you and point you towards someone who can help.
What you need for it to work
Very little: an hour when nobody will interrupt you, a place where you can talk normally and a connection that can handle a video call. A computer is more comfortable than a phone, but a phone will do. And what matters most is not technical: arriving wanting something to change, and trying out between sessions what we have agreed.
If you still have doubts, that is normal. The way to clear them is not to read more: it is to talk it through. Ten minutes on the phone, free and with no commitment. More about online sessions from Marbella.
The studies I mention
- Batastini, A. B., Paprzycki, P., Jones, A. C. T. & MacLean, N. (2021). Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clinical Psychology Review, 83, 101944.
- Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B. & Aboujaoude, E. (2021). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy, 28(6), 1535–1549.