The question often comes up in conversations about mental health: can you really feel helped, understood, even transformed, behind a screen? For a long time, the intuitive answer was no. The therapist's office, with its couch, soft lighting, and physical presence, seemed irreplaceable. Then scientific research got involved — and the results surprised many people.
What Science Says About Online Therapy Effectiveness
Comparative studies between in-person and remote therapy have multiplied since the 2000s, with notable acceleration following the COVID-19 pandemic. The scientific consensus that emerges today is solid enough to deserve serious consideration.
Meta-analyses that speak clearly
In 2018, a meta-analysis published in the Journal of Psychological Disorders covering more than 3,000 participants concluded that cognitive-behavioral therapy (CBT) delivered by video showed effectiveness equivalent to face-to-face CBT for treating depression, anxiety disorders, and post-traumatic stress.
More recently, a systematic review published in World Psychiatry (2022) analyzed 64 randomized controlled trials. Its conclusions are unambiguous:
- Online therapy reduces depressive symptoms with an effect size comparable to in-person sessions (d = 0.78 versus d = 0.83).
- The therapeutic alliance — the bond of trust between patient and therapist, considered the main predictor of success — builds just as solidly at a distance.
- Dropout rates do not differ significantly between the two formats.
These figures don't mean the two formats are identical. They mean they produce comparable therapeutic results in the vast majority of clinical situations.
The therapeutic alliance survives the screen
One of the most common arguments against online therapy was the impossibility of creating an authentic connection through a screen. Research largely invalidates this concern. A study by Sucala et al. (2012) published in the Journal of Medical Internet Research showed that patients rate the therapeutic alliance just as positively in teletherapy as in face-to-face sessions. The human brain, accustomed to decoding facial micro-expressions, intonations, and silences, works surprisingly well even in a digital space — provided the connection quality is good and the setting is secure.
Who is Online Therapy Particularly Suited For?
If overall effectiveness is comparable, certain profiles benefit particularly from remote format. This isn't a default choice, but a format that offers real, specific advantages.
People facing access barriers
- Rural or isolated areas: accessing a psychologist may require traveling several hours. Teletherapy eliminates this geographic barrier.
- Reduced mobility: physical disability, chronic illness, convalescence — situations where traveling requires significant effort.
- Busy schedules: parents of young children, professionals with non-standard hours, people who travel frequently.
- Financial cost: some platforms offer more accessible formats, reducing an important economic barrier.
People dealing with specific disorders
For individuals suffering from agoraphobia, severe social phobia, or anxiety disorders related to outdoor spaces, starting therapy from home can be the first achievable step. Several studies show these patients engage more easily in the therapeutic process when beginning remotely, with the possibility of gradually transitioning to in-person sessions.
Online therapy is also particularly well-suited for:
- Sleep disorders and insomnia
- Stress and burnout management
- Self-esteem work
- Support for uncomplicated grief
- Prevention and maintenance psychological follow-up
What Are the Real Limitations of Remote Therapy?
A scientifically honest approach requires naming situations where in-person care remains preferable, even essential.
Situations requiring in-office care
Teletherapy is not appropriate for all clinical situations. Experts agree in recommending in-person care — or even hospitalization — in the following cases:
- Active or high suicide risk: crisis management requires physical presence and immediate access to emergency resources.
- Severe psychiatric disorders: schizophrenia, acute bipolar disorder, personality disorders requiring in-depth clinical observation.
- Addictions with physical withdrawal: close medical monitoring then takes priority.
- Body-based therapies: some approaches (intensive EMDR, psychomotor therapy, certain somatic therapies) require physical presence.
Technical and environmental challenges
Session quality also depends on practical factors: stable internet connection, private space, absence of interruptions. A person living in a busy family environment or lacking private space may find it difficult to open up fully. These obstacles are real and should be anticipated.
How to Choose Your Therapeutic Format Well?
The decision between in-person and online shouldn't be dictated by fashion or convenience alone, but by an honest assessment of your needs and situation.
Questions to ask yourself before starting
- What is the nature of my concern? Support for everyday stress doesn't require the same resources as complex trauma.
- Do I have a private, quiet space for my sessions? Environmental confidentiality is as important as therapist confidentiality.
- Am I comfortable with technology? Poor mastery of digital tools can interfere with the therapeutic relationship.
- What are my concrete obstacles to in-person sessions? Distance, cost, availability — all legitimate factors to consider.
- Have I done therapy before? People who have already experienced psychological work often adapt more easily to remote format.
The emergence of digital support tools
Beyond simply moving the office online, digital technology has also enabled the emergence of new mental health support formats. Platforms like Sophie PSY offer support accessible anytime, particularly useful for people wanting initial exploration before committing to formal therapy, or for maintaining self-work between sessions. These tools don't replace professional clinical care, but constitute a relevant complement within a comprehensive care pathway.
The Verdict: Neither Better nor Worse — But Different
Research invites us to move beyond a false opposition. Online therapy is not a degraded version of office-based care: it's a different format, with its own strengths, identified limitations, and a growing body of scientific evidence attesting to its effectiveness in many situations.
What determines the success of therapy, whether online or in-person, remains fundamentally the same: the quality of the therapeutic relationship, patient motivation, the appropriateness of the approach to the problem being treated, and the consistency of engagement. The screen, ultimately, is just a medium — it's what happens through it that matters.
For anyone hesitating to take the step, the best approach remains discussing it with a mental health professional, who can assess with you which format is best suited to your specific situation. In psychology, the best format is one that allows the therapeutic work to truly begin.