Is online therapy effective?

"Is online therapy effective, or is it a compromise?" I hear some version of this on a lot of intro calls, usually from someone who has never been to therapy before and half-suspects that talking to a screen doesn't count. I'm Shambhavi, a counselling psychologist, and I do most of my work over video, audio and text. My honest answer is that for many people and many concerns, it works well. It also has real limits, and you deserve to know both before you decide.

What the research generally says

Online therapy has been studied for a good while now, and the use of it grew sharply during and after the pandemic. Studies comparing video therapy with in-person therapy have generally found similar outcomes for common concerns like anxiety, low mood and stress. Research has also found that people can build a strong working relationship with their therapist over video, which matters because that relationship is one of the things most closely tied to how helpful therapy feels.

The evidence on text-based therapy is smaller and more mixed, though many people find it useful, especially alongside or in between spoken sessions. And like any research, these are averages. They tell us online counselling can work. They can't tell you whether it will suit you in particular, which is why a trial session or two is the best test.

Online therapy vs in person: a quick comparison

What online counselling in India looks like day to day

In practice, people take sessions from all sorts of places. A parked car outside the office. A terrace in the evening. A hostel room with a roommate who's been politely sent to the canteen. A bedroom with the fan on and the door shut while the rest of the family watches the news. For many people, the fact that no neighbour or relative sees them walking into a clinic removes a big chunk of the "log kya kahenge" worry that kept them away in the first place.

It also makes flexible formats possible. At Nivaara Nest you can choose video, video with your camera off, audio only or text chat. Some people start with text because typing feels safer than saying things out loud, then shift to audio a few weeks later. Others keep their camera off on hard days. There's no right way to do it, and you can change your mind from one session to the next.

Continuity is the other big thing. Many people I work with are in their twenties and move a lot, for a job, a master's, a transfer or a family situation. Being able to keep the same therapist through that, instead of starting again each time, is worth a lot.

The honest downsides

Online therapy isn't a perfect substitute for everything, and pretending otherwise wouldn't help you.

• The internet drops. It happens, especially during monsoon or on a patchy mobile connection. We usually agree a plan early on, like switching to audio or moving to text for the rest of the session.
• Privacy at home can be hard in a joint family or a small flat. Headphones help, and so does text chat on crowded days.
• Screen fatigue is real if you've spent all day on work calls. Some people prefer audio for this reason.
• Your therapist picks up fewer body cues. Since my work is somatic and trauma-informed, I tend to check in more often: what's happening in your shoulders, your breath, your stomach right now? It sounds odd at first and quickly becomes natural.
• It's not an emergency service. If you're in crisis, please call Tele-MANAS on 14416 (free, 24×7) or emergency services on 112.

How to make video therapy work for you

1. Pick your spot beforehand, somewhere you won't be interrupted for 50 minutes. Try it once before the session if you can.
2. Use headphones, so the other person's voice stays with you.
3. Keep a glass of water and something to write on nearby.
4. Leave a few minutes before and after. Jumping straight from a work call into therapy, and straight back out, makes it harder to settle.
5. If someone might walk in, agree a simple word with your therapist that means "I need to pause".
6. Tell your therapist if the camera feels uncomfortable. Switching it off is completely fine.

When in person might suit you better

Some situations do need more than an online counsellor can offer. If you're in an acute crisis, need a medical or psychiatric evaluation, or might need medication, you'll want a psychiatrist too. We don't offer diagnosis or medication, but we help clients find a psychiatrist referral when that would help, and therapy can carry on alongside it.

If home isn't a safe place to talk at all, online sessions can still sometimes work through text or from somewhere outside the house, but your safety comes first. That's something to discuss openly on a first call. And some people simply prefer being in a room with another person. That's a valid preference, and worth honouring.

So, is online therapy effective for you?

The only way to really know is to try a few sessions and notice how you feel. Do you feel heard? Can you be honest? Are you leaving with something to think about or try? Those questions matter more than the medium. If you're unsure where to begin, read what happens in your first therapy session, or Cherry's guide on how to find an affordable therapist in India. If language is part of the question, she has also written about therapy in your own language.

You can also book a free 15-minute intro call with either of us. Our hours are in the evenings and on weekends, which tends to suit people who work or study, and you can ask anything you like about how online sessions would work for you.

Questions people ask