“I’ll be honest — I wasn’t sure therapy through a screen would really work.”
I hear some version of that in most first consultations. Usually it arrives a little apologetically, as though the person is worried they’re being rude. They’re not. It’s a fair question, and I would rather you ask it than quietly wonder.
So here is my honest answer, with the research behind it: for the trauma work I do, online therapy is not a compromise. It is not the lesser version you settle for because the good version is too far away. The evidence on this is now substantial, and it is more encouraging than most people expect.
What the research actually found
The largest analysis of this question is a 2021 meta-analysis by Ashley Batastini and colleagues, published in Clinical Psychology Review. They pooled 281 separate outcomes across 4,336 clients, comparing therapy delivered by video against therapy delivered in a room. Their conclusion was that video-delivered treatment produced effects largely equivalent to in-person care.
One detail in that paper stopped me when I first read it. Among the factors they examined, female clients tended to respond more favourably to video therapy than to in-person sessions. Not equally — more. For a practice like mine, which exists specifically to serve adult Christian women, that is not a small footnote.
Not a compromise. For women in particular, the research suggests something closer to an advantage.
It is not an isolated finding. A 2022 meta-analysis of randomised controlled trials by Annaleis Giovanetti and colleagues, looking specifically at depression, found no significant difference in outcomes between teletherapy and in-person psychotherapy. A 2023 systematic review in JMIR Mental Health examined telemedicine versus in-person care for post-traumatic stress, mood disorders and anxiety disorders, and found the two equivalent not only on symptom improvement but on patient satisfaction, working alliance, and how many people stayed in treatment.
That last measure matters more than it sounds. Dropping out of therapy is one of the most common ways treatment fails. If people are no more likely to leave, that tells you something real about whether the work is landing.
“But will we actually connect?”
This is the concern underneath the first one, and it is the right thing to be concerned about. Decades of research tell us that the relationship between therapist and client — what we call the therapeutic alliance — is one of the strongest predictors of whether therapy helps. If that could not form over video, none of the outcome numbers would matter.
It forms. Studies measuring working alliance in video-delivered therapy find ratings statistically comparable to in-person work.
What I’ll add from my own chair is something the research does not quite capture. People are often more truthful from their own homes. There is no waiting room. No one saw you walk in. You are in your own space, with your own tea, wrapped in your own blanket, and something about that lowers the cost of saying the hard thing out loud. I have watched clients disclose things in week three of online work that I suspect would have taken considerably longer across a desk.
Does EMDR work over video?
This is the question I get from people who have already done their reading, and it deserves a specific answer, because EMDR involves bilateral stimulation — and it is reasonable to wonder how that survives the journey through a webcam.
It survives well. Studies published between 2021 and 2023 have consistently found that remote EMDR produces symptom reduction comparable to in-person delivery, including one trial of 288 clients receiving virtual EMDR that found no significant difference between the two. EMDRIA, the profession’s governing body for EMDR, has published formal guidance for delivering it virtually.
Practically, bilateral stimulation adapts more easily than you would think. We can use on-screen visual tracking, audio tones through your headphones, or self-administered tactile stimulation — the butterfly hug, or alternating taps on your own knees. In some ways the self-administered forms suit trauma work: you retain control over the pace and intensity throughout, which for someone whose trauma involved loss of control is not a trivial benefit.
Why this matters particularly in Texas
Texas is enormous. That single fact shapes mental healthcare here more than any other.
A therapist who is trained in EMDR and Internal Family Systems, and who will treat your faith as a resource rather than a symptom to be managed around, is not a common combination. In Houston or Dallas you might find one. In Lubbock, Corpus Christi, Tyler, or any of the hundreds of smaller Texas towns, the honest answer is that you might not — and the alternative has historically been a long drive each way, every week, or going without.
I hold a Texas licence, which means I can work with anyone located anywhere in the state. Practising entirely online is not a convenience I adopted for my own sake. It is what makes it possible for a woman in West Texas to see a faith-integrated trauma therapist at all, on a Tuesday, without arranging childcare for a round trip to the nearest city.
There is also a quieter reason. In a small town, walking into a counsellor’s office is a visible act, and in a close church community that visibility carries a cost some women are not willing to pay. Online work removes that entirely. Whatever you think about a culture where seeking help still requires discretion, I would rather someone get help privately than not get help at all.
When I would tell you online is not the right fit
I would not be doing my job if I only gave you the case for it.
There are situations where online therapy is genuinely not the appropriate level of care, and I will say so directly in a consultation rather than take on work I cannot do well:
- If you are in active crisis, or having thoughts of ending your life, you need care that can respond in person and immediately.
- If you need a higher level of care — inpatient treatment, intensive outpatient, or medical supervision — weekly video sessions are not a substitute, and I will help you find the right referral.
- If you have no reliably private space for fifty minutes a week. Trauma work requires you to be able to cry, or shake, or fall silent, without someone walking in. If home cannot offer that, we need to solve it before we start.
- If your internet connection cannot sustain a stable video call. Processing difficult material through a freezing screen is its own kind of distressing.
None of these are hypothetical caveats added for completeness. They are the actual conversations I have.
A thought on presence
Some Christians carry a quiet intuition that the real thing has to happen in a room — that distance makes it lesser. I understand the instinct. We are embodied people, and incarnation sits at the centre of our faith.
But it is worth noticing that most of the New Testament is correspondence. Paul pastored churches he could not reach, through letters carried on foot, and did not appear to regard this as a diminished form of care.
For though I am absent in body, yet I am with you in spirit.
I am not claiming a webcam is a sacrament. I am saying that the conviction that God’s work requires physical proximity is not one our own scriptures particularly support. The Holy Spirit is not obstructed by broadband.
What a session actually looks like
Sessions draw on EMDR, IFS and somatic work, depending on what you need. We meet for fifty minutes on a secure, HIPAA-compliant video platform — not Zoom, Skype or FaceTime. You will need a private space, headphones if anyone else is home, and something to drink. That is genuinely the whole list.
The first session is mostly me listening. We will talk about what brought you, what you have tried, where your faith sits in all of this, and what you want to be different. We do not begin trauma processing on day one; we build stability and trust first, and we move at the pace your nervous system can tolerate rather than the pace either of us might prefer.
Before any of that, there is a free fifteen-minute consultation, which exists precisely so you can find out whether talking to me feels like anything at all — and where, if online work is not right for you, I can say so and point you somewhere better.
You have carried whatever this is for a long time. You do not have to drive across Texas to set it down.
References
- 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.
- Giovanetti, A. K., Punt, S. E. W., Nelson, E.-L., & Ilardi, S. S. (2022). Teletherapy versus in-person psychotherapy for depression: A meta-analysis of randomized controlled trials. Telemedicine and e-Health.
- Psychiatric treatment conducted via telemedicine versus in-person modality in posttraumatic stress disorder, mood disorders, and anxiety disorders: Systematic review and meta-analysis. JMIR Mental Health (2023).
- EMDR International Association. Guidelines for Virtual EMDR Therapy.