What online therapy is like, and what to set up first

Therapists use video, phone or messaging in different ways. Video is most like an in-person meeting because you can see each other. Phone calls remove the visual layer and can be easier if your internet is weak. Messaging covers a wide range - from quick check-ins to longer written exchanges. Each mode changes how you express yourself and how the conversation unfolds.

Profiles on this site list which formats a therapist names among their approaches, so check the therapist profile on /therapists/ to see what they say. Don’t assume any one profile offers every format - ask the person directly about the ways they work.

Checklist before a session - run through these items so you won’t be interrupted by simple problems.

• Device - pick a laptop, tablet or phone that you can use comfortably for the session and make sure it’s charged or plugged in.
• Internet and signal - test the connection ahead of time. If your Wi-Fi is unstable, consider a wired connection or switch to a phone call.
• Camera and sound - test the camera angle and microphone. Use headphones to reduce echo and keep the sound private.
• Power and updates - install any needed updates in advance and have a charger to hand.
• Notifications - mute apps and set your device to Do Not Disturb so you won’t be interrupted by messages or calls.
• Backup plan - agree with the therapist how you will reconnect if the connection drops (for example, a phone number to call).

If you plan to talk about the people you live with, pick a place where you will not be overheard. That matters more than which format you choose. A closed room with the door shut is best. If that is not possible, use headphones and put soft noise in the background - a fan or a white-noise app - and make sure doors are locked when you can.

Tell household members when you will be on a call and ask them not to interrupt. If you need to, schedule sessions for times when others are out or use a parked car, a quiet office, or another private place. If you share devices, sign out of shared browsers or clear history when you finish if that is important to you. Remember that messages and screenshots can be seen later by others, so consider what you put into written exchanges.

Video - sit with the camera at eye level and choose soft light on your face rather than bright backlight. Keep the background simple and remove anything you do not want visible. Look at the camera when you want to signal attention. If you need to show notes, ask the therapist how they prefer you share.

Phone - check you have a strong signal and a plan if calls drop. Use headphones that reduce background noise. Speak clearly and give cues since visual information is not present.

Messaging - clarify expectations up front. Ask how quickly the therapist responds, whether messages count as a session, and what kind of content works best. Messaging can be good for short reflections or scheduling, but it varies widely in tone and timing. Do not rely on messaging for emergencies.

Before your first paid session you may want to ask a few practical questions so you know what to expect. A short list you can use or adapt:

• Which formats do you offer - video, phone, messaging?
• How do you handle missed sessions and cancellations?
• How do you manage urgent concerns between sessions?
• Do you work with more than one person in a session, and how do you set up consent and privacy if others are involved?
• Are you licensed or registered where you practise?

These are sensible practical questions to raise when you contact a therapist. If you want help deciding which questions matter most to you, see /how-to-choose/ on this site. Remember that a profile describes what an individual lists about their approach and services; check the profile on /therapists/ and ask the therapist directly about anything not clear.

If you are frightened of someone in your life, joint sessions involving both of you are not appropriate. If you are in immediate danger, call emergency services right away - 911, 999 or 000 depending on your country. If you are thinking of harming yourself, feeling in severe crisis or struggling with thoughts of self-harm, call or text 988 in the United States, Samaritans at 116 123 in the United Kingdom, Lifeline at 13 11 14 in Australia, or your local emergency number. These numbers are for urgent situations and immediate danger.

This article does not offer medical advice or a diagnosis. A clinician who is actually talking with you is the person who can say what applies to your case.