Virtual Therapy Guide

Most of my practice is now virtual, and this guide covers everything prospective clients ask about it: how sessions work, who it fits (and who it doesn't), what it costs, how privacy is protected, and how to get the most out of it. Virtual therapy gives you a far wider choice of therapists than your driving radius allows, makes scheduling dramatically easier — and because my overhead is lower, my self-pay fee for virtual sessions is lower than for in-person work.

Who Virtual Therapy Works Best For

Virtual therapy means meeting with a licensed clinician by secure video rather than in an office. It's an especially strong fit if you:

• Want the best-matched therapist, not the nearest one — including access to specialty services that may not exist near you, like my nationwide fear of flying and public speaking anxiety groups.
• Have a schedule that makes commuting to appointments unrealistic — I see college students between classes and professionals on lunch breaks, including evening slots I couldn't offer if I had to be in an office.
• Are a couple or family whose members aren't in the same place — partners who travel, adult siblings in different cities, parents and college kids. Everyone joins from wherever they are, something an office can never offer.
• Move between states — students home for the summer, professionals who split time between coasts. I'm licensed to see clients in 44 states, so treatment continues wherever you are.
• Face mobility, transportation, health, or privacy barriers to office visits — there's no waiting room, and no chance of running into someone you know.
• Want costs down: no commute, no parking, no babysitter for couples with a sleeping infant — plus my lower telehealth self-pay rate.

When Virtual Therapy Is Not the Right Fit

I'd rather tell you this directly than have you discover it three sessions in. Virtual therapy is not ideal when:

• You can't get a private space. If a confidential hour is impossible where you live or work, the format works against the therapy.
• The method requires presence. A few techniques — EMDR in its standard form, play therapy for younger children, some hands-on interventions — don't translate fully to video. Whether virtual work suits a child depends on age and needs; I cover that in detail in my article on virtual vs. in-person effectiveness.
• Screens just don't work for you. Some people never feel as connected on video, and that feeling matters — the therapeutic relationship is the strongest predictor of outcome. If we start virtually and it isn't clicking, I'll say so, and I'm happy to refer you to a well-matched in-person colleague. In my experience very few clients end up needing that, but the door is always open.

Technical realities are worth naming too: connections drop (I keep a backup connection, but it happens), and video trims some nonverbal information — I've learned to ask a few more questions to compensate. These are manageable friction, not dealbreakers, but you should know they exist.

Is It Effective?

The research consistently finds virtual therapy as effective as in-person care across depression, anxiety, PTSD, and relationship concerns, and my own caseload bears that out: most of my practice is virtual, and I see no difference in outcomes between clients I treat online and in person. Some work is actually better virtually — exposure exercises happen in your real environment rather than a simulated one, and executive functioning supports get built directly into your actual routines. For the full picture — including the research, when in-person has the edge, and special considerations for children and families — see Is Virtual Therapy as Effective as In-Person?

The Approaches I Use Virtually

Nearly everything I do in the office translates online: CBT (with shared screens for thought records and exposure hierarchies), mindfulness-based work, ACT, motivational interviewing, psychodynamic therapy, and psychoeducation for conditions from ADHD to mood disorders. Rather than repeat it all here, I've written a dedicated piece on how each approach is adapted online, with case examples — from Schema Therapy to exposure work to ADHD coaching.

Privacy and Security

Sessions run on a secure, encrypted, HIPAA-compliant videoconferencing platform built for healthcare — not consumer video apps. Your side matters too: choose a private spot, use headphones, and if privacy at home is complicated, we'll problem-solve it together (cars parked somewhere quiet are a time-honored therapy venue). One firm rule: I won't conduct sessions while you're driving.

Getting the Most From Your Virtual Sessions

• Protect the hour. Same room, same time when possible — ritual helps the work. Tell housemates you're unavailable; a locked door and headphones handle most privacy concerns.
• Set up like it matters. Stable internet, charged device, camera roughly at eye level so we're actually looking at each other.
• Have a plan B. If video fails mid-session, we switch to phone and keep going — decide that with me in advance so a dropped connection costs us two minutes, not the session.
• Don't multitask. The biggest virtual-therapy failure mode isn't technology — it's treating the session like a call you can half-attend. Close the other tabs.
• Use the setting. Being home is an asset: we can look at the actual homework pile fueling the ADHD overwhelm, or do exposure practice in the real environment where the anxiety lives.

Virtual Therapy: Frequently Asked Questions