At a glance
Online is not a lesser version of the work, and it is not identical to it either. The question is not which is better in general but what the room adds for the particular thing you are bringing, and whether that is worth the travel. This article helps you weigh the two without guessing.
Clinical insights from 22 years in psychotherapy
I am Mark Colclough, MA, psychotherapist in Copenhagen. Qualified at the Psychosynthesis Education Trust and the University of East London. 22 years of full-time, face-to-face clinical practice.
- The choice itself carries something. When people switch setting at a particular point in the work, the switch is often about the subject that came up the week before.
- Consecutive days work differently. People who come for several sessions in a few days reach material that weekly hours had been circling for months.
- Continuity beats setting. An unbroken run of online hours does more than a better setting attended irregularly.
Clinical notes: My observations are anonymised and compounded from my session notes since 2004.
What does the room actually add?
Mostly the body, and the time either side of the hour.
In a room I can see the whole of you. A shoulder that lifts when a name comes up, a foot that starts moving, a hand that goes to the throat. None of that needs to be said, which matters when the thing in question is not yet sayable. On a screen I see a face in a rectangle and I work with what you report instead of what I observe.
The other addition is the margin. A room has a walk to it, a waiting few minutes, a door and a street afterwards. That structure does something for the nervous system that nobody plans and most people only notice when it is gone. Online you have to build it yourself, and many people do not.
What online does better
It keeps the work going when a room would have ended it.
A review that gathered the instruments used to measure the working relationship, and sorted roughly 1,000 of their items, looked at both face-to-face and online therapy and found the same themes running through both: trust, agreement on goals and methods, participation by both people, and attention to what the client needs.1 Its authors were blunt about how loosely the idea is defined across the field, so this is not a proof of equivalence. What it does suggest is that the things the relationship is made of are not peculiar to a room. In practice, people who move country, change jobs or have small children keep an online hour that they would have quietly dropped if it required a journey across a city.
A block of sessions instead of a weekly hour
If you are going to travel, travelling once for several sessions is usually worth more than travelling often for one.
A single session after a flight is mostly arrival. The useful version is two or three days with sessions on consecutive mornings, which removes the weekly reset where you spend the first 15 minutes re-establishing where you had got to. Material that has been held at arm’s length for months tends to surface on the second day, because there is no week in which to put it back.
The sensible pattern for most people living away is online as the spine of the work, with a block in person when something has become stuck or when a decision is close. The online hours then carry what the block opened, rather than starting again.
What makes an online session work
Most of what people blame on the medium is actually the conditions around it.
- A room you can speak in. If somebody might hear you, you will edit, and the editing is invisible to both of us for weeks.
- An hour that is not the last of your day. A session at the end of a working day gets whatever is left over.
- Something after it. Fifteen minutes with nothing in them, so the hour has somewhere to settle.
- Saying what I cannot see. Naming the tight chest or the sudden absence takes three seconds and restores what the camera removed. How I work is set out on my page about online psychotherapy.
Change those four before you conclude that the setting is wrong. Where they are all in place and the hour still feels thin, that is useful information rather than a technical fault.
How do I decide, and when should I stop deciding?
Decide by what you are bringing rather than by which format sounds more serious.
- Lean to the room. Where the work lives in the body, where there is nowhere private at home, or where something has stalled for months.
- Lean to online. Where regularity is the fragile part, where you move around, or where the alternative is no therapy at all.
- Either. Where you are working on something you can talk about, with a private room and an unhurried hour.
- Both. Online weekly, with a block in person when a decision is close or the work has gone quiet.
Stop deciding once you have started. People spend months weighing the format while the thing they wanted help with carries on, and the weighing is often easier than the beginning. If the setting turns out to be wrong, you will know within three or four sessions and it can be changed then.
A free 30-minute call is enough to work out which of those four you are in. I work in English with people wherever they are living, through online therapy in English, and in the room in Copenhagen when that is the better answer.
Questions people ask
Is online therapy a compromise?
It is a different setting with its own losses and its own advantages, not a reduced version. The loss is mostly bodily, and it can be worked with once it is named.
Would a few days in Copenhagen be worth the trip?
Usually yes if the work has stalled, and rarely worth it for a single session. Consecutive mornings do something a weekly hour cannot.
Can I start online and move to the room later?
Yes, and that is the most common pattern for people living abroad. Starting is the part that matters; the setting can change around it.
Does the time difference make weekly sessions impractical?
Rarely, and the hour you choose within your own day matters more than the gap between zones. Pick a time when you still have something left to bring.
What if I keep postponing the decision?
Then the decision is doing a job, and it is worth looking at what it is protecting you from. Weighing formats is a comfortable way to stay where you are.
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Sources
How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.
