Your Must-Read Guide For Starting Online Therapy

With lockdown in full force due to COVID-19, there has been an upturn in the demand for online therapy as anxiety around the pandemic increases. In 2017, 1.4 million people were referred to NHS mental health therapy – that's without even beginning to count those in private therapy. Where does this leave people needing face-to-face mental health support now that we're on lockdown? 

I work as a professional psychotherapist in a GP surgery and in private practice. I'm also a former Samaritans helpline listener. Over the past few weeks, the main thing we've been talking about in the therapeutic community is how to safely support clients online. Not every client has space equipped for remote therapy (hello, thin walls and too many housemates); moreover, those in precarious circumstances, including those living in fear of physical and emotional abuse, are not buffered by the usual protection of confidentiality that face-to-face therapy provides.

If you're unsure how to navigate the world of online therapy, I'm here to guide you, with tips on how to find credible therapists, how to spot red flags, how to avoid the murky pitfalls of the internet and how to get your self-isolation space 'therapy ready'. 

If you were already in therapy via the NHS or private before lockdown, you’ll likely have been offered options to move your sessions online. If not, discuss with your therapist.

If you aren’t in therapy yet, talk to your GP, otherwise you'll need to seek out qualified, ethical professionals who understand the differences between working online and in person. 

If you want private online therapy but money is tight, consider counselling agencies offering low-cost options. Mind and The Help Hub are good places to start, as are therapy training institutions. Employers may have structures in place for online support, such as employee assistance programmes.  

For independent online therapists, use a vetted counselling directory such as Welldoing.org, Counselling Directory, BACP or UKCP. 

Therapists use a variety of platforms, some of which are more secure than others. There are many remote options, from audio and video apps to phone calls, email, text and instant messaging. You should be aware of which are the most secure for confidentiality and privacy. Some platforms offer end-to-end encryption, like Zoom and Doxy. This means your conversation (in theory) can’t be tapped into through data algorithms leading to targeted adverts which may relate to issues you're specifically discussing. Hacking is a huge risk online, and you should know how your activities will be monitored. 

Doxy and VSee (also encrypted) are specific to certain health providers. Just like Zoom, they are free and operate by clicking on a link that your therapist gives you. With Zoom, once your session ends, there is no evidence of your conversation. Don’t publicise your meeting link in an open web space – this can be seen, hijacked and spammed.

Skype, FaceTime and WhatsApp download onto your device and anyone using it afterwards will see details of your latest contacts. In a situation of domestic violence, this is especially pertinent. When searching for therapy online, browse in private mode to prevent your activity coming up in history searches. If video or audio calls are unsafe, try Zoom instant messaging, or email (deleting messages afterwards).

Be wary of pop-up adverts and flashing logos purporting to offer online therapy: being too quick to click can lead to hacking, spamming, scams and viruses, all of which compromise your privacy and safety. Opportunists will take advantage right now. Take time to research random individuals or new companies offering support.

Be especially careful with community forums and social media (think: private Facebook groups). It’s easy to air your thoughts online but in the age of sharing, screenshots and retweets, you’re not in charge of what happens to them. These spaces are subject to trolling, harmful advice and misinformation. 

There are also huge differences between professional therapy and voluntary support. Many well-meaning people want to help but not everyone is qualified to do so. Counselling and therapy are professional services offering specialised skills. Anyone offering therapy should indicate a robust level of training – this will be a minimum of a graduate-level diploma in counselling (two plus years), all the way up to MA or even PhD. Therapy is not just a chat. On that note, know the difference between a counsellor, psychotherapist and psychologist: a clinical or counselling psychologist should have a doctorate and be licensed to practise with the Health and Care Professions Council (HCPC); professional counsellors and psychotherapists should be registered with legitimate professional bodies – there are many, with very similar sounding acronyms, so double check. If in doubt, here are a few: BACP, UKCP, COSRT, BPS, BABCP and BPC. You can run a search for a therapist on the professional body website. 

If you do go for voluntary support, opt for trusted charities and helplines including Samaritans, Cruse, OCD Action, Anxiety UK or Shout text support. While not therapy, they are safe, free to access, corona-ready and on hand to help. 

Trust your gut. If something feels dodgy, it probably is. It’s normal for therapy to feel challenging. You don’t even have to like your therapist. But if you feel unsafe, afraid or intimidated, these are red flags. An ethical therapist will not blur lines between therapy and other areas; you shouldn’t add them on social media or interact with them outside of session time beyond administration correspondence. There should be no sexually inappropriate comments or advances. Your therapist should arrive online, on time, appropriately dressed and be attentive. You should feel able to voice concerns. Unless you give express consent, sessions shouldn’t be recorded – check on Zoom if the record button is on. 

There are things you can do to ensure confidentiality. Use a private room, where you are certain you cannot be disturbed. Turn off all distractions such as phones, apps, social media and emails. Switch off smart speakers such as Alexa – you don’t want conversations overheard! 

Check your internet connection in advance to avoid using up precious therapy time fixing any problems. There’s nothing more demoralising than a technical hitch at a crucial moment in therapy. Agree a back-up plan with your therapist from the get-go, so that if your tech fails, they can call you on a number you’ve pre-agreed. When paying, don’t leave confidential details visible to others.

In online therapy, session endings can feel more abrupt than they do in person: at the click of a button, your therapist disappears. Don’t rush back to work too soon; take a few minutes after a session to digest what’s been said, make a cup of tea or use this opportunity to go for your once a day exercise allocation and process.