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

Video feels closest to in-person. You see facial expressions and gestures and can use visual aids or screen-sharing. It takes a little more attention to camera angle and lighting so you both can read each other comfortably.

Phone is simpler. Without video you may notice how voice and silence land differently - that can change the pace. Phone can feel easier if you are self-conscious on camera or if your bandwidth is poor.

Messaging covers a range of styles. Some therapists use scheduled live chat or video-text hybrids. Others use asynchronous messaging where you write and the therapist replies later. Messaging can be useful for short check-ins or when time zones and schedules make live sessions difficult. Expect a different rhythm - slower, and more like an ongoing conversation rather than a single hour.

Choose a device that feels reliable for you. Laptops and tablets usually give the steadier video frame, but phones work fine for voice or messaging.

Headphones with a built-in microphone reduce background noise and stop audio echoes. If you use video, position the camera at eye level rather than looking down at the screen.

Before the first session test your camera, microphone and internet. Close other apps that use bandwidth. If you expect weak Wi-Fi, have a charged phone ready as backup and know whether you can switch to a phone call quickly.

Find a place where you will not be interrupted for the length of the session and where you can speak freely. Tell household members in advance if possible, or put a note on the door. Use a room with a door if you can.

Lighting should face you rather than come from behind. A small table and a comfortable chair help. If you expect tears or strong emotion, have tissues ready and a glass of water nearby.

Use online therapy in a private space that you control - not in a noisy cafe or a crowded public transport carriage. If privacy is hard at home, consider a parked car, a quiet workplace room, or another private spot for the session.

Agree on a backup plan before you start. That could be reconnecting on the same platform, switching to a phone call, or a brief reschedule. You do not need to handle this on the fly - ask the therapist how they prefer to manage dropped connections before your first meeting.

If the connection drops mid-session, try reconnecting for a minute. If you cannot, use the backup phone number or messaging method you both agreed on. Keep the therapist's contact details somewhere accessible during the session.

If you are interrupted by someone in your home, pause and explain briefly. You do not have to give personal details to the interrupter - a short "I am on a private call" is enough. If the interruption makes you uncomfortable, ask to reschedule or continue another time.

• Decide whether you prefer video, phone or messaging and tell the therapist when you book.
• Charge your device and plug it in if possible. Have headphones ready.
• Choose a room where you will not be interrupted and check lighting and background.
• Test the platform briefly and keep a backup phone number to hand.
• Agree ahead of time about missed sessions, cancellations and how long a session will run - these are practical questions to clarify with any clinician.
• If you want to look at different practitioners, start at /therapists/ and read the notes on how to choose at /how-to-choose/.

When you look at listings, remember that names of approaches are just that - names. Some therapists list existential therapy among their approaches. Naming an approach is not a qualification in it, and this directory does not check training records. If professional registration matters to you, ask whether the therapist is licensed or registered where they practise and follow up with the appropriate body if you want confirmation.

Give yourself a few minutes afterwards. It helps to stand up, make a drink, or take a short walk around your space before returning to other tasks. That transition can be small and quiet - you do not need to schedule a long cooldown.

If anything in the session felt unclear to you - the next steps, scheduling, or fees - send a brief message or ask at the start of the next appointment. Clear communication keeps practical misunderstandings from building up.

If you find a different therapist might suit you better, look around at /therapists/ and use /how-to-choose/ to think through practical differences. No listing here is an endorsement. You can ask potential therapists about their experience, their session format, and whether they are licensed or registered where they practise.

If you are in crisis, or thinking about harming yourself or others, call the emergency number in your area right away - 911, 999 or 000 for immediate danger. For crisis support you can call or text 988 in the United States, call 116 123 in the United Kingdom to reach Samaritans, or call 13 11 14 in Australia to reach Lifeline.