Remote counselling & video-conference based CBT

Remote counselling & video-conference based CBT: certainly convenient, but does it work?

by Dr. Nicholas P. Sarantakis


The web has entered dynamically all aspects of our lives: For tracing our next job or home, for our ‘obedient fellow traveller/guide’ (GPS!), for discovering our next exotic destination, or for digging out our chances for love. However easy or hard it may be to find any of this, the wealth of information we can access online is unbeatable, even though we can certainly still make unwise choices: Internet is usually just a quicker route to where we want to be, but sadly it cannot guarantee the quality of the destination.

What happens though when this medium is also the ‘final destination’? What happens when we choose the therapist we want to work from the endless online profiles, but we also have all our sessions online? We may certainly save a tedious trip in the traffic, or in the crowded, tiny tube to get in time to our therapist’s venue, we usually pay less, but does it really work, as well as when we face our therapist in person (on top of facing our fears, anxieties and frustrations)?

A recent study at the University of Bristolii showed that although the effectiveness of computerised, impersonal CBT programmes is questionable, when the latter was actually delivered ‘live’ (e.g. video-conference based counselling) by a ‘real therapist’, it did respond efficiently to the needs of depressed clients’ and indeed 38% of them recovered to non-clinical scores after four months of therapy. Furthermore, a literature review published in the Counselling Psychologistiii illustrated how helpful online therapy can be (and will be even more in the future) for specific client populations, especially individuals who are isolated, who are expats, or do not have access to face-to-face sessions for various reasons. Moreover, the University of Leipzigiv convincingly supported the claim that internet-based CBT can be as effective as face-to-face therapy for the treatment of depression.

It is common lore nowadays that CBT and counselling can best help clients when they are individually-tailored and they take into account the unique personality of the client. Thus, some of us will feel ‘more at home’ sitting on the therapist’ couch, while others will prefer the comfort of our own armchair at home, while ‘e-facing’ our therapist. Therefore, perhaps the real question is not which form of therapy is best, but rather how clients that in fact prefer video-conference based counselling, can make the most out of it.

As practitioners of ‘remote therapy’ we need to research and develop a new set of tools suitable for this form of interaction with our clients, as we have done for face-to-face sessions. Indeed, we have to think ‘outside the box’ as we knew it, in order to use creatively the new opportunities offered and equally address the limitations. I am currently exploring such opportunities by exchanging information and reflections with my clients via email, by working collaboratively through electronic CBT protocols and also by negotiating with them updated counselling contracts, which will allow them to benefit from my ‘implicit presence’ in-between our sessions, while keeping a clear framework of boundaries.

Nevertheless, as psychotherapy is essentially a collaborative process, clients need to do their part, to make this work in the best way for them. Thus, I believe that some basic ‘guidelines’ could be the following:

  • If the practitioner offers to exchange (send or receive) reflection notes with the client in-between the sessions via email, the latter should certainly make use of this opportunity, as therapy does not only happen during the hour of the session, but also during the week when we think about the changes we want to make in our lives, when we try out new behaviours and when we reflect on our ongoing life
  • When therapists encourage email communication within the week, clients should make sure they are absolutely clear about this additional aspect of their counselling contract, in terms of the frequency and content of such communication, in order to maintain safe boundaries for both
  • As clients normally engage in online sessions from their home, they should make sure they protect the confidentiality of their sessions or email correspondence with their therapist, as the latter can only guarantee all that from their own
  • As there is more flexibility in online counselling, it is probably a good idea to choose a less busy, internet-wise, time for our session, to ensure – as much as we can – a good internet connection and thus a satisfactory sound and image during the video A poor internet connection can cause really frustrating and counter-productive interruptions to the process.
  • Being at the comfort of your home can easily produce the temptation to cancel of postpone Indeed, the counselling process requires a lot of energy and reflection and we sometimes feel like ‘we just do not have it’. But when we actually cancel, we sabotage our own benefit, as regularity and consistency are really important factors for effective therapy.
  • Perhaps, what we are mostly missing on video-conference based conversations is the direct eye contact: We just know that we are looking at each other, but we do not really feel it, as we do when we meet our therapist in Does this mean that the – essential – connection and therapeutic rapport cannot be established on a video-conference?
  • I feel that this lack of direct eye contact could in fact be used constructively, if we focus more on what our therapist is actually saying, rather than how they stir at us, on how they listen to us and ultimately on what we are saying to ourselves. As Rogersv eloquently put it, ‘as the therapist listens to the client, the client comes more to listen to himself or herself (…) becoming more real, more congruent, more expressing of what is actually going on inside’. 


ARTICLE WRITTEN BY: Dr. Nicholas P. Sarantakis. Integrative therapist and Counselling Psychology Lecturer at York St. John University. Part of counselling team at –

List of references: 

ii Link:

iii Link:

iv Link:

v Rogers, C. R. (2013). The basic conditions of the facilitative therapeutic relationship. In M. Cooper, M. O’Hara,

  1. F. Scmid, A. C. Bohart (Eds) The Handbook of person-centred psychotherapy & counseling (pp. 24-27). Hampshire: Palgrave Macmillan.

What is Online Therapy?



For many years, psychotherapy happened only in a counselor’s office.  It was

believed that this private setting was the only place that offered the safety and

professionalism required in a therapeutic relationship.


At some point in the 1970’s, telephone therapy became available.  While it was

very convenient for both patient and clinician, it also lacked the face to face

contact offered by in person consultations.


With the rise of the Internet, and especially Web video protocols like Skype and

Zoom, it became possible to duplicate the experience of the psychotherapist’s office

online.  Though there were problems in the beginning, measures were adopted to

maintain compliance with regulations and proper professional procedures in every

country where online therapy was available.


Web-based counseling has now been commonplace for many years. If conducted

properly by trained professionals, it can be just as effective as treatment in a

psychologist’s office.  And since the Internet is worldwide, a patient can choose

from many different specialists, who can treat many different conditions.  And the

fact that clients can talk with their therapist from the comfort of their home or

office reduces some of the anxiety associated with in-person treatment.


To find out if online therapy is right for you, feel free to contact


Therapion — Worldwide Online Counseling

How can we find happiness ?

How can we find happiness and peace right now, right here, where we are?

It doesn’t matter who you are, one time or another in your life, I am sure you craved for pure happiness. Pure happiness, most of us think, can replace the pain we go through in life. Pure happiness can actually be felt even with all the pain in life without replacing them. Happiness is unconditional… But we need to learn the nature of happiness before we can recognize it.


If you want to feel pure happiness…

First of all, do not get overwhelmed with other people’s thoughts. No matter who they are, no one has that much control over your happiness. Happy people are a bit individualistic, little bit selfish, and whole a lot of egoistic if you ask me.

If you are in a search for happiness, pay attention to yourself. Happiness exists within, not in other people. It’s a personal realization, an individual experience. There is only one thing that brings happiness and that is to have happy mindset. A happy mindset will help you learn how to handle life even during sad events. Because real happiness is beyond all life circumstances.

If you are seeking happiness, focus in the moment. Happiness is being aware of the present. By focusing on the past and future, you lose the opportunity to find that happiness. None of us can change the past. The past is like a movie we remember watching. If it’s a bad movie you didn’t like, make a mental note and move on… There is no need to sit down and worry about the movie we watched yesterday. Just remember to pick a better movie for yourself today.

What is the meaning of life on the way to happiness?

What does life mean to you? As a child things are simple. However as we grow older, we get ourselves into some complicated life problems. We work way too many hours to save way too little money; we focus too much on popular media and forget about our own inner child. We forget what life means to us and adopt other people’s descriptions. Happiness is to find our own true self and stay true to it!

And during all these searches for happiness and meaning for life battles, life happens and we find ourselves in depression and suffer from anxieties. Why? Why keep the battle to yourself? Therapy is the help we all should get in the path towards happiness. A therapist plays the role of gate keeper to your inner child. Give therapy a chance and see the benefits yourself!

Maya Angelou said it best:  “There is no greater agony than bearing an untold story inside you.”

Share your story with an online therapist at today.

WRITTEN BY:  Elif Angel Raynor, M.S.

Online Therapy Compared to Face-to-Face Therapy

In this article we’ll compare online therapy to the traditional method of delivering psychotherapy, i.e. seeing a counselor face-to-face.

online therapy vs face to face therapy

Online therapy services are becoming increasingly popular these days. Are they better than the traditional face-to-face therapy method? Are they as secure? Are they as expensive? Should I try them out? Let’s take a look at these key issues.

It’s a bit difficult to say what is “good, better, the best” in psychology or therapy. There’re no absolute truths in psychology, only your individual needs and preferences. This means that instead of asking what is good or bad, it’s more to the point to inquire: “What kind of a therapy method would best suit the particular situation I’m facing, or help me deal with an issue that I’m trying so hard to find a solution for?”

Whereas online therapy is perfectly fine for many of us, there are many individuals out there who’d hate it for one reason or another. Some people just hate technology, others just don’t feel comfortably using it, others don’t trust anyone unless they’re face-to-face, etc.

There are also many reasons for not liking to see a counselor in his / her office. For example, it’s too time consuming to get over there to attend a face-to-face session. Or, it may be too frustrating to have to leave home and then rush back again, and always during the rush hour. It may also be completely impossible to see a counselor without others noticing it, etc.

If we look at the price tag, it’s online therapy that’s often the more affordable option. Indeed, online therapy services can be a very cheap option. There are reliable therapy and counseling service providers on the net who offer e-mail sessions starting at 20 USD per question. That is already pretty cheap for talking with a qualified professional.

If you’re on a very, very low budget, one option is to join a free therapy forum. Just be careful to not give out any confidential data. Another thing, remember that joining a psychology forum it’s not online therapy, really. Talking with strangers may help you, but it may also confuse you more. So, let’s be careful out there.

That brings us to the security issue. Whether you conduct online therapy or face-to-face therapy, there are security issues to be deal with. We often tend to think that if I talk face-to-face with my therapist, then it’s private. However, if the office room has paper-thin walls, and many do, then this is just an illusion. The same applies to online therapy. If your therapist is absent minded and tends to lose his personal belongings in public places, then it’s quite risky to be his client. Could this happen? Could a therapist really forget his laptop in a bar or taxi? Yes, it can, and it has happened.

Should I now go and try it out? Yes! Why not? If you feel good about technology, you could definitely try it out, or at least go and search for some more information about it. It’s quite a fascinating subject. The New York Times wrote about it (September 23, 2011), Psychology Today wrote about it (July 30, 2010), and of course, there’s a Wikipedia article about it. All this material is online and ready to be read at your convenience. Hey, that’s just one of the many virtues of online services!

This article was written by Mr. Timo Kojonen, M.Sc., M.Psych., MBA, the managing director of website that specializes in providing Online Therapy and professional Online Counseling Services.

What is Skype Therapy ?

Skype therapy refers to talking with a therapist over the Internet using a popular video conferencing software called Skype. It’s free software that allows you to connect your own computer with another, and have a live conversation with your therapist, with or without a webcam.

skype therapy

What Should I Know About Skype Therapy?

Here some more key facts about it.

  1. Skype is not the only option.

Skype is a popular program for video conferencing. However, it is by no means the only option out there. Actually, there are lots of free video conferencing programs available on the web, which can be used for conducting a therapy session. Typical alternatives are Yahoo Messenger, Oovoo, MSN Live Messenger, etc.

  1. Video conferencing is free.

Most, if not all of these programs are free to use, at least, if you’re using a connection from your own computer to another. However, if you’re using Skype to call a landline phone, there’s a fee. If you’re using Skype to call your therapist’s cell phone, be prepared to pay quite a lot of extra money for making that call.

  1. Webcam is an option, not a must.

You can talk with a therapist using a webcam if you want to, but if you’d rather not, then you can also use Skype to just talk. Now, if you’re using the webcam option, you’ll see both yourself (at home) and your therapist (in his/her office) during the video conference, as the program allows two simultaneous live images to appear on the screen.

  1. Skype therapy is quite affordable.

Skype therapy sessions start at 60 USD for a 45-minute session. That’s the best price that I’ve found. (Actually, that is the rate we at offer to our clients). This makes Skype therapy quite affordable. In addition, there are a growing number of insurance companies that allow their clients to use their insurance to cover the cost of online therapy. If that applies to you, remember to ask for further instructions from you insurer before booking with a particular therapist. Not every therapist has the necessary qualifications to be accepted by the insurer.

  1. Book with a licensed and registered professional.

It is of upmost importance to book your Skype therapy session with a qualified and experienced therapist or counselor. A good guarantee is to search for a licensed and registered professional, which means that a third party has verified his diplomas and other qualifications.

  1. If you have doubts, ask!

If you have doubts about your therapist’s credentials, or have other doubts, it is wise to request more information before starting to use the service. A good therapist will be happy to explain about his / her educational background, experience and the kind of psychological method they apply in treatment.

This article was written by Mr. Timo Kojonen, M.Sc., M.Psych., MBA, the managing director of website that specializes in providing professional Skype therapy and other mental health services over the Internet. –

Psychological Counselling in Parkinson’s Disease

Parkinson’s disease is a chronic disorder affecting the way the brain co-ordinates the movements of the muscles in the body. Symptoms are both motor and non-motor. Non-motor symptoms include: depression, apathy and impulse control disorder. Online psychological support offers Parkinson’s disease patients a chance to deal with their emotional pain in the warmth and confidentiality of their home.

Parkinson’s disease is a chronic disorder affecting the way the brain co-ordinates the movements of the muscles in the body. Parkinson’s disease involves both motor and non-motor symptoms. Motor symptoms are stiffness, tremor, and slowness of movement. Treatment often provides good relief of symptoms for several years. Non-motor symptoms include: olfaction loss, bladder dysfunction, sleep behaviour disorder.

Among Parkinson’s disease psychological symptoms are: depression, apathy, impulse control disorder. Parkinson’s disease mainly develops in people over the age of 50, but the number of diagnoses in younger people is increasing.

Parkinson’s disease follows a reduction of dopamine production in the brain. Dopamine is a neurotransmitter (a chemical) conveying motor information down the nerves and the spinal cord to control the muscles of the body.

At the moment being, there is no cure for PD, however, medications can ease symptoms.

One third of people with Parkinson’s disease can experience anxiety and depression. Parkinson’s disease affects areas of the brain that control mood. Depression and apathy are the main psychological symptoms involved in Parkinson’s disese.

Depression symptoms can be: low mood, fatigue, loss of energy, weight loss (or gain), drowsiness or insomnia.

Apathy is a lack of inhitiative and involves a loss of interest. Apathy is not lazyness nor weariness, but it occurs when somebody does not take the inhitiative to start (purposeful) behaviours.

When a patient who is affected by Parkinson’s disease shows psychological symptoms such as the above mentioned, it is useful to speak with a psychologist.

Online psychological support is professional mental health intervention provided via email or videoconference.

Online therapy is suitable for patients in case of:

• No availability of services within a geographical area
• Need for anonymity
• Need or desire for specialized services
• Lack of transportation
• Disability
• Time management problems
• Low budget

Necessary skills are: typing skills, basic computer skills, internet access.

What are the benefits of an online therapy for a Parkinson’s disease patient?

When a patient first receives a diagnosis he feels himself, his life and his future threatened. The individual makes comparisons between his current situation and his previous idea of the illness. Then the patient begin struggling to develop a new representation of that illness. Patients often experience feelings of: shame, guilt, loneliness, fear, and anger in their everyday life. All these feelings interfere with patients relationships: family and their beloved ones.
Online psychological support offers Parkinson’s disease patients a chance to deal with their emotional pain in the warmth and confidentiality of their home. Being listenened will help patients understand and cope with their emotional distress.


About the author: Viola Nicolucci graduated in psychology from the University of Turin, Italy. With an expertise in health psychology, Viola works as psychologist in a private practice and is a member of the staff at

International Adaptation to E-Therapy

It’s  interesting to study the difference that exists between countries and continents as it comes to the use of Internet in psychotherapy and counseling.
In a bunch of European countries it’s the government that leads the efforts to help individuals in need of online mental help and peer support. This applies especially to Scandinavia and the U.K. In the U.S. it’s mainly  the private sector that is at the forefront when it comes to developing new types of counseling services, such as e-mail, Skype therapy, or interactive therapy programs. In Australia it’s mainly the university sector that has independently developed a rich variety of alternative therapy and self-help methods.In Central Europe the situation is quite complex.
Despite the interest that the global population is showing towards e-therapy options, the press and other media has taken a critical stance towards them. The main arguments against it is that the efficacy of such methods has not been studied in detail yet, and before the scientific studies are complete, it cannot be 100 % trusted. Another complaint is the price tag which the media perceives as very high.
Private service providers try their best to change these two negative views but the media is slow in updating their information.In some countries the bureaucracy plays on important role in slowing down the progress. In Brazil, for example, the legislators spent a decade in formulating a law that regulates the use of on line psychology and other on line services related to psychotherapy. The result is a failed decree that intents to bring in censorship and control all websites that offer web-based counseling services. They have even created a list of banned services, and a list of banned expression, that should not be found on therapy websites. If you fail to obey these imposed rules, you shall be sanctioned and stripped of your counseling license. Well, we could say many things about this, but perhaps it’s enough to point out that governmental watchdogs do not normally success if the do not collaborate with the private sector and cultivate a positive spirit. Regulation is good, but if you try to impose it with narrow-minded mentality,that is another story…
In some other countries we see the opposite. In Russia, for example, there’s a large number of “therapy websites” that are actually not dedicated to psychology or counseling, but to astrology and hocus pocus. No problem with that. We just point this out to show how different approaches exist in the world as it comes to what is good for you.

As always, our recommendation is that the consumer takes his or hers destiny into his or her own hands. Get informed, study many different alternatives before deciding for one, and contact the services provider if you have questions or doubts before starting a therapy treatment. As there’s no one truth in psychotherapy but instead many truths and a large variety of treatment options, it’s important to think of this issue as a question of preferences. I need to find out what is best for Me among the many, many alternatives that all promise wonders.

Written by Timo Kojonen. M.Sc., M.Psych., MBA. Therapion Consulting, CEO