Is online therapy effective? What the research shows

The short answer

Yes, for the kinds of problems most people see a psychologist about. Several independent research teams have pooled the trials that compared live video therapy with in-person therapy, and they reach the same conclusion: outcomes for anxiety, depression, PTSD, OCD and related conditions are about the same whichever way the therapy is delivered, provided it is the same evidence-based therapy delivered by a trained clinician.

Two caveats sit alongside that. The format does not make a weak therapy strong: what matters is the treatment and the person delivering it. And "online therapy" covers everything from a psychologist on a video call to a chatbot; the evidence below is about live video sessions with a clinician, which is what Mindwell and similar practices provide.

What the meta-analyses found

A meta-analysis pools the results of many separate studies so that patterns show more clearly than in any single trial. The main ones comparing video with in-person therapy are:

• Fernandez and colleagues (2021), Clinical Psychology & Psychotherapy: pooled studies of live psychotherapy by video and found it about as effective as in-person therapy across different treatment types and target problems.
• Batastini and colleagues (2021), Clinical Psychology Review: pooled 43 treatment studies and 14 assessment studies and found that videoconferenced treatment produced effects largely equivalent to in-person care, and that assessments by video led to similar decisions.
• Lin, Heckman and Anderson (2022), Clinical Psychology: Science and Practice: restricted the analysis to randomised clinical trials, the strictest kind of evidence, and found no significant difference in outcomes between synchronous teletherapy and in-person therapy.
• Greenwood and colleagues (2022), JMIR Mental Health: pooled 12 randomised trials for less common conditions, such as eating disorders, addictions and childhood mental health problems, and found no evidence of a difference between telehealth and face-to-face psychotherapy, although the trials were small.
• Norwood and colleagues (2018), Clinical Psychology & Psychotherapy: found that people rated the working alliance slightly lower by video than in person, yet treatment outcomes were no worse. The relationship forms a little differently on screen; it still does its job.
• Carlbring and colleagues (2018), Cognitive Behaviour Therapy: a related question, guided internet CBT versus face-to-face CBT, found equivalent outcomes. This is the evidence behind programmes such as Just a Thought.

Why video works as well as it does

The ingredients of good therapy travel. A clear explanation of what is keeping the problem going, a structured plan, practice between sessions and a psychologist who notices what you are not saying all work through a screen. For some treatments, video has a practical edge: exposure work for OCD or phobias can happen where the fear actually lives. Someone with contamination fears can touch their own kitchen bin during the session rather than a sanitised clinic doorknob; someone avoiding the motorway can do a session from their driveway before a planned drive.

Attendance matters too. People miss fewer sessions when there is no travel, no parking and no sitting in a waiting room hoping not to be recognised. For a shift worker in Whangārei or a parent in Timaru with a sleeping toddler, that is often the difference between finishing a course of therapy and drifting away from it.

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What suits online, and what does not

Generally well suited: anxiety disorders, panic, social anxiety, health anxiety, OCD, depression, PTSD, insomnia, stress and burnout, grief, relationship patterns and emotion regulation skills. These are the bulk of what psychologists treat and the bulk of the research base.

Needs more thought, and sometimes a different service:

• Someone currently at high risk of harming themselves, or in acute crisis. Online practices are not crisis services; emergency and community mental health teams are.
• Severe eating disorders or other conditions needing physical monitoring alongside therapy, where a team with medical input is safer.
• Formal cognitive or neuropsychological assessment, which often requires in-person testing.
• No private place to talk, or no reliable internet or device. A session overheard by a flatmate is not a confidential session.
• Significant hearing or visual impairment without the right supports, or a strong personal preference for being in the room.

A good online practice will say plainly when another service would serve you better.

Privacy and the practical side

Effectiveness depends partly on logistics. You need a private space for 50 minutes, a device with a camera and microphone, and a stable connection; mobile data on a phone is usually enough if Wi-Fi is patchy. Headphones keep the psychologist's side of the conversation private. Close other applications, silence notifications and, if you are using a work laptop, consider whether your employer can see your activity; a personal device is better.

Platforms built for health care encrypt the video stream and generate a unique link for each appointment, and reputable practices explain where your records are stored and who can see them. In New Zealand, psychologists handle your information under the Health Information Privacy Code 2020 whether sessions are online or in person. Our guide to privacy and confidentiality in online therapy goes through your rights.

Why this matters in New Zealand

The Mental Health and Wellbeing Commission's summary of the 2024/25 New Zealand Health Survey found that 10.5% of adults, about 456,000 people, wanted professional help for their mental health or substance use in the past year and did not get it. Distance and travel are part of that. Psychologists cluster in the main centres; a person in Westport, Kaitāia or the Chatham Islands may have no psychologist within a reasonable drive, and someone in a small town may know every clinician there personally.

Video removes the geography. It also widens choice: instead of the two psychologists in your region, you can see the one in Dunedin who has trained specifically in ERP for OCD, or one who works in your first language. For rural and small-town New Zealanders in particular, the evidence that online therapy works about as well as in-person for most common problems is not an academic point. It is the difference between treatment and no treatment. If you are weighing up the different kinds of online service, our comparison of online therapy options in NZ sets them side by side.

What this means if you book with Mindwell

Mindwell delivers all sessions by video, through Carepatron, which runs in your browser with nothing to install. Our psychologists use the therapies the research above was built on: CBT, ACT, ERP, EMDR, DBT, schema therapy and others, in 50-minute sessions, usually weekly or fortnightly. In your first session, your psychologist can talk with you about whether online therapy suits your situation, and suggest other services if it doesn't.

We work with adults 18+ anywhere in New Zealand, with no referral needed and first sessions typically available within 7 days. Mindwell is not a crisis or emergency service: if you are in immediate danger call 111, or call or text 1737 for free 24/7 support. Read more about online therapy in NZ or how booking works.

Related support: Online therapy in NZ · Privacy and confidentiality online · Your first session · Best online therapy in NZ: a comparison