Online Psychotherapy: Clinical Considerations

By Ofer Zur, Ph.D.

The internet has created many new possibilities for providing clinical services to patients who will not, prefer not, or cannot come to our offices. In some ways, this model of providing care is so new that we don’t even have agreement about what to call it! Telehealth, Tele-Mental Health, Telepsychology, Tele-Counseling and Online Psychotherapy are all terms that are used interchangeably to describe the provision of psychological care when the patient is outside of the therapy office. Using video, audio or both, clinicians are bringing treatment opportunities and continuity of care to a much larger audience than ever before.

Regardless of whether one practices TeleMental Health or not, the impact of the new type of “Tele” or “Online” services effect ALL mental health providers because it effects how the culture at large and current and potential clients’ approach and view general medical as well as mental health services.

“When is something gained, something else is lost.” There are many considerations for clinicians using technology to help our patients.  These considerations often include, who is the client, what are the clinical concerns, where is the client located, therapists’ comfort with digital technologies, therapeutic approach, style and orientation and much more. Then come some fascinating and important questions, such as, where does therapy takes place when our offices cease to be our exclusive place of work? It has been common or typical for psychotherapists, these days, to focus on the technology, states’ laws and whether this delivery platform is “HIPPA compliant”.  Equally important questions, that often get less attention, have been how different we may need to be when we are not physically present while working with patients or how do we apply or adjust our interventions and diagnostic tools, theoretical orientation and clinical interventions to effectively fit the online model.


  • Regardless of the modality (online or in the office) or what you call it (Telepsychology, Tele-mental Health, Online Psychotherapy), our work is always about the relationship.
  • Therapy with a patient when they or we are outside of the office can be a lifesaver or the only available option, but it is not beneficial for everyone.
  • Learn to assess and differentiate clients’ suitability to Tele-Psychology.
  • When online therapy is an option, therapists must make a clinical assessment whether a certain client is suitable for TeleMental Health format of therapy.
  • All the current ethical principles, scope of practice, and other standards and federal and states laws still apply.
  • Familiarize yourself with the relevant state laws that effect the practice of psychotherapy where BOTH you and your patient reside.
  • There are lots of guidelines and resources on Telepsychology available at the Zur Institute’s TeleMental Health Resource Page, so be sure to make use of them.
  • Understand how Telepsychology is different from ‘seeing’ someone in the office so you can explain, discuss and explore it with your patient.
  • Temptations like texting, responding on FB or Instagram, checking emails or websites while online via audio are much harder to resist when we are not face-to-face with our clients.
  • Transference and countertransference or similar explorations of the relationships with our clients are just as much a part of telepsychology and online psychotherapy as they are in face to face therapy.
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