Why I Choose to Run My Psychology Practice Online
In the last six years of working as a psychologist in Australia, I've worked with many people -children, teenagers, adults and families.
During that time, I've seen people cancel appointments, postpone therapy or stop attending altogether. Not because they didn't want support, but because getting to therapy became a barrier in itself.
The drive was too long. The car broke down. There was no one to leave the kids with. Some people didn't feel safe leaving their homes or comfortable being seen in a clinic waiting room. Others found the unfamiliar environment, uncomfortable furniture or physical accessibility of the building made it difficult to engage in therapy.
So they cancelled. Stopped. Postponed.
I started suggesting and offering telehealth as an alternative. The COVID-19 pandemic helped make online therapy more recognisable, accessible and, perhaps most importantly, acceptable.
And I began to see how much difference having that option could make.
But can you really connect through a screen?
Many people I worked with were hesitant at first.
One of the most common concerns I noticed, and something also reflected in research, was whether video therapy could offer the same authentic connection and therapeutic relationship as meeting in person.
After all, the relationship between a client and therapist is an important part of successful therapy.
But once people gave it a go, the feedback I often received was that they still felt connected, understood and seen.
The barriers to accessing support decreased, without compromising the connection.
What does the research suggest?
Effectiveness
Multiple systematic reviews and meta-analyses comparing telehealth with in-person therapy suggest that online psychological interventions can be just as effective for many people experiencing PTSD, mood disorders and anxiety disorders.
A meta-analysis of 35 randomised controlled trials involving 4,827 participants found no significant difference in outcomes for depression or anxiety, with a small advantage for telehealth reported in PTSD treatment.[1]
Research also suggests that improvements in mental health, quality of life and treatment satisfaction can be comparable between online and in-person therapy.[2]
In other words, therapy doesn't necessarily become less effective because it happens through a screen.
Therapeutic alliance
The therapeutic alliance is the relationship between a client and therapist, including the sense of trust, connection and collaboration that develops throughout therapy.
And it's one of the strongest predictors of positive therapy outcomes.
Research suggests that the working alliance developed through video therapy can be equivalent to in-person therapy.[3]
Interestingly, research has also found that clients may rate the therapeutic relationship more positively than therapists themselves, while therapists report similar therapeutic success across both settings.[3]
So, while connection through a screen may feel unfamiliar at first, it doesn't mean the relationship is any less meaningful.
The hidden costs of accessing therapy
When we talk about the cost of therapy, we usually think about the session fee.
But what about everything else?
The time spent travelling. The petrol. Parking. Childcare. Time off work. The physical and mental energy required to get there.
Research highlights several practical benefits of telehealth:
Less travel and fewer expenses. No commuting, navigating public transport, finding parking or paying for petrol. Research has identified saving time and resources as one of the most commonly reported advantages of telehealth.[4]
Fewer logistical demands. Telehealth can be particularly beneficial for people with mobility-related disabilities, transport barriers, caring responsibilities or demanding work schedules.[4]
Less time away from work and family. For some people, attending from home or work means not having to arrange childcare or take several hours out of their day for a single appointment.[4]
Reduced productivity costs. One study estimated more than $1.17 million in savings associated with driving time, alongside additional productivity savings of approximately $467,000 across the population studied.[5]
Greater comfort and accessibility. For people experiencing social anxiety, agoraphobia, PTSD, chronic pain or sensory sensitivities, simply entering a clinic can add another layer of stress.
Research into videoconferencing psychotherapy for panic disorder and agoraphobia has also shown promising outcomes, including evidence that it can be an effective alternative to in-person treatment.
Sometimes, removing the demands around attending therapy means people have more capacity for the therapy itself.
What about neurodivergent clients?
As I primarily work with neurodivergent adults, particularly autistic, ADHD and AuDHD people, this is an area I'm especially interested in.
For some neurodivergent people, telehealth isn't just something they tolerate because it's convenient. It can be a genuinely preferred way of accessing therapy.
And when you consider the different demands involved in attending an in-person appointment, it makes sense.
More sensory control, more opportunities for regulation
Attending therapy from your own environment means having greater control over your sensory experience.
You can adjust the lighting, wear headphones, sit in your favourite chair, wrap yourself in a blanket or have your pet nearby.
You can use fidgets, move around, change positions or take a moment when you need to.
For autistic people in particular, being able to access therapy from a familiar, predictable environment may reduce sensory demands and create more opportunities for regulation.
And when your nervous system isn't working so hard to manage the environment, you may have more capacity to engage in the therapeutic work.
Less masking and social performance
Think about everything that can happen before an in-person therapy session even begins.
Walking into a building. Finding reception. Making small talk. Sitting in a waiting room with strangers. Navigating unfamiliar social expectations.
For some neurodivergent people, these interactions come with additional masking and social demands.
Telehealth can remove some of these expectations.
You don't have to make eye contact with a receptionist. You can look away from the screen while talking, turn off your self-view or, where appropriate, use the chat function to communicate something that's difficult to say out loud.
Research exploring autistic adults' experiences of therapy adaptations has highlighted the importance of therapists being flexible around communication preferences, including not treating differences in eye contact as something that needs correcting.[6]
Connection doesn't have to look a particular way to be meaningful.
Less executive functioning demand
For ADHD and AuDHD people, getting to an appointment can involve a whole series of tasks.
Remembering the appointment. Planning the journey. Calculating travel time. Finding parking. Getting out the door. Managing unexpected delays.
And sometimes, all of that happens before you've even started therapy.
Telehealth can remove several of those steps.
Of course, online appointments still involve planning, remembering and transitioning between activities. But reducing the number of steps can make attending therapy feel much more manageable.
More flexibility in communication and processing
Neurodivergent people may have different preferences around how information is communicated, processed and remembered.
Some people appreciate knowing the structure of a session in advance.
Others benefit from written summaries, visual information, extra processing time or the opportunity to share their thoughts in writing.
Research with autistic adults has found that adaptations such as written session summaries, email communication and greater choice around therapy delivery can be particularly helpful.[6]
Telehealth can support many of these adaptations, depending on the therapist's approach and the client's needs.
It's not just about what we talk about in therapy, but how we create an environment where people can participate in ways that work for them.
What does the research say about neurodivergent people and telehealth?
Research in this area is still developing, but early findings are encouraging.
A pilot study exploring telehealth-delivered, autism-adapted cognitive behavioural therapy reported improvements in several areas, including mood.
A systematic review of telehealth interventions involving autistic children also reported generally positive acceptability and satisfaction.
While findings from child-focused interventions cannot automatically be applied to autistic adults, they contribute to a growing body of evidence suggesting that telehealth can be a valuable option when adapted to individual needs.
And that's the important part: individual needs.
Not every autistic or ADHD person will prefer online therapy. Some may find video calls tiring, prefer being physically present with their therapist or need a separate space away from home.
Neuroaffirming care isn't about assuming that telehealth is better for all neurodivergent people.
It's about recognising that people have different needs and offering flexibility wherever possible.
An honest look at the downsides
Of course, telehealth isn't for everyone.
Some research has reported slightly higher dropout rates for telehealth compared with in-person therapy, although findings vary depending on the population and type of intervention.
A reliable internet connection, access to a suitable device and a private, comfortable space are also important considerations.
Not everyone has access to these things.
Some people may live with others and struggle to find privacy. Others may find technology stressful, experience video-call fatigue or simply prefer the experience of being in the same room as their therapist.
There are also situations where in-person support may be more appropriate, particularly when someone needs immediate crisis intervention or a higher level of safety monitoring.
Telehealth isn't a universal solution.
But neither is in-person therapy.
The goal should be to make psychological support more accessible, not to insist that everyone accesses it in the same way.
My personal perspective as a therapist
As an AuDHD psychologist, I also value accommodating my own needs and creating a working environment where I can provide the best possible care without sacrificing my wellbeing.
Running my practice online allows me to create a space that works for my brain and body.
I can prioritise physical comfort, manage my sensory environment, take meaningful breaks between sessions, access things that help me feel safe and regulated, and preserve energy that would otherwise go towards commuting and navigating different environments.
And there's something else that's important to me.
I want to model the very things I encourage my clients to explore in their own lives.
That their needs matter.
That accommodations aren't something they need to earn.
That they don't have to constantly push through discomfort, ignore their bodies or fit themselves into environments that don't work for them.
That it's okay to do things differently.
So why wouldn't I extend those same values to myself?
For me, choosing to work online is also about questioning the idea that being a good therapist means following a particular model of how therapy should look.
I can be a committed, present and effective psychologist while also creating a sustainable way of working.
In fact, looking after my own wellbeing is part of how I continue showing up for the people I support.
Why I keep choosing telehealth
Through my clinical experience and the growing body of research, I see telehealth as a valid and effective way of providing psychological support.
For many people, particularly those living in regional and remote areas, people with disabilities, parents and carers, and neurodivergent people, it can offer greater accessibility, comfort and flexibility.
It can mean having your favourite fidget nearby, your dog curled up beside you, your headphones on, your camera adjusted to your comfort and your body supported in whatever position works best.
It can mean having your baby or toddler with you if that is the only (or preferred) way of accessing psychological support.
It can mean not spending an hour driving, worrying about parking, sitting in a waiting room or using up your energy before the session even begins.
And from my side of the screen, it means creating a working environment that allows me to offer care in a way that's sustainable for my own nervous system, too.
I don't believe therapy has to happen on a particular couch, inside a particular building or in the way we've always been told it should.
Sometimes it happens with a cup of tea, a blanket, a dog sleeping nearby and two people connecting through a screen.
Not worse. Just different.
And that's why I choose to run my psychology practice online.
written by Kasia Aksamit (Registered Psychologist)
Sources
Luo C, et al. (2022). A comparison of telehealth versus in-person psychotherapy: a meta-analysis of randomised controlled trials across 35 studies (n=4,827). Journal of Affective Disorders.
Shore JH, et al. Psychiatric treatment via telemedicine: systematic review of efficacy, satisfaction, and attrition in mood, anxiety, and PTSD. Psychiatric Services.
Berryhill MB, et al. (2019). Effect of videoconferencing psychotherapy on therapeutic alliance and outcomes: a meta-analysis. Psychiatric Services.
Taylor A, et al. Telehealth for allied health professionals: a scoping review of acceptability, resource-saving, and access advantages. Australian Journal of Primary Health.
Patel SY, et al. (2023). Productivity cost savings from telehealth use in outpatient mental health. JAMA Network Open.
Whaling K, et al. (2024). Autistic adults' ratings of helpfulness of adaptations to therapy: modality choice, sensory accommodations, and written communication. Autism.
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