Trying a Video Therapy Session? Here's How to Get the Most Out of It


Whether you have been going to therapy for a while or are trying it for the first time, a video therapy session is a bit different than meeting in person in both expected and unexpected ways. While both have their pros and cons, neither format is necessarily better than the other.

If you choose to try online, here are some considerations from Kate Sheehan, LCSW, managing director of the UCLA Center for Child Anxiety Resilience Education and Support (CARES) for making the most of your therapy session.

Choose your space unselfishly.

When you go to therapy at your therapist’s office, you have the benefit of a neutral space that never interacts with the rest of your life. But when clients first do a video session with me, they are often surprised by how different it feels just because of where they are sitting and what’s around them.

Location: If you are sitting in your kitchen, and you had an argument with your partner there last night, those feelings will be more vivid if you discuss it in therapy. That might be helpful, or it might not. This isn’t about making a right or wrong choice, but it is about being thoughtful about how our physical environment affects us.

Confidentiality: If you are in your bedroom, but your roommate can overhear your side of the conversation, you may not feel as free to express yourself as you would in the privacy of a therapist’s office.

Privacy: If you’re seeking privacy by sitting outside or in your car, how will you feel if a neighbor watches you there?

Innovation: Give yourself the gift of privacy, even if it means decking out a closet with your favorite pillow and lava lamp.

Consider the time of day.

There’s not a perfect time or a bad time for therapy. But it is important to think about what you do just before therapy and what you plan to do after therapy. This is true even when meeting your therapist in person. You should also honor your own rhythms and responsibilities.

Morning sessions: If you roll out of bed just before a session, you may find it more difficult to identify and/or articulate your thoughts and feelings.

Evening sessions: On the other hand, if you meet your therapist at the late end of a busy day, you may find it more difficult to focus on what you really want to be working on together. If you meet right after work, you may struggle to set aside whatever happened that day at work to get back to the issue you were really hoping to work on.

Post-session: After a therapy session, you might feel raw, relieved, drained, inspired, exhausted, exposed, or a host of other emotions. This is precious time. You could continue to explore your feelings, try out new interventions offered by your therapist, or work on coping strategies to soothe or validate yourself.

This transition time from the introspection of therapy back to “real life” is valuable practice time to stretch what you learn in therapy. This transition is highlighted when doing an online session, and switching off from therapy back into your regular home or work could be jarring.

Plan to make the most of the transition time. Offer yourself time to journal about your session, draw out a new insight, shake it off with your favorite dance tunes, meditate to keep the self-connection strong. Or ask your therapist what might be good to do next.

What will you look at? What will I look at?

Video sessions are about our voices and our faces. For some clients, this can feel overwhelmingly intense. For others, it can be a new healing experience of feeling truly seen.

Staring contests: You do not need to maintain constant eye contact with your online therapist. That can sound obvious, but there may be the temptation to do so. Our feelings for our therapist are complex and we may find ourselves feeling obligated to look at them, wanting to check their every subtle response, or we just may not know what else to look at. (Your therapist hopefully won’t be staring at you the whole time either, but your therapist should be watching you to help you notice your nonverbal communications.)

Distractions: Consider your background. Whatever is in the view of your therapist is open to therapeutic discussion. For example, if I can see a pile of dirty clothes on the floor behind you, and you are trying to convince me that your depressive symptoms have abetted, I will have questions about whether your laundry pile indicates some amotivation (difficulty getting things done) that goes along with even mild depression.

Set up your own therapeutic space.

This is a perfect time to build out your self-care corner with all the sensory supports you can pull together. See how many of your senses you can include to keep yourself grounded, focused, relaxed, or engaged.

Smell: I can’t light candles or incense in my shared office, but you can infuse your home space with whatever comforting, uplifting, or relaxing scents match your emotional need before, during and after an online therapy session.

Sound: You can have music on in the background, or nature sounds, or block out sounds by using headphones. You get to control what you hear and how much of it you hear.

Sight: If you are in need of particularly intense support for an issue, offer yourself something beautiful to look at? In order to help support some visual titration (easing up on the tough stuff, then diving back in), consider placing a photo of a favorite person or place in your line of sight. Or place a flower or favorite object near your screen. Then you can take turns looking at your therapist and looking at the object.

Taste: Being prepared with a soothing herbal tea or refreshing sparkling water can keep you hydrated, but it also provides another moment of a break for reflecting, processing, or integrating. Small pauses that happen in the therapy room may feel longer or more awkward at first in an online meeting. But time is a key element of the therapy session, and taking sips of a pleasant beverage may support you in taking breaks when they don’t feel natural.

Touch: Have you always wished your therapist’s couch/chair were more soft, firm, fluffy, smooth? Now’s your chance to surround yourself with the textures you enjoy. Try to spoil yourself. You’ll be sitting for 50 minutes (more or less) in one spot – make it the most physically comfortable time of your day if you can. The more at ease your body is, the more you offer a safe home base for your emotions to settle or rest during the therapeutic process.

Even with all of these suggestions, you may still prefer to meet a therapist in person. However, some of you will discover that online therapy is convenient and may have the extra benefit of speeding up the application of lessons from therapy, as you have an opportunity to apply new thoughts or behaviors immediately in the location you most need them.

One final consideration: If there is anything that makes you uncomfortable about your online therapy experience, please mention it to your therapist. Knowing what makes us uncomfortable (and why) and effectively communicating our needs is at the very heart of the therapeutic process. Be well.


The UCLA Center for Child Anxiety Resilience Education and Support (CARES) strives to create a community of support around children who are dealing with stress and anxiety. We do this through the creation and implementation of programs designed to help teachers, parents, and clinicians develop a greater understanding of the early signs of childhood anxiety and key strategies to help children and families build resilience.

Written by Kate Sheehan, LCSW, Managing Director of CARES