What Online Therapy Actually Feels Like (From Both Sides of the Screen)

By Jessica Oliver, MSW, LCSW · Clinical Director, Aspire Counseling

When Aspire Counseling first started offering more online sessions, I had questions.

I knew the research was solid. I knew clients in rural Missouri needed access. I knew our team had the training. What I wasn't sure about was whether it would feel personal enough.

The thing I love most about being a therapist is the connection. The trust that builds slowly across the room. The micro-moments when something shifts. I worried we'd lose some of that on a screen.

It's been a few years now. A substantial number of our clients see us online from throughout the state of Missouri. I see a mix of in person and online clients myself. So do most of our therapists. And I'll tell you what's surprised me. It doesn't feel less personal. It feels different in some ways, but personal in ways I genuinely didn't expect.

This post is the conversation I wish I'd had with another therapist back when I was wondering. It's drawn from my own clinical experience over the past few years, plus what I've learned from talking with two of our therapists who've each lived this comparison from a different angle. Mikayla Wichern, MSW, LCSW made the full transition from in-person practice in our Columbia office to fully online sessions when she relocated. Jill Hasso, LPC, who works out of our Lee's Summit office, currently sees clients three days a week online and two days in person.

Does online therapy actually feel personal?

Yes. In a lot of ways, it feels more personal than meeting in an office. You see the client in their actual life. Their pets. Their posters. The blanket they wrap up in for hard conversations. That kind of access can deepen a therapeutic relationship in ways an office can't.

When I started doing more online sessions, I expected I'd miss the office setting. I missed parts of it. But I also started noticing things I couldn't have seen in our Columbia or Lee's Summit space.

I meet pets. Dogs that show up halfway through a session. Cats that walk across the keyboard. I see a client's bookshelf and learn what they've been reading. I see the corner of their kitchen where they had a hard conversation with their mother last week. I see what makes them feel safe and what they haven't gotten around to fixing yet.

Mikayla put it this way, "When we're both in our natural environments, we both show up as our more authentic selves. We can connect even quicker than we might be able to in an office setting."

I agree. There's something about being in the place where you actually live that lets you show up as yourself sooner.

Jill has had the same experience from a different angle. She's noticed her clients seem more comfortable meeting from their own environment rather than rushing across town. Her words: "Removing barriers like commuting, traffic, travel time, and scheduling difficulties often makes it easier for people to attend therapy consistently and stay engaged in the process."

That consistency matters more than people might realize. Therapy works partly because of what happens in session. It also works because clients keep showing up. When the format reduces friction, more of the work gets done.

Can a therapist really do real clinical work online?

Yes, and some of it actually works better online. We can pull up worksheets together on screen. We can do EMDR using several types of bilateral stimulation that translate well to video. And for anxiety and OCD work, we can do exposures in your real environment instead of recreating them in an office.

This is the question we get most often, and it's the part that surprised me most clinically. Real evidence-based therapy translates online. In some cases, the format actually adds something.

When I'm delivering CPT for trauma, I love using the worksheets online. I share my screen, we can both see exactly where we are, and I type as the client talks. There's a clarity to it. The same is true for assessment sessions. The client sees what I'm writing in real time. That transparency builds trust. We've written more about the research on online trauma therapy here.

For EMDR, we use a few different methods of bilateral stimulation. Sometimes the butterfly hug, where the client crosses their arms and taps their shoulders. Sometimes knee tapping. We also have a website that we can both log into where a ball moves across the screen and the client follows it with their eyes. Each method works. The processing, the relief, the actual movement of the work, none of it depends on the room.

For exposure work, this is where online really shines. A client who's afraid of dirt can sit on the ground in their backyard with me virtually present. A client who's been avoiding sending a hard email can share their screen and write it with me right there. A client struggling with social anxiety can practice making the phone call they've been putting off, sitting in their kitchen, knowing I'm right there with them.

We're doing the work in the actual situations where the work needs to happen. That's a real clinical advantage.

Mikayla, one of our online therapists who specializes in OCD, sees this every day. As she said when we talked about it, "OCD treatment is one that can be better online because it gives a lot more flexibility with exposures instead of being stuck in an office." She also points out that for OCD specifically, online opens up access. There aren't a lot of therapists in Missouri who are formally trained in ERP. Online means we can match a client with the right specialist regardless of where in the state they live.

There are still a few small limitations. I have a window of tolerance diagram hanging on my office wall, and when I want to walk a client through it, I have to take it down and hold it up to the camera. That moment is seamless in person and a little clunky online. But that's a small workaround in a much bigger gain.

What's actually harder about online therapy?

Some things genuinely are harder online. Reading the full body of someone's response takes more attention. Tech can interrupt at the wrong moment. Connection still happens, but it asks both the therapist and the client to be a little more intentional than meeting in person.

I want to be honest about this part. Online isn't always the easier choice for the therapist.

Reading body language is different. On screen, I'm closer to a client's face than I'd be sitting across the room, so micro-expressions are easier to catch. But it's harder to see the foot tapping under the table or the small fidgeting that often tells me a client is approaching the edge of their window of tolerance. I've learned to ask more direct check-in questions to fill that gap.

Silence is also different online. In an office, a quiet moment feels like shared space. On video, it can feel for a second like the connection has frozen. I've learned to name that gently when it happens, so silence stays useful instead of unsettling.

Tech matters too. A frozen screen at the wrong moment can pull someone out of a hard piece of work. We've gotten good at backup plans. We use the healthcare version of Zoom under a Business Associate Agreement, which is reliable. But I won't pretend every session is seamless.

Privacy on the client's end is the other real consideration. We can't fully control what the client's home offers. We talk through that during the consultation and we problem-solve it together. Sometimes the answer is finding a private spot in the house. Sometimes it's headphones. Sometimes, as Mikayla often suggests to her clients, it's sitting in a parked car.

What about clients who do some sessions in person and some online?

That's actually one of my favorite arrangements. Some clients come in once a month and do the rest online. Others are mostly online and come in for a one-week trauma intensive. It can be the best of both formats, and it suits a lot of people's actual lives.

This may be my favorite scenario in my own practice. A client who comes to Columbia for the first session and does the rest online. A client who's mostly online but flies in for a week-long trauma intensive. A client who lives in St. Louis and drives in once every two months to anchor the work.

Each of these is real. Each works. It's not about format purity. It's about fitting the work to the client's actual life. We design the schedule around what's realistic for the client, not what's traditional for therapy.

What's surprised me most after a few years of doing this?

How quickly the screen stops feeling like a barrier. How much the home environment adds. And how often clients I worried might struggle online have ended up making meaningful progress, partly because the format made therapy actually possible for them.

The biggest thing was how quickly the screen stopped feeling like a barrier. The first few minutes of a session, I notice it. Ten minutes in, we're just talking. There's no glass wall. There's a person, a relationship, and the work.

Mikayla noticed something even more striking after she made her transition from the Columbia office to seeing all of her clients online. She told me, "I've even had some clients that have made more progress after moving to fully virtual."

Knowing that she took a full caseload from in person to virtual when she moved, that really struck me. She had that unique ability of watching the same clients in those two different environments.

She wasn't saying online is universally better. She was saying that for some people, the comfort of their own space, the absence of a commute, and the freedom to be themselves can remove small frictions that had been quietly slowing the work down. I've seen the same thing in my own practice.

Jill, has talked about a similar shift from a clinician's view. "When I'm able to work from a comfortable, focused space and spend less energy on logistics, I'm often able to show up with more consistency, attention, and presence for the people I work with."

That's been my experience too. The work itself hasn't gotten smaller. If anything, it's gotten easier to do consistently. Our team has watched clients reach goals on virtual sessions that they probably wouldn't have reached if travel and scheduling had stayed in the way. The American Psychological Association's telehealth research supports what most of us in the field have seen firsthand. For many concerns, telehealth and in-person care produce comparable outcomes.

What would I tell someone who's nervous to try online therapy?

Try it for a few sessions. Pay attention to whether you feel heard and whether the work is moving. The screen starts to feel familiar quickly. The relationship is what matters. And if it isn't a fit for you, we'll tell you that honestly.

Online therapy isn't right for everyone. Some people do their best work in a room. Some people need a higher level of care than telehealth alone can offer. We'll talk through that with you honestly during the consultation.

But if you've been on the fence, here's what I want you to know. The therapeutic relationship can absolutely be built through a screen. The clinical work, the trauma processing, the exposure therapy, the harder conversations, all of it works. We've watched it.

What you might want even more than that, though, is the small stuff. Knowing you don't have to schedule the commute. Knowing you can do this from your living room with your dog asleep on your feet. Knowing your therapist will see you in your real life, not the version of you that drove across town in office clothes.

If you've been waiting for the right specialist, and you're located anywhere in Missouri, you can reach out here. We'll figure out together whether online therapy is a fit for you, and we'll match you with the therapist on our team whose training and approach line up with what you're working through.

You can also learn more about how we handle online therapy on our Online Therapy in Missouri page.

Online therapy is appropriate for many concerns, but it isn't appropriate for someone in a severe psychiatric crisis. If you're having thoughts of suicide, call or text 988. If you're in immediate danger, call 911 or go to your nearest emergency room.

About the Author

This article was written by Jessica Oliver, MSW, LCSW, founder and Clinical Director of Aspire Counseling. Jessica has 15 years of clinical experience and is trained in EMDR, CPT, Prolonged Exposure, ACT, and ERP. She continues to see clients each week at Aspire's Columbia office and online, with a specialty focus on trauma and high-achieving professionals.

This post is based on conversations with Mikayla Wichern, MSW, LCSW, an Aspire clinician who specializes in OCD and ERP. Mikayla worked with clients in person at Aspire's Columbia office before transitioning to fully online sessions when she relocated, giving her a rare clinical view of the same therapy delivered in two different formats. The post was also shaped by conversations with Jill Hasso, LPC, an Aspire clinician based in our Lee's Summit office. Jill is similarly trained in both CPT and ERP. She currently sees clients three days a week online and two days in person, and her depth-oriented approach to therapy with high-functioning adults has been informed by her work in both formats. The insights in this post belong to all three of us.