The question of online versus in-person therapy used to be straightforward. Online was the option of last resort, used when geography or illness made meeting in person impossible. That changed permanently in 2020, and the change has not reversed. A good half of UK private therapy now happens online, and a meaningful number of people who started online in the pandemic have found they prefer it.
If you are choosing for the first time, particularly for anxiety, the question can feel weightier than it deserves. Both formats can work well. Both have quiet strengths. Neither will rescue or ruin the work on its own. This is a gentle look at how to think about it for your own circumstances.
The headline finding
The research, broadly, says that online and in-person therapy are roughly equivalent in outcome for most adults working on most things, including anxiety. Several large reviews of CBT for anxiety, depression and trauma have found similar effect sizes whether delivered face-to-face or via secure video. The therapeutic relationship — which is the strongest single predictor of outcome — can form well on screen, and most clients who do online therapy report feeling genuinely connected to their therapist within a few sessions.
That is the headline. The texture matters too.
Where online tends to suit anxiety
Online therapy has some quiet advantages for anxiety in particular.
The journey is gone. People with significant social anxiety, agoraphobia or panic that is set off by travel often find that the absence of the journey lowers the threshold to attending. You can sit on your own sofa, in your own clothes, with your own cup of tea. There is no waiting room. There is no risk of running into someone you know in the corridor. That can make the difference between coming and not coming.
Flexibility is greater. Online sessions can fit around school runs, around lunch breaks at work, around evenings when in-person travel would not work. For people whose anxiety is partly fuelled by an overwhelming schedule, the saved hour matters.
Consistency is easier. Many of my clients travel for work, or split their time between Surrey and London, or have a second home. Online means the work can continue without the gaps that travel used to enforce. For anxiety, regularity matters — weekly is meaningfully more useful than fortnightly, and fortnightly more useful than monthly.
And privacy is greater. You do not have to explain to a colleague where you are going at three on a Wednesday afternoon. For people who are not yet ready to tell others that they are in therapy, online removes one external pressure.
Where in-person tends to suit anxiety
In-person therapy has its own quiet advantages.
The body is more available. When we meet in the room, I can see more of you than the head-and-shoulders square that video gives. Subtle shifts in breath, in posture, in the way the body holds itself, in the speed of small movements — all of these are part of how anxiety lives in someone, and they are easier to notice in person. Body-based or somatic ways of working are also more straightforward in the room.
The space itself does some work. A consulting room that has been arranged thoughtfully — warm light, soft seating, a sense of containment — can settle a nervous system more quickly than a kitchen corner can. For people whose home is part of what they are anxious about, leaving it for an hour to think can be valuable in itself.
The separation is clearer. When you come to Cobham for a session and then go home, the work has a place. It is in the room. You leave it there. People sometimes find that online sessions blur the line between therapy and ordinary life in ways that make it harder to settle afterwards.
And technology is removed as a variable. No frozen video, no dropouts, no audio lag, no shared anxiety about whether the connection will hold. For people whose anxiety includes a strong control component, the simpler the technology, the easier the work.
Practical things to consider
Do you have a quiet, private space for online sessions? — This matters more than people realise. If the only place you can take a session is your bedroom, with a partner working in the next room, the work will be harder. If you have a home study, a shed at the bottom of the garden, or even a parked car that gives you privacy for fifty minutes, online can work well.
Are you in Surrey or within sensible travelling distance of Cobham? — Esher, Weybridge, Walton-on-Thames, Oxshott, Stoke d'Abernon, Leatherhead, Woking, Guildford and the wider area are all within a comfortable journey. If you are further afield, online is often the more sustainable choice.
What is the nature of your anxiety? — If your anxiety has a strong avoidant component — you find it hard to leave the house, you cancel things, you stay home when you would rather not — then deliberately choosing in-person can be a small piece of useful structure. The journey is a gentle exposure that compounds the work.
How sensitive are you to the technology itself? — Some people find video calls quietly exhausting in a way that they do not find in-person meetings exhausting. If you spend your working week on Teams or Zoom, the prospect of another video call on a Wednesday evening can feel like one more demand on the same depleted muscle.
What I offer
I offer both. In-person sessions are at Ivy House on Anyards Road in Cobham, which is two minutes from the town centre and easily reached from the surrounding Surrey villages. There is on-site parking and the building is shared with other psychologists and psychotherapists, so being seen there does not signal anything specific.
Online sessions are by secure video, using a platform compliant with UK clinical confidentiality standards. The link is sent ahead of each session. The sessions are not recorded. You can join from a laptop, tablet or phone — though a laptop or tablet is more comfortable for the work.
People are welcome to mix the two. Some clients come in person when they can and online when their week makes travel hard. That can work well, though I find a settled pattern — one or the other, mostly — tends to support the work a little more steadily.
A note on the first session
If you are unsure, I would gently suggest that wherever practically possible, the first session is in person. Not because it is necessary, but because meeting in the same room once usually makes the subsequent online sessions feel more grounded. You will have a sense of my voice, my pace, my presence — and the sessions on video will inherit that sense.
This is a suggestion, not a rule. If in-person is impossible, online is fine, and the work will still happen.
What the evidence cannot tell you
Two things the research finds harder to capture.
The first is that some people are quietly more comfortable speaking about difficult material from their own home. The familiar surroundings hold them in a way the consulting room cannot, and they say more, sooner. That can be a real piece of useful access for people who would otherwise have stayed silent for several sessions.
The second is that some people are quietly more comfortable speaking about difficult material when they have travelled away from their daily life to do so. The journey itself becomes part of the work — a small marker that this hour is different from the others.
You will not know which kind of person you are in advance. You can usually work it out by the second or third session, and you can change format if the other suits you better.
And finally
The format of the sessions matters less than the fit of the therapist. If you find someone whose presence settles rather than unsettles you, the work can happen well in either format. If the fit is wrong, no format will rescue it.
Choose the practitioner first. The medium second.
If you would like to talk
If something here has resonated and you would like to talk it through, you can arrange an introductory call by emailing me at FelicityJaggar@gmail.com or leaving a message on 07923 319800. The introductory call is free, lasts fifteen to twenty minutes, and carries no obligation to take anything further.