Online Psychotherapy & Video Therapy – effective and
capable of so much more
Here you will find comprehensive information about online psychotherapy and video-based counseling. This page outlines everything you need to know if you—or your child, family members, or other caregivers—are considering beginning therapy via secure video sessions.
I also share insights from my clinical work as a licensed child and adolescent psychotherapist, including practical experience, the effectiveness of online treatment, and the opportunities as well as the limitations of this format.
A clear guide to psychotherapy and counseling via video
I’ll be honest: in the beginning, I felt something similar myself.
Part of that hesitation came from the concern that conducting therapy online might not allow for the same level of accurate assessment or clinical depth as in-person sessions.
This is especially true for depth-psychological and psychoanalytic approaches, which rely heavily on the emotional dynamics within the therapeutic relationship.
Naturally, I was worried about missing something important on screen or not being able to hold the therapeutic process in the same way as I would in the room . . .
Over the past five years, I have gained extensive experience working with patients online — and my perspective has changed significantly. What once felt uncertain now feels familiar, reliable, and in many cases remarkably effective. The shift has also reshaped the day-to-day work in my outpatient practice in meaningful ways.
For that reason, I want to offer you a clear and transparent overview of what online therapy can (and cannot) do:
What works well in an online setting?
Where are the natural limitations?
And who is genuinely a good fit for this form of psychotherapy?
Inhalt
- A clear guide to psychotherapy and counseling via video
- Current experience with online therapy
- Written by a licensed Psychotherapist
- My first encounter …
- The effectiveness is scientifically proven
- The health insurance provider covers online
- Choosing a Therapist Regardless of Where You Live
- More continuity and better availability
- New therapeutic dimension
- Advantages of online therapy
- Analog versus digital communication
- Best practices for effective, professional online therapy
- Limits of Online Psychotherapy
- Caution with “Online Child Therapy/ Coaching”
- Privacy & Confidentiality: It’s about more than just technology
- FAQ on Online Psychotherapy
- Scientific and Legal Sources
Egenolffstraße 4a
D-60316 Frankfurt am Main | Nordend
& online
Written by Tobias Szuwart,
Licensed Psychotherapist
Tobias Szuwart is a licensed psychotherapist with more than 20 years of professional experience. He began his career in social work before opening his private practice in Frankfurt’s Nordend district, where he now also works worldwide through online psychotherapy and coaching.
His clinical focus is depth-psychology–based psychotherapy and parent counseling, with special experience in supporting parents, adolescents, and young adults.
“My first encounter with online psychotherapy—like for many others—began during the COVID period. Unlike many practices, I kept my office open throughout that time. Despite HEPA filters, distancing rules, and strict hygiene measures, it quickly became clear that some patients needed support urgently, especially while stuck in quarantine. To close these gaps in care, I began continuing weekly therapy sessions through certified video platforms.
Interestingly, the real shift didn’t happen during the pandemic itself but afterward. During and shortly after COVID, many people longed for direct, in-person contact again.
Only in the past one and a half to two years have I seen a clear and lasting change: online psychotherapy is now actively sought out—by adolescents, parents, professionals, students abroad, and people living in rural areas.”
Fakten & praktische Infos
Online Therapy: Key Facts & Practical Considerations
On the facts: The effectiveness of online therapy is scientifically proven
In clinical studies, online psychotherapy shows treatment outcomes comparable to traditional in-person therapy — especially for depression, anxiety and panic disorders, eating disorders, stress-related difficulties, burnout, OCD, and various other mental health conditions. Over recent years, therapists in outpatient practice have also reported predominantly positive experiences with the online format. Some now conduct most of their sessions virtually. Even colleagues who continue to work primarily in person appreciate the added flexibility of online therapy — simply because it aligns more closely with the everyday realities and life circumstances of many patients and families.
The health insurance provider covers online sessions from the very first appointment
Since January 1, 2025, statutory health insurance in Germany has allowed initial consultations and diagnostic sessions to take place via video — even without an in-person appointment beforehand.
For clients, this means that I can provide all insured psychotherapy services nationwide and, when appropriate, also to clients living abroad, as long as they hold German statutory insurance.
Initial assessments and a preliminary diagnostic evaluation by a licensed psychotherapist can already be conducted through certified video platforms. This allows clients to receive professional guidance early on — even when distance, illness, work commitments or mobility issues make in-person visits difficult.
Choosing a Therapist Regardless of Where You Live
With this new flexibility and lack of geographic restriction, I can now work with anyone who is insured through the German statutory health system—no matter where they currently live. It no longer matters whether someone is located near my practice in Frankfurt, in cities like Munich or Hamburg, in rural areas, or even abroad. Previously, this level of access was available only to self-paying clients or some privately insured patients.
This also increases the chance of finding a therapist with whom the personal connection and trust truly fit. Patients can now choose more freely, independent of location and based on therapeutic compatibility.
Ultimately, this brings the therapeutic relationship even more into focus—because it remains the key factor in effective treatment, whether sessions are held online or in person.
More continuity and better availability
Stable therapeutic processes despite changes in personal circumstances:
This means that the continuity of psychotherapy can be maintained — even during a move, illness, frequent travel, or a period of studying abroad. You no longer have to interrupt treatment and “start over somewhere else,” as was often the case in the past.
“In the middle of my therapy, I had to move to Switzerland for my studies. I was terrified I’d have to stop treatment altogether. Being able to continue online was a huge relief. Those last months helped me more than I expected — a lot of things finally came together.” – S., 23
New therapeutic dimension (not only for behavioral therapy)
In the diagnostic process, this format often allows for a clearer glimpse into a person’s living environment: “Now I can actually see where and how you live.”
Online therapy can also increase the therapist’s presence in a client’s everyday life. This is particularly relevant in depth-psychologically oriented online therapy, where this new relational aspect can have a strong impact — especially with regard to transference and the dynamics of the therapeutic relationship.
“It is not uncommon for patients to describe the feeling of being able to ‘invite their therapist into their home’.”
It goes without saying that this is not permitted from a legal standpoint, as maintaining an appropriate professional distance is essential. It would also be practically impossible to implement within the daily routine of a psychotherapy practice.
Online formats are particularly suitable for cognitive-behavioral therapy and systemic therapy (including family therapy), as these approaches rely strongly on manualized methods and structured techniques. The required regular exercises can be carried out easily online or supported through brief check-ins and chat-based follow-ups.
Advantages of online therapy:
Lowering barriers effectively
- Better access to therapists who are a good personal fit
- Shorter waiting times for an initial consultation or an available therapy slot
- Saves time and money: no travel required – especially helpful for work, family responsibilities or studying
- Less inhibition or shame: video sessions reduce emotional hurdles and can make it easier to begin therapy, especially for anxiety disorders
- Familiar environment: many people find it easier to open up emotionally at home
- Faster availability: often possible at short notice during crises or stressful periods
- Accessible and flexible: suitable even with limited mobility, illness or in later adulthood
Analog versus digital communication
Many will be familiar with the communication theorist Paul Watzlawick:
“Every message has both an analog and a digital level.”
The digital level refers mainly to factual, content-related information.
The analog level, on the other hand, includes relational aspects, self-expression and — above all — nonverbal communication.
Some colleagues attribute the unconscious aspects of psychotherapy particularly strongly to body language. Online, this analog level is indeed somewhat reduced.
It therefore depends on how well the therapist is able to work with the camera as a medium in order to create therapeutic presence in the digital space — because anyone experienced with video knows that cameras can “swallow” parts of facial expression and gesture.
Best practices for effective, professional online therapy from the comfort of your home
In consulting processes and parent-coaching sessions that focus on practical, solution-oriented work around specific situations or challenges, I have had consistently positive experiences with fully online formats. In many cases, online treatment was preceded by an in-person contact or several individual or group sessions. However, in most situations a direct online start would also have been entirely possible. It is also becoming increasingly clear that “online” is being requested more and more often.
Limits of Online Psychotherapy
In child and adolescent psychotherapy, online sessions clearly reach their limits. Play therapy, for example, requires an appropriate physical space along with the materials and expressive opportunities needed to make (often unconscious) themes visible.
Behavioral therapy can also be difficult to conduct online, because children and adolescents up to around age 15 – and often even older – need direct, in-person contact to build a stable therapeutic relationship and to maintain a reliable therapeutic frame.
Younger children rely heavily on nonverbal communication, facial expression, gestures, and play to mirror emotions and form a relationship – all aspects that can only be captured to a limited extent online. From a developmental standpoint, children are in particularly sensitive phases.
Sessions with parents or caregivers, however, can be carried out very well online and can support or prepare ongoing therapeutic processes. This also relieves parents, who are often already at their limit, from the added time pressure of traveling to appointments.
Caution with “Online Child Therapy”
“Online child coaching” or “online child psychologists,” and similar offerings, are not legitimate therapeutic treatments in the medical or psychotherapeutic sense. They are often provided by coaches or alternative practitioners who do not have the required professional training — and certainly not a state license — to work therapeutically with children.
Please make sure to always check the correct professional title.
Privacy & Confidentiality: It’s about more than just technology
In online therapy, privacy and confidentiality play a crucial role. The platforms used must provide end-to-end encryption, comply with data-protection regulations, and be approved by the relevant German regulatory bodies. This ensures that the content of each session is kept as secure as possible on the technical side.
However, technical security is only one part of it. Equally important is the social privacy of the conversation. Online sessions require a protected environment in which no one can accidentally overhear — or intentionally listen in — whether family members, roommates, or others nearby. A confidential space is essential so that inner experiences, thoughts and emotions can unfold safely during the session.
FAQ on Online Psychotherapy
Online psychotherapy is appropriate for teens aged 15 and older, young adults, and adults — especially in cases of:
- Online psychotherapy is appropriate for teens aged 15 and older, young adults, and adults — especially in cases of:
- Depression
- Anxiety disorders
- Overload / burnout
- Stress-related symptoms
- Adjustment disorders
- Social anxiety
- Fears related to leaving the house
- Work- or family-related scheduling constraints
- College, studying abroad, relocation . . .
Wann ist Online-Psychotherapie eine echte Alternative?
Online-Therapie ist eine vollwertige Alternative, wenn Präsenztermine nicht möglich sind (beruflich, gesundheitlich, räumlich) oder wenn Patienten sich im eigenen Umfeld leichter öffnen können.
Is online psychotherapy effective?
Yes. Studies show that it is comparable in effectiveness to in-person therapy, especially for depression, anxiety disorders, and stress-related conditions.
When is video therapy particularly helpful?
- when time constraints make regular in-person sessions difficult
- when mobility limitations are present
- when shame, inhibition or emotional blocks make office visits harder
- when there is significant geographical distance
- during crises or periods of high stress
- when additional stability is needed between in-person sessions
Can an entire course of psychotherapy take place online?
Yes, in many cases psychotherapy can be conducted fully online. Since 2025, psychotherapeutic consultations and initial diagnostic sessions can also be carried out via video. What truly matters is not the medium itself, but the therapeutic relationship and the professional quality of the treatment. In some clinical situations or acute crises, however, in-person sessions may still be necessary.
For whom is online therapy not suitable?
Video sessions are not suitable for very young children, for play-therapy approaches, or for situations that require close in-person interaction or crisis intervention on site. They are also not sufficient in cases of severe psychological crises or acute risk of self-harm or harm to others. In such situations, in-person treatment or inpatient care in a psychiatric or psychosomatic clinic is the appropriate option.
How does a video therapy session work?
The structure is largely the same as a traditional in-person session. You choose a private, undisturbed space, log in at the scheduled time through a certified video platform (you typically receive the link by email from the therapist), and conduct the session as usual. A stable internet connection, a functioning device (PC, laptop, smartphone, iPad, …) with a camera, and a private setting are essential.
Which providers are certified?
Approved video platforms must comply with the requirements of the German National Association of Statutory Health Insurance Physicians, be GDPR-compliant, and use end-to-end encryption. Common providers include Epikur, Videosprechstunde.net, Viomedi, and other platforms officially certified by the KBV.
Does health insurance cover the costs?
Yes. Statutory health insurance in Germany covers online sessions in the same way as in-person appointments, as long as they are conducted through an approved video provider. Private insurance companies generally reimburse these services as well, although the extent of coverage may depend on the individual plan or contract.
Do I need a referral from a physician?
No. You do not need a physician’s referral to begin online psychotherapy or online counseling.
What do I need technically?
You will need:
- a device with a camera, microphone, and either speakers or headphones (smartphone, tablet, laptop, or desktop computer)
- a stable internet connection
- a quiet, private space where you won’t be overheard or interrupted
- the login details for the certified video platform
- Nothing more is required.
Scientific and Legal Sources
The scientific and legal sources provided are in German, as they relate to the German healthcare system and regulatory framework.
- Bundespsychotherapeutenkammer Bundesgesundheitsministerium
- Etzelmueller, A., Vis, C., Karyotaki, E., Baumeister, H., Titov, N., Berking, M., Cuijpers, P., Riper, H. & Ebert, D. (2020). Systematische Übersichtsarbeit und Meta-Analyse zur Wirksamkeit internetbasierter kognitiver Verhaltenstherapie im regulären Versorgungsalltag erwachsener Patient*innen mit Depression und Angststörungen. In: Journal of Medical Internet Research, 22(8), Artikel e18100 – https://doi.org/10.2196/18100
- Mack, S. et al. (2014). Untersuchung zur Inanspruchnahme psychotherapeutischer und psychiatrischer Versorgungsangebote in der erwachsenen deutschen Bevölkerung (DEGS1-MH Modul). International Journal of Methods in Psychiatric Research, 23(3), 289–303. https://doi.org/10.1002/mpr.1438
- Carlbring, P., Andersson, G., Cuijpers, P., Riper, H. & Hedman, E. (2018). Aktualisierte Meta-Analyse zum Vergleich internetbasierter und face-to-face durchgeführter kognitiver Verhaltenstherapie bei psychischen und somatischen Störungen. Cognitive Behaviour Therapy, 47(1), 1–18. https://doi.org/10.1080/16506073.2017.1401115
Egenolffstraße 4a
60316 Frankfurt am Main | Nordend
& online