Online therapy, done properly
Most of what is written about online therapy argues about whether it works. That argument is settled. What is worth writing about is what makes it work, and when it does not.
This practice has delivered psychotherapy by secure video for years. It is not a reduced version of the consulting room offered to people who cannot get there. For a substantial number of clients it is the better setting, and for some it is the only one in which the work could happen at all.
What the evidence says
Randomised trials comparing video-delivered psychotherapy with in-person treatment have repeatedly found no statistically significant difference in symptom reduction.
A twelve month service evaluation at Cardiff and Vale University Health Board went further: patients who received EMDR online finished treatment with lower PTSD scores than those seen in the room.
The consistent caveat across that literature is fidelity. Online work succeeds when the therapist adapts the protocol properly. It fails when the same session is simply pointed at a webcam. That is a difference in practitioner, not in medium.
The reason nobody writes down
Confidentiality is usually offered as a formality. Online, it is the substance.
If you live in a small country, an expatriate community, a professional circle or a village, there is a reasonable chance that a local therapist knows someone you know. Not through any fault of theirs. Circles overlap.
That is a mild inconvenience if the subject is stress at work. It is not mild at all if the subject is your drinking, your marriage, or an eating disorder you have never told anybody about.
Working with someone outside your network removes a risk that no amount of local professionalism can remove. For a good number of clients here, that is the whole reason they made contact.
Who this practice sees online
People anywhere in the United Kingdom. Specialist psychotherapy is concentrated in a few London postcodes, and that is a fact about property prices rather than about where people need help. Someone in Manchester, Leeds, Bristol, Newcastle or the Highlands is no less likely to be dealing with an eating disorder, an addiction or complex trauma, and considerably less likely to find a doctoral-level specialist within an hour’s travel. NHS waiting lists for specialist provision run to months in much of the country. Online work removes the journey and the wait without removing the specialism, and it costs less than the equivalent hour in a consulting room.
People living abroad. A substantial part of the practice is international, in English and in French. Clients across the Gulf, Asia, Europe, Africa and the Americas, many of them expatriates who cannot find specialist English or French-speaking treatment where they are.
People whose specialism is not available locally. Complex cases where addiction, trauma and an eating disorder sit in the same person are poorly served by clinicians who work with one of the three. Geography should not decide whether you can find someone who follows the whole of it.
People who cannot be seen. Public figures, people in small professional communities, people whose employment would be affected by being recognised in a waiting room.
People who cannot travel weekly. Continuity matters more than the room. An hour every week for two years does more than a fortnightly journey that lapses in winter.
What is treated online
People rarely cross a border for a generalist. They can find one where they live. What is not available where they live is the specialism, and that is what this practice is for.
Online EMDR therapy
EMDR is delivered by video using the standard protocol, with bilateral stimulation adapted for the screen. Over a hundred EMDR sessions have been delivered this way in this practice, including some of its best outcomes, and the Cardiff evaluation above found online delivery holding its own against the room.
What decides the outcome is not the medium but the preparation phase before reprocessing begins. That is the part most often rushed, and rushing it online is worse than rushing it in person, because there is less in the frame to steady someone afterwards. It is not appropriate where a person is medically unstable, at immediate risk, or has nowhere private to sit.
Online therapy for addiction
Alcohol, cocaine, gambling, sexual compulsivity, prescription medication. For many people this is the only version of treatment they will accept, because it requires no absence from work that anyone has to explain, and no name on a clinic’s admission list.
That is not a compromise. It is the senior specialist option for someone who will not go residential, and the continuity for someone who has just come out of one and found that the hard part starts at home.
What it cannot be is a detox. Where withdrawal from alcohol or benzodiazepines carries real physical risk, that is medical treatment and it comes first. It is said at the assessment, not discovered later.
Online eating disorder treatment
Anorexia, bulimia, binge eating and compulsive exercise, with a particular specialism in men — the subject of Dr Jacquet’s doctorate.
Across most of the world, specialist eating disorder provision for adults is thin, and for men it is close to absent. Online work is frequently the only route to a doctoral-level specialist, and the reason a good number of international clients are here at all.
Where weight or physical state needs monitoring, that has to be arranged locally alongside the therapy. Whether it is needed is assessed at the first conversation, and where outpatient work is not a safe first step, that is said directly.
Online Jungian analysis
Analysis depends on continuity and frequency far more than on physical proximity, which makes it unusually well suited to video, and it can run at higher frequency by agreement. Dream work in particular translates without loss.
And also
Complex and childhood trauma. Midlife crisis. Low self-esteem. Bereavement. Relationship difficulty.
When medical treatment comes first
This is psychotherapy, not medical treatment. Withdrawal from alcohol or benzodiazepines can be dangerous and occasionally life threatening, and needs to be managed by a GP, an addiction psychiatrist or a medically supervised detox rather than attempted alone. Where that is what is needed, it is said at the assessment and the referral is made.
The same applies where a psychiatric assessment should come first or run alongside the work, and where the right answer is residential treatment rather than weekly sessions. Therapy does the work that follows stabilisation, and it does that work better once stabilisation is in place.
A platform, a directory, or a practice
The results for online therapy are mostly directories and subscription platforms, so it is worth being clear about the difference, including where they are the better choice.
A platform matches you to whoever is available, at a low monthly fee, usually for a fixed number of shorter sessions. For mild to moderate anxiety or low mood, and for people who mainly need to be heard consistently by someone competent, that is a reasonable thing to buy and this practice is not a better use of the money.
A directory gives you a list and leaves the judgement to you. Useful if you already know what you are looking for.
A practice is one clinician, chosen deliberately, for as long as the work takes. It costs more. It is worth more only where the presentation needs a specialism — complex trauma, addiction, an eating disorder, analysis — because that is the point at which being matched to whoever is free stops being good enough.
The honest test is not which is better. It is whether what you are dealing with needs a specialist. If it does not, use a platform and keep your money.
Where online work is the wrong answer
This matters more than the list above, and it is the part most services leave out.
Online work is not appropriate where someone is medically unstable, in withdrawal that needs supervision, or at immediate risk of harm. It is not appropriate where there is nowhere private — a person taking sessions in a parked car or a bathroom is not in a therapeutic space, however good the clinician, and that is worth solving before the first session rather than tolerating for six months.
And it is not appropriate where someone needs the containment of physically leaving their life in order to change it. Some people do. Being told so honestly is more useful than being enrolled.
Establishing which of these applies is the purpose of the first consultation. It is a mutual assessment, and deciding this is not the right place is one of its possible outcomes.
What you need, and what actually matters
A reliable connection, a device with a camera, headphones, and a room where you will not be interrupted for fifty minutes.
The last of those is the one people underestimate. The technology is rarely the problem. Privacy at your end usually is, and it is worth solving properly before the first session rather than working around it for six months.
How long you will wait
Enquiries are normally answered within two hours. A first appointment is usually available within three days, evenings included. There is no waiting list.
That is worth stating plainly, because it is unusual and because it matters more than it sounds. NHS specialist provision for eating disorders and complex trauma runs to months across much of the country, and a good deal of private practice keeps a list too.
The gap between deciding to start and actually starting is the dangerous interval. Ambivalence is part of what brings people to therapy in the first place, and three weeks of silence gives it everything it needs. Three days does not.
Practicalities
Sessions are fifty minutes, usually weekly, by secure video. Some work is better served twice weekly, and that is discussed rather than assumed.
Clients may be seen by Dr Jacquet or, where appropriate, by an Associate working under his clinical supervision. The choice is yours and fees differ accordingly.
Work is available in English or French.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
In person as well: Harley Street, Fitzrovia, Central London and Colchester.
On whether it works: a review of the evidence, including what the therapeutic alliance research shows and where it stays silent.