Online Couples Therapy by Video: How It Works, Step by Step
Online couples therapy is a live, scheduled session with a licensed therapist over video. At spiral2grow, sessions with Moshe Ratson, LMFT, MBA, take place on Zoom and last 45 minutes, the same length as an office session. You can join together from one room or from two places. Here is how to set it up, step by step.
Is online marriage counseling the same service as in-person therapy?
Yes. At spiral2grow, online couples counseling, online marriage counseling and online premarital counseling are the same work as the sessions held in the Midtown Manhattan office. The practice lists couples counseling, marriage therapy and premarital counseling as available both in person and online, with the same 45-minute session length in either format. The only real difference is where you sit.
Online sessions are live conversations, not an app, a course or a chat service. You book a time in advance, and at that time you meet Moshe Ratson, LMFT, MBA, on Zoom. If you want to know whether video works as well as meeting in a room, that question has its own article: what the research says about online couples therapy. This article is about the practical side.
Step 1: What should you ask in the free phone call?
Every new inquiry starts with a free 15-minute phone consultation. It is a chance to describe what is going on between you, hear how Moshe works and decide whether you want to book. For online work, a few extra questions are worth raising on that call:
- Will you join from one room or two? Both are possible. More on that below.
- Would you like to mix formats? If you can sometimes get to the office, ask about combining in-person and video sessions. One of you can also come to the office while the other joins by video.
- What are the current fees? Contact the practice for current fees. The practice is self-pay and works out of network with insurance.
Licensed in New York State, Moshe Ratson (LMFT, MBA) welcomes inquiries from individuals and couples in other states. Telehealth eligibility is evaluated individually based on state licensing regulations and professional requirements. Contact spiral2grow to explore whether therapy services may be available in your location.
For a fuller picture of that first call, see what happens on a free phone consultation. After it, the first session is scheduled by phone.
Step 2: Should you join from one room or two locations?
The practice says partners can join a couples session from the same room or from two different places. Each setup has tradeoffs.
One room, one screen. This is the closest thing to sitting on the office couch. You can see each other’s reactions, and the session does not end with each of you alone in a different place. The challenge is practical: you need a screen big enough for the therapist to see both faces, and a room where neither of you feels cornered. Sit side by side, close enough to fit in the frame, with the camera at eye level.
Two locations, two screens. This works when you live apart for now, when one of you travels or works late, or when a session would be hard to fit around a commute. It can also help when being in the same room tends to escalate an argument. The downside is that you cannot read each other’s body language as easily, and after a hard session one of you may be left alone with it. If you join separately, agree in advance on when you will talk afterward. If distance is a regular part of your relationship, the article on long-distance relationship problems may also help.
If you are in the same home but want separate screens, use separate rooms. Two devices in one room usually cause echo and feedback.
Step 3: How do you set up the technology?
The practice’s guidance is simple: a computer with internet access, with a broadband or reasonably fast connection helping. In practice, a little preparation prevents most problems.
- Test before the first session. Zoom offers a test meeting page where you can check your internet and device settings. Do this a day or two ahead, not five minutes before.
- Use a laptop or desktop if you can. A phone held in someone’s hand moves, shrinks both faces and tempts you to check notifications.
- Get the camera to eye level. Stack the laptop on books. Light should face you, not come from a window behind you.
- Plug in. Charge or connect the device, and close other apps and browser tabs that compete for bandwidth.
- Think about sound. Headphones keep your voices from carrying through thin walls. If you share one screen, use the computer’s speaker and microphone so you both hear the same thing.
- Know the fallback. If a technical problem cuts a session short, the practice resumes or reschedules it as soon as possible. Keep the practice phone number handy.
Step 4: How do you keep the session private at home?
Privacy is the part of video therapy people underestimate. In an office, the door closes and the room belongs to you for 45 minutes. At home you have to create that. The practice asks clients to choose a place where they can be present for the whole session without interruptions or distractions, and New York’s professional guidance on telepractice lists privacy and the protection of confidential information among the issues video work raises.
A few things help:
- Children. Book the session for school hours, nap time or after bedtime, or arrange a sitter or a relative. Older children may be curious, so a simple explanation such as “we have a meeting and need quiet” is usually enough. Avoid holding the session where children could overhear even part of it.
- Roommates or family at home. Choose the room farthest from shared spaces, close the door, and consider a fan or white-noise machine outside the door. Some couples tell housemates they need the space for an hour.
- Work devices and shared accounts. If you can, use a personal device and account rather than an employer’s laptop.
- Phones. Put them on do not disturb, face down, out of reach.
- A car is a fallback, not a plan. A parked car can work for one session if nowhere else is private. Never join while driving.
Step 5: What does a video session at spiral2grow look like?
At the scheduled time, you join the Zoom meeting and Moshe Ratson, LMFT, MBA, joins too. The session runs 45 minutes, the same as in the office, and sessions are usually weekly. The content is the same as in person. Moshe describes his approach as active, compassionate, practical and results-oriented, and he draws on Emotionally Focused Therapy, Internal Family Systems, the Gottman Method and mindfulness practices. Sessions focus on the patterns that keep a problem going and on skills such as communication, de-escalation and boundaries. Homework is given periodically to keep the work going between sessions.
Two habits make video sessions work better. First, give yourselves five minutes before the session to settle, rather than stepping straight out of a work call. Second, protect ten minutes afterward. In an office, the trip home gives you time to cool down. At home, you can walk straight from a hard conversation into dinner or bedtime, so a short walk or a cup of tea between the two helps. If you would like to arrive with clear goals, see how to prepare for couples therapy.
You can read more about the format on the practice’s online counseling page and about the service itself on the couples counseling page.
When is video not the right choice?
The practice is direct that online therapy is not appropriate for everyone. It is not the right choice in an emergency, if you are having thoughts of harming yourself or someone else, if you have psychotic symptoms, or if you need intensive support, hospitalization, a prescription or a medical diagnosis. If you are in crisis, call or text the 988 Suicide & Crisis Lifeline or call 911.
Video also raises a specific safety issue. If you are afraid of your partner, or if your partner monitors your devices or controls who you talk to, a session held in your shared home is not a safe place to speak. In that situation, couples therapy is not the right first step in any format. Confidential support is available from the National Domestic Violence Hotline at 1-800-799-7233.
Some couples simply find the office easier. If arguments escalate fast at home, or one of you drifts toward the screen, meeting in Midtown Manhattan near Grand Central Station may suit you better, and some couples use both.
Ready to try a session by video?
If you would like to talk through whether video, the office or a mix fits your situation, request a free phone consultation with Moshe Ratson, LMFT, MBA. Sessions take place in Midtown Manhattan or Online by Video, and the call is a low-pressure way to ask your questions first.
Common questions
No. Partners can join a session from the same room on one screen or from two different places on separate devices. One room keeps you physically together and lets you see each other react. Two locations can help when you live apart, travel, or argue more when you are side by side. Mention your plan during the free phone consultation.
spiral2grow does not bill insurance directly and works as an out-of-network provider for both office and video sessions. If your plan has out-of-network mental health benefits, you may be reimbursed for part of the fee using the receipt the practice provides. Call your insurer first, and contact the practice for current fees.
Video sessions at spiral2grow are held on Zoom. You schedule a time in advance and join at that time from your own location. It helps to test your camera, microphone and connection before the first session and to use a laptop or desktop at eye level rather than a handheld phone.
You can, but neither is ideal. A parked car is private and can work for one session when home is not, though never while driving. An office often has colleagues nearby, thin walls and work devices. A room with a closed door where both of you can talk freely for 45 minutes.
Sources
- Engaging in Telepractice (Marriage and Family Therapists), New York State Education Department, Office of the Professions
- Join Meeting Test, Zoom
- 988 Suicide & Crisis Lifeline, 988 Suicide & Crisis Lifeline
- National Domestic Violence Hotline, The National Domestic Violence Hotline
This article is part of the Couples Counseling Guide. It is general information, not a substitute for care from a licensed professional who knows your situation.
This article is for general education. It is not a substitute for professional advice, diagnosis or treatment.
