Does Online Couples Therapy Work?
The research so far says yes, with caveats. Studies comparing couples sessions by video with the same sessions in person have found similar improvements in relationship satisfaction and a similar bond with the therapist. The studies are small, though, and video is not the right setting when there are safety concerns or no privacy at home.
What do studies of video couples therapy show?
The most direct test is to give couples the same help in two formats and compare. An Australian research team did this with 30 couples randomly assigned to face-to-face or videoconference sessions of a six-session behavioral program. Relationship satisfaction and mental health improved in both groups, and the improvement did not differ by format. Ratings of the working relationship with the therapist were also the same in both groups and rose over time.
A US trial with military veterans who had PTSD and their partners compared a brief couple therapy delivered in an office with the same therapy delivered by home-based telehealth. PTSD symptoms and relationship satisfaction improved in both formats, with no significant difference between them, and the changes held at six months.
A 2021 systematic review looked across 37 papers on videoconference therapy for couples and families. It concluded that video delivery was feasible and acceptable to clients and that the included studies pointed to it being an effective way to deliver this kind of therapy.
How strong is that evidence?
It is encouraging, and it is not the last word. A few limits are worth knowing before you rely on it.
- The samples are small. Thirty couples is enough to show two formats are in the same range. It is not enough to rule out modest differences.
- The programs were short and structured. The Australian study used a six-session skills program, not open-ended therapy for a couple in crisis.
- Some groups were specific. Veterans with PTSD and their partners are not the same as every couple in New York.
- The review did not pool the numbers. Its authors did not run a meta-analysis, so there is no single combined estimate of how well video works.
- Follow-up was brief. Three to six months tells you little about how a couple is doing two years later.
A fair summary is that video sessions have performed about as well as office sessions wherever the two have been compared, and that nobody has yet shown this across every kind of couple and problem. For the broader evidence on therapy itself, see what the research says about couples therapy.
Can you really connect with a therapist through a screen?
This is the worry most couples raise first. The same research group interviewed 15 couples before and after a course of video sessions. Many started out doubtful that a therapist could show empathy over a screen. By the end, most described the experience as positive, and couples consistently said they were able to connect with the therapist. Some said the slight distance of the screen made them feel more comfortable and more in control.
That is a small interview study, so treat it as a description of what some couples experienced. It does match the trial finding that the therapist bond was just as strong on video.
Is an online program the same as online therapy?
No, and the difference matters when you read claims about “online couples therapy.”
Self-guided relationship programs are a separate category. The most studied one in the US was tested with 300 heterosexual couples who were randomly assigned to start right away or wait two months. Couples worked through about eight hours of online activities with four 15-minute calls from project staff. Compared with the waiting group, they reported better relationship satisfaction and fewer symptoms of depression and anxiety.
That is a real result, but it describes a structured course with light coaching. It does not involve a licensed therapist who gets to know the two of you, responds to what happens in the session, and adjusts the work as it goes. Text-based apps and chat services are different again and have not been tested in the same way for couples. When this article says online therapy, it means live video sessions with a licensed therapist.
When does video fit well, and when is the office better?
Neither format is better for everyone. These points usually decide it.
| Video tends to suit you if | In person tends to suit you if |
|---|---|
| Travel time is the main reason you keep postponing | You have no private room at home or at work |
| One of you travels often or you live in different places for now | Arguments escalate fast and you want a neutral room to contain them |
| You have young children and limited childcare | One of you tunes out or multitasks on screens |
| You both feel more at ease talking from home | Your connection is unreliable |
Some couples mix the two, coming to the office when they can and meeting by video when schedules are tight. If the pressure on your relationship is mostly about living apart, the article on long-distance relationship problems covers that situation.
When is online couples therapy not the right choice?
Video sessions are not suitable in a crisis. If either of you is thinking about self-harm, call or text the 988 Suicide and Crisis Lifeline or call 911.
They are also not the right first step if you are afraid of your partner or there is violence or coercion in the relationship. The National Domestic Violence Hotline does not encourage couples counseling with an abusive partner, in any format. Video adds a further problem, because a therapist cannot tell who else is in the room or what happens once the call ends. You can reach the hotline at 1-800-799-7233. The article on when couples therapy is not recommended goes into this in more detail.
How do you get the most out of a video session?
- Sit together if you can. One screen, both of you in frame, so the therapist can see how you respond to each other.
- Protect your privacy. Close the door, use headphones if walls are thin, and choose a time when children are asleep or out.
- Use a computer on a stable connection. A laptop on a table works better than a phone in your hand.
- Remove distractions. Silence notifications and close other windows.
- Leave a buffer. In an office you have the walk home to settle. At home, plan ten quiet minutes before you go back to work or parenting.
- Have a backup plan. Agree in advance what happens if the call drops.
At spiral2grow, online sessions are held by video on Zoom at a time scheduled in advance and run 45 minutes, the same as office sessions. You can read more about Online by Video sessions at spiral2grow.
When is it worth getting help, in either format?
The format matters less than starting. If you keep having the same argument, if you have gone quiet with each other, or if one of you is wondering whether to stay, those are good reasons to talk to a couples therapist now. Choose the format you will reliably attend. A video session you keep is worth more than an office session you cancel. The couples counseling page describes how the work is approached at spiral2grow.
Ask about format before you book
If you are unsure whether video or the office would suit you, a free phone consultation is a good place to ask. Moshe Ratson, LMFT, sees couples in Midtown Manhattan and Online by Video. Contact spiral2grow to request a call.
Common questions
In the studies that compared them directly, yes. Couples improved by similar amounts whether sessions were by video or face to face, and they rated their connection with the therapist the same. Those studies were small and used short, structured programs, so the finding is promising but has not been confirmed for every kind of couple or problem.
Often, yes. Each partner can join the video call from a separate place, which helps when one of you travels or you are living apart. Sitting together is usually better when it is possible, because the therapist can see how you react to each other. Ask the therapist whether they can work with you where each of you is located.
A computer with a camera, a reasonably fast internet connection and a private space where you will not be interrupted for the full session. Headphones help if others are nearby. Close other apps and silence your phones. It also helps to agree with the therapist in advance on what to do if the connection drops.
No. Self-guided programs and apps walk you through set lessons, sometimes with brief coaching calls. Research on one such program found real benefits, but it is a course, not therapy. Live video sessions involve a licensed therapist who gets to know both of you and adjusts the work to what is happening in your relationship.
Sources
- Couples Therapy Delivered Through Videoconferencing: Effects on Relationship Outcomes, Mental Health and the Therapeutic Alliance (Kysely et al., 2022), Frontiers in Psychology, via PubMed
- A randomized trial of brief couple therapy for PTSD and relationship satisfaction (Morland et al., 2022), Journal of Consulting and Clinical Psychology, via PubMed
- Videoconferencing psychotherapy for couples and families: A systematic review (de Boer et al., 2021), Journal of Marital and Family Therapy, via PubMed
- Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study (Kysely et al., 2020), Frontiers in Psychology, via PubMed
- A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning (Doss et al., 2016), Journal of Consulting and Clinical Psychology, via PubMed
- 988 Suicide and Crisis Lifeline, 988 Lifeline
- Should I Go To Couples Therapy With My Abusive Partner?, 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.
