Does online therapy work for children and young people?

When the pandemic pushed mental health services online in 2020, many clinicians were sceptical about whether remote therapy could be effective with children and young people. Several years of evidence later, the picture is more nuanced and more positive than many expected.

What the research shows

Multiple systematic reviews have now examined the effectiveness of online and video-based therapy for children and adolescents. The evidence is strongest for CBT delivered via video for anxiety disorders, where outcomes are broadly comparable with face-to-face delivery. A 2022 review published in the Journal of Child Psychology and Psychiatry found that internet-delivered and videoconference-delivered interventions produced significant reductions in anxiety and depression symptoms in young people, with effect sizes similar to in-person treatment. The evidence is less developed for younger children, complex presentations, and relational therapies that depend heavily on nonverbal communication, but for the majority of presentations treated in private CAMHS settings, online delivery is clinically sound.

Why many young people prefer it

Teenagers in particular often engage more readily with online therapy than face-to-face. The reasons are consistent across clinical observation and research. Being in a familiar environment reduces the intimidation of a clinical setting. Some teenagers find eye contact and physical presence during difficult conversations overwhelming, and the screen creates a manageable distance. Reduction in travel logistics removes a practical barrier to attendance. There is also evidence that young people with social anxiety, one of the most prevalent presentations in adolescent mental health, engage particularly well with video-based therapy. The reduced social exposure can allow them to begin therapeutic work that they would struggle to initiate in person.

The practical advantages

Online delivery removes significant practical barriers to accessing mental health care. Children and young people in rural or semi-rural areas face genuine access challenges: a round trip to a clinic in a city takes time out of the school day, creates travel costs, and may require a parent to take time off work. Online delivery means that a child in rural Scotland can access the same consultant psychiatrist or psychologist as a child in central London. For families managing complex schedules, online appointments also offer flexibility that makes sustained engagement with treatment more realistic.

When in-person is preferable

Online delivery is not appropriate for all situations. Initial assessments for complex presentations often benefit from in-person observation. Some therapeutic approaches, particularly those involving young children or using creative and play-based methods, work better face-to-face. And where there is active risk, an in-person clinical relationship provides important safeguards. A good provider will be clear about when online delivery is appropriate and when it is not.

What good online therapy looks like

The modality of delivery matters less than the quality of the clinician. Good online therapy for young people should involve a clinician who is trained and registered with the relevant professional body, a clear treatment plan with defined goals, regular review, and the same standards of clinical note-keeping and safeguarding that apply to face-to-face work.

If you would like to find out whether online therapy at Blip is the right fit for your child, you can begin an enquiry using the link below.