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 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
Complex and childhood trauma. Addiction, including alcohol, cocaine, gambling and sexual compulsivity. Eating disorders, with a particular specialism in men. Midlife crisis. Low self-esteem. Bereavement. Jungian analysis and dream work.
EMDR is included. Bilateral stimulation can be delivered remotely and the protocol holds. Over a hundred EMDR sessions have been delivered by video in this practice, including some of its best outcomes.
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.
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.
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, Central London, Bermondsey and Colchester.
Common questions
Does online therapy actually work?
The research says yes, and so does the practice. 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 found that patients treated online finished with lower PTSD scores than those seen in the room. The consistent caveat in that literature is fidelity: it works when the therapist adapts the protocol properly, not automatically because it is on a screen.
What can be treated online?
Almost everything this practice treats: complex and childhood trauma, addiction, eating disorders, midlife crisis, low self-esteem, relationship difficulty and Jungian analysis. EMDR is included, because bilateral stimulation can be delivered remotely and the protocol holds. What cannot be done online is medical treatment, and that distinction is made at the assessment rather than discovered later.
Is online therapy confidential?
Sessions are held by secure video and the same professional confidentiality applies as in the consulting room. For many clients the online setting is more private, not less. If you live in a small community, an expatriate circle or a professional network where everybody knows everybody, seeing someone outside it removes a risk that a local therapist cannot remove however careful they are.
Can I have online therapy from outside the UK?
Yes. A substantial part of this practice is international: clients in the Gulf, Asia, Europe, Africa and the Americas, working in English or French. Registration is with the United Kingdom Council for Psychotherapy and the Health and Care Professions Council, and the same standards apply wherever you are.
How long are online sessions and how often?
Fifty minutes, usually weekly. Some work, particularly Jungian analysis and complex trauma, is better served at twice weekly. Frequency is discussed at the assessment rather than assumed, and it changes over the course of treatment.
What do I need for an online therapy session?
A reliable connection, a device with a camera, headphones, and a room where you will not be interrupted for the hour. The last of those matters more than the technology. Sessions taken in a car outside the office are possible but rarely the best use of the time.
When is online therapy not the right answer?
When there is a medical emergency, when withdrawal from alcohol or benzodiazepines needs supervision, when someone is in the acute phase of an eating disorder and needs monitoring, or when the situation genuinely calls for a person in the room. Those cases are identified at the assessment and referred appropriately.
Do you offer online therapy in French?
Yes. Dr Jacquet is French and works in both languages. A significant part of the online practice is francophone, including clients in Belgium, Switzerland, Lebanon, Monaco and Canada as well as French speakers living in London.