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Online therapy across the UK
I see adults, teenagers and children anywhere in the UK by video. For this kind of treatment, working online is not a compromise: for a good number of problems it is the better way to do it.
Where I work
I hold appointments online across the whole of the UK, England, Scotland, Wales and Northern Ireland, and in person near Ravenshead, Nottingham and Mansfield. Most of my work is online, and most people who start online stay online.
The reason is not convenience, although it is convenient. Specialist ERP is thin on the ground in the UK, and geography should not decide whether you get the right treatment. Without a local OCD specialist, video removes the problem.
Why exposure work often goes better online
Exposure and Response Prevention works by facing the situations that set the anxiety off, without doing what you normally do to make the feeling stop. Almost none of those situations are in a consulting room. In a clinic, exposure work is simulated or discussed and then attempted alone later in the week, when the plan has started to blur.
Online, we go to where the problem lives.
- Contamination OCD gets treated in the actual bathroom, with the actual taps and the towel that has been off-limits for two years.
- Checking rituals get treated at the actual front door, at the time of day you normally leave.
- School refusal work happens at the real school run, in the hallway where the arguing starts.
- Health anxiety work happens on your own phone, at the moment the urge to google arrives.
- Ordering, symmetry and “just right” compulsions get treated in the room where the objects are.
Anxiety learning is famously context-bound: what your brain learns in a therapist’s office does not always travel home. When the practice happens where the problem occurs, there is less to transfer.
What a session can look like
A typical exposure session might involve fifteen minutes of planning at your desk, then you carrying the laptop to the kitchen, doing the agreed task with me watching and coaching, then sitting with the discomfort while we talk about what your brain expected and what happened. It is agreed in advance every time.
What you need practically
- A private space. Somewhere you will not be overheard or walked in on. Some people use a car on the driveway.
- A decent connection. Not fast, just stable. If video drops we switch to audio and carry on.
- A device with a camera. A laptop or tablet is easiest for talking; a phone is better for exposure tasks, because it comes with you.
- Headphones, which help more than people expect, for privacy and for hearing each other.
- Somewhere to write. Paper or a notes app. Between-session practice needs recording.
You do not need to install anything. I send a link before each session.
How sessions with children and teenagers work
Online work with young people needs more structure than with adults, not less. I set the rhythm out at the start, so nobody is caught out by parents appearing or leaving.
Sessions begin with parents for a few minutes: how the week went, what practice happened, what got in the way. Then parents step out and I work with the child or teenager directly. Then parents come back for the last ten minutes, so the plan is agreed by everybody rather than relayed by a fourteen-year-old.
Teenagers often prefer video to a clinic, and will say more from their own bedroom than across a desk. Younger children need shorter segments, props, games and a parent present. For a nine-year-old with OCD, a session might involve a chart on the wall, a timer, and a parent running the exposure while I coach both.
Where a child will not attend, treatment can be delivered entirely through parents using SPACE, which translates to video without losing anything.
Confidentiality, and what happens if things get difficult
Sessions are held on an encrypted platform, I work from a private room, and I do not record sessions. Notes are kept securely and in line with UK data protection law. Confidentiality has the same limits online as in person: I would break it if I believed you or someone else was at serious risk of harm, and would tell you wherever it is safe to.
Distance raises a practical question, dealt with at the assessment rather than in the middle of a crisis. I take your address, your GP’s details, and the name and number of someone to contact in an emergency, and I note the local urgent mental health route where you live, which differs across the four nations. If someone becomes acutely unwell during a session, I stay on the call and we use the plan we agreed.
The honest limits
Online is not right for everything, and I would rather say so plainly.
- If you have nowhere private to talk, the work suffers. This is the most common obstacle, and it matters more than technology.
- Some exposure tasks cannot be replicated on a screen: a needle phobia needing a clinical setting, or driving anxiety where the passenger seat is the point.
- Where risk is significant and changing, or someone needs a local team in person, private video work is not the right container.
- Some people concentrate better in a room with another person. That is a good reason to choose in-person sessions near Nottingham and Mansfield.
If you are not sure, that is worth working out on the free 30-minute call. Plenty of people mix the two: assessment in person, then treatment online.
Common questions
Is online therapy as good as in person for OCD and anxiety?
For the treatments I deliver, video work holds up well, and for some problems it has practical advantages that a consulting room cannot match. ERP depends on facing the situations that actually trigger the difficulty, and most of those situations are at home. Online, we can work in the room where the ritual happens rather than talking about it afterwards. Where in-person work would clearly be better, I will say so.
What do I actually need to take part?
A device with a camera, a reasonably stable internet connection, and somewhere you can talk without being overheard. Headphones help. A laptop or tablet is easier than a phone for most sessions, though for exposure tasks a phone is often better because you can carry it with you.
Can you see me if I live outside England?
Yes. I am registered with the HCPC and work with people across the whole of the UK, including Scotland, Wales and Northern Ireland. Crisis and NHS pathways differ between the four nations, so at the assessment I take a note of your GP and your local urgent care route.
Does online work for young children?
It works better than most parents expect, with some adjustments. Younger children need shorter segments, more games and props, and a parent nearby to help with tasks. What online loses in the room it often gains at home, where the actual practice has to happen anyway.
Is video confidential?
Sessions are held on an encrypted platform, I take sessions from a private room, and I do not record them. The bigger practical risk is usually at your end, so it is worth arranging somewhere you will not be interrupted or overheard.
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Free 30-minute call
Not sure whether this is the right fit?
Start with a free 30-minute call. We talk through what is going on, and I tell you honestly whether I think I can help. If I cannot, I will try to point you to someone who can. No obligation, no charge.
Weekdays, 9am to 9pm. No GP referral needed.