Can I have online therapy from abroad?

Why do I not want to start again with someone new?

Because being known takes a long time to build and about 10 minutes to lose.

When you move, nearly everything that holds your sense of yourself goes at once: the language in the street, the people who knew you before, the route you took without thinking. The therapy hour is often the last thing left that does not have to be explained from the beginning. Keeping it is not avoidance of a new therapist. It is a reasonable wish to keep one relationship where the history is already in the room.

That said, it is worth holding the other half of it honestly. A therapist who has only ever known you in one country can be slow to see how much the new one is doing to you. So the continuity is worth having and it needs saying out loud when it starts to work against you, which it sometimes does around the six-month mark, when the new place stops being temporary.

Does the work hold up across the distance?

The relationship itself survives the screen better than most people expect.

A review of nine studies comparing therapy delivered face to face, online and in mixed form found the working relationship broadly comparable across all three, in adults being treated for depression or anxiety.¹ One of those studies found the relationship rated lower by patients in the early weeks of a purely online arrangement, with the difference gone by the eighth week. The link between the relationship and the result was less consistent online than in the room, which the authors treat as an open question rather than a finding.

Practitioners asked about their own experience of working online say something similar and more specific: the relationship holds, while the room is better for emotional expression and for forming the bond quickly in the first place.² That was 10 practitioners in one country talking about their own impressions, so it describes a view from the therapist’s chair rather than a measurement. It matches mine. Continuing online with someone you already know is a different proposition from starting online with someone you do not.

What does a time difference actually do to a session?

It moves the hour to a part of the day you are a different person in.

An hour that used to sit mid-morning, when you were awake and had not yet spent the day being competent, can become 21:00 on a Thursday, after dinner, with the day already behind you. You arrive tired, or wound up, or relieved to be finished rather than ready to start. None of that makes the session impossible. It does change what is available in it, and it is worth naming rather than absorbing.

A difference of one or two hours is mostly an inconvenience. Something closer to eight or nine means one of us is working at the edge of the day, and the one at the edge will be slower. Where the gap is large, I would rather we agree the hour deliberately, with its cost understood, than keep the old slot because it is familiar.

Where does the session happen when I have no room of my own?

The room matters more abroad, not less, because so little else is settled.

At home you knew which door shut properly. In a new flat, a sublet or a hotel, you are working out each week where you can speak without lowering your voice, and the hour starts with that calculation rather than with what you came to say. People manage it in all sorts of ways: a bedroom with headphones, a parked car, a booked room somewhere ordinary. What matters is that it is the same place most weeks, because repetition is doing some of the work a consulting room would have done.

The other half of the room is what happens after. A session abroad usually ends straight into an empty flat in a city where nobody knows you have just spent an hour on something difficult. That is a real loss and it is worth planning for rather than discovering.

How do I make this work, and when is it the wrong arrangement?

Decide the shape of it in advance, because a fortnightly hour that is never at the same time quietly becomes a monthly one.

• Fix the hour in your own local time. Not in mine. An hour that moves with the clocks twice a year is one you will miss twice a year.
• Agree what happens when the connection fails. Rejoin once, then continue by telephone, is usually enough. Knowing there is an arrangement is what matters.
• Say where you are at the start. Which city, which room, who else is in the flat. It takes 20 seconds and it tells me what kind of hour this can be.
• Keep 20 minutes after. Abroad there is nobody to meet afterwards by accident, so the gap has to be deliberate.
• Review it at three months. Whether the arrangement is still serving the work is a question for both of us, not a loyalty test.

There are situations where continuing from abroad is not the right answer. If what you need now belongs to the place you are in, the language you are living in and the people around you, a therapist who shares none of that will always be working at one remove. If you have nowhere you can speak freely, the arrangement will keep bending around that, and no amount of goodwill fixes it. And if the move itself is the thing you cannot look at, the familiar hour can become a way of keeping the old life running rather than facing the new one, which is worth saying plainly between us. A free 30-minute call is enough to work out whether keeping the hour serves you or holds you.

Questions people ask

Can I keep seeing you if I leave Denmark?

Usually yes, and it is worth agreeing the new shape of it before you go rather than after. The arrangement that worked here rarely survives a move unchanged.

How big a time difference still works?

Up to about three hours changes very little, and beyond that the hour needs choosing rather than inheriting. What matters is which part of your day you are giving to it.

What if I am travelling and no two weeks look the same?

Then a fixed fortnightly hour will serve you better than a weekly one you keep moving. An hour that holds is worth more than an hour that is frequent.

Does the work change if we are never in the same room?

The relationship holds and the body goes quiet, so you have to supply out loud what I would otherwise see. Saying that your chest has tightened takes seconds and gives the hour back what the camera removed.

Is it worth starting therapy online if I am abroad and we have never met?

It can work, and the first few sessions ask more of both of us than they would in a room. Starting at a distance is a different thing from continuing at one.

Sources

1. Therapeutic alliance across delivery modalities: a systematic narrative review of alliance strength and outcome prediction in face-to-face, online, and blended psychotherapy. Journal of Zhejiang University-SCIENCE B, 2026.
2. Therapy beyond the screen: a qualitative exploration of tele-therapy experiences among clinical psychologists and speech and language therapists. Healthcare, 2026.

How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.