Digital CAT – the Basics

Since COVID imposed the need for strict social distancing many therapists had to quickly adapt to new ways of working.  For most this has meant offering their skills online via digital technology. Even before this, online or digital therapy has been growing in popularity. It can offer more accessibility and choice for people seeking help.  The unique features of online communication can mean that, for some, it works better that traditional face-to-face therapy. For others it may feel much more difficult and challenging.

As a potential client seeking therapy, what implications does this have for you, and what should you consider?

What is digital or online therapy?

Online therapy is a fast growing way of accessing therapy or counselling via technology. This can be in the form of ‘apps’, or self help platforms.  Or it could be in the form of working with a therapist through an electronic device.  You might use a desktop or laptop computer, Ipad, tablet, smart phone or landline to meet with a therapist.

Therapy can be take place using video conferencing, instant messaging, email, or VOIP (voice over internet protocol) like a telephone call. It is generally recommended that therapists have undertaken specific training in order to offer these mediums safely.

Do therapists have to have specific qualifications to work online?

No, therapists currently do not have to have any special or additional qualifications to work in this way. However, there are some important differences to working online.  Therapists who have chosen to undertake specific training may be better equipped to work with you. This is especially important for example, in terms of data protection, and working safely and ethically online.

It is important to note that there is currently no regulation of online therapists.  You can ask individual therapists what their experience is and whether they have undertaken professional training on working remotely.

The Association of Counselling and Therapy Online is an organisation which “promotes, maintains, improves and advances online counselling and psychotherapy and other online psychological support as a recognised method of therapeutic delivery within the mental health professions”.  ACTO’s website directory lists therapists who have had specific training to work online.

Is it effective and can it work for me?

There is research to suggest that it is effective and that an effective relationship between therapist and client is as possible online as it is in face-to-face work.  Your therapist should be able to help you to think through some of the pros and cons to working online. If the therapist does not think it is suitable for you, they will take time to explain why. 

What do I need to consider?


Communication can feel different online, and you need to be aware of this. There is more scope for misunderstandings, for example in the absence of physical or nonverbal cues.  Technology is also prone to ‘glitches’ or periods when communication becomes out of ‘synch’ and there is nothing coming back. It is important to keep communication open and check things out if you might have misheard or misunderstood something. Your therapist will do the same.

Trust and safety

Trust and safety are fundamental basics of a positive alliance with your therapist.  Being online can understandably increase mistrust about the technology. You may feel extra wary about how your therapist takes care of the sensitive data and other information you share. Your therapist will take time to explain how they aim to take care of this.  They will be guided by legal protections such as GDPR. They will make sure you understand things and that decisions you make will be done with informed consent.


Boundaries are important to consider. Usually when you travel to meet a therapist face-to-face, the therapist will set up the environment in a way that provides clear boundaries.  You will be in their therapy room, away from other parts of your life and people in it.  The therapist will set up certain conditions, perhaps without you even noticing.  For example, doors will be closed, usually there will be no interruptions, and soundproofing will be adequate. The therapist will keep track of start and end times for the session.  Your journey to and from therapy may give you a chance to prepare for it and process it afterwards.

When you are meeting a therapist online, you need to be able to manage some of these boundaries yourself. This will help you protect your own privacy and confidentiality.  Try to make sure you will be free of interruptions.  Think of the session in the same way as you would a face-to-face session. Switch off your phone and try to minimise distractions, ‘pop ups’, or others walking in whilst you are in session. 

Give yourself ten-to-fifteen minutes before the session to prepare for it. Take some time after the session too if you can. This gives you a chance to note how you feel, and get yourself ready to return to other activities. It may also help the work you did in the session ‘sink in’ so you can better hold on to it.

Staying emotionally safe

People sometimes find it easier to talk from the comfort of their own space. But it’s useful to consider how it might feel after a session, when you are in your own home.  Some people prefer to keep therapy very separate, away from the rest of their life. This may be particularly important to think through if your therapy is likely to involve very intense feelings, or trauma.  If your home environment does not feel very safe, then you may prefer to meet face-to-face instead.

Whatever your questions or concerns are, about online therapy your therapist will be keen to answer them as best as possible.

What is it like to have CAT online?

We plan to publish another blog soon about particular aspects of cognitive analytic therapy that may be influenced by working together online.

We also hope to share a first hand account from someone who has had therapy online.

Cal Nield recently retired after many years in the NHS as a CAT psychotherapist, and continues to work within independent practice.  Cal is a member of ACAT’s Ethics Committee and leads a special interest group for ACAT members working digitally.  She has held a position as a director of ACTO and continues to be an active member of the online therapy community.

Digital CAT – The Basics by Cal Nield is licensed under CC BY-SA 4.0