I started my private practice shortly before COVID-19 changed almost everything about how therapists worked.

I hadn’t planned to build an online practice. When in-person sessions became unsafe, moving online felt like an emergency fix, a way to keep supporting clients until things went back to normal. 

At first I wasn’t sure what would translate through a screen. 

Therapy depends so much on connection and presence. I also specialized in trauma therapy and EMDR, which raised more questions. Could I do this work responsibly online? Would clients feel supported processing difficult material from their own homes? 

I had to think differently about privacy, the client’s environment, and whether each person was a good candidate for online trauma work. I found tools for online EMDR and got more deliberate about grounding and planning what we’d do if the technology failed mid-session. 

It was an adjustment for me and my clients, but I began to see that I could provide high-quality care online in a way that worked well for many of them. 

For many people, meeting online made it easier to participate consistently. They liked being in a familiar place, with their pets and comfort items close at hand. Transportation, busy schedules, and health concerns became less of a barrier. 

Emerging research has echoed what I’ve seen in my own practice: remote EMDR can be a feasible and effective option. A 2024 systematic review described the evidence as promising, though suitability still depends on the client and the setup. 

If you’re curious about online EMDR, I was one of the clinicians interviewed for Social Work Today’s article, “EMDR Online.” The article explores both the potential benefits and the important clinical considerations involved in offering EMDR virtually.

As offices reopened and the acute pandemic period eased, I chose to continue working exclusively online rather than returning to an office or creating a hybrid practice. 

Online practice fit the way I wanted to structure my work and my life, and it was working for my clients. What began as a temporary fix had become a sustainable way to practice. 

Telehealth didn’t disappear when in-person care returned. It became a lasting part of mental health care, particularly in behavioral health, and many clinicians now maintain either fully online or hybrid practices.

Practicing online also changed how I thought about geography.

When I worked from a physical office, my potential clients were largely limited to people who lived close enough to reach that office. Online, I could work with people throughout my state. As I developed a more specialized practice focused on trauma therapy and EMDR, that broader reach became increasingly important.

Finding specialized therapy often depends more on fit than on geography. Someone looking for a particular combination of experience, approach, and personality may not find that clinician within a few miles of home.

As an online provider, I could build my practice around the work I was most prepared and motivated to do, and clients could choose me for my specialization rather than simply my location. 

Once I’d seen what online practice could do within one state, expanding across state lines felt like the natural next step. It also brought challenges I hadn’t anticipated. 

Continue the series

Next: A License Is Not a Referral Network: What I Learned Expanding My Practice Across State Lines