Why I Don’t Use a Camera in Therapy (and Why It Works Better)

Almost every therapist in 2026 offers video. It’s the default. It feels modern, professional, intimate. You can see each other’s faces.

I don’t offer video. I offer audio only. And after 15 years of practice, across three continents, with hundreds of clients, I’m convinced it works better.

Not for everyone. I’m not claiming that. But for most people, and especially for the kinds of people who come through my door, audio is the more effective container.

Let me explain why.

The Cognitive Load of Video

When you’re in video therapy, you’re managing multiple channels of information at once. You’re seeing the therapist’s face. You’re hearing their voice. You’re aware of how you look on screen. You’re managing the technical setup. Your nervous system is doing translation work constantly. “Is that expression a flicker of judgment? Is that pause a sign they’re bored? Am I allowed to look away from the camera, or is that rude?” It’s not conscious, but it’s happening.

And here’s the thing: it’s particularly problematic for the clients I work with most. Depersonalization clients often feel intensely self-conscious about being seen. It’s part of the unreality. People with trauma histories sometimes experience eye contact or visual scrutiny as threatening. Clients living abroad who are worried about cultural judgment or legal status often experience camera-based therapy as surveillance.

Expat clients, clients in the Gulf, clients from conservative cultures, clients who’ve experienced sexual trauma, clients with DPDR, clients with autism who find eye contact exhausting. They often say the same thing: “I felt safer on the phone.”

What Changes Without a Camera

When there’s no camera, something shifts. You’re not managing your face. You’re not being looked at. There’s a kind of permission to be dishevelled or vulnerable or unperformed that camera therapy, no matter how warm the therapist, still doesn’t quite allow.

It’s not new. Phone therapy has existed for decades. But it fell out of fashion when video became available. Everyone assumed video must be better. More intimate. More real.

Visual Intimacy vs Actual Intimacy

There’s a distinction between visual intimacy and actual intimacy. Real intimacy is being completely unedited with another person. It’s the permission to not look okay while also being fully listened to and met.

Why Audio Works for Depth Work

Audio therapy is also clinically superior for certain modalities. I work primarily with Internal Family Systems, Acceptance and Commitment Therapy, and Schema Therapy. These are depth therapies. They require the ability to turn fully inward without the parallel track of managing how you appear to another person. When I’m guiding a client deeper into parts work, or helping them lean into distress during exposure therapy, I don’t want half their attention still allocated to how they look on screen.

What the Research Actually Says

There’s also something about voice. Without the distraction of visual processing, you listen more carefully. There’s a research literature on this. Phone-based therapy produces equal or better outcomes to video for most conditions. The therapeutic relationship feels different. Deeper. More like a true conversation between two people who are each present without the demands of a camera.

Some clients say it feels more like talking to a friend. That matters. The therapeutic relationship is the most powerful tool in psychotherapy. Anything that deepens it works.

The Practical Reality of Privacy

There’s also the practical reality of privacy. Video therapy requires adequate space, good lighting, no interruptions. Audio therapy requires five minutes of quiet, anywhere. That’s a significant advantage for people whose lives are chaotic or whose privacy is limited.

A Deliberate Choice, Not a Limitation

I should be clear: this isn’t a limitation. It’s a choice. A deliberate clinical choice rooted in years of evidence about what works. I don’t offer video because I believe audio is more effective. And that belief comes from countless conversations with clients who say, “I never thought I’d prefer phone therapy, but I do. I feel less watched. I can be more honest.”

The research is clear that the therapeutic relationship, not the medium, is what drives outcome. But within that relationship, the medium shapes what’s possible. Audio, for most of my clients, opens doors that camera closes.

Want to Try It?

If this resonates, the full clinical rationale is on my audio-only therapy page, or you can book a first session directly. Sessions are by phone or secure call, anywhere in the world.