Why Online Therapy Works Well with OCD treatment

by Dr Claudette Portelli


Keywords: online therapy, obsessive-compulsive disorder, resistances, effectiveness, efficiency, brief strategic therapy, the OCD clinic, research, benefits, therapeutic alliance


Meta-description: Highlights the benefits of online therapy with OCD and its variants. In addition to being a versatile and convenient option in supporting mental health problems in general, online therapy offers a number of significant benefits specific for people with OCD, including access to specialized experienced OCD therapists, working in real-life settings and provides close support. Ongoing clinical research carried out at the OCD clinics, reveals a better understanding of how brief strategic online therapy can improve therapeutic alliance and compliance to treatment even in the most resistant cases of OCD.


From our clinical-research work held at the OCD clinics in Malta, Italy, Ireland and France, we came to witness that online therapy is surprisingly effective for OCD patients, and in some ways, potentially even more effective than conventional face-to-face methods of treatments.

Yet, when online therapy first emerged, many were hesitant to embrace it, questioning its effectiveness and efficiency. All changed with the pandemic. As the saying reads “necessity is the mother of invention “. The Covid pandemic, brought patients and professionals to have to make use of online therapy, challenging this idea, to go beyond this limit.

In fact, in the study, Giovanetti, et al., (2022) debunk the myths about online options to recognize online therapy as a valid alternative to traditional face-to-face therapy. Their longitudinal study compares online therapy to traditional face-to-face sessions to show no significant differences in outcomes for a broad range of mental health issues, including depression and anxiety.

Wootton et al., (2023) demonstrate that online therapy offers a number of significant benefits that make it a viable and accessible option for many people.  Vitry, et al., (2021) collected a significant body of evidence to support the efficacy and effectiveness of online therapy following a systemic-strategic approach.


OCD is highly resistant to treatment


Obsessive-compulsive disorders (OCD) are often regarded as an intimidating lifetime condemnation by patients but also by professionals who are not appropriately trained to treat OCD. OCD symptoms can be highly disruptive, causing significant distress and impacting daily life.  Various research demonstrates that OCD are highly resistant to change (Nardone, Portelli, 2005; Gibson et al., 2021).


So, the legitimate question is, can online therapy work with OCD patients?


OCD and its variants are characterized by repetitive rituals or compulsions which are performed to cease the obsessive thoughts. These are paradoxically further fed and bring the person to be caught in devastating vicious circles, with seemingly no-way outside. Regarded as impossible cases.


The OCD clinics apply the Brief Strategic Approach in treating OCD with its variants (Portelli, 2004). Following the wisdom of the School of Palo Alto (California) and The Centro di Terapia Strategica (Arezzo), the OCD clinics in Malta, Italy, Ireland and France, carries out ongoing clinical action research so as to render therapy with OCD always more effective and efficient. Most OCD are fear based, but there are variants that can be non-phobic, holding anger, pain or even pleasure as their dominant primary emotion or sensation (Portelli, Papantuono, 2018). Thus, a thorough operative diagnosis needs to be carried out to understand its non-ordinary logic, so as to choose the most appropriate protocol and treatment (Nardone, Portelli, 2013).


Challenges of Traditional Therapy for OCD:


  • Leaving the House: For individuals with OCD, compulsions related to leaving the house or fear of contamination can make traditional in-person therapy difficult. Severe OCD patients find it too challenging to go to the clinic.


  • Unfamiliar Environments: New environments can trigger anxiety in people with OCD, potentially hindering therapeutic progress. OCD find it difficult to step out from their familiar environments, which often become their ‘(dis)comfort zone’


  • Limited Availability of Specialists: OCD specialists might not be readily available in all locations, limiting access to targeted treatment.


  • Missing appointments: Often patients miss out on attending therapy because they are either sick, leaving office late, stuck in traffic, no one to take care of the kids, etc. Patients need to be followed regularly and closely to keep the line and overcome the obsessive thoughts and compulsive behaviors.



Effective and efficient on-line therapy at the OCD clinics


In line with the findings of Perini et al. (2009), who claim that expert-led online interventions enable significant clinical changes in patients, at The OCD Clinic, we study how to render the online session more effective and efficient especially for OCD treatment. Our mission is to put together rigorous scientifically validated treatment protocols adaptable to the particularity of each case, to enable their patients to achieve the desired effective and efficient results even with online therapy. Indeed, recent research has shown that online treatment is particularly efficient with a strategic and systemic approach in various psychological problems (Vitry, et al., 2021).

Today, we can say that in certain cases, such as depression, anxiety disorders and OCD, the level of efficiency of online therapy is even higher than in cases treated by traditional modalities (Karyotaki et al. 2018; Giovanetti et al. 2023).


Benefits of Online Therapy for OCD:


  • Access to OCD Specialists: Online platforms connect patients with OCD specialists regardless of location. This broadens treatment options and increases the likelihood of finding a therapist with expertise in OCD.



  • Increased Accessibility: Online therapy eliminates the need to travel, making it easier for individuals with OCD to access treatment regardless of their compulsions or location. With online therapy, there is no need to travel to the therapist’s office. This means saving time and money, as well as greater flexibility to schedule sessions according to ones needs. Sessions can be scheduled at unconventional times, such as evenings or weekends, to best suit patients’ personal and professional commitments.


  • Reduced Anxiety and Avoidance: The familiar and comfortable home environment can significantly lower anxiety associated with therapy sessions. This reduction in anxiety can facilitate open communication and deeper exploration of OCD symptoms. For some OCD sufferers, the act of traveling to therapy appointments can itself be a trigger or a source of anxiety. Online therapy eliminates this barrier and makes seeking help more This can be especially helpful for those with OCD that focuses on social interactions or contamination fears.


  • Flexible Scheduling: Online therapy offers more flexibility in scheduling appointments. This allows individuals with OCD to fit treatment around their compulsions and daily routines, minimizing disruption. The online session can be carried out at home, from the office, in the car and even when abroad.


  • Better therapeutic alliance and compliance: Online therapy offers a more familiar and comfortable environment, which may facilitate greater openness and sharing (Mallen et al 2005). The distance, given by being behind a screen, reduces emotional involvement, this can make the patient experience a greater sense of protection, which facilitates exposure. Moreover, through the use of technology, the OCD therapist can follow clients closely. Patients can share their daily tasks and progress with their therapist, making them feel more supported and more motivated in challenging the obsessions and compulsions. This increases the therapeutic alliance and compliance to therapy.
  • Close-ups increase concentration: The video captures more clearly the non-verbal language that can help the OCD therapist tailor make the protocol onto the patient. Numerous patients affirm that online sessions make them feel more concentrated on what they are saying and what the therapist refers to them. Even OCD therapists affirm that online sessions help them be more concentrated when carrying out their operative diagnosis and also in proceeding in understanding of how every task (action) informs their next task, to bring further progress, and consolidate results. This is necessary to guide the OCD patient from occasional corrective emotional experiences to radical second order change.


Exposure in real-life settings: A core treatment for OCD is exposure to risk (fear of dirt, disorders, mistakes, hurting others or oneself, misfortune, etc.) This involves gradually exposing patients to their triggers while resisting compulsions.  Online therapy allows therapists to guide patients through exposure exercises in their own environment, where triggers are most likely present. Imagine someone with contamination OCD struggling with doorknobs. In online therapy, the therapist can coach them through the anxiety of touching an actual doorknob at home, rather than relying on a hypothetical scenario in an office setting.


Immediate and Close Support:  Traditional therapy typically involves weekly or bi-weekly sessions. Online platforms allow for more frequent check-ins or even live coaching during exposure exercises. This provides a much-needed support in the moment when encountering triggers. Especially with OCD patients, sessions need to be regular to motivate change and consolidate results. Clients need to be followed closely to keep the line.



  • Sarah, a 25-year-old woman with severe OCD related to germs, struggles to leave her house due to contamination fears. Online therapy allowed Sarah to start therapy and receive effective treatment from an OCD clinic specialist in the comfort and safety of her own home, minimizing anxiety and facilitating progress. Online therapy allowed Sarah to engage in therapy from her home environment, where she felt safe and less anxious. This calmer state allows her to focus on addressing his OCD symptoms more productively

until she was able to go out of the house, and she eventually met me, her therapist, during a seminar held at the OCD clinic.


  • Robert, a 30-year-old man with OCD characterized by preventive and reparative rituals triggered by his excessive concern for perfection. Online therapy allowed the therapist to understand the obsessive order Robert has surrounded himself with, guiding him to insert small disorders into his order. Robert proudly shared his disorders with his OCD therapist on video. This helped him be more motivated to carry out the given tasks.


  • Sani, a 20-year-old university student living in Dubai, struggled to find a qualified OCD therapist nearby. She had carried out numerous therapies but they were not helpful with her obsessive and compulsive behavior. Through online therapy platforms, Sani connected with the OCD specialist in Malta. This allowed Sani to receive evidence-based treatment despite the limited local resources.



In summary, in addition to being a versatile and convenient option for many people seeking support for mental health problems, online therapy offers a number of significant benefits for people with OCD, including accessibility, cost-savings, comfort, privacy, flexibility and access to a specialized experienced OCD therapist.

Our ongoing clinical action research shows that online therapy increases therapeutic alliance and compliance to therapy. Online therapy offers significant benefits for OCD, since it considers individual needs and difficulties related to the OCD problem. By overcoming the challenges associated with traditional therapy, online platforms can facilitate significant progress in managing OCD symptoms and improving quality of life more effectively and efficiently.

Yet at the OCD clinics, work is still in progress.