Working with a DBT Therapist Online: What to Expect
If you are thinking about working with a DBT therapist online, you probably want to know what the sessions will actually be like, and whether it will suit you. This page walks through how I work, from the first session to the structured skills sessions, and answers the questions people ask before they start.
What happens in the first sessions
A first session with me always involves taking some history and getting to know you and what has brought you to therapy. This can take a few sessions. We keep going until we have covered the goals of therapy and made a plan for how to proceed together.
I work very collaboratively. If you are open to different approaches, I will present the options available and we will see where you want to go. That might be DBT, EMDR, talking therapy, or a mix.
If you come looking for DBT
Some people arrive knowing they want DBT, and that is fine. We still start by taking a history, so I understand your situation. Then we begin the skills.
DBT skills are taught in a set order:
- Mindfulness first. Learning to notice what is happening in you and around you, without judging it. Everything else builds on this.
- Distress tolerance. Getting through painful moments without making things worse.
- Then we choose. Either emotion regulation (understanding intense emotions and changing how they affect you) or interpersonal effectiveness (asking for what you need and keeping relationships and boundaries healthy), depending on what you need most.
What a skills session looks like
These sessions are much more structured than an open conversation. Each one follows the same pattern:
- We review the week’s practice. What did you try, what worked, what got in the way.
- We talk about your week. What came up, and where the skills could have helped.
- We introduce a new skill and practise it. In the last part of the session, so you leave knowing exactly what to try before we meet again.
The practice between sessions is what makes DBT work in daily life, so the review at the start of each session matters as much as the new skill.
Questions people ask before starting
Does DBT work online? The research so far is encouraging, though limited. A 2022 scoping review looked at 11 studies of online DBT, including five clinical trials with 437 people. It found that online DBT is feasible, and that people attended more often online than in person, with similar improvement among those who stayed in therapy. The authors say it may be as safe and effective as face-to-face, while noting real challenges: managing risk, technology problems, and therapists being prepared for it. Most of that research was on full DBT programmes, not one-to-one skills sessions like mine, so I can’t promise it applies in exactly the same way.
Can DBT skills help without doing the whole programme? Possibly. A 2026 systematic review and meta-analysis looked at stand-alone DBT skills training for people with borderline personality disorder. Across the five studies it could combine, people improved a lot on symptom severity and depression, and about 71% stayed to the end. There are limits you should know about: the studies were of group skills training, only included people with that diagnosis, and measured change from before to after, so they can’t tell us how much of the improvement was due to the skills. The results also varied between studies. It is encouraging, not proof, and your own result may be different.
Do I have to do DBT? No. If you are not sure it is right for you, the first sessions are there to work that out together. If you are not sure you need therapy at all, you can try the 3-minute self-reflection quiz. If another approach appeals to you more, that is a good reason to choose it.
What does it cost, and how do I start? You can see my fees here. The best first step is a free call, where we can talk about what you are looking for and whether we are a good fit.
You can also read more about online DBT therapy, or about how I work with complex trauma and EMDR.
This article is general information and isn’t a substitute for individual professional advice. If you’re in crisis, call 999 (UK), 112 (EU) or Samaritans on 116 123.
