Online Therapy in English — for Expats in Portugal
Living in Lisbon, Porto, the Algarve, or anywhere in Portugal — our certified English-speaking therapists offer the same clinical depth as in-person sessions, entirely online. Also available internationally.
"The therapeutic alliance — not the format — determines outcomes. A good therapist, present through a screen, is still a good therapist."
— Online Therapy Research, 2022
Comparable Outcomes
Studies confirm online therapy produces results equivalent to in-person work for anxiety, depression, PTSD, and relationship difficulties.
Continuity of Care
Your therapeutic relationship continues regardless of travel, relocation, or schedule changes — no interruptions, no starting over.
Strong Alliance Online
Patients consistently report genuine connection and meaningful progress, even in fully remote sessions conducted via video.
The Evidence
What research says about online therapy
The question "does online therapy really work?" has been studied extensively since the early 2000s. The findings are consistent — and stronger than many people expect.
"Videoconference psychotherapy produces outcomes equivalent to face-to-face therapy across a broad range of presentations, including anxiety, depression, PTSD, and relationship difficulties."
— Simpson & Reid, 2014 · Journal of Telemedicine and Telecare
Anxiety & Depression
A 2018 updated meta-analysis found internet-delivered CBT equivalent to face-to-face CBT across psychiatric and somatic conditions — including anxiety symptoms — with no significant difference in outcomes (Carlbring et al., 2018, Cognitive Behaviour Therapy). The landmark earlier meta-analysis in World Psychiatry by Andersson et al. (2014) reached the same conclusion across 13 RCTs.
For depression, a large systematic review covering over 3,800 participants concluded that online psychotherapy produced equivalent symptom reduction to in-person treatment, with no significant difference in dropout rates (Luo et al., 2020, Journal of Medical Internet Research). If you're unsure whether what you're experiencing is anxiety, our symptoms of anxiety checklist is a good starting point.
Trauma & PTSD
Research on PTSD treatment via video — including exposure-based protocols — has shown clinically significant improvement comparable to office-based delivery. A VA-funded randomised non-inferiority trial (Morland et al., 2015, Journal of Clinical Psychiatry) found no difference in outcomes between veterans receiving group CBT for anger in-person versus via video.
Importantly for our ISTDP work: the somatic dimension of trauma — noticing bodily signals, tracking anxiety in the body — is preserved through video when the camera frame includes the upper body and the therapist is trained to work with what is visible.
Couples & Relationship Therapy
EFT (Emotionally Focused Therapy) has been studied specifically in the online format. Research by Wiebe & Johnson (2016) found the same stages of change and same therapeutic processes occurring in video-delivered EFT as in in-person sessions — with the added finding that some couples reported greater openness at home.
This aligns with what we observe clinically: couples often find their own environment reduces defensiveness, making the emotional work more accessible from session one.
The Therapeutic Alliance
The single strongest predictor of therapy outcome — across all modalities — is the quality of the therapeutic alliance (Wampold, 2015, Psychotherapy Research). Early concerns that this relationship would be weaker online have not been supported by evidence.
Multiple studies measuring alliance quality in video therapy have found scores equivalent to or higher than in-person treatment (Sucala et al., 2012, Journal of Medical Internet Research). Clients report feeling genuinely heard, and therapeutic progress follows the same arc as office-based work.
What this means for you
Choosing online therapy is not a compromise. For expats and internationally mobile clients, it is often the superior choice — providing access to therapists who genuinely understand your context, without the limitation of geography.
If your therapeutic relationship relocates with you, continuity is maintained. If your schedule changes, the online format adapts. The clinical depth does not diminish — and the research, consistently, confirms this.
Choosing a Format
Online or in-person — when each makes sense
Both formats produce equivalent clinical outcomes for most presentations. The choice usually comes down to your circumstances rather than effectiveness.
Online tends to suit you when
— You live outside Lisbon — Porto, the Algarve, Braga, or a smaller town without English-speaking therapists
— Your schedule changes weekly, or you travel for work
— You may relocate and want a therapeutic relationship that moves with you
— You open up more easily from your own space
In-person tends to suit you when
— You're in Lisbon and value the ritual of a dedicated, protected space
— Home offers no reliable privacy for a 50-minute conversation
— Screens are already most of your day and you want therapy to feel different
— Intense emotional work feels safer with someone physically present
You don't have to decide permanently — many of our clients alternate. Sessions at our Lisbon office (Rua Pinheiro Chagas 32, near Saldanha metro) and online sessions can be combined in whatever rhythm works for your life.
Self-assessment
Is online therapy right for me?
8 short questions to help you understand whether online therapy is likely to be a good fit — and what kind of support might work best for where you are right now.
"The right format matters — but it's rarely a barrier. Most people can work effectively online. This assessment helps us both understand where to start."
Piotr Szmyt
ISTDP Psychotherapist
When you're going through a difficult time, are you generally able to manage between sessions — without needing immediate support?
Do you sometimes experience things that others around you don't seem to notice — unusual perceptions, voices, or thoughts that feel like they're coming from outside yourself?
How stable does your sense of who you are feel — your values, your sense of direction, how you relate to people close to you?
When strong emotions come up — anger, fear, sadness — how difficult is it for you to prevent them from taking over or leading to actions you later regret?
In important relationships, do you find that things tend to go from feeling very close to very conflicted — sometimes quite suddenly?
Do you have access to a private, quiet space where you could speak freely for 50–70 minutes without being interrupted?
When you imagine talking openly about something emotionally difficult with a therapist over a screen — how does that feel?
How would you describe your current level of day-to-day functioning — work, relationships, basic self-care?
Online therapy is a good fit
Online therapy is likely to work well for you
Based on your responses, you have the internal resources and practical conditions that make online therapy an effective option. The research consistently shows that for people in your situation, video-based sessions produce outcomes equivalent to in-person work — and the flexibility of the online format can be a genuine advantage, particularly for expats and people with busy or changing schedules.
You can manage between sessions without needing immediate support
Your day-to-day functioning is sufficiently stable for exploratory work
A good therapeutic relationship forms just as readily over video
In-person may be more beneficial
In-person therapy would likely serve you better — though online remains possible
Your responses suggest that the physical presence of a therapist — the ability to be in the same room, to read each other fully, to have a stable and contained environment — may be particularly important for the work you need to do right now. This is common for people navigating more intense emotional patterns or relational difficulties.
That said, if in-person therapy isn't accessible where you are, online therapy can still be genuinely valuable. We'd simply want to discuss your situation carefully in a first session to make sure the format is workable for you.
In-person sessions at our Lisbon office are available
If you're outside Lisbon, we can discuss whether online is a viable option
The first session is always exploratory — no commitment required
We'd like to suggest a different starting point
We'd recommend speaking with a psychiatrist before beginning therapy
Some of your responses suggest that what you're experiencing right now may benefit from a broader assessment before beginning regular psychotherapy. This isn't a reflection of how serious or valid your difficulties are — it's simply that a psychiatrist is better placed to evaluate the full picture and recommend the most appropriate support.
Psychotherapy can still be a very important part of your journey — but starting with a psychiatric consultation means that any therapy you do will be better informed and more carefully tailored to where you are.
A psychiatric assessment can happen alongside or before therapy
Your GP can provide a referral, or a private psychiatrist can be seen directly
We're happy to discuss your situation and help you find the right direction
This is not a diagnostic tool. The questions below are designed to give you a general sense of which format might suit you — not to assess or classify your mental health. Whatever your result, we encourage you to get in touch if you have questions.
Our Team
Your therapists, online since 2020
Piotr Szmyt
ISTDP Psychotherapist · IEDTA Certified
Conducting ISTDP sessions online since 2020, adapting the somatic and psychodynamic approach to the video format without loss of clinical depth.
Full profile →
Sylwia Latacz
Licensed Psychologist · EFT Couples Therapist · OPP Registered
Based in Lisbon and registered with the Ordem dos Psicólogos Portugueses, Sylwia specialises in EFT couples therapy and individual work with expats across Portugal — online since 2020.
Full profile →Our Methods, Online
How ISTDP and EFT translate to video
ISTDP online
Intensive Short-Term Dynamic Psychotherapy tracks anxiety as it appears in the body — muscle tension, sighing, shifts in posture. A common assumption is that this can't work over video. In practice, a well-framed camera makes these signals clearly observable, and the format adds something unexpected: clients at home often defend less, so core feelings surface sooner.
Piotr conducts ISTDP assessment blocks and ongoing sessions online for clients across Portugal, with the same active, focused technique used in the office. New to the method? Read what ISTDP is and why you may want to try it.
EFT couples therapy online
Emotionally Focused Therapy works with the cycle between partners — pursuit, withdrawal, protest, shutdown. On video, couples sit in their own living room, which means the cycle shows up exactly as it does in daily life, not a softened office version of it. That authenticity is clinically useful.
Sylwia works with couples who share a screen at home and with partners joining from two different cities — a format impossible in traditional office-based therapy.
The Process
How online therapy works with us
From first contact to an ongoing therapeutic relationship — a simple, thoughtful process built around your needs and timezone.
Initial Contact
Reach out via email or the booking form. We respond within 24 hours to arrange a convenient time — no waiting lists, no lengthy intake forms.
First Session via Google Meet
Your 70-minute initial consultation takes place on Google Meet — free, secure, available on any device. We'll explore your situation and determine whether this is the right fit.
Regular Weekly Sessions
Sessions typically occur weekly or bi-weekly at a consistent time. You'll always work with the same therapist — continuity is central to effective therapy.
Getting Ready
How to prepare for
your first online
session
A little preparation makes a real difference.
Book Your First SessionTechnical Check
Test your Google Meet connection in advance. Ensure your microphone and camera work, and that your internet connection is stable.
Camera Placement
Frame the camera from the waist up rather than face-only. Much of our clinical work relies on reading posture, breathing, and physical tension — the screen should show enough of you for that to be possible.
Private Space
Choose a room where you will not be interrupted and feel comfortable speaking freely. Sessions cannot take place in cafes or shared offices.
Reflect Before You Connect
Think about recent situations where your problem shows up. What would feeling better actually look like for you?
Allow Time After
Don't schedule a meeting immediately after the session. A brief period of quiet allows you to integrate what emerged. If anxiety runs high between sessions, our guided Jacobson relaxation training can help.
Come as You Are
You don't need to prepare a summary of your life. Confusion and not knowing where to start are perfectly normal — and workable.
Built for Expats
Therapy designed for expat life
in Portugal
Portugal attracts thousands of English-speaking expats every year — from the UK, the US, Germany, the Netherlands, Brazil and beyond. But finding a therapist who genuinely speaks your language, understands your context, and meets you online is still surprisingly difficult. We built our practice around exactly this.
Both Piotr and Sylwia have lived outside their countries of origin and work exclusively in English. We support expats across Portugal — in Lisbon, Porto, Cascais, the Algarve and smaller towns — as well as clients who have recently relocated internationally and want to maintain continuity of care. For a broader look at finding support abroad, see our guide to online therapy for expats in Europe.
- — Cultural adjustment and persistent sense of not fitting in
- — Loneliness coexisting with an outwardly successful life
- — Relationship strain amplified by relocation stress
- — Loss of professional identity in a new country
- — Anxiety about visas, finances, family abroad
- — Grief for the person you were before you left
- — Multicultural couple dynamics and communication gaps
You don't need to be in crisis to benefit from therapy. The quiet difficulty of building a life in a place that isn't yours — without your network, without the language — that is enough.
— Piotr Szmyt, Psychotherapist
Online Couples Therapy also available
Both Piotr and Sylwia offer couples therapy via video — for couples in different cities or those who prefer the online format.
Couples Therapy Page →Fees
Clear, transparent pricing
No hidden fees, no intake charges. Official invoices provided for insurance reimbursement upon request.
Initial Consultation
€90
70-minute extended first session
— Explore your goals and challenges
— Assess therapeutic fit together
— Establish a plan for ongoing work
— Full clinical consultation depth
BOOK NOWIndividual Online Session
€70
50-minute weekly or bi-weekly
— Consistent therapist every session
— Flexible scheduling across timezones
— Google Meet — secure & free
— Hybrid option available
BOOK NOWISTDP Intensive Session
€120
90-minute extended intensive
— Deep focus on core emotional patterns
— Body-aware somatic approach
— For complex or trauma presentations
— With Piotr Szmyt (IEDTA certified)
BOOK NOWClinical Practice
Session recording — with your consent
We may occasionally ask for your permission to record a session. Recording is never done without explicit consent — and you are always free to decline.
If you agree, you'll be asked to confirm this in writing when you book your first session — simply indicate your preference in the contact form or email.
Why we record
In advanced clinical practice, reviewing session recordings is now considered a standard of care. It allows the therapist to revisit the session with fresh attention — noticing subtle emotional responses, evaluating the precision of interventions, and identifying moments that deserve further exploration in the next session.
What happens to recordings
Recordings are used exclusively for clinical review by your therapist — never shared with third parties. They are stored securely and deleted after review. Consent can be withdrawn at any time, and declining has no effect on the quality or continuity of your therapy.
You don't have to wait for the right moment.
The first session is exploratory, low-pressure, and designed to see whether this is the right fit. No waiting lists. No lengthy intake forms.
References
Sources cited on this page
Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22(6), 280–299. doi:10.1111/ajr.12149
Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1–18. doi:10.1080/16506073.2017.1401115
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13(3), 288–295. doi:10.1002/wps.20151
Luo, C., Sanger, N., Singhal, N., et al. (2020). A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis. EClinicalMedicine, 24, 100442. PubMed: 32775969
Morland, L. A., Mackintosh, M. A., Rosen, C. S., et al. (2015). Telemedicine versus in-person delivery of cognitive processing therapy for women with posttraumatic stress disorder: A randomized noninferiority trial. Depression and Anxiety, 32(11), 811–820. PubMed: 26243685
Wiebe, S. A., & Johnson, S. M. (2016). A review of the research in Emotionally Focused Therapy for couples. Family Process, 55(3), 390–407. doi:10.1111/famp.12229
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. PubMed: 26407772
Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., & Montgomery, G. H. (2012). The therapeutic relationship in e-therapy for mental health: A systematic review. Journal of Medical Internet Research, 14(4), e110. PubMed: 22858538