Online Therapy Platforms & Games for Powerful Sessions

The advent of online therapy offers tough new challenges, but also exciting opportunities to expand and enhance the practice.

If you are setting out on your online practice or just looking for some fun new ideas, this piece is a great place to start. Read on for exercises, activities, tips, and more to help you make your online therapy practice a safe, effective, and rewarding one.

Before you dive in, we recommend you start our full access free trial of Quenza, our online therapy platform for blended care professionals. Our integrated suite of user-friendly digital tools will help you design and deliver engaging, effective, and unique interventions straight to your clients’ mobiles, while running your practice conveniently from any connected device.

Is Online Therapy Effective? 6 Benefits

Online therapy is not brand new, but research is often slow to catch up to the day’s trends. However, in this case, the research interest was there long before it was a mainstream practice; online therapy has been a subject of effectiveness studies for the last two decades.

Here’s a quick timeline of some studies on the effectiveness of mobile therapy:

• 2004: A review of the current empirical evidence found that online therapy led to significant improvements in panic disorders, eating disorders, and posttraumatic stress and grief, was effective for marital therapy, and resulted in decreases in anxiety and positive session outcomes in psychotherapy clients. The sample sizes were all small, but results were promising.
• 2008: A meta-analysis of 92 studies involving nearly 9,800 clients found that the impacts of online therapy were statistically significant, and similar to the effects of traditional, face-to-face therapy.
• 2014: A systematic review and meta-analysis of internet-delivered cognitive behavioral therapy (ICBT) including 13 studies and over 1,000 participants reported that ICBT was just as effective as traditional face-to-face CBT. The studies included treatment of social anxiety disorder, panic disorder, depressive symptoms, body dissatisfaction, tinnitus, sexual dysfunction, and a phobia.
• 2017: Another review of online CBT for depression found that online CBT was equivalent to traditional, face-to-face CBT in terms of improving depressive symptoms. The analysis included 29 studies published between 2006 and 2016.

Of course, new studies are coming out all the time, so this timeline is hardly comprehensive, but it shows that there is a good basis of evidence for the effectiveness of online therapy, even as far back as 2004. Plus, aside from being as effective as traditional, face-to-face therapy, there may also be some extra benefits to online therapy.

There is a good basis of evidence for the effectiveness of online therapy, even as far back as 2004.

There are many benefits to therapy in general, and both in-person and online therapy have their pros and cons, but the advantages of online therapy have only become more pronounced over the last few years – especially since recent health scares have moved even more interactions online.

According to an early discussion of online therapy, these are the unique benefits it offers:

1. Greater convenience and increased access to care. People with limited mobility, time restrictions, and living in remote areas have much greater access to care through online therapy; this is true for clients and therapists.
2. Disinhibition and internalization. Online communication lends itself to less inhibition, meaning the client can “cut to the chase” and dispense with some of the “social masks” they might normally wear.
3. Enhanced self-reflection and ownership of the therapeutic process. Written online communication can offer both the client and the therapist more opportunity for reflection, as well as giving the client a greater sense of control over their own self-disclosure.
4. Therapeutic nature of writing. When therapist and client interact via written online communication, the client gets to benefit from both the therapeutic relationship and the therapeutic effects of writing about their problems and challenges.
5. Telepresence and transference. Online therapy can give clients the sense that they are in a caring person’s presence (the therapist) without actually sharing physical space; in writing-based communication, the client may be more easily able to move past the superficial aspects of communication and move right to the deeper connection.
6. Greater resources are available for sharing. With online therapy, it’s easy to send links, documents, audio files, and video clips for greater knowledge sharing and psychoeducation.

These benefits have remained important and impactful in the nearly two decades since this list was published, and it could be argued that even more benefits have surfaced: things like greater capacity for group therapy, easier access to culturally competent mental health care, greater therapist productivity, and lower mental healthcare-related costs.

The bottom line is that online therapy is as effective and efficient (or even more so) as in-person therapy; but is it as safe as in-person therapy?

Is Online Therapy Safe?

Online therapy is obviously physically safer – for both therapists and clients – than in-person therapy, as it removes even the possibility of harmful physical contact.

However, it does introduce some new risks: violations of privacy. That’s why it’s vital for the therapist to do everything within their power to keep the client’s personal data and communications safe and secure.

To do this, the therapist can follow some important “do’s and don’ts” and pick a solid, secure online therapy platform.

Do’s and Don’ts for Your Online Therapy Session

What are some important tips and things to keep in mind for keeping an online therapy session safe and effective? Social worker Nellie Galindo has some excellent do’s and don’ts to keep in mind.

Do’s:

• DO train yourself, your staff, and your clients (if needed) on the telehealth technology. You don’t want any confusion right before a session starts!
• DO check your background to see what is in the client’s view. Declutter the space and make sure there is nothing embarrassing or potentially upsetting.
• DO use proper lighting to make sure your client can see your face easily and clearly.
• DO keep an eye on your camera placement. Make it easy for your client to maintain comfortable eye contact with you, and make sure your monitor placement doesn’t make it seem like you’re “looking down” on your client.

Don’ts:

• DON’T jump into a session without testing it first. Find a colleague, family member, or friend who is willing to help you test it.
• DON’T be afraid to show your pets – they can actually help build rapport and ease your clients into the session, especially if you work with children.
• DON’T lose power! Make sure you are plugged in or have a charger handy in case your battery runs low.

What Is the Best Online Therapy Platform Option?

Getting back to keeping your online therapy sessions safe and effective, it’s vital that you choose a good online therapy platform. There are many options out there, but you want to make sure you know what your needs are and what features each platform offers to ensure you make the best choice for you and your practice.

At a minimum, you should narrow your list of options to those that provide HIPAA-compliant communication to safeguard your clients’ privacy and keep your practice aligned with legal requirements in your state, territory, or country. Check out our piece on the best therapy apps and platforms available for an online therapy practice to learn more.

If you want to learn more about apps you can recommend for your clients to help them on their therapeutic journey, check out the best apps we’ve found.

“Telehealth has the potential to increase access to evidence-based treatments for populations that have historically been underserved, including those in rural areas and individuals with mobility limitations.”

– Dr. David Mohr, Professor of Preventive Medicine, Northwestern University

10 Games and Activities for Your Online Therapy Session

Perhaps even more so with online therapy than with traditional, face-to-face therapy, you’ll need to work to hold on to your client’s attention. With clients in a setting that has a decidedly non-“clinical” feel to it and tons of opportunities for interruption, it can be hard to get into the therapy headspace.

There are many techniques to engaging your clients and keeping their focus, including using good videoconferencing software, prepping your clients for their session, and taking care with lighting, décor, and the overall feel of the space you’re in. However, one of the best ways to engage clients in therapy is through the use of games and activities to open the session and get things moving.

Here’s a list of 10 icebreaker activities and games that might work for you and your clients:

1. Word Clouds: You can guide your client through building an online word cloud that highlights what is important to them, what they want to get out of therapy, or any other relevant topic.
2. Life Timelines: Building a timeline with the most important milestones in the client’s life can help you get to know your client better and create a foundation of mutual understanding.
3. Pictionary: This fun game can easily be made into a therapy-related one if you direct your client to draw something that is important to them, or to tell you an important story from their life with their picture.
4. Wheel of Names: This activity is great for an icebreaker in a group online session. Find a list of icebreaker questions that are relevant to your clients’ age group and enter all their names into a wheel, spin it, and have whoever it lands on pick a question to answer.
5. Show and Tell: It’s not just for kids – and it works great for clients who are in their own homes! Have them take a minute or two to grab something that is important to them, then have them bring it back and give a “show and tell” presentation on it.
6. Name, Place, Animal, Thing: Another great group activity, this game has the therapist pick a letter and each participant must name a famous person, a place, an animal, or a thing that begins with that letter. The first person to type all four into the chat box wins the game.
7. 20 Questions: This is a classic game that can be easily played via a virtual medium. You can either play the original version with each other or find one of the many websites that will pit you and your client against a computer to see if it can guess your object.
8. About Me: There are many resources and worksheets available for this activity, or you can create your own. The idea is to have both you and your client fill out a worksheet that’s all “about me” and screen share them to get to know each other better.
9. Storymaker: You can use a virtual whiteboard or a dedicated website for this activity that involves storytelling. Your client will use words, pictures, and drawings to tell you a story about their life or something important to them.
10. Would You Rather: There are online versions of this game (do a quick web search and you’ll see), or you can create your own “would you rather” pairs. The idea is to present two different but similarly salient (whether desirable or unpleasant) choices and to have your client pick between them. It’s a fun and easy way to break the ice and learn about each other.

Best Activities for Kids

If you work with kids, you know that they often need games or activities to stay engaged and on-task during sessions, and this is even more true for online sessions. The list above provides some great options for working with children, but there are many more activities and games to choose from.

When you’re trying to keep kids engaged in online therapy, remember to pick activities that:

• Involve some sort of interactivity, like drawing or coloring.
• Are visually interesting or stimulating (particularly those that are colorful).
• Require some sort of movement, whether that’s getting out of their seat to go find an object or just clicking the mouse to play a game or complete a task.
• Includes a verbal component; you don’t want kids completing an activity or worksheet in silence, so make sure you are communicating during the activity.

If you use an activity that requires screen sharing, try to make sure they are still able to see you. It’s especially important for kids to be able to see the person they are working with in order to maintain a connection and open up.

Whatever platform you use for videoconferencing, Quenza can help you facilitate these activities for your sessions. You can send clients resources, have them fill out worksheets beforehand, and line up the activities and games for them via a care pathway. When you start the session, it’s as easy as pulling up Quenza and making a couple of clicks!

3 Unique Online Therapy Tools and Interventions in Quenza

There are also unique and engaging therapy tools that you can find hosted entirely in Quenza.

You’ll find these free templates in your Expansion Library, shown below:

Your Expansion Library includes convenient pre-made Activities such as assessments, exercises, meditations, lessons, and other interactive templates, all of which can be branded using your custom logo.

For example, you might want to send one (or all!) of the following activities to your clients:

1. The Best Possible Resilient Self: This activity walks the client through describing a personal challenge they are facing, the factors that make it challenging, and how they can overcome it with the best possible version of themselves, or most resilient version of themselves.
2. Three Minute Breathing Space: There’s rarely a time when meditation won’t help your client, so consider assigning this quick and simple perspective-shifting exercise to your client before diving into some deeper or more difficult work.
3. The Top 5 Values: If you want to help your client clarify what is most important to them and what areas they want to work on, this activity is an invaluable starting point. It lists values and guides your clients in choosing their top five most important values, what each value means to them, and why they are important.

With Quenza’s customizable pre-made activities and activity builder, the sky is the limit for games, activities, worksheets, and other resources you can create, share with, and assign to your clients. Keeping them engaged with interactive and thought-provoking content is a must, especially when you’re working entirely virtually.

Resources for Online Therapy Practitioners

The internet offers a whole host of tips, tricks, techniques, and other resources for just about any career or activity – the trouble is narrowing the deluge of information down to solid, reliable sources.

For the best and most up-to-date information on practicing online therapy, check out our blog. We post new articles frequently, bringing the best and most relevant information directly to you.

The Role of Technology in Modern Therapy

The integration of technology in therapy has revolutionized how practitioners deliver care and how clients receive support. Technology offers innovative tools that go beyond traditional therapy methods, providing interactive and engaging ways to conduct sessions.

For instance, virtual reality (VR) can create immersive environments for exposure therapy, helping clients confront and overcome their fears in a controlled setting. Additionally, mobile apps allow clients to track their progress, practice mindfulness, and receive real-time feedback from their therapists.

These technological advancements not only enhance the therapeutic experience but also provide therapists with valuable data to tailor their approaches to each client’s unique needs. By leveraging technology, therapists can offer more dynamic, responsive, and personalized care, ultimately improving client outcomes and satisfaction.

Future Trends in Online Therapy Platforms

The landscape of online therapy is continuously evolving, with several emerging trends set to shape the future of the field.

One significant trend is the use of artificial intelligence (AI) to support therapists and clients. AI can analyze client data to identify patterns and suggest personalized interventions, enhancing the effectiveness of therapy.

Moreover, AI-powered chatbots can provide immediate support to clients outside of regular sessions, offering coping strategies and resources during crises.

Another trend is the increasing use of telehealth services, which expand access to therapy for individuals in underserved areas. Telehealth not only breaks down geographical barriers but also reduces the stigma associated with seeking mental health support.

Furthermore, the integration of wearable technology, such as smartwatches and fitness trackers, allows therapists to monitor clients’ physical and emotional well-being continuously. These devices can track stress levels, sleep patterns, and activity levels, providing a comprehensive view of the client’s health.

As technology advances, online therapy platforms will continue to innovate, offering more sophisticated and accessible solutions for mental health care.

How Do You Choose the Right Online Therapy Platform?

Selecting the optimal telehealth platform requires evaluating several clinical and operational factors. Practitioners should consider their specific modality requirements, client demographics, and integration needs before committing to any single solution.

Many practitioners find that trialing a platform with a small subset of clients before full adoption helps identify workflow issues that may not be apparent during initial evaluation.

What Are the Ethical Considerations for Online Therapy?

Telehealth practice introduces unique ethical dimensions that practitioners must navigate carefully. Professional organizations including the APA and NASW have published specific guidelines addressing informed consent, boundary management, and competency requirements in digital therapeutic contexts.

Practitioners must ensure their informed consent documents explicitly address the risks and limitations of telehealth, including potential technology failures, privacy limitations in the client’s environment, and emergency protocols. Cross-jurisdictional practice requires understanding licensing reciprocity agreements and ensuring compliance with regulations in both the practitioner’s and client’s locations.

Cultural sensitivity takes on additional dimensions in online therapy. Screen-mediated communication may obscure nonverbal cues important in cross-cultural therapeutic work, and practitioners should proactively discuss how the virtual format may affect the therapeutic relationship with diverse client populations.

How Can Practitioners Measure Online Therapy Outcomes?

Systematic outcome measurement is essential for demonstrating the effectiveness of online interventions and refining treatment approaches. Digital platforms offer unique advantages for data collection that can enhance clinical decision-making.

Routine outcome monitoring allows practitioners to identify treatment stagnation early and make data-informed adjustments to their approach, whether that involves modifying interventions, adjusting session frequency, or considering referral for specialized care.

How Do You Build Strong Client Engagement in Virtual Sessions?

Maintaining client engagement in a virtual environment requires deliberate strategies that account for the unique challenges of screen-mediated communication. Research suggests that the therapeutic alliance in online therapy is comparable to in-person work when practitioners actively attend to relationship-building elements.

Active engagement strategies include using shared screen features for collaborative work on treatment materials, incorporating multimedia psychoeducation resources, and leveraging between-session digital tools to maintain therapeutic momentum. Practitioners who assign structured activities through their platform report higher client completion rates compared to verbal homework assignments alone.

Session structure also plays a critical role. Beginning each session with a brief check-in using a validated measure creates accountability and gives clients a sense of measurable progress. Varying session formats between traditional dialogue, skills practice, and interactive exercises helps prevent the “Zoom fatigue” that can undermine engagement in ongoing telehealth relationships.

Final Thoughts

Online therapy is here to stay. Luckily, there are tons of resources available to guide and develop your online therapy practice in our blog, and more are being developed all the time.

Check back often to see what’s new here!

If you’re keen to start sharing inspiring, motivational online therapy solutions under your practice brand, don’t forget to start your free 30-day Quenza trial.

You’ll find everything you need to create interactive and unique interventions, worksheets, quizzes, assessments, learning materials, and more in Quenza’s specially designed online toolkit for e-therapists, so that you can take your psychology or counseling practice online today.

Frequently Asked Questions

Is online therapy as effective as in-person therapy?

Research consistently shows that online therapy produces outcomes comparable to in-person therapy for many conditions, including depression, anxiety, and PTSD. A meta-analysis of randomized controlled trials found no significant difference in treatment outcomes between telehealth and face-to-face delivery for CBT-based interventions. However, effectiveness may vary depending on the specific condition being treated and the client’s comfort with technology.

What features should I look for in an online therapy platform?

Essential features include HIPAA-compliant video conferencing, secure messaging, appointment scheduling, client progress tracking, and homework assignment capabilities. Advanced platforms also offer customizable assessments, automated psychoeducation pathways, outcome measurement tools, and practice management integration. Prioritize platforms that provide a Business Associate Agreement (BAA) for regulatory compliance.

Can I practice online therapy across state lines?

Cross-state telehealth practice depends on your profession’s licensing requirements and any interstate compacts your state participates in. The PSYPACT agreement covers psychologists in participating states, while ASWB’s mobility initiative addresses social workers. Always verify current regulations, as telehealth licensure requirements continue to evolve following pandemic-era temporary provisions.

How do I maintain client engagement during virtual sessions?

Effective virtual engagement strategies include using screen-sharing for collaborative exercises, incorporating interactive digital activities, assigning structured between-session tasks through your platform, and varying session formats to prevent screen fatigue. Beginning each session with a brief validated check-in measure creates accountability and gives clients a tangible sense of progress throughout treatment.

What are the biggest challenges of online therapy?

Common challenges include technology barriers for certain client populations, difficulty reading nonverbal cues through a screen, managing crisis situations remotely, ensuring client privacy in their home environment, and navigating cross-jurisdictional licensing requirements. Practitioners can mitigate these challenges through thorough onboarding protocols, clear emergency procedures, and ongoing training in telehealth-specific competencies.

How do I handle emergencies during online therapy sessions?

Establish a crisis protocol before beginning telehealth services. This should include obtaining the client’s physical location at each session, identifying local emergency contacts and crisis services, maintaining a backup communication method, and documenting clear procedures for wellness checks. Include emergency protocols in your telehealth informed consent and review them periodically with clients.

References

References:

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2. Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorp, N. M., Lohr, J., & Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111-131. https://doi.org/10.1037/a0027924

3. 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. https://doi.org/10.1002/wps.20151

4. Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: A 2013 review. Telemedicine and e-Health, 19(6), 444-454. https://doi.org/10.1089/tmj.2013.0075

5. 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. https://doi.org/10.2196/jmir.2084

6. Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. General Hospital Psychiatry, 35(4), 332-338. https://doi.org/10.1016/j.genhosppsych.2013.03.008

7. Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22(6), 280-299. https://doi.org/10.1111/ajr.12149

8. Berger, T. (2017). The therapeutic alliance in internet interventions: A narrative review and suggestions for future research. Psychotherapy Research, 27(5), 511-524. https://doi.org/10.1080/10503307.2015.1119908

9. Wind, T. R., Rijkeboer, M., Andersson, G., & Riper, H. (2020). The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health. Internet Interventions, 20, 100317. https://doi.org/10.1016/j.invent.2020.100317

10. Connolly, S. L., Miller, C. J., Lindsay, J. A., & Bauer, M. S. (2020). A systematic review of providers’ attitudes toward telemental health via videoconferencing. Clinical Psychology: Science and Practice, 27(2), e12311. https://doi.org/10.1111/cpsp.12311