Online Therapy Across Texas

For most of the clinical work I do, the research and my own clinical experience both suggest the modalities are comparably effective. Studies across a range of presentations — anxiety, depression, PTSD, grief, relationship issues, and many others — generally find no meaningful difference in outcome between competent in-person work and competent online work. There are specific situations where in-person work is more suitable, which I mentioned above. For the substantial majority of clients seeking the kind of depth-oriented work I offer, online therapy is a genuinely viable form of the work.

It happens, and it is rarely a problem. We will agree on a backup at the start — usually a phone call — so that if the video fails, we can finish the session by using another video option or audio. Occasional technical interruptions do not derail therapy. If a session is unworkable due to connectivity, we reschedule.

Yes, if you have a reliable private space at work (a closed office, a meeting room, a parked car in a corner of the parking lot). Open workspaces, coffee shops, or shared spaces are generally not private enough for the kind of work we will be doing. Some clients schedule sessions over a lunch break or before/after work hours from their work location, with a private space arranged. Others find home is the better setting.

Yes, as long as you are physically located in Texas at the time of the session. Whether you are at home in Houston, traveling for work in El Paso, or visiting family in the Rio Grande Valley, the session is workable. If you cross out of Texas — into Oklahoma, New Mexico, Mexico, or elsewhere — we cannot meet during that period under Texas licensure rules. Let me know in advance about travel so we can plan.

Yes. I see German-speaking clients across Texas by video, and many find it makes therapy available that would otherwise not be. The depth of the work in a first language often reaches material that translation does not.

It depends on your plan. The insurances I currently accept — BCBS, Curative, United Healthcare (Optum), and Medicare (traditional Medicare and Medicare Advantage plans from BCBS and United Healthcare) — generally cover telehealth psychotherapy at the same rate as in-person sessions. Specific coverage, copays, and out-of-pocket costs vary by plan. The FAQ page has more on insurance and self-pay options.

Yes. Several of my San Antonio clients see me primarily in one mode and occasionally in the other, depending on schedule, weather, or what fits a particular week. The work transfers without disruption.

This is the most common practical concern. Privacy at home is real privacy when the household supports it — when family members understand you have an appointment, do not interrupt, and stay out of earshot. For many clients, this works well. For situations where home privacy is genuinely not available (housing instability, controlling partners, very small living spaces), we can look at alternatives together: a quiet outdoor setting, a parked car, a private space at work, or in-person sessions in San Antonio if you can come.