I hear a version of this question almost every time someone reaches out for the first time. What is this actually going to look like? Is it going to be awkward talking to a screen? Will it actually work, or is it a watered-down version of real therapy?

These are fair questions. And I want to answer them honestly, because I think the uncertainty about what telehealth therapy actually involves stops a lot of people from starting something that could genuinely change their lives.

So let me walk you through it. Not the brochure version. The real version.

First, Telehealth Therapy Is Real Therapy

I want to start here because I think there is still a perception that online therapy is somehow less effective than in-person therapy. In fact, multiple studies have found that telehealth therapy produces outcomes comparable to in-person treatment for anxiety, depression, burnout, and a range of other concerns.

What telehealth changes is the logistics, not the quality of the work. You do not have to drive to an office, find parking, sit in a waiting room, or carve out three hours from your day for a fifty-minute session. For the high-achieving women I work with, that practical barrier alone is often what has kept them from getting support for years.

What the First Session Actually Looks Like

The first session is not what most people expect. We are not diving straight into your childhood or your deepest fears. The first session is largely about me understanding who you are, what is bringing you in right now, and what you are hoping to get out of this.

I will ask about what is going on currently. I will ask about your history. I will ask what has and has not worked for you before. And I will explain how I work so you have a clear sense of what our time together will look like going forward.

By the end of the first session, most clients tell me they feel relieved. Not because anything has been fixed yet, but because they finally feel like someone actually understands what they are dealing with.

How Telehealth Therapy for Anxiety Actually Works

Anxiety is not just a thought pattern. This is one of the most important things I want people to understand before we start working together. Anxiety lives in the body. It lives in the nervous system. The racing heart before a hard conversation, the shallow breathing during a high-stakes presentation, the way your shoulders live somewhere near your ears by the end of a long day. That is anxiety operating at a physiological level.

This is why I incorporate somatic therapy into my work. Somatic approaches help you understand and shift what is happening in your body, not just in your mind. We work with breathwork, with body awareness, with the physical sensations that show up when anxiety spikes. Over time this builds what I think of as nervous system literacy. You start to recognize the early signals, and you develop real tools for working with them before they escalate.

Alongside somatic work, I use evidence-based approaches including elements of cognitive behavioral therapy and acceptance and commitment therapy, adapted to what each individual actually needs. There is no one-size-fits-all protocol here. What we do in our sessions is shaped by you.

What Progress Looks Like

This is the question I find most meaningful to answer, because I think a lot of people come into therapy without a clear picture of what they are actually working toward.

Progress in therapy for anxiety does not look like the anxiety disappearing. It looks like your relationship with the anxiety changing. You start to notice it earlier. You stop fighting it so hard. You develop the capacity to be anxious and still function, still make decisions, still show up for the things that matter. And gradually, the anxiety loses some of its grip.

For the high-achieving women I work with, progress often also looks like something quieter: a reduction in the constant background hum of worry. The ability to sit still without immediately reaching for the next task. A sense of groundedness that was not there before.

Most clients begin to notice real shifts within the first two to three months. Deeper patterns take longer. I will always be honest with you about where things stand and what I see happening.

What You Need to Get Started

Practically speaking, you need a private space and a reliable internet connection. That is it. You can meet from your home, your office, your car if that is the only private space you have during a workday. Sessions are conducted via Doxy.me, which is a HIPAA-compliant video platform. You do not need to download anything. You just click a link.

I am licensed in New Jersey, New York, and Florida, and credentialed through PSYPACT, which allows me to work with clients in over 40 states. So wherever you are, there is a good chance we can work together.

A Note on Starting

I want to say something to the person who has been considering this for a while and keeps finding reasons to wait. The timing is never going to be perfect. The schedule is never going to magically open up. And the anxiety is not going to resolve itself while you are figuring out the right moment to address it.

The first step is just reaching out. You can reach out here or by calling (848) 219-0136. We will have a conversation, no pressure, no commitment. You decide from there whether it feels right.

Dr. Angela Wilkos is a licensed psychologist providing telehealth therapy for anxiety and burnout across New Jersey, New York, Florida, and all PSYPACT participating states.