"An exploratory study of therapist perceptions of the differences in therapeutic alliance between videoconference therapy and face-to-face therapy"

Michelle S. Abel Horowitz's School of Psychology

This phenomenological-qualitative, exploratory study examined therapist perceptions of the differences in therapeutic alliance between videoconference and face-to-face (FTF) therapy, and serves to reconcile findings between psychology and related academic disciplines. The psychological literature asserts that the alliance is comparable in the FTF and videoconference environments (Antonacci, Bloch, Saeed, Yildirim, & Talley, 2008; Bee et al., 2008; Day & Schneider, 2002; Richardson, Frueh, Grubaugh, Egede, & Elhai, 2009; Simpson, 2009). Other disciplines, such as social psychology, management, human resources, and communication assert that videoconferencing has a discriminate effect on relational behavior, with greater attention to tasks, and a reduction in affective behaviors (Johnson, Bettenhausen, & Gibbons, 2009; Meijas, 2007; Rosetti & Surynt, 1985). Twelve licensed, doctoral-level psychologists who conduct therapy in FTF and with videoconference technology were interviewed. The therapists’ experiences with videoconference therapy were primarily limited to videoconference as an adjunct to FTF therapy. Therapeutic alliance was found to be adequate in the videoconference environment. The alliance was reported to be qualitatively inferior to FTF, but good enough to conduct an adequate therapy. Consistent with other studies, therapists reported that the collaboration and negotiation aspects of the alliance, which were characterized as content-laden aspects of therapy were not compromised, but the perceived affective experiences of intimacy and empathy were qualitatively inferior in videoconference; they reported feeling less present, less real, less connected in the videoconference condition. Other arising issues with regard to video therapy included diagnostic limitations, lack of non-verbal cues, anticipatory avoidance due to technology, a perceived diminished importance of the therapy hour, and difficulty with focus and attention on the part of the therapists. Those in this sample were disinclined to engage in 100% videoconference therapeutic formats, and were ill-prepared for technologically induced variances, such as setting practical and ethical guidelines, securing privacy, and managing the visual environment. Results are limited by the modest experience of therapists in this sample with videoconference therapy. It is recommended that further research is necessary to explore the effect of videoconference on therapy, and to examine the effect of physical versus remote presence on the therapeutic relationship.

KEYWORDS: Therapeutic Alliance, Teletherapy, Skype Therapy, Videoconference Therapy, Face-to-Face Therapy, Physical Presence, Two-Dimensional, Relational Behavior, Mediated Communications