The working alliance in teletherapy
By Élody Bourgouin
Doctoral student in psychology, University of Montreal, Canada | October 2023
This article first appeared in Traumag (Fall 2023), a magazine published by the Trauma Studies Center affiliated with the University of Montreal. Permission for republication was obtained from the magazine’s editors and from the author. The article was originally published in French and translated by Alexandre Lemyre, Ph.D.
Due to the major impact of the COVID-19 pandemic on healthcare service delivery, many professionals had to innovate in order to maintain their services. Teletherapy, which involves providing care via communication technologies, has become a common solution. Currently, more than 80% of psycho-social practitioners in the province of Quebec (Canada) use videoconferencing in their practice, compared to 18-35% before the pandemic (Ordre des psychologues du Québec [Order of psychologists of Quebec; OPQ], 2023). Despite the general appreciation toward this mode of service delivery, some remain reluctant to engage in psychosocial support via digital technologies (Lambert and Barley, 2001).
How effective is teletherapy, and can it be compared to in-person therapy?
Psychosocial interventions offered via videoconferencing have been shown to be equivalent to in-person interventions for a variety of psychological issues (Ignatowicz et al., 2019) and clienteles (Norwood et al., 2018). The people benefiting from these services have also largely expressed satisfaction with them (Maier et al., 2021). A survey conducted by the OPQ revealed that 73% of the psychologists questioned felt that their clients appreciated the flexibility offered by teletherapy (OPQ, 2023).
What is the working alliance, and does teletherapy hinder its development?
The working alliance is generally described as a dynamic collaboration between practitioner and client. It is characterized by open communication and active participation on both sides. The working alliance plays a central role in the therapeutic process, creating an environment conducive to personal growth and positive change, and helping to achieve pre-established goals (Lecomte et al., 2004). To date, the literature suggests that teletherapy can help develop a positive and lasting working alliance. Indeed, levels of commitment, client-therapist collaboration, and satisfaction are comparable to those in face-to-face sessions, particularly in family and couple therapy (Bouchard, 2020). However, according to a survey conducted by the OPQ, 59% of practitioners considered that relationships would be of poorer quality in teletherapy, and up to 30% believe that teletherapy harms the therapeutic alliance (OPQ, 2023), particularly with new clients. These data concur with the study by McCoyd et al. (2022), which suggests that the loss of body language, reduced eye contact and distractions caused by the “remote” context could explain this perception.
What other aspects should be considered before committing to teletherapy?
There are a number of advantages and disadvantages to taking part in teletherapy. Firstly, this mode of service delivery requires less time on the part of professionals and clients, which would increase attendance (more flexibility in scheduling, no travel time; McCoyd et al., 2022). Nevertheless, teletherapy would be less satisfactory for some users who have more difficulty using digital technology, or those who have concerns about confidentiality. Moreover, some people may have difficulty finding a private and quiet space for their sessions.
Teletherapy, therefore, represents a promising alternative to in-person practice. Although this method can be destabilizing at first, it can be just as effective. It is important to stress that the quality of the relationship between client and therapist (or the working alliance) is a key factor in the effectiveness of therapy, whatever the mode of delivery. It is normal not to find a therapist with whom you are comfortable the first time, regardless of the mode of delivery. Keep in mind that if you feel uncomfortable with your therapist, you can seek out a professional with whom you feel better.
References
Bouchard, S. (2020, août). Psychothérapie par vidéoconférence: efficacité, alliance thérapeutique et informations pratiques (webinaire) [Videoconference psychotherapy: effectiveness, therapeutic alliance and practical information (webinar)]. Ordre des psychologues du Québec. https://www.ordrepsy.qc.ca/catalogue-des-activites-de-formation-continue
Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357–361.
Ignatowicz, A., Atherton, H., Bernstein, C. J., Bryce, C., Court, R., Sturt, J. et Griffiths, F. (2019). Internet videoconferencing for patient-clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digital Health, 5, 1-27.
Lecomte, C., Savard, R., Drouin, M.-S. et Guillon, V. (2004). Qui sont les psychothérapeutes efficaces? Implications pour la formation en psychologie [Who are the efficient psychotherapists? Implications for training in psychology]. Revue Québécoise de Psychologie, 25(3), 73–102.
Maier, C. A., Riger, D. et Morgan-Sowada, H. (2021). “It’s splendid once you grow into it:” Client experiences of relational teletherapy in the era of COVID-19. Journal of Marital and Family Therapy, 47(2), 304–319.
McCoyd, J. L. M., Curran, L., Candelario, E. et Findley, P. (2022). “There is just a different energy”: Changes in the therapeutic relationship with the telehealth transition. Clinical Social Work Journal, 50(3), 325-336.
Norwood, C., Moghaddam, N. G., Malins, S. et Sabin-Farrell, R. (2018). Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis. Clinical Psychology & Psychotherapy, 25(6), 797-808.
Ordre des psychologues du Québec. (2023). Sondage sur la pandémie de la COVID-19 – Télépratique [COVID-19 pandemic survey – Telepractice]. https://www.ordrepsy.qc.ca/fr/sondage-telepratique-membres
The content of this article was last updated on October 31, 2023
