Does Telehealth Allow For The Development of A Strong Therapeutic Alliance?

For the past 10 years, teletherapy along with telehealth education, prevention, and awareness programs have started to gain popularity. Treatments provided over the web and via web apps have expanded access to quality treatment for individuals with limited financial means and in even the most remote areas.  Clinicians and researchers alike have been collecting data to evaluate the efficacy of these programs; this data has shed light on the potential success of these programs supporting more widespread support for and utilization of telehealth treatment options. Results from a recent study evaluating the quality of the therapeutic alliance developed in videoconference therapy for individuals with PTSD provided new and important data.

The aforementioned PTSD study developed to address a number of concerns expressed by clinicians who are partial to face-to-face interventions. Some clinicians feel that telehealth or videoconferencing therapies are risky, that an unconventional approach to psychotherapy would not allow for a healthy therapeutic alliance. A second argument of the clinical community is that, while video conferencing does allow for a visual experience of treatment, it intervenes with the ‘sense of presence’. The sense of presence refers to the unique and subjective experience of being in a specific place when in reality, the individual is actually physically somewhere else. While it is not hard to understand the concerns of the clinical community, researchers promoting teleconferencing feel they have developed a form of treatment that most closely resembles a traditional face-to-face consultation experience and that the pros outweigh the cons when considering that certain populations may have no other supportive outlet. Prior to this PTSD-specific study, several different psychological conditions had been studied and consistently results demonstrated no significant difference in the quality of the therapeutic alliance formed when comparing face-to-face treatment to videoconferencing treatment. The article published to Liebertpub states “video conferencing does not appear to compromise the scope or depth of the topics discussed in therapy or the emotions that clients feel.” Regardless of these early publications, the topic requires more research to speak to the generalizability of these results.

The PTSD study aimed to evaluate the effectiveness of video conferencing specifically in the treatment of PTSD with CBT as “victims of trauma may sometimes adopt a defensive interpersonal style, characterized by mistrust. The creation of a therapeutic atmosphere that allows trauma victims to feel safe is therefore important in order to foster non-threatening contact, which in turn promotes the healing of relational problems triggered by a traumatic experience.” Given the particular level of importance alliance plays in this specific diagnosis/treatment, a video conferencing program would need to be closely scrutinized to ensure it could be a viable option. 46 Participants received CBT treatment over a period of 16-25 weeks (17 of them by video conference and 29 in person). Therapy consisted of four modules: psychoeducation, training in anxiety management, imaginary and in vivo exposure and strategies to prevent relapse. Results demonstrated that in both face-to-face and teleconferencing conditions, therapeutic alliances developed “similarly and markedly.” Importantly, variables that researchers expected to affect the therapeutic alliance building, such as level of comfort with remote communication, proved to have no major impact on the quality of the alliance formed. Remote treatment offerings did not serve as unsatisfactory aspects of treatment to clients whereas a general defensive attitude toward therapy or lack of preparation did. These results mirror the data collected in earlier studies and are quite promising to the health care system.

The ability to form quality relationships and therapeutic bonds via telehealth and videoconferencing programming will continue to eliminate barriers to entry for individuals without access to face-to-face treatment. While face-to-face treatment is still considered the gold-standard option, individuals with a barrier to entry can rest assured that specialized care can now be just a click away.

Columbus Park offers video-therapy as an option for those who live too far from our offices to attend face-to-face sessions (although patients must be in NY State due to licensing limitations).  Further reflective of our belief that video-therapy represents an invaluable development for the mental health field, Columbus Park recently launched a novel videoconference platform called my3square, that offers meal support via video for eating disorder sufferers all over the country.  Participants join group sessions by video, sharing the screen – and a meal – with peers who are similarly motivated to work towards eating disorder recovery. Read more about my3square here.



Germain, V., Marchand, A., Bouchard, S., Guay, S., Drouin, M.S. (2010) Assessment of The Therapeutic Acclians in Face-to-Face or Videoconferencing Treatment for Posttraumatic Stress Disorder. Cyberpsychology, Behavior, And Social Networking. 13: 29-35.