The therapeutic relationship in in-person, video call, and telephone psychotherapy sessions.

OBJECTIVE

To examine whether and how patients' perceptions of working alliance, alliance ruptures, real relationship and affective reactions towards the therapist differ across in-person, videoconferencing and telephone psychotherapy sessions.

METHOD: A total of 1175 adult patients undergoing various individual psychotherapies completed self-report measures following sessions conducted in-person (746 sessions), via video call (1037 sessions), or by telephone (149 sessions). Linear mixed models with marginal structural model (MSM) were employed. Interaction effects with age group, time-in-treatment and session frequency were also examined.

RESULTS

Patients reported similar levels of alliance, real relationship, positive and negative affective reactions and occurrences of alliance ruptures and repairs in both in-person and video call sessions. However, levels of alliance dimensions-agreement on therapy goals, therapy tasks and affective bond-were significantly lower in telephone sessions compared to in-person (β = -.21 to -.25) and video call (β = -.34 to -.37) sessions. Positive affective reactions were also lower in telephone sessions compared to video call sessions (β = -.22). Age, time in treatment and session frequency significantly moderated some associations.

CONCLUSIONS

The therapeutic relationship is comparable between in-person and video call sessions. Telephone sessions, however, are associated with lower working alliance and in-session positive affective reactions.