Cultivating online therapeutic presence: strengthening therapeutic relationships in teletherapy sessions

Abstract

With the recent global pandemic, therapists have had to shift their psychotherapy practice online, as they have been unable to maintain a face to face relationship due to physical distancing measures. This has created an immediate need to understand how to build and maintain strong therapeutic relationships while navigating this new online therapeutic environment. With the removal of face to face therapy, there is a question of how the therapeutic relationship is to be maintained and fostered over the internet, through considering the necessity of cultivating and maintaining therapeutic presence. This article will discuss therapeutic presence as a precondition to effective therapeutic relationships and a positive therapeutic alliance. An exploration will follow of the challenges of cultivating therapeutic presence in online therapy ; followed by tips to encourage and support both the therapist and the client to remain present while engaging in telepsychotherapy. A final discussion will include implications for future research and clinical training for cultivating presence in telepsychotherapy as well as integrating what has been learned during the pandemic back into face to face sessions.

Will We Ever Again Conduct in-Person Psychotherapy Sessions? Factors Associated with the Decision to Provide in-Person Therapy in the Age of COVID-19

“…For the quantitative phase of the study, we developed an anonymous online survey with 43 questions to answer the research questions. The survey was designed following the recent literature (Feijt et al, 2020 ; Geller, 2020 ; Inchausti et al, 2020 ; Mitchell, 2020 ) and a content analysis of the email messages posted on psychotherapy listservs. For example: I have asked my office landlord for rent reductions, and what will make you feel safe for yourself and your patients in order to return to the office?…”

“…For the qualitative phase of the study, we developed an interview guide with 10 questions that were based on the recent literature and empirical data on remote therapy during the pandemic (Geller, 2020 ; Inchausti et al, 2020 ; Mitchell, 2020 ). Phone interviews were conducted by the research team using a protocol that began by giving the participants an introduction to the study and was followed by asking the participants open-ended questions relating to their experiences with telepsychotherapy and their reasons for returning to the office to resume in-person sessions.…”

COVID-19 Adaptations for Health Service Psychology Internship Training in a Medical School

“…As interns progressed through their experiential training, they developed a stronger and more flexible version of what Geller ( 2020 ) refers to as ‘therapeutic presence’- a way of being with the client, which provides greater opportunity for therapeutic growth. Although establishing a therapeutic presence may be challenging under normal circumstances, it can be even more difficult when the opportunity to be F2F with a client is restricted by the necessity either of wearing a mask or by conducting interventions remotely (Geller, 2020 ). However, it is still possible, and at times, even more necessary for the trainee therapist to focus on the patient and their needs.…”

Attachment‐based family therapy in the age of telehealth and COVID‐19

“…Some strategies can mitigate these challenges. Therapist still can use voice tone, pacing, and body language (Gellar, 2020). Most telehealth platforms allow therapists to see themselves, thus allowing them to monitor their own physical expression.…”