“I miss not being able to offer my couples a box of tissues…”: Couples' and therapists' perspectives on the therapeutic alliance with the transition to online couple therapy

Abstract

The purpose of this study is to advance theory concerning the experiences of couples and therapists involved in online couple therapy and the meanings they assign to them, with a particular focus on the therapeutic alliance. Using constructivist grounded theory methodology, in‐depth semi‐structured online interviews were conducted with 36 individuals, including 18 couples who had participated in online couple therapy via videoconference. Additionally, 15 couple and family therapists were interviewed in four online focus groups. Our analysis indicates three dimensions that impact the formation of the therapeutic alliance in online couple therapy: (1) emotional closeness, as a conduit for establishing physical or emotional space; (2) limited care, due to the therapist's difficulty providing comfort and security; and (3) body language, as reflected in the lack of physical presence and the close inspection of the face, at two opposite ends of a continuum. We discuss our findings through the lens of the closeness‐distance dynamic, which posits that therapists' ability to regulate themselves depends on their clients' emotional needs. We conclude with implications for clinical practice.

Mastery of teletherapy is related to better therapeutic relationship and presence in teletherapy: the development of the teletherapy intervention scale

“…Since then, teletherapy has become part of standard practice for many clinicians ( Van Daele et al, 2020 ; Sheperis and Smith, 2021 ; Kwok et al, 2022 ), and a vast amount of research has suggested comparable efficacy with in-person treatment (e.g., Lin et al, 2022 ). Lots has been written about therapists’ experiences of the therapeutic process in teletherapy during the pandemic ( Békés et al, 2020 ; Perry et al, 2020 ; Rosen et al, 2020 ; Van Daele et al, 2020 ; Hanley and Wyatt, 2021 ; Helps and Le Coyte Grinney, 2021 ; Nuttman-Shwartz and Shaul, 2021 ; Poletti et al, 2021 ; Machluf et al, 2022 ; Stukenberg et al, 2022 ; Aviram and Nadan, 2023 ). These studies showed that overall, therapists had a reasonably favorable experience, often better than they expected, and their attitudes toward teletherapy became more positive ( Békés et al, 2020 ; Humer et al, 2020 ).…”

Therapist perspectives on telehealth-based virtual reality exposure therapy

“…These ndings contribute to the literature in several important areas. First, while therapists reported broad bene ts of telemental health services, they acknowledged telehealth involved communication limitations.The tendency to feel less personable over video calls has been a common nding in post-pandemic telehealth(Aviram & Nadan, 2023;Connolly et al, 2022;Cowan et al, 2019), and may have negative impacts upon therapeutic relationships (Aafjes-Van Doorn et al, 2023). Therapists in this study were enthusiastic about the potential to engage clients with VR technologies to build stronger therapeutic alliances.…”