Psychotherapists' acceptance of telepsychotherapy during the COVID‐19 pandemic: A machine learning approach

Abstract

Objective This study aimed to develop predictive models of three aspects of psychotherapists' acceptance of telepsychotherapy (TPT) during the COVID‐19 pandemic, attitudes towards TPT technology, concerns about using TPT technology and intention to use TPT technology in the future. Method Therapists ( n = 795) responded to a survey about their TPT experiences during the pandemic, including quality of the therapeutic relationship, professional self‐doubt, vicarious trauma and TPT acceptance. Regression decision tree machine learning analyses were used to build prediction models for each of three aspects of TPT acceptance in a training subset of the data and subsequently tested in the remaining subset of the total sample. Results Attitudes towards TPT were most positive for therapists who reported a neutral or strong online working alliance with their patients, especially if they experienced little professional self‐doubt and were younger than 40 years old. Therapists who were most concerned about TPT were those who reported higher levels of professional self‐doubt, particularly if they also reported vicarious trauma experiences. Therapists who reported low working alliance with their patients were least likely to use TPT in the future. Performance metrics for the decision trees indicated that these three models held up well in an out‐of‐sample dataset. Conclusions Therapists' professional self‐doubt and the quality of their working alliance with their online patients appear to be the most pertinent factors associated with therapists' acceptance of TPT technology during COVID‐19 and should be addressed in future training and research.

The development of a self‐report scale to assess therapists' acceptance of telepsychotherapy

“…On the other hand, it is also possible that once the pandemic related restrictions have been lifted, telepsychotherapy might be seen as a less preferable, and less effective treatment option research conducted during the pandemic shows that even though therapists had a reasonably favorable experience with telepsychotherapy during the pandemic (Békés & Aafjes‐van Doorn, 2020; Humer et al, 2020) many therapists remain undecided or unlikely to continue using telepsychotherapy post‐pandemic (Békés & Aafjes‐van Doorn, 2020; Machluf et al, 2021). These studies found that age (Cioffi et al, 2020), clinical experience (Békés & Aafjes‐van Doorn, 2020; Nuttman‐Shwartz & Shaul, 2021) previous experience with using telepsychotherapy (Békés & Aafjes‐van Doorn, Prout, et al, 2020; Boldrini et al, 2020), experienced challenges (Békés, Aafjes‐van Doorn, Luo, et al, 2021; Békés, Aafjes‐van Doorn, Zilcha‐Mano, et al, 2021), number of telepsychotherapy patients treated (Korecka et al, 2020), and psychotherapy orientation (Humer et al, 2020) were prominent factors that were related to therapists' attitudes towards telepsychotherapy.…”

“…The sudden switch to remote therapy format also posed various additional challenges to adapt to telepsychotherapy and use it in an optimal manner, such as lack of training and experience with providing telepsychotherapy, issues with patient privacy, worries about confidentiality, technological glitches, etc., which might hinder the continued utilization of telepsychotherapy once the pandemic ends (e.g., Békés, Aafjes‐van Doorn, Luo, et al, 2021; Békés, Aafjes‐van Doorn, Zilcha‐Mano, et al, 2021; Feit et al, 2021; Neven, 2020; Phillips et al, 2021). Therefore, the current COVID‐19 circumstances provide an important opportunity, an experiment in nature (Craig et al, 2012), to understand the factors that impact therapists' acceptance of telepsychotherapy technology, as well as their intentions of using it in the future.…”

Impact of COVID‐19 social distancing measures on routine mental health care provision and treatment outcome for common mental disorders in the Netherlands

“…Videoconferencing treatment is still viewed as an inferior treatment option to in‐person by many professionals and patients (Békés et al, 2021 ). In our own surveys, among both groups, a majority indicated a preference for a return to in‐person treatment or in‐person blended with videoconferencing when COVID‐19 lockdown restrictions are lifted (de Beurs et al, 2021a , 2021b ), stating that interpersonal contact and information transfer is leaner as non‐verbal and implicit communication is lacking.…”

“…However, a recent literature review (Cataldo et al, 2021 ) demonstrated divergence between professionals and patients in how videoconferencing impacts the therapeutic relationship: Many professionals highlight difficulties in establishing an effective therapeutic relationship in treatment via videoconferencing, whereas patients are generally satisfied with the relationship in videoconference therapy. Békés et al ( 2021 ) mentioned that therapists differ in their ability to establish a strong therapeutic bond through videoconferencing treatment and also investigated professional self‐doubt (in general and with this new technology). They concluded that both the view of the therapeutic relationship and professional self‐doubt generate hesitance among therapists to use videoconferencing.…”

“…Many practitioners in MHC feel that treatment delivery in a videoconferencing format is ultimately inferior to in‐person therapy (Humer et al, 2020 ). Practitioners also state that they feel less confident when delivering therapy in this form (Aafjes‐van Doorn et al, 2020 ; Békés et al, 2021 ). The latter authors mention a decrease in confidence among therapists because they are afraid of not being fully attentive themselves or that their clients are easily distracted.…”