How teletherapy benefits the therapeutic relationship

All signs point to the fact that teletherapy is very much here to stay. Clients want it, payers are continuing to cover it, and many providers love it too. Teletherapy is a very different dynamic than in-person services. In person, therapists can pick up on the energy and body language in the room and use that to strengthen the therapeutic alliance. The truth is that in teletherapy, even if the camera’s on, some of those cues are harder to pick up on.  There are some ways, however, that teletherapy actually makes building the therapeutic alliance more successful. Here’s what we know from the research and from our experience as providers.

Three ways teletherapy can improve the therapeutic relationship

Teletherapy can be more than just a preference. We believe — and the research backs this up — that meeting virtually makes therapy easier and more equitable. These 3 examples illustrate how.

1. Teletherapy is accessible and convenient.

Virtual therapy has been a huge win for health equity because it makes it much easier for people to get the care they need. People don’t have to take as much time off work, travel, take public transportation, or sometimes even have to arrange for childcare. In areas where there are few in-person therapists, like rural towns, teletherapy brings access to people who didn’t have it before. People are no longer limited to providers in their community or within driving distance.

2. Teletherapy can reduce the power imbalance.

There is new research out about the ability of a telehealth environment to help establish a neutral power balance because the client has more control over their environment. Therapists can use this information to make a person feel even more comfortable when they’re first starting therapy or while developing the relationship.  Additionally, in video sessions, therapists may be able to get a better window into a person’s home environment. Being able to see a person’s context can be especially helpful for marriage and family therapists and social workers, who rely on an understanding of a person’s environment and psychosocial context. There’s an opportunity to better understand a client’s life when you’re virtually in their home, and that can help a client and therapist better connect. 

3. Teletherapy can lessen feelings of overwhelm and intimidation.

There’s a new theory in psychotherapy called the “online calming hypothesis.” The theory is that people are less overwhelmed and less intimidated when they’re engaged in telehealth versus an in-person visit. This can be especially important for people who have social anxiety or interpersonal challenges. In these situations, going to an office to see a therapist for the first time may be too much for them to go through.  Teletherapy is convenient, discreet, and less overwhelming — which can make forming an alliance a bit easier right off the bat. Because of the safety of the environment, clients may also have an easier time being vulnerable and sharing what they’re feeling.  Many therapists may also feel less stress because they’re not commuting and have more time to prepare between sessions. You can take control of your environment and take breaks when you need to. When you’re in a more comfortable environment and happier with your setup, that can make you a better clinician for your clients.

Remember: Teletherapy might not be a good fit for everyone

We know that teletherapy isn’t right for everybody and therapists have a responsibility to know when it’s not a fit. In some cases, teletherapy may be more challenging — but not impossible — because of a client’s age, issues with technology, or discomfort with seeing oneself on camera. For the following clients, teletherapy may not be the best option:

• Clients who are resistant to being on camera: Phone sessions every once in a while can be okay, but if a client really is resistant to being on camera, in-person sessions may be better. Face-to-face interaction is important.

• Clients who need a higher level of care: If someone needs wraparound services, virtual care won’t be the best way to do that. Referring out is recommended.
• Clients with extreme levels of fear or paranoia: If you have someone who’s paranoid, who is afraid, or who believes the session is being recorded, that would be a significant concern for continuing a teletherapy relationship.
• Clients with patterns of boundary violation: Even if it’s happening virtually, violation of boundaries is not okay. If someone has a history of crossing boundaries, doing teletherapy in their intimate space may not be appropriate.
• Clients who struggle with technology: If the use of technology is interfering with the therapeutic process, the session may be more about the frustration with tech instead of the actual reason a person is seeking care.

• Clients without safe spaces to take sessions: For the safety of the client and the effectiveness of treatment, having a secure, safe, and confidential space to take sessions is important. If this isn’t possible, in-person care may be better.

How Rula supports clients and therapists

Rula is a behavioral health company that’s powered by technology. Our network of thousands of therapists delivers outpatient individual, couples, and family therapy to people ages five and up.  At Rula, we’re deeply committed to providing high-quality care that improves lives. Doing that also requires investing in our providers and supporting their private practices with insurance, compliance, and logistics. Interested in learning more? Watch our webinar: The Importance of Therapist/Client Fit in Teletherapy. Learn more about joining Rula