Objective: This paper explores the therapeutic relationship, engagement and communication for participants using telepsychiatry (i.e., video; TP), telebehavioral health (TBH) and other technologies. Methods: The goal of this concept paper is to help clinicians, teachers and researchers consider the intersection of the following three topics: 1) the therapeutic relationship in psychiatric and behavioral health care; 2) how TBH affects the therapeutic relationship, engagement, communication, and boundaries; and 3) research findings on telepresence (TPr), virtual reality (VR) and augmented reality (AR) applied to clinical care. A keyword search focused on concept areas: 1) therapeutic relationship, engagement, communication, boundaries, clinical; 2) telepsychiatry, telemental or telebehavioral health, telepsychology); 3) psychotherapy via technology; 4) computer/technology-mediated communication; and 5) telepresence related to technologies (virtual, augmented, reality, environment). Results: From a total of 4,712 potential references, 453 were eligible for full text review and 77 papers directly related to the concepts. From papers' references and a review of books and popular literature, 12 other sources of information (i.e., papers, books, other) about TPr and VR were found. Though few studies literally discuss the therapeutic relationship, the impact of technology on clinical engagement and communication is growing, from clinical (e.g., psychotherapy) and non-clinical (e.g., communication, TPr) literature. The historical evolution of TPr and VR shows that definitions, foci of studies (e.g., social neuroscience to business) and assessments vary widely. TP and TBH care can be improved by concepts of TPr, avoiding distractions, understanding the technology-human interface, measures of TPR for clinical use and the use of simulation for training. Conclusions: Additional evaluation/research is needed to ensure quality care, training, and evaluation of the therapeutic relationship while preventing potential pitfalls.
