Adjusting to a new reality: Consensual qualitative research on therapists' experiences with teletherapy

Abstract

Objective In the wake of the COVID‐19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process. Methods Thirty‐one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method. Results Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in‐person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process. Conclusion Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process‐level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities.

Online psychotherapy as a first clinical experience during the Covid-19 pandemic: A new generation of psychotherapists in the digital age

“…Although the impact of the Covid-19 pandemic on helping professionals-in-training has been the focus of many recent studies, the interest in psychotherapists in training remains largely a peripheral part of larger quantitative studies [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. What can generally be said is that therapists were overwhelmed and thus felt insecure in their professional role and clinical work [ [12] , [13] , [14] , [15] , [16] , [17] ]. Everyone, including psychotherapists, was influenced by this experience in their private and professional lives [ [18] , [19] , [20] , [21] , [22] , [23] ].…”

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

“…Therapists noted that they had become more open and willing to share their personal experiences compared to their in-person practice ( Mitchell, 2020 ). Similarly, some therapists (as well as patients, see Shtrackman, Békés et al, 2023 ) reported a sense of connecting more as humans besides professional and patient, and letting patients see more of them as persons ( Békés et al, 2023 ). Some therapists reported that they used self-disclosure as a tool to compensate for the physical distance, especially when supporting patients during a time of global distress ( Nuttman-Shwartz and Shaul, 2021 ; Aafjes-Van Doorn et al, 2023 ).…”

“…However, therapists also reported several challenges in teletherapy. For example, therapists noted that the teletherapy sessions often feel less deep emotionally and more superficial, and the teletherapy setting pulls them to provide support and counseling rather than engaging in a more open-ended exploration of the patients’ inner world ( Békés et al, 2023 ). Therapists often attempted to compensate for this by becoming more active and directive, and avoiding silences in teletherapy sessions.…”

“…In addition, therapists reported that creating emotional closeness via teletherapy required a more active effort ( McCoyd et al, 2022 ). Further, some therapists reported that it was more difficult to read their patients’ emotions and they tended to feel more disconnected from their patients; as one therapist put it: “The one thing I am missing is the feel in the room” ( Békés et al, 2023 ). In order to make up for the lacking nonverbal signals from body movement, therapists tended to make an effort to express their own feelings and emotional reactions verbally.…”

Therapist self‐disclosure in teletherapy early in the COVID‐19 pandemic: Associations with real relationship and traumatic distress

“…For therapists, conducting sessions from their home may involve more (willingly or unwillingly) TSD, which may shift therapists' perceptions of the therapeutic relationships. While post‐pandemic research is needed to differentiate the impact of the global, shared stressor of the pandemic and that of the therapy format on the increased real relationship, evidence suggests that this sense of authenticity and egalitarian approach may benefit patients and the therapeutic process (Békés et al, 2023), yet also knowing that TSD is not always beneficial (Hill et al, 2018). It can thus be challenging for therapists to navigate therapeutic actions involving authenticity and self‐disclosure.…”