New Avenues to Facilitate Engagement in Psychotherapy: The Use of Videoconferencing and Text–Chat in a Severe Case of Obsessive‐compulsive Disorder

Abstract

Client engagement is a necessary component of psychotherapy, but it can be challenging to foster in clients with severe and complex problems. Telehealth technology influences the clinical dyad in unique ways and offers new opportunities for approaching the challenge of client engagement. In this article, we present a qualitative case study of a client with severe and complex obsessive-compulsive disorder (OCD) who received 40 sessions of cognitive-behavioural-based psychotherapy administered through a mix of videoconference and text-chat. The results suggest that telehealth technology may have facilitated client engagement by helping to reduce interpersonal anxiety, thus allowing the client to continue disclosing and discussing issues that were espoused in shame, guilt, and embarrassment.

Videotherapy and therapeutic alliance in the age of COVID‐19

“…Reynolds, Stiles, Bailer, and Hughes (2013) refer to the ‘online calming hypothesis’, claiming that many therapists and clients experience the online environment as more comfortable and less threatening than the in‐person setting, as shown by evidence that therapists and clients experience low arousal levels in online therapy. The additional safety experienced in this context may make online or videoconferencing‐based therapy a less threatening option, especially for anxiety‐based disorders, such as social phobia, agoraphobia, obsessive compulsive disorder and other groups who find close contact overwhelming, such as autistic spectrum disorders (Reynolds, Stiles, Bailer, & Hughes, 2013; Stubbings, Rees, & Roberts, 2015).…”

“…This evidence‐based technological option for therapeutic contact may finally have an opportunity to live up to its potential as communities around the world move rapidly online and where videoconferencing communication is the new normal (Berwick, 2020). Further, synchronous videoconferencing sits amongst, and can be used alongside, a suite of digital mental health modalities or ‘psycho‐technologies’, including text‐chat, audio calls, virtual reality, mental health apps and online forums (e.g., Stubbings, Rees, & Roberts, 2015).…”

Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review

“…In an interesting case study [53], a client with severe obsessive-compulsive disorder received 40 psychotherapy sessions via videoconferencing during which the client disclosed a number of low-shame issues. Adding text chat in later sessions promoted the disclosure of clinically important information, particularly regarding feelings of shame, guilt, and embarrassment, which the client had difficulty disclosing in video-only sessions.…”

Intervenção psicológica à distância em tempos de pandemia: da revisão de literatura à reflexão profissional

“…No que diz respeito à eficácia e comparando os tipos de intervenção (à distância e presencial), vários estudos assinalam não ter encontrado diferenças ao nível da eficácia, nomeadamente em problemáticas tais como a depressão (Berryhill et al, 2019;Osenbach et al, 2013;Yang, Vigod, & Hensel, 2019), perturbações de ansiedade (Bouchard et al, 2004;Rees & Maclaine, 2015;Shepherd et al, 2006;Tuerk, Yoder, Ruggiero, Gros, & Acierno, 2010;Yuen et al, 2010), perturbações relacionadas com o álcool (Slone, Reese, & McClellan, 2012;Tarp, Bojesen, Mejldal, & Nielsen, 2017), perturbação obsessiva compulsiva (POC, Himle et al, 2006;Stubbings, Rees, & Roberts, 2015), insónia (Lichstein et al, 2013); PSPT (Morland et al, 2014;Shreck et al, 2020), psicose (Sharp, Kobak, & Osman, 2011).…”