Telepsychotherapy and the Therapeutic Relationship: Principles, Advantages, and Case Examples

Abstract

Telepsychotherapy offers a novel way to reach and form strong psychotherapeutic relationships with many different types of patients, and it may foster therapeutic intimacy in ways that in-person psychotherapy cannot. More research is needed to further explore this unique modality.

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…For instance, some patients actually report feeling more comfortable and are able to be more open and honest when discussing difficult subjects because of the "protection" or distance afforded by the virtual space of the session. 68,69 Clinicians, too, may feel safer evaluating patients with risk of aggression. 69 As the vignette in Table 1 highlights, rapport can even be established under acute and challenging circumstances.…”

“…69,72 Exposure to these advantages may help mitigate clinician's concerns, as successful therapeutic relationships have been established using telepsychiatry across multiple patient populations and psychiatric symptoms. 68,71,[73][74][75][76] COMMUNITY/CULTURAL Telepsychiatry practice often involves challenging culture gaps 16,77 and differences in values. 16,33,38,45,62,67,69,77,78 Psychiatrists from elsewhere may be unfamiliar with local resources and make recommendations for services that are scarce.…”

“…In addition, for in-home sessions, a quiet secluded space is essential, yet challenging to ensure in shared living environments. 68,77 Moreover, the home environment pushes limits of traditional therapeutic boundaries. Patients eager to share may introduce clinicians to partners and children and invite clinicians remotely into their living spaces in ways not possible from traditional officebased settings.…”

“…47,57,77,112,114,134 In addition, there is support for a "hybrid model" that extends and supplements in-person care, a model with potential to improve physician and patient satisfaction and acceptance. 8,19,30,68,69,103,135,136 Benefits that attract psychiatrists to telepsychiatry that deserve further exploration include flexibility in scheduling and increased diversity of practice by working in different settings (schools, prisons, homes, and hospitals) and with different populations (prisoners, students, employees, hospital patients, and outpatients). 47,50,119 In addition, the opportunity to support local practitioners and provide much needed care into rural and remote communities is a major motivation of many telepsychiatrists.…”

Telehealth Decreases Rural Emergency Department Wait Times for Behavioral Health Patients in a Group of Critical Access Hospitals

“…13 Several researchers have also reported that, at a minimum, telebehavioral care is noninferior to in-person behavioral care, [14][15][16] and patients with some behavioral health conditions may even experience improved health outcomes through telebehavioral care compared to in-person care. 17 Access to telebehavioral care has also been reported to reduce the need for inpatient hospitalization. 5 More research is needed regarding temporal, disposition, and cost outcomes for patients with behavioral health diagnoses, who are treated with telehealth in rural EDs to explore any differences in these ED patient outcomes, 6,12 based on different behavioral health diagnoses.…”