The effects of telepsychology format on empathic accuracy and the therapeutic alliance: An analogue counselling session

Abstract

Objective The primary purpose of this study was to evaluate whether psychotherapy format (videoconferencing, telephone or in‐person) influenced therapist empathic accuracy and clients’ perceptions of the therapeutic alliance. We also evaluated whether client attitudes towards using telepsychology influenced the therapeutic alliance in the telepsychology formats. A secondary purpose was to determine whether empathic accuracy predicted the therapeutic alliance differently across service delivery formats. Method A randomised block design was used to assign volunteer clients (N = 58) to receive one session of psychotherapy in a videoconferencing, telephonic or in‐person format. Clients completed two therapeutic alliance measures and a telepsychology attitudes measure, and both therapists and clients completed an empathic accuracy measure. Results There were no statistically significant differences between the conditions on therapist empathic accuracy or therapeutic alliance. Attitudes towards telepsychology and empathic accuracy were both significant predictors of alliance in the telepsychology delivery formats. Interestingly, empathic accuracy did not predict the therapeutic alliance for clients in the in‐person condition. Conclusions Although preliminary, the results suggest that the technology‐mediated psychotherapy processes of empathic accuracy and therapeutic alliance seem to be similar to in‐person psychotherapy. Empathic accuracy, however, may be a more salient process for clients who receive services in a telepsychology format. Process‐focused research may highlight important distinctions in technology‐mediated psychological services that inform both practice and policy.

Attitudes of Australian psychologists towards the delivery of therapy via video conferencing technology

“…Medicare and private insurance companies will provide reimbursement for psychological services (American Psychological Association, 2019). Reese et al (2016) argue that the emphasis in telehealth research to date has been on outcomes (for reviews, see Osenbach, O'Brien, Mishkind & Smolenski, 2013;Rees & Maclaine, 2015;Varker, Brand, Ward, Terhaag & Phelps, 2018), and less is known about the processes of psychotherapy and how these may differ across modalities of delivery. They argue that therapeutic alliance has long been reported as a robust predictor of treatment outcome yet there has been a lack of focus of research in this area.…”

“…However, therapists reported feeling ‘uncomfortable’ in situations involving high expressed emotion, complex countertransference reactions, high‐risk disclosure, or when difficulties were experienced using worksheets (Richardson et al, 2015). Reece et al (2016) compared the extent to which trainee psychologists ( n = 6) could perceive empathy accurately among 46 clients, when comparing different modalities, including VCT, telephone and f2f. They defined empathetic accuracy ‘as the ability to perceive accurately how another person is feeling’, as per Levenson and Reuf's (1992, cited in Reece et al, 2016, p. 257) definition.…”

“…Reece et al (2016) compared the extent to which trainee psychologists ( n = 6) could perceive empathy accurately among 46 clients, when comparing different modalities, including VCT, telephone and f2f. They defined empathetic accuracy ‘as the ability to perceive accurately how another person is feeling’, as per Levenson and Reuf's (1992, cited in Reece et al, 2016, p. 257) definition. Reece et al (2016) also drew on theory and empirical research in social psychology that suggests that it is exposure to verbal content, rather than non‐verbal cues that is key to the development of empathetic accuracy (see Gesn & Ickes, 1999).…”

“…They defined empathetic accuracy ‘as the ability to perceive accurately how another person is feeling’, as per Levenson and Reuf's (1992, cited in Reece et al, 2016, p. 257) definition. Reece et al (2016) also drew on theory and empirical research in social psychology that suggests that it is exposure to verbal content, rather than non‐verbal cues that is key to the development of empathetic accuracy (see Gesn & Ickes, 1999). Results indicated that therapists displayed similar levels of empathetic accuracy regardless of mode of delivery.…”

“…Psychology has a rich tradition in utilising theory to explain and predict behaviour. Except for the study performed by Reece et al (2016), research on VCT has lacked the incorporation of theory. Richardson and Simpson (2015) identify barriers, which may underpin psychologists' resistance towards VCT in their commentary; however, these barriers have not yet been subjected to empirical validation.…”