Related Experiment Video
Updated: Nov 20, 2025

Functional Near-Infrared Spectroscopy Hyperscanning Study in Psychological Counseling
Published on: January 17, 2025
An explanatory sequential investigation of the working alliance as a change process in videoconferencing
Carl Norwood1, Rachel Sabin-Farrell1, Sam Malins2
1Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
Objectives And Design:
Debate exists as to patient experience, and the importance, of the working alliance (WA) in videoconferencing psychotherapy (VCP). This study used a two-phase explanatory sequential design to investigate the WA as a change process in VCP.
Methods:
Phase I: sessional VCP outcome and WA data were analysed using multilevel modelling (n = 46). Phase II: participants (n = 12) from Phase I were recruited to semi-structured interviews, analysed using thematic framework analysis.
Results And Conclusions:
Results demonstrate: (1) a significant correlation between WA and outcome (F(1, 15.19) = 25.01, p < 0.001), (2) previous session WA significantly predicted outcome in the next session (F(1, 355.61) = 4.47, p < 0.05), and (3) previous session outcome significantly predicted next session WA (F(1, 55.3) = 15.19, p < 0.001), with three core themes explaining patient experience (engaging with the medium, connection with the therapist, and working via the medium). Results are discussed and future research recommended.
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