Changes in Clinical Process as a Result of Online Therapy: Findings from a Single Case Study

Introduction: This study examined changes in the clinical interaction in a single clinical dyad between sessions conducted in person and sessions conducted remotely, applying linguistic indicators based on multiple code and referential process theory. Methods: Sessions from an ongoing psychotherapy of a male patient in his late 30s were audio-recorded and transcribed. Linguistic indicators, including the Weighted Referential Activity Dictionary (WRAD), were scored, and graphed using the Discourse Attributes Analysis Program (DAAP). The sessions included 8 sessions immediately before online work, 10 sessions immediately following the implementation of online work, and 12 sessions collected several months after the clinical dyad had been working remotely. Results: A comparison of in-person sessions to telehealth sessions shows that the patient spoke more in post-telehealth sessions but with decreased emotional engagement, as evidenced by a decrease in WRAD. The therapist appeared to be working harder to communicate that he was listening as evidenced by an increase in the measure of non-turn vocalizations (interjections such as hmm). Discussion: It appears that both patient and therapist were working harder to remain connected and communicate that they were present but with limited emotional engagement. This pattern remained unaltered at a 2-month followup. The findings address empirically the subjective experience of many clinicians who have switched to remote treatment. Implications for the future of remote therapy are discussed.