Perspectives of Therapeutic Alliance Using Telemental Health for Adolescents: A Scoping Review

The purpose of this article is to conduct a scoping review, which examines research evidence on therapeutic alliance development in adolescents while using telehealth during mental health encounters (telemental health). Thirty-seven percent of all high school students in the United States reported poor mental health during the pandemic, and 44% reported sadness and/or hopelessness in the past year. Therapeutic alliance is a collaborative relationship between patient and provider with a strong affective bond and agreement on treatment tasks and goals. Telehealth may facilitate access, but preliminary research demonstrates provider challenges for building therapeutic alliance during telehealth visits in adolescents. CINAHL, Embase, PsycINFO, PubMed, Google Scholar, and ProQuest were searched through June 2023. Inclusion studies examined therapeutic alliance in mental health patients with a mean age of 14 to 18 years and synchronous telehealth use. Articles published in English; publication dates and geographic location were not excluded. A total of 1091 articles were obtained after duplications were discarded. Three reviewers, working in pairs, independently reviewed each citation against predetermined criteria. Joanna Briggs Scoping Review Methodology, the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Review process organized the findings. The 9 articles that met the criteria were case reports, descriptive, qualitative, mixed methods, and a partially randomized patient preference pilot study. There were 416 adolescent participants (mean age = 15.74 years). Five themes synthesized the findings: "established relationship prior to telemental health," "diagnoses best suited for telemental health," "role of technology," "therapeutic space and privacy," and "appointment attendance." A recommendation emerged in offering a hybrid approach. However, many barriers still exist in the complex, high-risk, and geographically challenged patient. Telemental health can bridge the divide between those who traditionally cannot access treatment, but providers must learn how to develop relationships virtually. Another recommendation is to allow adolescents alone time and privacy with the provider. Further research is needed to assess therapeutic alliance using telehealth between adolescents and clinicians in the postpandemic era, particularly from the adolescents' perspective. Limitations included that three studies occurred before March 2020, when the SARS-CoV-2 (COVID-19) pandemic started, and the remaining articles occurred during the pandemic when social distancing measures were in place. Therefore, this limited study methods to single-group designs, and many of the participants already established a relationship with their provider before shifting to telehealth, so there was less focus on the initiation of therapeutic alliance via telehealth.