The therapeutic alliance during remotely delivered therapy: A Delphi study with health professionals

Delivering psychological therapy via videoconferencing and telephone is now commonplace across mental health services, but many therapists remain concerned about the impact on the therapeutic alliance. This study aimed to establish consensus amongst psychological therapists regarding the factors involved in establishing and maintaining the therapeutic alliance during remote therapy interventions.

Psychological therapists from a range of professional backgrounds were invited to complete a three-Round Delphi survey online. Round 1 generated qualitative data which was used to develop a list of statements relating to key factors in establishing and maintaining alliance in therapy delivered over the telephone or videoconferencing. Participants were invited to rate their level of agreement with these statements in Rounds 2 and 3.

Of the 149 participants who completed Round 1, 93 completed Round 2, and 71 participants completed all three Rounds. Following Round 3, a high level of agreement (above 80%) was obtained in relation to 31/63 statements reflecting communication style, contracting, quality and value, environment, emotional differences, effort, and technological aspects of engaging clients in this way. Participants reported similar views for therapies delivered via telephone and videoconferencing.

Clinicians who have had to navigate the rapid rise in online delivery of therapy have valuable insights which warrant sharing amongst communities of practicing therapists and those in training. Identifying factors which therapists agree are important in developing alliances with patients remotely also guides researchers in identifying factors that warrant further investigation through empirical studies.