Acuity, Diagnosis, and Community Factors in Virtual and In-Person Treatment: Qualitative Study

Area of Science:

• Mental Health
• Psychotherapy Research
• Telehealth Studies

Background:

• The COVID-19 pandemic rapidly increased virtual psychotherapy adoption, highlighting its importance for care continuity.
• Concerns exist regarding virtual care's impact on therapeutic relationships, community, and support for complex clinical needs.

Purpose of the Study:

• To compare virtual and in-person mental health care mediums.
• To evaluate impacts on therapeutic relationships, community dynamics, clinical presentation, and clinician skill utilization.

Main Methods:

• Grounded theory design with intensive outpatient mental health clients and clinicians.
• Six structured focus groups (clients and clinicians) were conducted.
• Thematic analysis of transcripts until theoretical saturation.

Main Results:

• In-person treatment enhances client-clinician engagement and interpersonal connection (therapeutic alliance, peer support).
• Virtual care showed nuanced differences in relational dynamics and perceived effectiveness.
• In-person care is more effective for clients with high acuity and complex diagnoses, supporting clinical skills.

Conclusions:

• The medium of care significantly impacts therapeutic experience for both clients and providers.
• Community, relationships, and clinical skills are affected by care modality.
• Client acuity and diagnosis are critical factors in selecting virtual or in-person care.