Psychologists' and patients' views on empathy in teletherapy: A mixed-methods study

Empathy is key to successful psychotherapy. However, how it is experienced and communicated in teletherapy remains poorly understood despite the widespread use of this modality. The current study compared how psychologists and patients view empathy and its communication in teletherapy.

A convergent mixed-methods design was used with separate samples of psychologists (n = 92) and adult patients (n = 80) who completed online questionnaires on empathy, alliance, telepresence, and attitudes, along with open-ended questions on empathy and its communication. Quantitative and qualitative strands were merged through a side-by-side joint display analysis.

Patients perceived significantly more empathy than psychologists reported feeling during teletherapy. Psychologists found videoconference therapy to be more demanding, particularly due to technical issues and unfamiliarity. Patients more strongly believed that telepresence and a strong alliance help compensate for the shortcomings of this modality. Despite these differences, members of both groups broadly agreed on the definition of empathy and on the best ways to communicate it during teletherapy, identifying compensatory strategies and key markers of empathy.

Although they shared similar views on empathy, patients rated their psychologists as more empathic than psychologists rated themselves in teletherapy. This pattern emerged at a time when this modality was being rapidly integrated into clinical practice, and both samples had limited experience with it. These findings reinforce the value of this modality and highlight the need to support clinicians unfamiliar with it.

Understanding how patients interpret empathy can help psychologists tailor their communication to meet those expectations. Training and peer support could help reduce psychologists' perceptions of added burden and better target the skills that strengthen empathic communication in teletherapy. Priorities include using salient nonverbal cues, making explicit verbal checks, inviting routine patient feedback, and allowing more time to build attunement to patient expectations.