Adapting to expectancy violations during telehealth interactions with clients: Communication and technological...

Counselors used mediated channels to offer therapy to clients during the COVID-19 Pandemic. Virtual therapy is convenient, yet recent research suggests it may not be an appropriate modality for all clients. In this study, we interviewed counselors to learn about their experiences of challenging or confronting clients virtually in the United States by integrating interaction adaption theory with frameworks of technological affordances of care. In-depth interview data from 31 counselors suggest their ability to read body language cues, a need for privacy, and lack of distractions are requirements when issuing challenges. Counselors' experienced expectancy violations such as clients walking away from the camera, shouting, making faces, and being silent. Counselors' desire to build rapport, have therapeutic sessions, and to want to be in control while helping clients navigate turbulent emotions during a challenge were often thwarted due to the online modality. Counselors adjusted to telehealth limitations while challenging clients by focusing on visual cues such as facial expressions and tone of voice, which are technological affordances in virtual therapy. Other counselors sought clarification regarding non-verbal cues such as silence and facial expressions. Counselors adapted to expected violations using compensation and reciprocity. Counselors' requirements, expectancies and desires seem to inform their interactional position toward issuing a challenge. Counselors who understand and adapt to the affordances of technology during virtual therapy may be in a better position to successfully challenge clients. Thus, this study extends previous research on mental telehealth care during the pandemic by integrating a communication lens of interaction adaptation theory with the literature on the role of technology in virtual therapy to examine the technological affordances during counselor and client interactions.