The therapeutic relationship in videoconferencing psychotherapy: a qualitative study of therapists’ experiences

Objective: The growth of videoconferencing psychotherapy (VP) requires a closer conceptualization of the therapeutic relationship in VP. Therefore, we investigated the therapeutic relationship in VP from the clinicians’ perspective. Method: We conducted three focus groups with 27 Italian VP professional psychotherapists of different theoretical orientations, focusing on their experience of the therapeutic relationship in VP. Data analysis was conducted through inductive thematic analysis. Results: The following themes emerged: (a) construction and management of the online setting (regarding the complexity of the therapeutic boundaries in VP and the efforts to manage this); (b) meaning construction of the request for help and the therapeutic process (regarding how patients and therapist represent the meaning of the therapeutic space and work in VP); (c) patient and therapist involvement in the online relationship (addressing the depth of the therapeutic relationship in VP in terms of intimacy, openness/closure, distance/closeness, and involvement); (d) new elements of the therapeutic relationship introduced by VP (regarding the source and nature of information about the patient and the effects of the technical environment on the relationship); (e) nonverbal aspects and corporeality in VP (dealing with how different aspects of para-and extralinguistic communication may impact the therapeutic relationship in VP); (f) differences in the quality of the emotional and relational level of VP (regarding the emotional attitudes and reactions of patients and therapists and the overall quality of the therapeutic relationship); (g) treatment satisfaction and drop-out (regarding ease of leaving the session, patient satisfaction, and difficulties in terminating therapy); and (h) personal characteristics of patient and therapist that influence VP (regarding the impact of patients personality and therapists training/approach on the progress of VP). Conclusions:Results suggest that the therapeutic relationship in VP has specific features that distinguish it from face-to-face psychotherapy. Implications for practice, training, and research are discussed.