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The relationship 

It is widely recognised that the relationship is the biggest factor in a client’s progress during therapy and, as this relationship also has the power to allow the client to view other relationships more positively, it is obviously crucial that it is not hindered by an online presence. This can be a concern for some clients, though, resulting in a reluctance to work online. 

Whilst there is a physical distance between the client and the therapist online, in practice, the screen allows for people to move nearer to it, meaning that, in one sense, the client and therapist are, in fact, physically closer. 

Historically, online therapy was fairly specialist and sometimes viewed as secondary to face to face therapy but the necessity to work online, created by the pandemic, allowed for rapid movement in the development of this form of working and forged a need to research its effectiveness on a larger scale. Research has found that positive therapeutic relationships can be formed via video therapy, providing that the therapist is confident in working online and that the client’s issues are carefully considered in terms of appropriateness, therefore there is a need for therapists to have appropriate online training. 

The power dynamic within a therapy room can be a potential barrier to the therapeutic relationship, with the therapist in the comfort of their room and the client having to enter a space in which they lack that security. Clients may, therefore, be more inclined to open up in the safety of their own home, so working online can help to dissolve the power imbalance and encourage openness.  

What does the research say? 

One study, by Preschl, Maercker and Wagner (2011), discovered, in a comparison of face to face and online CBT, that relationships were just as strong online, and Watts et al. (2020), discovered a potentially stronger therapeutic relationship in clients engaging in online CBT. Simpson et al. (2009) also found that online clients felt ‘less self-conscious and intimidated’ and Mitchell’s recent study (2020) found that online clients tend to ‘emerge with higher levels of hope.’  

Online therapy can also mean that clients seek help who may be generally more reluctant to engage, and a study by McKenna and Bargh (2000) found that those who struggled with relationships may actually create stronger therapeutic relationships online. Online therapy has, therefore, increased access, such as to those with neurodiversity or social anxiety, for example, as well as to those with physical disabilities. 

How effective is it? 

Recent studies suggest that, whilst there are challenges in working online, and client presentation needs to be considered carefully, it is perfectly possible to form a close therapeutic relationship online and have equally successful outcomes. With some clients, this may be the only form of therapeutic relationship with which they feel comfortable, therefore it has increased access and thus increased connection. It is clear, though, that therapists need to be confident and competent, to contract appropriately and adapt to this way of working, therefore training is key in forming a strong online therapeutic relationship. 

25th August 2023