The Counseling Relationship in Online Psychotherapy: What Does the Research Say?

Counseling Relationship

My previous article on online counseling defined and explored the impact of technological counseling on the nature of the therapeutic relationship. This article takes this discussion a bit deeper through exploring some of the research into establishing and maintaining a counseling relationship in online psychotherapy. As discussed in the previous article, the relationship between counselor and client is viewed as paramount to a successful therapeutic process. It also explored some of the challenges to developing such a relationship online, pointed to the evidence that suggests that online psychotherapy is at least as efficacious as traditional counseling and offered some possible explanations for this. But what does the research say about online relationships between clients and counselors?

A limited number of studies exploring the counseling relationship in online psychotherapy are available.

Hufford, Glueckauf, & Webb, 1999 (cited in  Richards and Vigano, 2012) compared the therapeutic relationship in video conferencing and face-to-face counseling in a teenage population. They found that the teenagers reported a higher level of alliance in the face to face setting. In contrast another older study (Cohen & Kerr, 1998 cited in Richards and Vigano, 2012) described comparable ratings from clients in online and face to face settings with regards to their perceptions of the expertise, appeal and trustworthiness of their therapist. Clients rated face to face counselling higher with regards to levels of arousal but reported similar ratings for depth and positivity between online and face-to-face settings.

Similarly Cook and Doyle (2002 cited in Richards and Vigano, 2012) found comparable scores with regard to the therapeutic alliance when comparing online psychotherapy to face-to-face settings. Online clients also subjectively reported feeling a strong bond with their counselors. Prado and Meyer (2004 cited in Richards and Vigano, 2012)) reported that clients and counselors in online settings were able to generate a solid working alliance. Another study (see Mallen et al., 2005 cited in Richards and Vigano, 2012) found that traditional psychotherapy was better than online communication in creating a therapeutic relationship, but in terms of emotional understanding the two approaches were comparable. A study by McKenna and Bargh (2000 cited in Richards and Vigano, 2012) identified that socially isolated and anxious clients who struggled to form relationships had a greater likelihood of forming deep and sustainable relationships online.

While some of these earlier studies point to a stronger relationship in a face-to-face setting, most point to comparable perceptions of the therapeutic relationship in traditional versus online psychotherapy. The perspective of a comparable level of alliance in traditional and online psychotherapy is increasingly endorsed by later studies that indicate the viability of developing online counseling relationships (Hanley, 2009; Leibert, Archer, Munson, & York, 2006; Reynolds et al., 2006 all cited in Richards and Vigano, 2012)).

Many of these studies have major methodological limitations including poor or no face-to face comparison groups as well as small sample sizes. Many of them have a more qualitative analytical approach which brings with it a lot of richness and understanding of the issue under investigation but does not contribute to debates regarding the efficacy or validity of online psychotherapy. Clearly more research is needed in order to more thoroughly evaluate the efficacy and nature of the therapeutic relationship in online psychotherapy. In particular there is a need for larger more scientifically validated studies. There is also a need for studies that explore whether indeed the features of the therapeutic relationship that play a key role in traditional psychotherapy have the same kind of facilitative function in online psychotherapy (Richards and Vigano, 2012). For instance King et al. (2006 cited in Richards and Vigano, 2012) identified that session impact had a stronger mediating effect than the working alliance in an online psychotherapy setting. Other studies point to unique considerations and modifications in the therapeutic relationship that need to be incorporated when working online (Anthony, 2000). These include approaches to building trust, communicating empathy, structuring and deepening the therapeutic alliance (Fletcher-Tomenius and Vossler, 2009 and Ekberg, Barnes, Kessler, Malpass, and Shaw, 2013). A great deal more exploration is required in building a more full understanding of the therapeutic relationship in online psychotherapy.

References:

Anthony, K. (2000) The nature of the therapeutic relationship within online counselling. Thesis submitted as part of requirements toward an MSc in Therapeutic Counselling.

Ekberg, S., Barnes, R., Kessler, D., Malpass, A., & Shaw, A. (2013). Managing the therapeutic relationship in online cognitive behavioral therapy for depression: Therapists’ treatment of clients’ contributions. Language@Internet, 10, article 4. (urn:nbn:de:0009-7-36986)

Fletcher-Tomenius, Leon and Vossler, Andreas (2009). Trust in Online Therapeutic Relationships: The Therapist’s Experience. Counselling Psychology Review, 24(2) pp. 24–34.

Richards, D. and Vigano, N. (2012) Chapter 59: Online Counseling pp. 699-707.  In Yan, Z (Editor) (2012) Encyclopedia of cyber behavior.  University of Albany, U.S.A.