Skip to main content
SpringerLink
Log in

Change to the Therapeutic Frame: Exploring the Therapeutic Alliance When Transitioning from Face-to-Face Therapy to Videoconferencing

  • ORIGINAL ARTICLE
  • Published:
International Journal for the Advancement of Counselling Aims and scope Submit manuscript

Abstract

The use of videoconferencing to deliver therapeutic services to clients has increased in recent times amongst mental health clinicians such as counsellors, psychologists, and psychotherapists. During lockdown periods associated with the COVID pandemic, most Australian mental health clinicians were required to transition their existing therapy clients from face-to-face to telehealth. The aim of the current study was to explore mental health clinicians’ experiences transitioning their existing therapy clients from a face-to-face modality to video conferencing, in order to understand potential implications to the therapeutic alliance. The study had a qualitative design using semi-structured interviews with 16 practicing psychologists. Inductive thematic analysis of the interviews revealed several unique findings. Psychologists reported that the change of frame, from face-to-face to videoconferencing, was helpful or unconstructive to the therapeutic alliance depending on client’s attitudes towards telehealth. Challenges for the therapeutic alliance included a lack of control over the environmental conditions and disruptions caused to the previously arranged tasks and goals of therapy. What helped the therapeutic alliance navigate the change of frame, was innovating news ways of working collaboratively, the prior establishment of a bond in person, and maintaining other aspects of the frame with consistently. The implications of these findings are discussed herein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Akhtar, S. (2018). Unusual interventions: alterations of the frame, method, and relationship in psychotherapy and psychoanalysis ((1st ed). ed.). Routledge.

    Book  Google Scholar 

  • Bashshur, R. L., Howell, J. D., Krupinski, E. A., Harms, K. M., Bashbur, N., & Doarn, C. R. (2016). The empirical foundations of telemedicine interventions in primary care. Telemedicine Journal and e-health, 22(5), 342–375. https://doi.org/10.1089/tmj.2016.0045

    Article  PubMed Central  PubMed  Google Scholar 

  • Batastini, A. B., Jones, A. C. T., Lester, M. E., & Davis, R. M. (2020). Initiation of a multidisciplinary telemental health clinic for rural justice-involved populations: rationale, recommendations, and lessons learned. Journal of Community Psychology, 48(7), 2156–2173. https://doi.org/10.1002/jcop.22424

    Article  PubMed  Google Scholar 

  • Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.

    Google Scholar 

  • Berger, T. (2017). The therapeutic alliance in internet interventions: a narrative review and suggestions for future research. Psychotherapy Research, 27(5), 511–524. https://doi.org/10.1080/10503307.2015.1119908

    Article  PubMed  Google Scholar 

  • Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.

    Article  Google Scholar 

  • Boudreaux-Ramirez, Z. (2022). Utilization of telemental health by mental health professionals during covid-19. Electronic Theses, Projects, and Dissertations, 1411.

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

    Article  Google Scholar 

  • Bromberg, P. M. (2007). The analytic moment doesn’t fit analytic “technique”: commentary on Tony Bass’s “when the frame doesn’t fit the picture”. Psychoanalytic Dialogues, 17(6), 909–921. https://doi.org/10.1080/10481880701704068

    Article  Google Scholar 

  • Burgoyne, N., & Cohn, A. S. (2020). Lessons from the transition to relational teletherapy during COVID-19. Family Process, 59(3), 974–988. https://doi.org/10.1111/famp.12589

    Article  PubMed Central  PubMed  Google Scholar 

  • Cherry, E. F., & Gold, S. N. (1989). The therapeutic frame revisited: a contemporary perspective. Psychotherapy: Theory, Research, Practice, Training, 26(2), 162–168. https://doi.org/10.1037/h0085415

    Article  Google Scholar 

  • Connolly, S. L., Miller, C. J., Lindsay, J. A., & Bauer, M. (2020). A systematic review of providers’ attitudes towards telemental health via videoconferencing. Clinical Psychology Science and Practice, 27, 1–19. https://doi.org/10.1111/cpsp.12311

    Article  Google Scholar 

  • Cowan, K. E., McKean, A. J., Gentry, M. T., & Hilty, D. M. (2019). Barriers to use of telepsychiatry: clinicians as gatekeepers. Mayo Clinical Proceedings, 94(12), 2510–2523. https://doi.org/10.1016/j.mayocp.2019.04.018

    Article  Google Scholar 

  • Downing, L., & Marriot, H. (2020). Mapping Australian psychologists’ experiences of telehealth during the COVID-19 pandemic [White paper]. Affect Media. Retrieved June 16, 2021, from https://www.affectmedia.com.au/wp-content/uploads/2020/06/Telehealth-and-Psychology-WhitePaper_2020.pdf

  • Epstein, R. S. (1994). Keeping boundaries: maintaining safety and integrity in the psychotherapeutic process. American Psychiatric Press.

    Google Scholar 

  • Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvarth, A. O. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172

    Article  PubMed  Google Scholar 

  • Flückiger, C., Rubel, J., Del Re, A. C., Horvath, A. O., Wampold, B. E., Crits-Christoph, P., Atzil-Slonim, D., Compare, A., Falkenstrom, F., Ekebald, A., Errazuriz, P., Fisher, H., Hoffart, A., Huppert, J. D., Kivity, Y., Kumar, M., Lutz, W., Muran, J. C., Strunk, D. R., et al. (2020). The reciprocal relationship between alliance and early treatment symptoms: a two-stage individual participant data meta-analysis. Journal of Consulting and Clinical Psychology, 88(9), 829–843. https://doi.org/10.1037/cou0000424

    Article  PubMed  Google Scholar 

  • Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth benefits and barriers. The Journal for Nurse Practitioners, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013

    Article  PubMed  Google Scholar 

  • Germain, V., Marchand, A., Bouchard, S., Guay, S., & Drouin, M. S. (2010). Assessment of the therapeutic alliance in face-to-face of videoconference treatment for posttraumatic stress disorder. Cyberpsychology, Behaviour and Social Networking, 13, 29–35. https://doi.org/10.1089/cpb.2009.0139

    Article  Google Scholar 

  • Gold, S. N., & Cherry, E. F. (1997). The therapeutic frame: on the need for flexibility. Journal of Contemporary Psychotherapy, 27(2), 147–155. https://doi.org/10.1023/A:1025664228870

    Article  Google Scholar 

  • Haigh, F., Kemp, L., Bazeley, P., & Haigh, N. (2019). Developing a critical realist informed framework to explain how the human rights and social determinants of health relationships works. BMC Public Health, 19, 1–12. https://doi.org/10.1186/s12889-019-7760-7

    Article  Google Scholar 

  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experiential approach to behaviour change. Guilford Press.

    Google Scholar 

  • Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: a 2013 review. Telemedicine Journal and E-Health, 19(6), 444–454. https://doi.org/10.1089/tmj.2013.0075

    Article  PubMed Central  PubMed  Google Scholar 

  • Howgego, I. M., Yellowlees, P., Owen, C., Meldrum, L., & Dark, F. (2003). The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Australian & New Zealand Journal of Psychiatry, 37(2), 169–183. https://doi.org/10.1046/j.1440-1614.2003.01131.x

    Article  Google Scholar 

  • Kaźmierczak, I., Zajenkowska, A., Rogoza, R., Jonason, P. K., & Ścigała, D. (2023). Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants. PlosOne, 18(3), e0281046. https://doi.org/10.1371/journal.pone.0281046

    Article  Google Scholar 

  • Khoshrounejad, F., Hamednia, M., Mehrjerd, A., Pichaghsaz, S., Jamalirad, H., Sargolzaei, M., Hoseini, B., & Aalaei, S. (2021). Telehealth-based services during the COVID-19 pandemic: a systematic review of features and challenges. Frontiers In Public Health, 9, 711762. https://doi.org/10.3389/fpubh.2021.711762

    Article  PubMed Central  PubMed  Google Scholar 

  • Kirkbride, R. (2016). Contracting and establishing the therapeutic frame. In R. Kirkbride (Ed.), Counselling children and young people in private practice: a practical guide (pp. 25–43). Karnac Books.

    Google Scholar 

  • Kirkwood, K. (1998). The validity of cognitive assessments via telecommunications links. PhD thesis, University of Edinburgh, Scotland.

    Google Scholar 

  • Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the national institute of mental health treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology, 64(3), 532–539. https://doi.org/10.1037//0022-006x.64.3.532

    Article  PubMed  Google Scholar 

  • Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open, 7(8). https://doi.org/10.1136/bmjopen-2017-016242

  • Kullgard, N., Holmqvist, R., & Andersson, G. (2022). Premature dropout from psychotherapy: prevalence, perceived reasons and consequences as rated by clinicians. Clinical Psychology In Europe, 4(2), 1–16. https://doi.org/10.32872/cpe.6695

    Article  Google Scholar 

  • Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Trainin, 38(4), 357–361. https://doi.org/10.1037/0033-3204.38.4.357

    Article  Google Scholar 

  • Langs, R. (1982). Psychotherapy: a basic text. Jason Aronson.

    Google Scholar 

  • Lin, T., Stone, S. J., Heckman, T. G., & Anderson, T. (2021). Zoom-in to zone-out: therapists report less therapeutic skill in telepsychology versus face-to-face therapy during the COVID-19 pandemic. American Psychological Association, 58(4), 449–459. https://doi.org/10.1037/pst0000398449

    Article  Google Scholar 

  • Lindhiem, O., Bennett, C. B., Trentacosta, C. J., & McLear, C. (2014). Client preferences affect treatment satisfaction, completion, and clinical outcome: a meta-analysis. Clinical Psychology Review, 34(6), 506–517. https://doi.org/10.1016/j.cpr.2014.06.002

    Article  PubMed Central  PubMed  Google Scholar 

  • Luo, C., Sanger, N., Singhal, N., Pattrick, K., Shams, L., Shahid, H., Hoang, P., Schmidt, J., Lee, J., Haber, S., Puckering, M., Buchanan, N., Lee, P., Ng, K., Sun, S., Kheyson, S., Cho-Yan Chung, D., Sanger, S., Thabane, L., & Samaan, Z. (2020). A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: a systematic review and meta-analysis. EClinical Medicine, 24. https://doi.org/10.1016/j.eclinm.2020.100442

  • Maier, C. A., Riger, D., & Morgan-Sowada, H. (2021). “It’s splendid once you grow into it:” client experiences of relational teletherapy in the era of COVID-19. Journal of Marital Family Therapy, 47, 304–319. https://doi.org/10.1111/jmft.12508

    Article  PubMed  Google Scholar 

  • Martin, D. J., Garske, J. P., & Davis, K. (2000). Relation of the therapeutic alliance with outcome and other variables: a metanalytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.

    Article  PubMed  Google Scholar 

  • McCoyd, J. L., Curran, L., Candelario, E., & Findley, P. (2022). “There is just a different energy”: changes in the therapeutic relationship with the telehealth transition. Clinical Social Work Journal, 50(3), 325–336. https://doi.org/10.1007/s10615-022-00844-0

    Article  PubMed Central  PubMed  Google Scholar 

  • McLeod, J. (2013). Developing pluralistic practice in counselling and psychotherapy: using what the client knows. European Journal of Counselling Psychology, 2(1), 51–64.

    Article  Google Scholar 

  • Mohr, D. C., Ho, J., Duffecy, J., Reifler, D., Sokol, L., Burns, M. N., Jin, L., & Siddique, J. (2012). Effect of telephone-administered vs face-to-face cognitive behavioural therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. JAMA, 307(21), 2278–2285. https://doi.org/10.1001/jama.2012.5588

    Article  PubMed Central  PubMed  Google Scholar 

  • Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health, 20. https://doi.org/10.1186/s12889-020-09301-4

  • Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy, 48(1), 4–8. https://doi.org/10.1037/a0022180

    Article  PubMed  Google Scholar 

  • Norwood, C., Moghaddadam, N. G., Malins, S., & Sabin-Farrell, R. (2018). Working alliance and outcome effectiveness in videoconferencing psychotherapy: a systematic review and noninferiority meta-analysis. Clinical Psychology & Psychotherapy, 25, 797–808. https://doi.org/10.1002/cpp.2315

    Article  Google Scholar 

  • Orlando, J. F., Beard, M., & Kumar, S. (2019). Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health. PLOS One, 14(8). https://doi.org/10.1371/journal.pone.0221848

  • Perle, J. G., Langsam, L. C., Lutchman, S., Levine, A. B., Odland, A. P., Nierenberg, B., & Marker, C. D. (2013). Attitudes toward psychological telehealth: current and future clinical psychologists’ opinions of internet-based interventions. Journal of Clinical Psychology, 69(1), 100–113. https://doi.org/10.1002/jclp.21912

    Article  PubMed  Google Scholar 

  • Rasmussen, B., Perry, R., Hickey, M., Hua, X., Wong, Z. W., Guy, L., Hitch, D., Hiscock, H., Dalziel, K., Winter, N., & Maier, A. B. (2022). Patient preferences using telehealth during the COVID-19 pandemic in four Victorian tertiary hospital services. Internal Medicine Journal, 52(5), 763–769. https://doi.org/10.1111/imj.15726

    Article  PubMed Central  PubMed  Google Scholar 

  • Richardson, L., Reid, C., & Dziurawiec, S. (2015). “Going the extra mile”: satisfaction and alliance from an evaluation of videoconferencing telepsychology in rural Western Australia. Australian Psychologist, 50(4), 252–258. https://doi.org/10.1111/ap.12126

    Article  Google Scholar 

  • Ring, M., & Gysin-Maillart, A. (2020). Patients’ satisfaction with the therapeutic relationship and therapeutic outcome is related to suicidal ideation in the attempted suicide short intervention program (ASSIP). The Journal of Crisis Intervention and Suicide Prevention, 41(5), 337–343. https://doi.org/10.1027/0227-5910/a000644

    Article  Google Scholar 

  • Ruwaard, J., Schrieken, B., Schrijver, M., Broeksteeg, J., Dekker, J., Vermeulen, H., & Lange, A. (2009). Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cognitive Behaviour Therapy, 38(4), 206–221. https://doi.org/10.1080/16506070802408086

    Article  PubMed  Google Scholar 

  • Safran, J. D., & Kraus, J. (2014). Alliance ruptures, impasses, and enactments: a relational perspective. Psychotherapy, 51(3), 381–387. https://doi.org/10.1037/a0036815

    Article  PubMed  Google Scholar 

  • Schmidt, J. (2016). Recognise, repair, and resolve: understanding ruptures within the therapeutic alliance. Masters Thesis, St. Catherine University, and the University of St. Thomas.

    Google Scholar 

  • Seeman, G. (2013). Getting the most out of psychotherapy. Psych Central. Retrieved June 16, 2021, from https://psychcentral.com/lib/getting-the-most-out-of-psychotherapy/

  • Simms, D. C., Gibson, K., & O’Donnell, S. (2011). To use or not to use: clinicians’ perceptions of telemental health. Canadian Psychology, 52(1), 41–51. https://doi.org/10.1037/a0022275

    Article  Google Scholar 

  • Simpson, S., Richardson, L., Pietrabissa, G., Castelnuovo, G., & Reid, C. (2021). Videotherapy and therapeutic alliance in the age of COVID-19. Clinical Psychology & Psychotherapy, 1–13. https://doi.org/10.1002/cpp.2521

  • Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychopathology: a review. Australian Journal of Rural Health, 22(6). https://doi.org/10.1111/ajr.12149

  • Taylor, A., Caffery, L. J., Gesesew, H. A., King, A., Bassal, A. R., Ford, K., Kealey, J., Maeder, A., McGuirk, M., Parkes, D., & Ward, P. R. (2021). How Australian health care services adapted to telehealth during the COVID-19 pandemic: a survey of telehealth professionals. Frontiers in Public Health, 9, 648009. https://doi.org/10.3389/fpubh.2021.648009

    Article  PubMed Central  PubMed  Google Scholar 

  • Thaker, D. A., Moneypenny, R., Olver, I., & Sabesan, S. (2013). Cost savings from a telemedicine model of care in northern Queensland, Australia. Medical Journal of Australia, 199(6), 414–417. https://doi.org/10.1111/ajo.13452

    Article  PubMed  Google Scholar 

  • Thompson, R. B. (2016). Psychology at a distance: examining the efficacy of online therapy. Honours Thesis, Portland State University.

    Book  Google Scholar 

  • Tremain, H., McEnery, C., Fletcher, K., & Murray, G. (2020). The therapeutic alliance in digital mental health interventions for serious mental illnesses: narrative review. JMIR Mental Health, 7(8). https://doi.org/10.2196/17204

  • Tri Atmojo, J., Tri Sudaryanto, W., Ernawati, A. W., & Arradini, D. (2020). Telemedicine, cost effectiveness, and patients’ satisfaction: a systematic review. Journal of Health Policy and Management, 5(2), 103–107. https://doi.org/10.26911/thejhpm.2020.05.02.02

    Article  Google Scholar 

  • Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2018). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: a rapid evidence assessment. Psychological Services, 16(4), 621–635. https://doi.org/10.1037/ser0000239

    Article  PubMed  Google Scholar 

  • Werbart, A., Bylehn, L., Jansson, T. M., & Philips, B. (2022). Loss of rituals, boundaries, and relationship: patient experiences of transition to telepsychotherapy following the onset of COVID-19 pandemic. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.835214

  • Wootton, R., Yellowlees, P., & McLaren, P. (2003). Telepsychiatry and e-mental health. Royal Society of Medicine Press.

    Google Scholar 

  • Young, J. E. (1990). Cognitive therapy for personal disorders: a schema-focused approach. Professional Resource Exchange, Inc.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, Australia

    Anthony Shoullis, Simone Mohi, Elly Quinlan, James Collison & Georgia Braude

Authors
  1. Anthony Shoullis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Mohi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elly Quinlan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Collison
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Georgia Braude
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elly Quinlan.

Ethics declarations

Competing Interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shoullis, A., Mohi, S., Quinlan, E. et al. Change to the Therapeutic Frame: Exploring the Therapeutic Alliance When Transitioning from Face-to-Face Therapy to Videoconferencing. Int J Adv Counselling 45, 458–474 (2023). https://doi.org/10.1007/s10447-023-09516-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10447-023-09516-1

Keywords

Search

Navigation