An explanatory sequential investigation of the working alliance as a change process in videoconferencing psychotherapy
Open accessAbstract
OBJECTIVES AND DESIGN: Debate exists as to patient experience, and the importance, of the working alliance (WA) in videoconferencing psychotherapy (VCP). This study used a two-phase explanatory sequential design to investigate the WA as a change process in VCP. METHODS: Phase I: sessional VCP outcome and WA data were analysed using multilevel modelling (n = 46). Phase II: participants (n = 12) from Phase I were recruited to semi-structured interviews, analysed using thematic framework analysis. RESULTS AND CONCLUSIONS: Results demonstrate: (1) a significant correlation between WA and outcome (F(1, 15.19) = 25.01, p < 0.001), (2) previous session WA significantly predicted outcome in the next session (F(1, 355.61) = 4.47, p < 0.05), and (3) previous session outcome significantly predicted next session WA (F(1, 55.3) = 15.19, p < 0.001), with three core themes explaining patient experience (engaging with the medium, connection with the therapist, and working via the medium). Results are discussed and future research recommended.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the context of a non-inferiority trial, the higher working alliance and perceived therapist competence in VCP were interpreted as suggesting that VCP may not be less effective than face-to-face CBT.
“In the context of a non-inferiority trial, these results were interpreted as suggesting that VCP may not be less effective than face-to-face CBT (for more on the treatment alliance in VCP, see also [34,82,83,84]).”
Cites
Society and the Adolescent Self-Image
Rosenberg, M. (1965) · doi:10.1515/9781400876136 · Cited by 30,126 · see citing works
How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability
Guest, G., Bunce, A., & Johnson, L. (2006) · Field Methods · doi:10.1177/1525822x05279903 · Cited by 20,808 · see citing works
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-013-0528-y · Cited by 12,038 · see citing works
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013) · BMC Medical Research Methodology · doi:10.1186/1471-2288-13-117 · Cited by 10,865 · see citing works
(1995) · Cited by 6,909 · see citing works
Multilevel analysis : an introduction to basic and advanced multilevel modeling
Snijders, T. A. B., & Bosker, R. (1999) · Cited by 6,830 · see citing works
Achieving integration in mixed methods designs-principles and practices
Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013) · Health Services Research · doi:10.1111/1475-6773.12117 · Cited by 5,772 · cited 1× · see citing works
“An explanatory sequential design was used (Fetters et al., 2013), wherein the quantitative aspect of the study (Phase I; multilevel modelling [MLM] of quantitative data) precedes and informs the qualitative analysis (Phase II; semi‐structured participant interviews).”
MethodThe generalizability of the psychoanalytic concept of the working alliance.
Bordin, E. S. (1979) · Psychotherapy: Theory, Research & Practice · doi:10.1037/h0085885 · Cited by 5,238 · see citing works
Qualitative data analysis for applied policy research
(2002) · Analyzing Qualitative Data · doi:10.4324/9780203413081-14 · Cited by 4,964 · see citing works
Qualitative data analysis for applied policy research
Ritchie, J., & Spencer, L. (2010) · Analyzing qualitative data · doi:10.4324/9780203413081_chapter_9 · Cited by 4,800 · see citing works
Development and validation of the working alliance inventory
Horvath, A. O., & Greenberg, L. S. (1989) · Journal of Counseling Psychology · doi:10.1037//0022-0167.36.2.223 · Cited by 3,520 · see citing works
Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review
Martin, D. J., Garske, J. P., & Davis, M. K. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.3.438 · Cited by 3,355 · see citing works
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015) · Psychological Medicine · doi:10.1017/s0033291714000129 · Cited by 3,152 · see citing works
Resilience in the Face of Catastrophe: Optimism, Personality, and Coping in the Kosovo Crisis
Riolli, L., Savicki, V., & Cepani, A. (2002) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.2002.tb02765.x · Cited by 2,166 · see citing works
The alliance in adult psychotherapy: A meta-analytic synthesis
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018) · Psychotherapy · doi:10.1037/pst0000172 · Cited by 1,763 · cited 10× · see citing works
“The 46 participants used in Phase I met the following eligibility criteria: (1) received VCP CBT as part of the source RCT; (2) attended two or more VCP sessions; (3) completed outcome measures for at least two appointments.”
BackgroundResultInfluentialLee, K. M. (2004) · Communication Theory · doi:10.1111/j.1468-2885.2004.tb00302.x · Cited by 1,631 · see citing works
SALKOVSKIS, P. M., RIMES, K. A., WARWICK, H. M. C., & CLARK, D. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702005822 · Cited by 1,351 · see citing works
A review of therapist characteristics and techniques positively impacting the therapeutic alliance
Ackerman, S. J., & Hilsenroth, M. J. (2003) · Clinical Psychology Review · doi:10.1016/s0272-7358(02)00146-0 · Cited by 1,176 · see citing works
Coronaphobia: Fear and the 2019-nCoV outbreak
Asmundson, G. J. G., & Taylor, S. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102196 · Cited by 1,103 · see citing works
Sirey, J. A., Bruce, M. L., Alexopoulos, G. S., Perlick, D. A., Friedman, S. J., & Meyers, B. S. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.12.1615 · Cited by 796 · see citing works
The COVID-19 pandemic: the ‘black swan’for mental health care and a turning point for e-health
Wind, T. R., Rijkeboer, M., Andersson, G., & Riper, H. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100317 · Cited by 782 · see citing works
A research approach to improving our quality of life.
Flanagan, J. C. (1978) · American Psychologist · doi:10.1037/0003-066x.33.2.138 · Cited by 755 · see citing works
Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.6.842 · Cited by 646 · see citing works
Jungmann, S. M., & Witthöft, M. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102239 · Cited by 635 · see citing works
The revised cognitive therapy scale (CTS-R): psychometric properties.
Blackburn, I.-M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., & Reichelt, F. K. (2001) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465801004040 · Cited by 568 · see citing works
Miller, S. D., Duncan, B. L., & Brown, J. (2003) · Cited by 445 · see citing works
Therapeutic alliance in videoconferencing psychotherapy: A review
Simpson, S. G., & Reid, C. L. (2014) · Australian Journal of Rural Health · doi:10.1111/ajr.12149 · Cited by 420 · see citing works
The Revised Helping Alliance Questionnaire (HAq-II) : Psychometric Properties.
(1996) · PubMed Central · Cited by 394 · see citing works
Thematic Analysis and Its Reconceptualization as ‘Saliency Analysis’
Buetow, S. (2009) · Journal of Health Services Research & Policy · doi:10.1258/jhsrp.2009.009081 · Cited by 379 · see citing works
Technological innovations in mental healthcare: harnessing the digital revolution
Hollis, C., Morriss, R., Martin, J., Amani, S., Cotton, R., Denis, M., & Lewis, S. (2015) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.142612 · Cited by 375 · see citing works
Psychotherapy change process research: Realizing the promise
Elliott, R. (2010) · Psychotherapy Research · doi:10.1080/10503300903470743 · Cited by 367 · see citing works
Norwood, C., Moghaddam, N. G., Malins, S., & Sabin‐Farrell, R. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2315 · Cited by 324 · see citing works
Self-citationTherapeutic alliance predicts symptomatic improvement session by session.
Falkenström, F., Granström, F., & Holmqvist, R. (2013) · Journal of Counseling Psychology · doi:10.1037/a0032258 · Cited by 296 · see citing works
A meta-analytic examination of client–therapist perspectives of the working alliance
Tryon, G. S., Blackwell, S. C., & Hammel, E. F. (2007) · Psychotherapy Research · doi:10.1080/10503300701320611 · Cited by 286 · see citing works
Qualitative Change Process Research on Psychotherapy: Alternative Strategies.
Elliott, R., Slatick, E., & Urman, M. L. (2001) · Cited by 239 · see citing works
Campbell, A., & Hemsley, S. (2009) · Clinical Psychologist · doi:10.1080/13284200802676391 · Cited by 225 · see citing works
Harvey, A. G., & Gumport, N. B. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.02.004 · Cited by 221 · cited 1× · see citing works
“Although the relative paucity of evidence for a link between WA and outcome in remote psychotherapy, remote delivery of psychotherapy is growing in popularity and evidence base (Hollis et al., 2015).”
BackgroundCrits-Christoph, P. F., Gibbons, M. B. C., Hamilton, J. L., Ring‐Kurtz, S., & Gallop, R. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0023668 · Cited by 220 · see citing works
The effects of safety behaviors on health anxiety: An experimental investigation
Olatunji, B. O., Etzel, E. N., Tomarken, A. J., Ciesielski, B. G., & Deacon, B. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.07.008 · Cited by 192 · see citing works
Therapeutic Alliance in Face-to-Face Versus Videoconferenced Psychotherapy.
Rees, C. S., & Stone, S. (2005) · Professional Psychology Research and Practice · doi:10.1037/0735-7028.36.6.649 · Cited by 189 · see citing works
Psychotherapy mediated by remote communication technologies: a meta-analytic review
Bee, P. E., Bower, P., Lovell, K., Gilbody, S., Richards, D., Gask, L., & Roach, P. (2008) · BMC Psychiatry · doi:10.1186/1471-244x-8-60 · Cited by 189 · cited 2× · see citing works
“However, debate exists around the WA in VCP. Conventional wisdom has suggested a better WA could be facilitated face‐to‐face, due to the reduced interpersonal richness of communication in VCP (Bee et al., 2008).”
BackgroundMorland, L. A., Mackintosh, M.-A., Rosen, C. S., Willis, E., Resick, P., Chard, K., & Frueh, B. C. (2015) · Depression and Anxiety · doi:10.1002/da.22397 · Cited by 176 · see citing works
Strunk, D. R., Brotman, M. A., & DeRubeis, R. J. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.03.011 · Cited by 169 · see citing works
Tyrer, P., Cooper, S., Salkovskis, P., Tyrer, H., Crawford, M., Byford, S., Dupont, S., Finnis, S., Green, J., McLaren, E., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(13)61905-4 · Cited by 167 · see citing works
Two aspects of the therapeutic alliance: Differential relations with depressive symptom change.
Webb, C. A., DeRubeis, R. J., Amsterdam, J. D., Shelton, R. C., Hollon, S. D., & Dimidjian, S. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0023252 · Cited by 150 · see citing works
Does alliance predict symptoms throughout treatment, or is it the other way around?
Zilcha‐Mano, S., Dinger, U., McCarthy, K. S., & Barber, J. P. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035141 · Cited by 128 · see citing works
Zilcha‐Mano, S., Muran, J. C., Hungr, C., Eubanks, C. F., Safran, J. D., & Winston, A. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000058 · Cited by 126 · see citing works
Therapy via videoconferencing: a route to client empowerment?
Simpson, S., Bell, L., Knox, J., & Mitchell, D. (2005) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.436 · Cited by 105 · see citing works
Germain, V., Marchand, A., Bouchard, S., Guay, S., & Drouin, M.-S. (2009) · CyberPsychology & Behavior · doi:10.1089/cpb.2009.0139 · Cited by 105 · see citing works
Bischoff, R., Hollist, C., Smith, C. W., & Flack, P. (2004) · Contemporary Family Therapy · doi:10.1023/b:coft.0000031242.83259.fa · Cited by 102 · see citing works
Telehealth service delivery for persons with alcoholism
Frueh, B. C., Henderson, S., & Myrick, H. (2005) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x0501100701 · Cited by 98 · see citing works
Bouchard, S., Payeur, R., Rivard, V., Allard, M., Paquin, B., Renaud, P., & Goyer, L. (2000) · CyberPsychology & Behavior · doi:10.1089/109493100452264 · Cited by 82 · see citing works
Psychologist treatment recommendations for Internet-based therapeutic interventions
Mora, L., Nevid, J. S., & Chaplin, W. F. (2008) · Computers in Human Behavior · doi:10.1016/j.chb.2008.05.011 · Cited by 71 · see citing works
Reciprocal influence of alliance to the group and outcome in day treatment for eating disorders.
Tasca, G. A., & Lampard, A. M. (2012) · Journal of Counseling Psychology · doi:10.1037/a0029947 · Cited by 67 · see citing works
Morriss, R., Patel, S., Malins, S., Guo, B., Higton, F., James, M., Wu, M., Brown, P., Boycott, N., Kaylor-Hughes, C., et al. (2019) · BMC Medicine · doi:10.1186/s12916-019-1253-5 · Cited by 60 · see citing works
Self-citationProbst, G. H., Berger, T., & Flückiger, C. (2022) · Verhaltenstherapie · doi:10.1159/000503432 · Cited by 54 · see citing works
Patient affect experiencing following therapist interventions in short-term dynamic psychotherapy
Town, J. M., Hardy, G. E., McCullough, L., & Stride, C. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.637243 · Cited by 42 · see citing works
Falkenström, F., Kuria, M. W., Othieno, C. J., & Kumar, M. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000363 · Cited by 25 · see citing works
Sudden Gains and Sudden Losses in the Clients of a "Supershrink": 10 Case Studies
Hansen, B. P., Lambert, M., & Vlass, E. N. (2015) · Pragmatic Case Studies in Psychotherapy · doi:10.14713/pcsp.v11i3.1915 · Cited by 19 · see citing works
Malins, S., Moghaddam, N. G., Morriss, R. K., Schroder, T. A., Brown, P., Boycott, N., & Atha, C. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22910 · Cited by 7 · see citing works
Self-citationMalins, S., Moghaddam, N. G., Morriss, R. K., & Schroder, T. A. (2019) · Psychotherapy Research · doi:10.1080/10503307.2019.1657250 · Cited by 5 · see citing works
Self-citationClients’ Perspectives on, Experiences of, and Contributions to the Working Alliance
Bedi, R. P., & Hayes, S. (2019) · Oxford University Press eBooks · doi:10.1093/med-psych/9780190868529.003.0006 · Cited by 5 · see citing works
Lambert (1996) · doi:10.1002/(sici)1099-0879(199612)3:4
Flagged first, then by citations
Cited by
Sorted by citations
Bouchard, S., Dugas, M. J., Belleville, G., Langlois, F., Gosselin, P., Robillard, G., Corno, G., & Marchand, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195924 · Cited by 21 · see citing works
Bouchard, S., Berthiaume, M., Robillard, G., Allard, M., Green‐Demers, I., Watts, S., Marchand, A., Gosselin, P., Langlois, F., Belleville, G., et al. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2816 · Cited by 7 · see citing works
- Authors
- Norwood, C., Sabin‐Farrell, R., Malins, S., & Moghaddam, N. G.
- Affiliations
- University of Nottingham (GB)
- University of Lincoln (GB)
- Corresponding author
- Norwood, Carl
- Venue
- Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2021-01-22
- Volume
- 77
- Issue
- 6
- Pages
- 1330-1353
- ISSN
- 0021-9762 (ISSN-L)
- 1097-4679
- OpenAlex
- W3004233989
- Cited by
- 12
- References
- 63
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 6
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Clinical Psychology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (publishedVersion, cc-by)
- Lincoln Repository (University of Lincoln) (acceptedVersion)
- Nottingham ePrints (University of Nottingham) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NIHR300822, NIHR301292)
- Department of Health and Social Care
- Engineering and Physical Sciences Research Council
- European Regional Development Fund
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Keywords
- therapeutic relationship, external beam radiotherapy, change processes, patient experience
- MeSH terms
- Humans, Professional-Patient Relations, Psychotherapy, Videoconferencing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
