Working Alliance in Online Therapy as Compared to Face-to-Face Therapy: Preliminary Results
Abstract
Online therapy, defined as the provision of mental health services through the Internet, is a growing field that has sparked an abundance of interest and controversy. A primary concern in the practice of online therapy is whether a working alliance, considered a central component of successful therapy, can develop when participants are geographically separated. Working alliance scores were compared between a small, primarily female sample of online therapy consumers and a representative sample of traditional face-to-face therapy clients. Results revealed significantly higher means on the goal subscale and composite score of the Working Alliance Inventory in the online sample, suggesting that a working alliance can be adequately established in therapy delivered online. No significant differences in the level of working alliance were found within the online therapy sample with respect to modality of communication, client presenting problem, or therapist. Themes from comments suggest the importance for participants of the disinhibiting effects of the medium.
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Previous studies have provided evidence that a therapeutic alliance may be established successfully in fully internet-delivered therapy, even to degrees comparable to or higher than in traditional face-to-face treatment.
“Previous studies have provided evidence that a therapeutic alliance may be established successfully in fully internet-delivered therapy, even to degrees comparable to or even higher than in traditional face-to-face treatment (Pihlaja et al., 2018; Hadjistavropoulos et al., 2017; Cook and Doyle, 2002; Sucala et al., 2012; Andersson et al., 2012).”
From Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response (2021) · cites this paper as Cook and Doyle, 2002
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- Authors
- Cook, J. E., & Doyle, C.
- Affiliations
- Portland State University (US)
- Lewis & Clark College (US)
- ORCID
- Cook, Jonathan E.
- Venue
- CyberPsychology & Behavior
- Publisher
- SAGE Publications
- Published
- 2002-04
- Volume
- 5
- Issue
- 2
- Pages
- 95-105
- ISSN
- 1094-9313 (ISSN-L)
- 1557-8364
- OpenAlex
- W2102823714
- Cited by
- 503
- References
- 40
- Citations by year
- 2026: 6 · 2025: 20 · 2024: 18 · 2023: 36 · 2022: 32 · 2021: 53 · 2020: 36 · 2019: 23 · 2018: 18 · 2017: 21 · 2016: 31 · 2015: 26 · 2014: 26 · 2013: 21 · 2012: 28
- FWCI
- 7.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CyberPsychology & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- therapeutic relationship, online therapy, face-to-face therapy, Working Alliance Inventory, goal setting, therapist characteristics
- MeSH terms
- Adult, Aged, Aged, 80 and over, Mental Disorders, Female, Humans, Male, Mental Health Services, Middle Aged, Psychotherapy, Surveys and Questionnaires, Work, Internet
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