Therapeutic alliance in videoconferencing psychotherapy: A review
Abstract
Psychotherapy services are limited in remote and rural areas in A ustralia and across the globe. Videoconferencing has become well established as a feasible and acceptable mode of psychological treatment delivery. Therapeutic alliance ( TA ) is an essential factor underlying successful therapy across therapeutic models. In order to determine the state of knowledge regarding TA in psychotherapy via videoconferencing, a literature review was conducted on research studies that formally measured TA as primary, secondary or tertiary outcome measures over the past 23 years. The databases searched were Medline, PsycArticles, PsycINFO , PsycEXTRA and EMBASE . Searching identified 9915 articles that measured satisfaction, acceptability or therapeutic rapport, of which 23 met criteria for the review. Three studies were carried out in A ustralia, 11 in USA , 4 in C anada, 3 in S cotland and 2 in E ngland. Studies overwhelmingly supported the notion that TA can be developed in psychotherapy by videoconference, with clients rating bond and presence at least equally as strongly as in‐person settings across a range of diagnostic groups. Therapists also rated high levels of TA , but often not quite as high as that of their clients early in treatment. The evidence was examined in the context of important aspects of TA , including bond, presence, therapist attitudes and abilities, and client attitudes and beliefs. Barriers and facilitators of alliance were identified. Future studies should include observational measures of bond and presence to supplement self‐report.
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Reports on development of therapist-client rapport during videoconference sessions are mixed, with some indicating providers struggle to build therapeutic alliances and others indicating videoconferencing does not hinder rapport.
“Reports on development of therapist-client rapport during videoconference sessions are mixed, with some indicating that providers struggle to build therapeutic alliances [26,73], whereas others indicate that videoconferencing does not hinder the therapist-client rapport or therapeutic alliance [73,74].”
From Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review (2025) · cites this paper as [74]
Even before the pandemic, some groups of patients, like migrants, different groups of minorities, and people in remote areas, were difficult to reach through mental health programs.
“Even before the pandemic, some groups of patients, like migrants [20], different groups of minorities [21], and people in remote areas [22], were difficult to reach through mental health programs.”
Therapeutic alliances can also be reached during videoconferencing, with clients rating bond and presence as equal to face-to-face settings.
“Generally, reasonable user satisfaction and feasibility of interventions have been found [30], and studies show that therapeutic alliances can also be reached during videoconferencing, with clients rating bond and presence as equal to face-to-face settings [22].”
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]).”
Simpson and Reid reported that several studies support the notion that videoconference treatments can generate a strong therapeutic bond right from the onset of treatment.
“In their review of the VC literature, Simpson and Reid [61] reported that several studies support the notion that VC treatments can generate a strong therapeutic bond right from the onset of treatment [26,62,63].”
Several studies have suggested that building a working alliance is not an end in and of itself in the treatment of anxiety disorders but rather a basis upon which patients and their therapists can work to reach changes in core beliefs that maintain the disorder.
“Several studies have suggested that building a working alliance is not an end in and of itself in the treatment of anxiety disorders but rather a basis upon which patients and their therapists can work to reach changes in core beliefs that maintain the disorder [26,61,62].”
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- Authors
- Simpson, S. G., & Reid, C. L.
- Affiliations
- University of South Australia (AU)
- Murdoch University (AU)
- Corresponding author
- Simpson, Susan G.
- Venue
- Australian Journal of Rural Health
- Publisher
- Wiley
- Published
- 2014-12
- Volume
- 22
- Issue
- 6
- Pages
- 280-299
- ISSN
- 1038-5282 (ISSN-L)
- 1440-1584
- OpenAlex
- W2166097570
- Cited by
- 420
- References
- 104
- Citations by year
- 2026: 34 · 2025: 41 · 2024: 42 · 2023: 59 · 2022: 60 · 2021: 90 · 2020: 35 · 2019: 20 · 2018: 11 · 2017: 11 · 2016: 7 · 2015: 8 · 2014: 1 · 2013: 1
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian Journal of Rural Health (publishedVersion)
- PubMed (publishedVersion)
- Murdoch University Research Portal (submittedVersion)
- Victoria University Research Repository (Victoria University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- 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, telemedicine, client satisfaction, acceptability, therapeutic rapport, bonds, presence
- MeSH terms
- Humans, Professional-Patient Relations, Psychotherapy, Videoconferencing
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