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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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In the citing paper
“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]
In the citing paper
“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.”
In the citing paper
“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 citing paper
“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]).”
In the citing paper
“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].”
In the citing paper
“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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Metadata
- 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
- 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 › Clinical Psychology › Counseling Practices and Supervision
- Keywords
- therapeutic relationship, telemedicine, client satisfaction, acceptability, therapeutic rapport, bonds, presence
- 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 ›
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