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Abstract
With the increased use of telepsychology since the onset of COVID-19, there is an increased need to better understand the process of psychotherapy delivered remotely. The Contextual Model is a model of the common factors and aims to describe the mechanisms of change in psychotherapy. Included in this model is the therapeutic alliance, which is the most widely researched common factor and is found to be consistently related to the process and outcome of therapy. However, much of the existing literature on alliance in telepsychology is examined through randomized controlled trails, which may have limitations when generalized to community-based mental health or low-income individuals. The current study is a naturalistic study that aims to fill the gap in the literature by examining the development of the therapeutic alliance between in-person and videoconferencing psychotherapy during the early phase of therapy for trainee therapists and for patients. This research also sought to study the relationship between therapeutic alliance and outcome. Finally, the study explored the relationship between therapeutic alliance and telehealth usability. A total of twenty-four patient and trainee therapist dyads were enrolled in the study. Data revealed that trainee therapists did not report a significant difference in alliance between in-person and videoconferencing during the early phase of a new therapeutic relationship. Patients reported significantly higher alliance scores for in-person therapy compared to telepsychology at session three but there was not a difference between groups at the first and fifth session. Second, data did not support a significant relationship between alliance and outcome for patients. Finally, there was not a significant relationship between therapeutic alliance and telehealth usability for patients or for trainee therapists. Results of this study should be interpreted with extreme caution due to the small sample size, though they may provide considerations for future research with this population. Clinical applications and future research may focus on the significance of the third session for the therapeutic alliance in a new therapeutic relationship as well as the feasibility and preferences of telehealth and in-person therapy sessions with this population. Limitations, clinical applications, and future directions are discussed.