Therapeutic Alliance In Clinical Videoconferencing: Optimizing The Communication Context

Purpose This chapter addresses methods to establish or bolster therapeutic alliance with patients engaged in clinical videoconferencing (CV). The chapter will present a brief summary of the existing literature on therapeutic alliance to support a discussion of how therapeutic alliance may be impacted when conducting CV services. The chapter will also denote modifications to standard clinical behaviors which have been linked to strong therapeutic alliance in CV settings. Context The information is helpful for clinicians and managers because alliance has been demonstrated to be related to clinical outcomes for behavioral treatments. Stakeholders and clinicians new to CV contexts often question the ability of CV services to facilitate appropriate levels of alliance; accordingly, it is helpful to have access to a quick-reference summary in order to provide support for programming. Moreover, though the scientific literature base regarding CV provides broad evidence that appropriate alliance is most often achieved via CV, it is still important to convey specialized nuances of alliance in CV contexts. The authors have logged over 10,000 clinical hours via CV and have amassed a significant amount of highly-specific procedural knowledge regarding at-distance relationship building through practical experience and trial and error. Accordingly, the information is helpful in preventing those new to CV from starting from scratch or recreating the wheel when considering alliance in CV contexts.Tools The chapter provides the following tools: a brief review of the literature regarding therapeutic alliance and the effects of alliance on clinical outcomes in CV contexts, a list of psychotherapy contexts in which CV treatment has been associated with strong or adequate patient-provider alliance, a separate list of more general health care domains in which CV treatment has been associated with strong or adequate patient-provider satisfaction, a list of clinical techniques and clinician attributes that have been empirically associated with alliance, a more targeted list of suggestions to bolster alliance in CV contexts, a provider-oriented checklist of tasks to complete before initial CV sessions to safeguard alliance, a provider-oriented checklist of tasks to complete during initial CV sessions to safeguard alliance, and a checklist of procedures for when patients express concerns regarding receiving treatment via CV modalities. Finally, links to resources documenting technical and physical configurations to support alliance in CV contexts are provided, as are sample videos of provider/patient interactions over the modality.