The Clinical Relationship
The provider-patient relationship, also referred to as therapeutic alliance, has long been concluded as an essential component of positive clinical outcomes (Horvath & Luborsky, 1993; Lambert & Barley, 2001; Sharf et al., 2010). To ensure an appropriate relationship through technology, providers should take specific steps. First, they should explain potential differences between F2F and technology-based encounters, including the potential loss of certain nonverbal behaviors (e.g., leg bouncing that may be off camera). While summarizing these limitations, the provider should also take care to balance this information with indications that past research has demonstrated that the provider-patient relationship can effectively be built and maintained through technology mediums, including videoconferencing. Once services begin, the provider should take an active role in fostering the therapeutic alliance, including utilizing empathetic responding, ensuring active collaboration with the patient, and monitoring for rupture markers that may indicate that the patient is either experiencing difficulties, may not feel comfortable, or is disengaged with the processes. Such rupture markers may include overt or indirect expression of negative sentiment or hostility, disagreement about goals or tasks of the treatment, compliance issues, avoidance maneuvers (e.g., becoming oppositional or avoidant when discussing therapeutic processes), self-esteem-enhancing operations (e.g., self-justifying their own actions), and general nonresponsiveness to interventions (Safran et al., 1990; Safran et al., 2001). Finally, the provider should take care to consider, evaluate, and potentially remedy any dual relationships that may arise as a result of the use of the videoconferencing.
Standards of Care for the Delivery of Interventions
To uphold the highest standards of care, guiding organizations’ documentation also indicates that providers should consider the unique issues that may arise with intervention approaches using technology. Applying their competence gained from education, providers must critically evaluate their practice in terms of how strategies must be adapted (e.g., how specific CBT techniques can be applied through videoconferencing), the limitations of this approach, and how these adaptations will compare to F2F methods. More directly related to the patient, the provider must also determine if such adaptations have been evaluated in the research for demographics similar to the patient, including age, sex, gender, diagnostic condition, and general history. Further, the provider should consider the role of cultural issues, as well as the potential influence of any comorbid cognitive, physical, or mental health-related challenges that may influence the treatment processes. Ultimately, such considerations can help ensure the appropriateness of the patient for the use of technology in their psychological care. In efforts to evaluate the technology-based strategies, the provider should implement targeted measurement. Such evaluation can not only focus on the clinical outcomes, but also technology-focused factors, such as the patient’s comfort with the technology, as well as any changes in attitude related to either mental health or technology following usage. Critical evaluation is essential, as if gains are not made or sustained during treatment, the provider must consider whether issues are related to the technology use itself, or another factor, before considering a modification of their treatment plans.