Therapists' perception of the working alliance, real relationship and therapeutic presence in in-person therapy versus tele-therapy

Figures & data

Table I. Descriptive statistics (N = 826).

	n	%	M(SD)
Gender
Female	536	64.9
Male	281	34.0
Non-binary	13	1.1
Location
United States of America	708	85.7
Europe	41	5.0
Canada	24	2.9
Other	53	6.4
Ethnicity*
White	556	67.3
Hispanic or Latino	45	5.4
Asian or Asian Indian	63	7.6
Middle Eastern	7	.8
American Indian or Alaska Native	108	13.1
African American	38	4.6
Native Hawaiian or Pacific Islander	21	2.5
Professional field
Social work	108	13.1
Psychology	423	51.2
Counseling	89	10.8
Nursing	37	4.5
Medicine	108	13.1
Marriage and family therapy	47	5.7
Other (e.g., psychoanalyst/psychotherapist)	37	4.5
Therapeutic orientation*
Behavioral	64	7.7
Cognitive	87	10.5
Humanistic	39	4.7
Psychodynamic	241	29.2
Psychoanalytic	177	21.4
Integrative	137	16.6
Systemic	40	4.8
Patient population*
Children	59	7.1
Adolescents	121	14.6
Adults	575	69.6
Older adults	37	4.5
Other	34	4.1
Most often used therapy type
Individual	699	85.0
Group	68	8.3
Couples	40	3.6
Family	25	3.0
Proportion of time wearing mask in in-person sessions presently			60.43(38.03)
Reason for conducting telepsychotherapy sessions*
Mandatory (1–100)			46.75(29.68)
Own choice (1–100)			67.01(29.27)

Note. * Multiple answers were possible for each percentage continuum per respondent.

Table II. Comparison of relational variables for in-person therapy vs. teletherapy.

	In-person		Teletherapy
	M	SD	M	SD	t	p	Effect size Hedges's g (95% CI)
Working Alliance (N = 776)	3.97	0.73	3.98	0.71	−.32	.75	.01 (−.02, .05)
Bond (N = 778)	4.17	0.82	4.17	0.80	−.56	.96	.00 (−.07, .07)
Task (N = 787)	3.78	0.84	3.80	0.79	−1.29	.20	−.05 (−.12, 02)
Goal (N = 786)	3.87	0.86	3.87	0.85	.13	.90	.01 (−.07, .08)
Real Relationship (N = 709)	3.62	0.55	3.58	0.54	3.60	.00	−.07 (−.11, −.04)
Realism (N = 719)	3.57	0.59	3.55	0.58	2.57	.01	.10 (.02, .17)
Genuineness (N = 722)	3.64	0.59	3.62	.57	2.41	.02	.09 (.02, 16)
Therapeutic Presence (N = 685)	5.01	0.87	4.83	0.84	−8.45	.00	−.21 (−.26, −.16)

Note. Differences in real relationship scores were no longer significant (p > .01) with clinical experience controlled.

Figure 1. Effect sizes of the 15 items that differed the most between in-person and teletherapy.

Note: We selected all the items with an effect size d ≥ .10. The original items were paraphrased in the figure. The center line indicates no difference, positive numbers indicate larger values in-person, and negative values indicate larger values in teletherapy. (TP) = the item is from the therapeutic presence measure; (RR) = the item is from the real relationship measure.

Figure 2. Working alliance differences between in-person and teletherapy by therapeutic orientation.

Note: The Y-axis does not start at 0 and does not reflect the full Likert scale of the measure.

Figure 3. Therapeutic presence differences between in-person and teletherapy by therapeutic orientation.

Note: The Y-axis does not start at 0 and does not reflect the full Likert scale of the measure.

Figure 4. Therapeutic presence differences between in-person and teletherapy by therapy type.

Note: The Y-axis does not start at 0 and does not reflect the full Likert scale of the measure.

Figure 5. Illustration of the directions of the moderations of COVID-related variables on the difference in the relational variables between in-person and teletherapy.

Note: Y-axes do not start at 0 and do not reflect the full Likert scale of the measures.