With organizations and clinicians making decisions about their immediate futures with telehealth, new research regarding the role of telehealth therapeutic alliance outcomes is particularly pertinent. In line with numerous studies demonstrating that many telehealth services produce outcomes that are similar to in-person treatment (Krzyzaniak et al., 2021; Thomas et al., 2021), questions remain about how telehealth can be used to develop and maintain a strong therapeutic alliance between patients and providers (Simpson & Reid, 2014).
Alternatively referred to as the working alliance, the helping alliance, or the alliance, a therapeutic alliance used herein refers to the therapeutic activities that strengthen the quality and collaborative aspects of the client-therapist or patient-provider relationship (Flückiger et al., 2018; Horvath et al., 2011). Such an alliance is believed to reflect relationship qualities and facilitative conditions that contribute to change in behavioral health treatment. Contributing factors include acceptance, empathy, openness, and a collaborative partnership (Agnew-Davies et al., 1998). In early writings about the therapeutic alliance, Bordin (1979) outlined three contributing components: agreement on therapeutic goals, agreement on therapeutic tasks, and a positive bond.
Telehealth Therapeutic Alliance Research
Although much has been published about telehealth, less is known about the quality of therapeutic relationships in a virtual setting. A 2022 study published in the Journal for Technology in Behavioral Science by Sara J. Sagui-Henson and colleagues studied the components of the therapeutic alliance (a mechanism posited to underly successful treatment) and their association with positives. The study examined (1) participant ratings of components of the therapeutic alliance with virtual providers, (2) changes in subjective well-being and depressive symptoms in clients with positive scores on a depression measure, and (3) the association between alliance and participants’ well-being.
The study included 3,087 adults, with a median age of 36 ± 9 years, in a sample that was 54% female.
Participants had digital access to these types of professionals using videoconference sessions between 9/29/2020 and 9/12/21:
- Licensed therapist (18%)
- Certified coach (65%)
- Both (17%)
The Working Alliance Inventory and the World Health Organization-Five (WHO-5) Well-Being Index scores were used to measure changes. Descriptive and inferential statistics were used to assess alliance ratings across demographics, utilization types, and the association between alliance and w
