Psychotherapy using distance technology: A comparison of face-to-face, video, and audio treatment.

Abstract

This study compared selected process and outcome variables across 3 modes of psychotherapy: faceto-face, real-time video conference, and 2-way audio (analogous to telephone). Results from 80 randomly assigned clients suggested that differences in process and outcome among the 3 treatments were small and clinically promising in comparison with the untreated control group. Experimental comparisons of process and outcome in distant versus face-to-face conditions may influence the future practice of psychology. Conventional wisdom insists that, for most purposes, the therapist and client must be in the same room. Overall, our training as psychologists has emphasized face-to-face contact as the ideal. It will be interesting to discover whether this is true. Moreover, what conditions are required to establish psychological contact with another person and, in fact, what constitutes psychological contact at all, are salient questions in the age of Internet discourse (e.g., Kraut et al., 1998). These research questions are significant for therapist training, choice of treatment, and application of previous research findings. Our effort to compare face-to-face, video, and audio individual therapy addressed two aspects of substitutability. On the process side, the working alliance was examined in all three conditions. Bordin (1979) conceptualized this alliance as the emotional bond between client and therapist, the quality of client and therapist involvement in the tasks of therapy, and the amount of concordance on goals between therapist and client. Reviewing studies of the predictive validity of the alliance variable, Henry, Strupp, Schacht, and Gaston (1994) found empirical support for alliance– outcome associations no matter how outcome was measured, who measured it, or what psychotherapeutic school of thought was represented. These reviewers entertained “the hypothesis that the alliance is a causal ingredient of change” (p. 485). On the outcome side, several assessments were combined, following the advice of Strupp and Hadley (1977) that evaluation of outcome should include multiple sources of information (therapist and client) and multiple targets for change (symptom change, satisfaction level, problem resolution). As implied above, our research questions were straightforward: Does level of working alliance differ according to mode of delivery (face-to-face, audio, or video)? Does outcome differ according to mode of delivery and in comparison to a no-treatment wait-list control group?