PPRNet Clinical summary: Are Therapists Less Skillful in Teletherapy Than In-Person Therapy?

There is sufficient evidence that providing psychotherapy by videoconferencing is likely as effective as therapy in person. However, many therapists feel less skillful and effective when delivering therapy virtually. This is potentially a problem since over 60% of psychologists provide videoconferencing therapy to patients as part of their practice. However, these studies rely on therapists’ self-reporting of skills and are not based on their actual performance. Therapists are notoriously inaccurate when self-reporting their behaviours in therapy and tend to over- or under-estimate their skills. No studies have assessed therapists’ actual skill behaviours in videoconference-delivered vs. in-person therapy. In this unique study, Lin and colleagues trained 223 licensed therapists and trainees to respond to brief simulated video clips of therapy patients who present interpersonally challenging situations. The therapists were randomly assigned to (1) view a video clip scenario of an in-person therapy session, or (2) view a video scenario of a teletherapy session. After viewing one of the video scenarios, therapists’ facilitative interpersonal skills were evaluated by a performance task designed to assess their ability to respond to the difficult situation and to facilitate positive changes. Independent raters assessed the therapists’ facilitative interpersonal skills. Therapists had lower levels of observer-rated facilitative interpersonal skills in teletherapy scenarios than in-person therapy scenarios (p < 0.01). Compared to therapists in the in-person condition, therapists in the teletherapy condition had lower levels of verbal fluency, hope, persuasiveness, emotional expression, empathy, and alliance bond capacity. Researchers identified three classes of therapists from the data: (1) developing therapists (54.26%) who had somewhat lower skills in teletherapy, (2) teletherapy experts (34.98%) who had high-level skills in teletherapy, and (3) teletherapy challenged therapists (10.76%) who showed significantly lower facilitative interpersonal skills in teletherapy. These results were unrelated to age, gender, theoretical orientation, or acceptance of teletherapy. 

Practice Implications

On average, therapists are less skilled at addressing challenges in teletherapy than in in-person therapy. Differences in the two modalities may lead to a real loss of interpersonal skills among therapists. Targeted training should focus on specific skills related to working in the teletherapy modality, such as being sensitive to non-verbal cues, using different means of conveying empathy and warmth in a virtual context, and identifying and managing alliance ruptures in remote settings.

Lin, T., Aafjes-van Doorn, K., Heckman, T.G., Antebi-Lerman, E., & Anderson, T. (2025). Are therapists less skilful in teletherapy than in-person therapy scenarios? A latent profile analysis of facilitative interpersonal skills. Clinical Psychology and Psychotherapy, 32, e70047. https://doi.org/10.1002/cpp.70047.