After the COVID-19 pandemic, over 70% of clinicians currently provide virtually delivered therapy (VDT). VDT has comparable outcomes to in-person therapy for many mental health problems. Despite this, we know little about the impact of VDT on therapists’ well-being and professional lives. In this PPRNet study, we explored how working with VDT affected psychotherapists’ well-being and professional practices to inform training and improve therapists’ personal and professional experiences working online. We interviewed 19 psychotherapy providers who were members of the PPRNet, and we conducted a thematic analysis of the interviews. Therapists saw on average 79% of their patients virtually. The therapists’ mean age was 49 years (SD = 11.74), most worked in private practice (79%), represented a range of professions (psychotherapists, psychologists, social workers), education levels, experience (11 years on average), and reported a range of theoretical orientations (CBT, psychodynamic, integrative). The first major theme that emerged from coding the interviews was personal lifestyle and well-being. Therapists appreciated the flexibility and convenience afforded by VDT (hours of work, appointment scheduling, and not commuting). However, VDT disrupted opportunities for physical exercise inherent in walking or biking to work, and so therapists had to be deliberate about remaining physically active during the workday. Therapists also described increased cognitive and emotional effort when working online due to challenges in maintaining their attention and staying emotionally connected with clients in a virtual space. They also had a harder time maintaining a manageable caseload, as the “convenience” of working with VDT led them to take on more cases. The second major theme concerned professional practice. Therapists saw VDT as a means of increasing accessibility to patient populations that were previously unavailable to them (e.g., patients in different cities or from rural or remote areas). However, therapists had to adapt business practices related to confidentiality, insurance coverage, and compliance with professional regulations, all of which added to their burden. They felt that their experience of therapeutic engagement in VDT was lower, and they felt more isolated, missing the informal connection with other professionals during the workday. The third major theme concerned providing therapy. Some therapists used technology, such as screen sharing, to enhance their interventions. However, therapists felt that some patients were not as amenable to working in the VDT format (children, those with major mental illnesses). Therapists also had to adjust their process skills and be more intentional with their interventions because they had fewer nonverbal cues to work with.
Practice Implications
Therapists noted both positive and negative effects on their well-being and professional lives from working in the virtual format. Therapists should take care to balance caseloads, incorporate positive health behaviours in their workday, and participate in professional networks to mitigate the potential negative impacts. Ongoing professional development should focus on building and enhancing therapists' skills to maintain therapeutic presence and engagement while working virtually, including more intentional use of verbal responses and the identification of subtle nonverbal cues during sessions.
Houle, S.A., Mistry, N., Kolodziejczyk, S., Baker, S., Baldwin, D., Garceau, C., Sylvestre, J., & Tasca, G.A. (2025). Therapist well-being in the context of virtual care: A qualitative study. Counselling and Psychotherapy Research, 25, e70045. https://doi.org/10.1002/capr.70045