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8 Vital Keys to Teletherapy’s Unique Brand of Therapeutic Relationship

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Is Technology the Answer or Part of the Problem?

Although technology is driving so much positive change in healthcare and in therapy, we can’t lose sight of the centrality of the human connection. Effective clinical interventions require real people delivering care. The personal relationships that providers develop with their patients or clients are essential. What we can never forget is that the gifts of technology should complement the human connection, never replace it.

Why the Therapeutic Relationship is So Essential

In the early days of psychotherapy, there was hardly any emphasis placed on the importance of the therapeutic relationship. Not until Carl Rogers, the founder of humanistic or “person-centered” therapy, came along in the 1950s, did clinicians begin to see the fundamental connection between this alliance and effective therapy.

Carl Rogers, known as “the father of the therapeutic alliance,” articulated the three essential aspects of a healthy therapeutic relationship:

  1. Empathy- Is the therapist supportive and understanding?
  2. Congruence- Is the therapist genuine and not pretending to be a guru?
  3. Unconditional Positive Regard- Does the therapist see your human value?

Since then, research has confirmed what so many clinicians have intuitively known; a healthy and nurturing therapeutic relationship is a critical component of a successful client experience. Some studies have even identified it to be the most essential common denominator in effective outcomes.

When a task force from APA’s (American Psychological Association) Society of Clinical Psychology sought to identify treatments that could be empirically supported, they found that the “therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment” and that “the therapy relationship accounts for why clients improve (or fail to improve) at least as much as the particular treatment method.”

Dr. John Norcross, who headed up the task force, defined the therapeutic alliance or relationship as being “the quality and strength of the collaborative relationship between client and therapist, typically measured as agreement on the therapeutic goals, consensus on treatment tasks, and a relationship bond.” Along with empathy and genuineness, this alliance represents an integral part of the therapeutic relationship.

And while the therapeutic relationship has an added dimension of significance in the mental health arena, its importance cannot be underestimated regarding speech-language and occupational therapy as well. This is because clients will be reluctant to become vulnerable, take direction from, or work with a therapist to whom they don’t feel connected. In every therapy, the bond is of fundamental concern.

8 Ways to Nurture the Digital Relationship

1. Safety

Children can often sense from early on in the session whether or not the therapist is judgmental. While the child desires feedback from the clinician, that feedback must be delivered in an informative rather than critical manner. Granted, both feedback and criticism involve evaluation. However, the difference lies in that criticism involves judgment and fault finding, while feedback is the sharing of corrective information.

2. Validation

Another essential aspect of therapy is soliciting the child’s feelings about how the session is going. Without validating the child by providing him/her the opportunity to share feelings, it is unlikely that the session will realize its intended objective. This validation requires unconditional acceptance that provides the child a sense of comfort.

3. Rapport

Just as in onsite therapy you need to first establish and maintain a rapport with the client, so too in your teletherapy sessions, you need to enter with a professional yet relaxed and friendly appearance. At times direct your gaze towards the camera to simulate eye contact, while at others, focus on the screen to indicate that you are paying attention to the client.

4. Nonverbals

When delivering onsite therapy, you can use body language to convey your attention and even mirror the client’s posture to help build that relationship. While using nonverbal language can pose a challenge in teletherapy, don’t give up on it completely. Lean in, tilt your head to match the client’s, nod, and display facial expressions that show that you are connected with the client at the moment.

5. Empathy

In onsite therapy, you can show your empathy through facial expressions and gestures. Although you don’t have quite the same latitude with teletherapy, you still have the capacity to offer words of sensitivity and encouragement to convey your empathy towards the client. It is critical that you remain engaged with the client and stay responsive to the person, not just the screen.

6. Authenticity

Often when a client arrives for therapy, there are a few casual moments before the session begins to settle into the therapy space. Engaging in small talk with the client during this time is an opportunity for the therapist to be genuine through short and appropriate self-disclosures. While teletherapy doesn’t naturally provide these moments beforehand, the therapist should lead off the session with some small talk anyway.

7. Presence

Offering your embodied presence in the session will further create psychological safety for your client and for yourself. Physical distance should not be viewed as the opposite of presence, since research indicates psychological presence is integral to the therapeutic alliance built online. Consider using a larger screen to allow more visual contact and gestures with your full body versus just your face.

8. Eye Contact

Maintain your eye view at the level of the camera so clients experience you looking at them. If you are looking down at the camera, clients may experience you looming over them. Place the video box of your client as close to the camera as possible. This will help to maintain your eyes close to the camera to keep as direct eye contact as possible.

There’s No Time to Waste

It’s clear that teletherapy is not only here to stay but, according to many, will continue to expand as well. And when you fully grasp how a healthy and nurturing therapeutic relationship is such a crucial component of an effective session, you will quickly realize the need to prioritize developing the tools you’ll need to build those relationships with your clients. Don’t delay learning and implementing those critical keys to your success.

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