Zoom-In to Zone-Out: Therapists Report Less Therapeutic Skill in Telepsychology Versus Face-to-Face Therapy During the COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic has resulted in a rapid transition from in-person therapy to teletherapy. This study examined mental health providers' perceptions of the differences between in-person therapy and teletherapy in common therapeutic attributes and identified therapist characteristics that predicted differences. A sample of 440 therapists and trainees completed an online survey that assessed their provision of clinical services since the outbreak of COVID-19. Therapists provided ratings for having used 28 therapeutic attributes (e.g., empathy, emotional expression) and skills for in-person therapy and teletherapy. Those attributes were clustered into three factors via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA): common therapeutic skills (e.g., warmth), extra-therapeutic influence (e.g., providing resources), and perceived outcome (e.g., symptom reductions). Therapists perceived poorer common therapeutic skills, decreased outcomes, and reduced extra-therapeutic influence when conducting teletherapy compared to in-person therapy. Therapists who reported poorer common therapeutic skills in teletherapy tended to be male, younger, utilize experience-based and relational therapies, have smaller caseloads, and had little training and no prior experience in teletherapy. Additionally, being male, utilizing experience-based and relational therapies, and having no training in teletherapy were associated with therapists' perception of reduced outcome in teletherapy. More intensive training and support in these attributes/skills are needed to improve therapists' confidence and ability to use therapeutic skills during teletherapy and ultimately improve the quality of psychological services in the era of teletherapy. Clinical Impact Statement Question: How do therapists perceive telepsychology differently from face-to-face therapy during the COVID-19 pandemic? Findings: Therapists felt less skilled in most therapeutic attributes when conducting teletherapy compared to face-to-face therapy. Meaning: Training and support are needed to improve therapists' abilities to use therapeutic skills in telepsychology, particularly those therapists who have little experience with and training in telepsychology. Next Steps: It is important to examine whether and how therapists being less skilled in teletherapy versus face-to-face therapy may result in diminished client outcomes.