Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic.

IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL
Psychotherapy Research Pub Date : 2024-06-01 Epub Date: 2023-07-03 DOI:10.1080/10503307.2023.2229505
Katherine A Davis, Fanghui Zhao, Rebecca A Janis, Louis G Castonguay, Jeffrey A Hayes, Brett E Scofield
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Abstract

Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment.Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome.Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress.Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy - in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.

远程治疗和面对面心理治疗中的治疗联盟和临床结果:COVID-19大流行期间的一项非劣效性研究。
本研究旨在为远程治疗背景下临床变量的各种有限研究提供信息。方法 我们采用了队列设计和非劣效性统计方法,对一个大学心理咨询中心的大量匹配样本进行了研究,这些样本在每次治疗前都会报告治疗联盟和心理困扰,这也是该中心常规临床实践的一部分。在 COVID-19 大流行后接受远程治疗的 479 位客户与大流行前接受面对面治疗的 479 位客户进行了比较。进行了非劣效性检验,以调查两种服务方式之间是否存在有意义的差异。此外,还对客户特征进行了研究,将其作为模式与联盟或结果之间关系的调节因素。结果 与接受面对面心理治疗的客户相比,接受远程治疗的客户在联盟和临床结果方面并不逊色。在种族和民族方面,发现对联盟有明显的主效应。留学生身份对治疗结果有明显的主效应。结论 研究结果表明,远程心理治疗在临床过程和结果上都有相应的效果,因此支持继续使用远程心理治疗。然而,对于提供者来说,重要的是要意识到心理治疗中存在的心理健康差异--无论是面对面还是通过远程治疗。本文从研究和临床意义的角度讨论了研究结果和发现。此外,还讨论了远程治疗作为一种可行的治疗方法的未来研究方向。
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来源期刊
Psychotherapy Research
Psychotherapy Research PSYCHOLOGY, CLINICAL-
CiteScore
7.80
自引率
10.30%
发文量
68
期刊介绍: Psychotherapy Research seeks to enhance the development, scientific quality, and social relevance of psychotherapy research and to foster the use of research findings in practice, education, and policy formulation. The Journal publishes reports of original research on all aspects of psychotherapy, including its outcomes, its processes, education of practitioners, and delivery of services. It also publishes methodological, theoretical, and review articles of direct relevance to psychotherapy research. The Journal is addressed to an international, interdisciplinary audience and welcomes submissions dealing with diverse theoretical orientations, treatment modalities.
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