Application of process factors to the inter-video modality : an examination of expectations and the therapeutic relationship in therapy conducted through a video-link.

Abstract

Background. This thesis reports the findings of four studies that examined the effect of different variables (e.g., video-link use, shame, therapist eye-contact) on expectations and the therapeutic relationship in the context of Inter-video therapy. Results are discussed with respect to promotion of Inter-video therapy, improvement of clients’ Inter-video therapy experience, and recommendations regarding therapist style of eye-contact. Method. One survey study and three experimental studies were performed. Study 1 (N = 197), a survey study, examined Inter-video therapy preferences and expectations. Study 2 (N = 36) evaluated the effect of therapist-participant physical similarity on Inter-video therapist expectations. Study 3 (N = 19) manipulated therapist eye-contact to evaluate the effect of eyecontact on the therapeutic relationship. Study 4 (N = 49) examined both the effect of eye-contact on the therapeutic relationship and the influence of expectations on this relationship and on outcome. Study 4 also evaluated the association between session measures (empathy, alliance, session evaluation) and outcome. Results and implications. There was a clear discrepancy between participants’ perception of Inter-video therapy (hesitant) and their experience of it (positive), indicating more positive information about this e-therapy modality may be important to enhance expectations and hence use. Therapist rather than therapy expectations had an effect on Inter-video therapy experiences and outcome. As reported in the studies, more visual, factual and personal information about the therapist may increase Inter-video therapist expectations. Therapist-participant physical similarity did not appear to have a positive influence on expectations; indeed it had a negative influence for males with prior therapy experience. Consistent with prior research, participants rated their Intervideo therapy experiences positively, reflected in high rating of working alliance and empathy across the eye-contact conditions. There was no clear positive effect of more direct eye-contact. Instead, there was an interaction effect between eye-contact and shame, indicating the downcast eye-contact associated with video-link communication might assist initial engagement with clients who struggle with shame. Unexpectedly, there was a significant difference in the relationship between the session measures and one of the outcome measures as a function of eye-contact. The difference indicated eye-contact might moderate the relationship between alliance and outcome and this might be important for future research to consider. Conclusions. Participants in this research experienced Inter-video therapy very positively, and results indicated the eye-contact distortion associated with Inter-video therapy should not be a cause for concern regarding the therapeutic relationship. Indeed the downcast eye-contact might facilitate therapy engagement for some clients and could be one reason why some clients perceive Inter-video therapy as more comfortable than in-person therapy. However, the research also indicated participants’ perceptions and expectations toward Inter-video therapy were tentative, especially as compared to perceptions and expectations toward in-person therapy. This latter finding will be important to address to further develop the use and outreach of Inter-video therapy.