Exploring the Therapeutic Alliance in Remotely Delivered Therapy

Abstract

Paper one is a systematic review and meta-synthesis of qualitative data exploring the views of children and adolescents, their parents and therapists pertaining to the therapeutic alliance during remotely delivered synchronous therapy (through videoconferencing, telephone, or text). Four databases were searched, and 13 papers were identified. Using thematic analysis, within a critical realist epistemological framework, two main themes were identified: disconnection and the redistribution of power and control. Results suggested that a common sense of disconnect within therapeutic relationships was experienced, which young people used to their advantage to moderate their engagement within therapy, leading to an increased sense of control and empowerment. Clinicians felt disempowered, and lacking confidence leading to creative adaptations to practice to achieve therapeutic relationships akin to those experienced face-to-face. Paper two is a Delphi study that aimed to explore consensus relating to views of clinicians about ‘key ingredients’ required to establish and maintain therapeutic alliances during remotely delivered therapy, and to explore how these differ from face-to-face settings. Qualitative data were gathered through open-ended questionnaires which were used to develop a list of statements. Participants then rated their agreement with these statements, and responses underwent consensus analysis. Thirty-two statements reached adequate consensus (an agreement of >80%) in the areas of contracting, quality/value, environment, technology, communication style, emotional differences, and effort. These were used to develop recommendations for clinical practice. Paper three provides a critical reflection of the meta-synthesis, the empirical paper, and the research process. This includes consideration of strengths and weaknesses alongside personal reflections. 

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Katherine Berry (Supervisor) & Sandra Bucci (Supervisor)