In Brief

Clients' participation in psychotherapy tends to be higher when they are not face-to-face with their therapists, according to a study in the October issue of Journal of Counseling Psychology.

The study compared process and outcome variables among three modes of psychotherapy--face-to-face, video and audio.

"While most people would expect that clients would be less open and engaged in an electronic form of communication, in both distant modes, clients participated significantly more," says researcher Susan X Day, PhD, of Iowa State University and the University of Houston. Researcher Paul L. Schneider, PhD, of University of Illinois at Urbana-Champaign and GeoLearning Inc., also worked on the project, which was conducted at the University of Illinois.

Day says clients may participate more in distant mode therapy because they feel they have to work harder to convey statements and expressions to the therapist when not in a face-to-face setting.

Another possibility is that in face-to-face meetings, clients were getting a traditional mode they have seen in television and the movies, so they might already have conventional ideas on how they are supposed to behave, Day posits. With audio or video counseling, however, clients are exposed to a new setting where they are unsure how to act, and so they try something new.

In the study, 80 clients were randomly assigned to either a face-to-face setting, video teleconference, audio-only (using a hands-free device) or to a wait-list no treatment condition. Clients underwent five sessions of cognitive-behavioral therapy.

"Some problems might lend themselves more to distance [modes] than face-to-face," Day says, adding that some clients might feel more comfortable with self-revelation when there is distance. For instance, a client with an eating disorder revealed more in the audio mode than face-to-face, Day says.

Results of the outcome analysis in the study revealed that audio and video distance modes, compared with face-to-face therapy, provide similarly effective treatments. "The evidence of equal effectiveness is a hopeful sign, given the last decade's growth in distance delivery of psychotherapy," Day says.