Study: “I miss not being able to offer my couples a box of tissues…”: Couples’ and Therapists’ Perspectives on the Therapeutic Alliance with the Transition to Online Couple Therapy

Authors: Alon Aviram, Yochay Nadan

Source: https://doi.org/10.1111/famp.12853

What Is Practically Relevant About This Study?

For many of us, the transition to online therapy during the pandemic brought numerous challenges, particularly in maintaining a strong therapeutic alliance. This study sheds light on how both couples and therapists perceive these changes and the impact they have on the therapeutic relationship. A key point highlighted in the study is the loss of physical presence, which is often perceived as a symbolic act of care—such as offering a tissue during emotional moments. This is made more difficult by digital distance and can impair the perception of support and empathy from the therapist.

A practical takeaway from the study is the need to be more conscious of nonverbal cues during online sessions, which are often lost in digital communication. As therapists, we can try to bridge this gap by offering more verbal affirmations and emotional resonance to compensate for the lack of physical gestures. Additionally, it may be beneficial to involve the space in which the couple is situated during the session more actively in the therapy, by asking questions like “Where do you feel most comfortable in this room?” or “What do you notice about your partner in this context?” This could help foster the emotional closeness that might otherwise be lost due to physical distance.

Methodology of the Study

The study was conducted using a qualitative approach based on Constructivist Grounded Theory (CGT). A total of 36 individuals were interviewed, including 18 couples who had participated in online couple therapy and 15 couple and family therapists who were interviewed in four online focus groups. The interviews were semi-structured and conducted online over several months. The data were analyzed using the constant comparison method, where similarities and differences within and between interviews were examined. Three main dimensions were identified that influence the formation of the therapeutic alliance in online therapy: emotional closeness, limited care, and body language. These dimensions were refined through the analysis of the interviews and categorized by repeatedly comparing data from various interviews.

Limitations

A major limitation of the study is the relatively small and culturally homogeneous sample, consisting predominantly of Israeli therapists and well-educated couples. This limits the generalizability of the findings to other cultural and social contexts. Additionally, only couples who had completed at least ten sessions were included, which may have led to the exclusion of experiences from couples who were less engaged or who dropped out early.

Peer-Review

This study was published in the “Family Process” journal, which is a peer-reviewed journal.

Disclosure

This text was generated with the help of ChatGPT and was editorially reviewed and edited. The study contents were not used as training material, and the analysis was conducted in compliance with current best practices regarding copyright.