Working Alliance in Online Therapy as Compared to Face-to-Face Therapy: Preliminary Results

TLDR

Online therapy is a rapidly expanding field, yet a key concern is whether a working alliance can develop when participants are geographically separated. Working alliance scores were compared between a small, primarily female sample of online therapy consumers and a representative sample of traditional face‑to‑face therapy clients. Online therapy participants scored significantly higher on the goal subscale and overall Working Alliance Inventory, with no differences by communication modality, presenting problem, or therapist, and comments highlighted the medium’s disinhibiting effects.

Abstract

Online therapy, defined as the provision of mental health services through the Internet, is a growing field that has sparked an abundance of interest and controversy. A primary concern in the practice of online therapy is whether a working alliance, considered a central component of successful therapy, can develop when participants are geographically separated. Working alliance scores were compared between a small, primarily female sample of online therapy consumers and a representative sample of traditional face-to-face therapy clients. Results revealed significantly higher means on the goal subscale and composite score of the Working Alliance Inventory in the online sample, suggesting that a working alliance can be adequately established in therapy delivered online. No significant differences in the level of working alliance were found within the online therapy sample with respect to modality of communication, client presenting problem, or therapist. Themes from comments suggest the importance for participants of the disinhibiting effects of the medium.