The Biggest Challenge of Telepractice

If there was one area more than any other that would seem to highlight the deficiency of telepractice it would be in the arena of the relationship between the therapist and client.  Research shows that a high percentage of the success in any therapy is directly proportional to the relationship between therapist and client, otherwise known as the “therapeutic alliance”.


1. The Therapeutic Alliance

According to the world-renowned psychologist, Carl Rogers, “There are three important qualities a client should look for when seeking a therapist: empathy, genuineness, and respect.” These qualities are at the core of what is known as the “therapeutic alliance,” the precious bond between the therapist and client, essential to any successful therapy.


Although Carl Rogers was speaking specifically about psychological therapy, there are certainly parallels to other types of therapy as well. After all, the success of even the most skilled and experienced telepractice therapist will be heavily impacted by the relationship with the client. What are the components of the therapeutic alliance?


A. Empathy

Empathy is the ability of the therapist to identify with and understand the client’s situation, feelings, and motives. If the speech therapist isn’t sensing where the child is at the moment, the therapy is going nowhere fast. This, notwithstanding that the teletherapy session is of a more technical nature than psychological counseling.


B. Genuineness

Aside from empathy, the client needs to sense that the therapist’s interest is genuine.  Perhaps nothing is more damaging to the clinical experience than for the client to believe that the therapist is “in it for the money” or some other ulterior motive. In any therapy, the client is exposing his/her vulnerabilities that bring discomfort.  This discomfort will only be magnified by a therapist who is disingenuous.


C. Respect

Respect is necessary to establish the safety that is instrumental in the therapeutic alliance.  It is only when the client is fully accepted, both strengths and weaknesses, that an environment has been established where transformation can hope to occur.



While conveying empathy, warmth and respect may be more of a challenge in the telepractice venue; they cannot be avoided.  And has been amply demonstrated by many a therapist, sincerity in all its forms can be conveyed through the webcam when the necessary effort is continuously made.


2. A Surprising Discovery

A study conducted by Simpson (2011) in the Shetland Islands, found that clients not only were able to develop a positive therapeutic relationship through video conferencing, but they also reported feeling as though the videoconferencing enhanced the therapeutic relationship.


According to two different clients, video conferencing “is sufficiently personal without being so personal as to be confrontational…there was good personal contact but without an invasion of personal space, and the clients in the videoconferencing condition reported being able to speak more freely and felt less self-conscious than they would if they had met with a therapist face-to-face.”


In other words, the distancing effects of video conferencing promote a sense of security helping clients feel more comfortable and less scrutinized. This consequently makes them feel more at ease.  Again, although while this study was done in the psychological realm, its findings can be extended to speech therapy and telepractice as well.


3.  Increasing client-therapist rapport in telepractice

While the therapeutic alliance is necessary, it is not sufficient.  Another critical component of effective therapy is an excellent rapport between client and therapist.  The client needs to experience the therapist as being “right there.” What then can be done to neutralize the inherent challenges germane to telepractice to maximize this rapport?


A. Active listening

Active listening is vital in all therapy, no less so in telepractice. Therapists need to pay very close attention to the words and reactions of the client.  They need to assure the client that his/her voice is being heard and understood. This is critical to any success the therapist wishes to enjoy with the client.


B. Verbally engaging

Research shows that rapport increases as the therapist becomes more verbose. The more the therapist engages the client in dialogue instead of only listening, the better rapport will be. Related to this is the need to engage the client emotionally, even in speech therapy.


C. Emulating the client’s speech

When speaking with the client, the speech therapist needs to use metaphors, phrases, and words that are familiar to the client to build a strong rapport. This begins with the therapist listening carefully to the client’s language and expression, and then attempting to imitate it in the therapist’s communication. Devoid of direct eye contact and body language, this “verbal connection” is all the more crucial in telepractice.

The Bottom Line

While telepractice poses unique challenges regarding both the therapeutic alliance and therapist-client rapport, for the dedicated therapist these are hurdles that can and must be surmounted.  The powerful combination of commitment, caring and wisdom will address this vital concern so that the plethora of benefits afforded by telepractice can be fully enjoyed.