Articles
2026: Online Advance Publication

Patient experiences in receiving virtual psychotherapy: a qualitative study

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 4 March 2026
96
Views
55
Downloads
1
HTML

Authors

Virtually delivered psychotherapy is a widely adopted means of providing mental health interventions. There is little research on patients’ perspectives on this mode of delivering therapy, and their perspectives are important given that patient factors predict a large proportion of mental health outcomes. This study explores patients’ experiences with online psychotherapy to help inform best practices. Thirty-three patients who were currently receiving synchronous, virtually delivered psychotherapy were interviewed. The interview focused on patient experiences, both positive and negative, and their recommendations for improving virtually delivered therapy. Interviews were audio-recorded and transcribed. We used an inductive approach to thematic analysis in coding the transcripts. Audit trails and reflexive and independent coding ensured the trustworthiness and fidelity of the identified themes. Themes reflecting positive patient experiences included convenience, accessibility, and connection with the therapist. Themes of negative experiences included technology-related challenges, perceived disconnection due to not being physically present with a therapist, concerns about safety, and privacy issues. Patient characteristics and personal circumstances interacted with the online modality to affect their experiences. Patients recommended enhancing privacy and safety, utilizing online tools effectively, and encouraging therapists to be more deliberate in their non-verbal communication. For clinicians and researchers, this study outlines patients’ perspectives on the aspects of virtual care that work effectively and those that could benefit from further improvement.

Downloads

Download data is not yet available.

Citations

Ahmedani, B. K., Yeh, H. H., Penfold, R. B., Simon, G. E., Miller-Matero, L. R., Akinyemi, E., & Rossom, R. C. (2024). Psychotherapy disruption before and after the transition to virtual mental health care induced by the COVID-19 pandemic. Psychiatric Services, 75(2), 108–114. doi: 10.1176/appi.ps.20230181
Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., & Thorp, S. R. (2012). Videoconferencing psychotherapy: a systematic review. Psychological Services, 9(2), 111–131. doi: 10.1037/A0027924
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, 16(3), 252–260. doi: 10.1037/h0085885
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi: 10.1191/1478088706qp063oa
Canadian Psychological Association (2023). CPA guidelines on telepsychology. Available from: https://cpa.ca/docs/File/Practice/Telepsychology_Guidelines-September_2023-EN_FINAL.pdf
Cataldo, F., Chang, S., Mendoza, A., & Buchanan, G. (2021). A perspective on client-psychologist relationships in videoconferencing psychotherapy: Literature review. JMIR Mental Health, 8(2). doi: 10.2196/19004
Chen, C. K., Nehrig, N., Wash, L., Schneider, J. A., Ashkenazi, S., Cairo, E., Guyton, A. F., & Palfrey, A. (2021). When distance brings us closer: leveraging tele-psychotherapy to build deeper connection. Counselling Psychology Quarterly, 34(3–4), 554–567. doi: 10.1080/09515070.2020.1779031
Cluver, J. S., Schuyler, D., Frueh, B. C., Brescia, F., & Arana, G. W. (2005). Remote psychotherapy for terminally ill cancer patients. Journal of Telemedicine and Telecare, 11(3), 157–159. doi: 10.1258/1357633053688741
Davis, K. A., Zhao, F., Janis, R. A., Castonguay, L. G., Hayes, J. A., & Scofield, B. E. (2024). Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic. Psychotherapy Research, 34(5), 589–600. doi: 10.1080/10503307.2023.2229505
Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410. doi: 10.1037/pst0000175
Ferguson, J. M., Wray, C. M., Van Campen, J., & Zulman, D. M. (2024). A new equilibrium for telemedicine: Prevalence of in-person, video-based, and telephone-based care in the veterans health administration, 2019–2023. Annals of Internal Medicine, 177(2), 262–264. doi: 10.7326/M23-2644
Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., & Aboujaoude, E. (2021). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy, 28(6), 1535–1549. doi: 10.1002/CPP.2594
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. doi: 10.1037/pst0000172
Geller, S. M., Greenberg, L. S., & Watson, J. C. (2010). Therapist and client perceptions of therapeutic presence: The development of a measure. Psychotherapy Research, 20(5), 599–610. doi: 10.1080/10503307.2010.495957
Giordano, C., Ambrosiano, I., Graffeo, M. T., Di Caro, A., & Gullo, S. (2022). The transition to online psychotherapy during the pandemic: a qualitative study on patients’ perspectives. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(3), 386–398. doi: 10.4081/ripppo.2022.638
Hajiheydari, Z., Rezaeian, H., & Rasouli, R. (2024). Online counseling after coronavirus pandemic: A qualitative study from the perspective of Iranian counselors and clients. International Journal for the Advancement of Counselling, 46(1), 60–75. doi: 10.1007/S10447-023-09532-1
Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, 114523–114523. doi: 10.1016/j.socscimed.2021.114523
Houle, S. A., Mistry, N., Kolodziejczyk, S., Baker, S., Baldwin, D., Garceau, C., Sylvestre, J., & Tasca, G. A. (2025). Therapist well-being in the context of virtual care: A qualitative study. Counselling and Psychotherapy Research, 25, e70045. doi: 10.1002/capr.70045
Karyotaki, E., Ebert, D. D., Donkin, L., Riper, H., Twisk, J., Burger, S., Rozental, A., Lange, A., Williams, A. D., Zarski, A. C., Geraedts, A., van Straten, A., Kleiboer, A., Meyer, B., Ünlü Ince, B. B., Buntrock, C., Lehr, D., Snoek, F. J., Andrews, G., & Cuijpers, P. (2018). Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clinical Psychology Review, 63, 80–92. doi: 10.1016/j.cpr.2018.06.007
Khoshrounejad, F., Hamednia, M., Mehrjerd, A., Pichaghsaz, S., Jamalirad, H., Sargolzaei, M., Hoseini, B., & Aalaei, S. (2021). Telehealth-Based Services During the COVID-19 Pandemic: A Systematic Review of Features and Challenges. Frontiers in Public Health, 9, 711762. doi: 10.3389/fpubh.2021.711762.
Levitt, H. M., Bamberg, M., Creswell, J. W., Frost, D. M., Josselson, R., & Suárez-Orozco, C. (2018). Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report. American Psychologist, 73(1), 26–46. doi: 10.1037/amp0000151
Lin, T., Heckman, T. G., & Anderson, T. (2021). The efficacy of synchronous teletherapy versus in-person therapy: A meta-analysis of randomized clinical trials. Clinical Psychology: Science and Practice, 29(2), 167–178. doi: 10.1037/cps0000056
Lepak, M. M. (2022). Utilization of presence awareness in trauma therapy. Trauma Care, 2(4), 589-599. doi: 10.3390/traumacare2040049
Lo, B., Strudwick, G., Mah, L., Mushquash, C. J., McKenzie, K., Khenti, A., & O’Neill, B. (2022). Effective modalities of virtual care to deliver mental health and addictions services in Canada. Science Briefs of the Ontario COVID-19 Science Advisory Table, 3(66). doi: 10.47326/ocsat.2022.03.66.1.0
Miles, M. B., Huberman, A. M., & Saldaña, J. (2014). Qualitative data analysis: A methods sourcebook (3rd ed.). Sage Publications.
Nogami, W., Nakagawa, A., Kato, N., Sasaki, Y., Kishimoto, T., Horikoshi, M., & Mimura, M. (2023). Efficacy and acceptability of remote cognitive behavioral therapy for patients with major depressive disorder in Japanese clinical settings: A case series. Cognitive and Behavioral Practice, 30(4), 635–645. doi: 10.1016/j.cbpra.2022.04.002
Norcross, J. C., & Lambert, M. J. (Eds.) (2019). Psychotherapy relationships that work: Evidence-based therapist contributions (3rd ed., Vol. 1). Oxford University Press. doi: 10.1093/med-psych/9780190843953.001.0001
Norcross, J. C., & Wampold, B. E. (Eds.). (2019). Psychotherapy relationships that work (3rd ed., Vol. 2). New York: Oxford University Press. doi: 10.1093/med-psych/9780190843960.003.0001
Olfson, M., McClellan, C., Zuvekas, S.H., Wall, M., & Blanco, C. (2025). Trends in outpatient psychotherapy among adults in the US. JAMA Psychiatry, 82(3), 253-263. doi: 10.1001/jamapsychiatry.2024.3903
Rubel, J. A., Rosenbaum, D., & Lutz, W. (2017). Patients’ in-session experiences and symptom change: Session-to-session effects on a within- and between-patient level. Behaviour Research and Therapy, 90, 58–66. doi: 10.1016/j.brat.2016.12.007
Simpson, S., Guerrini, L., & Rochford, S. (2015). Telepsychology in a university psychology clinic setting: A pilot project. Australian Psychologist, 50(4), 285–291. doi: 10.1111/ap.12131
Smith, K., Moller, N., Cooper, M., Gabriel, L., Roddy, J., & Sheehy, R. (2022). Video counselling and psychotherapy: A critical commentary on the evidence base. Counselling and Psychotherapy Research, 22(1), 92–97. doi: 10.1002/capr.12436
Song, L.-L., & Foster, C. (2022). Patients’ and therapists’ experiences of CBT videoconferencing in anxiety disorders. The Cognitive Behaviour Therapist, 15, e14. doi: 10.1017/S1754470X22000083
Soto, A., Smith, T. B., Griner, D., Domenech Rodríguez, M., & Bernal, G. (2018). Cultural adaptations and therapist multicultural competence: Two meta‐analytic reviews. Journal of Clinical Psychology, 74(11), 1907–1923. doi: 10.1002/jclp.22679
Swift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2018). The impact of accommodating client preference in psychotherapy: A meta‐analysis. Journal of Clinical Psychology, 74(11), 1924-1937. doi: 10.1002/jclp.22680
Tran, Q. D. (2024). Going beyond waitlists in mental healthcare. Community Mental Health Journal, 60(4), 629–634. doi: 10.1007/s10597-024-01233-2
Trondsen, M. V., Tjora, A., Broom, A., & Scambler, G. (2018). The symbolic affordances of a video-mediated gaze in emergency psychiatry. Social Science & Medicine, 197, 87–94. doi: 10.1016/j.socscimed.2017.11.056
Verkooyen, R., Broers, N. J., & Dandachi-FitzGerald, B. (2024). No pain, no gain revisited: The impact of positive and negative psychotherapy experiences on treatment outcome. Frontiers in Psychology, 15, 1378456. doi: 10.3389/fpsyg.2024.1378456
Waite, M. R., Diab, S., & Adefisoye, J. (2022). Virtual behavioral health treatment satisfaction and outcomes across time. Journal of Patient-Centered Research and Reviews, 9(3), 158–165. doi: 10.17294/2330-0698.1918
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277. doi: 10.1002/wps.20238

How to Cite



Patient experiences in receiving virtual psychotherapy: a qualitative study. (2026). Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2026.888