Clients' experiences of online CBT after the most recent lockdown
Research type
Research Study
Full title
What are clients' experiences of receiving online cognitive behavioural therapy after the most recent lockdown of the Covid-19 pandemic?
IRAS ID
322230
Contact name
Ashlee Whittingham
Contact email
Sponsor organisation
City, University of London
Duration of Study in the UK
1 years, 5 months, 1 days
Research summary
Lay Summary: The study found four main themes and nine related subthemes (a more specific or detailed area relating to the theme) that show how people personally experienced remote CBT. These themes help us understand what made remote therapy easier or harder for clients. The main themes and subthemes are blow:
1. The Remote Paradigm Eliminates Obstacles: Ease and Freedom from In-person Barriers Five people noted that aspects of remote therapy, including technology, devices, messaging platforms, and the ability to work from home or in a remote location, made the process easier for them and helped with tasks that would have been more challenging in person. So, remote therapy gave them more comfort and freedom compared to face-to-face sessions.
1a). Removing Barriers Through Accessibility: If it Was Not Online, “I probably wouldn’t have done it”
Five people said that doing therapy remotely made it easier for them to get help. This is because as going in person would have been hard. They talked about different things that made in-person therapy difficult, like mobility issues, finding it hard to leave the house, or other challenges. However, being able to do it remotely removed those problems. This was important because some said they would not have gotten help at all if remote therapy had not been an option.1b) Convenience facilitates engagement: “There were no bumps in the road”
Three people said they liked how easy and convenient online therapy was. Using phones, computers, and messaging made it simple to share information or start sessions. They felt it was easier to stay involved in therapy this way, especially since things like doing written tasks or waiting for appointments felt harder in person. As remote therapy was more flexible, they found it easier to take part even when they were feeling upset.1c) Being at home: “A place of familiarity and comfort” Four people said that doing therapy from home gave them things they could not get in person, such as being around familiar things, having more privacy and control, or handling certain situations more easily. Being at home made them feel safer and more comfortable, which mattered a lot when they were feeling distressed.
2. Interferences as Barriers to Engagement: Accepting or Rejecting When Things get in the Way Five people noticed the things that got in the way of the therapy session because of doing it remotely. These things (interferences) were usually distractions, interruptions and/or technical difficulties. People were split in how they responded to this, as some found them more disruptive than others.
2a) Being burdened by interferences: “A hard time keeping my focus”
Four people talked about how doing therapy remotely came with distractions like technology problems, issues with their devices, or things going on at home. Examples included notifications popping up or problems opening documents. These interruptions happened often, were hard to control, and made it harder to focus, especially when they were already feeling distressed. For them, these interferences felt like an extra burden they did not want.2b) Overlooking technical difficulties: The effect was “Minimal like not massively”
Two people had very different experiences with technical difficulties during remote therapy, as they were not bothered by them. Even when things like internet problems or glitches happened, they stayed calm and did not let them get in the way of their progress3.Establishing a Therapeutic Relationship Using the Communication Device: Bridging the Distance Four people said that things like having the camera on or off during video calls helped them feel more connected to their therapist. These parts of the device were important in building a good relationship, making the device itself a key part of the therapy experience.
3a) Control Over Communication Channels: The Device Bolsters Authentic Expression Three people noticed the difference between using the phone or video for therapy and felt more in control of how much they or their therapist could see. Being able to choose whether to show themselves or their surroundings made them feel more comfortable, which helped them open up more and connect better with their therapist.
3b) The Screen as a Channel for Emotional Closeness: Creating a Sense of Connection Three people said they preferred video calls over phone calls for therapy. Seeing their therapist’s face and reactions in real time helped them feel more connected and made communication easier, which strengthened their relationship with the therapist.
4. The Impact of No Physical Presence: A Sense of Being Disconnected Five people spoke about their experience of building a connection with the therapist through telephone or video call. Without seeing them physically, it was harder to form a strong connection. This made the connection feel strange so some people felt a bit disconnected from their therapist.
4a) Having a Restricted View: A Struggle to Read Body Language Four people said it was harder to connect with their therapist without being able to see their full body language like facial expressions, gestures, or posture. On phone calls, they could not see the therapist at all, and on video calls, they only saw their face. They felt that missing these non-verbal cues made it harder to fully connect, even if they already had some level of relationship.
4b) The challenges of a Virtual Relationship: “That felt slightly odd”
Three people said they never met their therapist in person, which made the relationship feel a bit odd by the end of therapy. Even though they felt connected, it was hard to fully make sense of having a close bond with someone they had only seen online. Some felt that being vulnerable is easier when you’ve met someone in person, so only knowing the therapist virtually made the relationship feel less real or slightly disconnected.Towards the start of the Covid-19 pandemic, measures proposed by governments caused a rapid shift between online therapy being the minority to the predominant method of therapeutic interventions. This is because therapists who were working face-to-face began working online. Research to date on online therapy in relation to the Covid-19 pandemic look at therapists’ attitudes, perceptions and experiences of it, mostly during the lockdown period of March to June 2020. There is however limited research investigating the attitudes or experiences of 'clients' receiving remote therapy during the pandemic. Research has also shown that the type of therapy used affects the type of difficulties encountered.
As clients are underrepresented, this research aims to investigate their experiences on receiving online therapy. In addition, as the pandemic is entering a more stable phase, this research aims to look into experiences after the lockdown of the pandemic as this may provide further insight. As cognitive behavioural therapy (CBT) is structured in nature and had concerns from therapists, this research aims to investigate clients’ experiences on receiving remote CBT after the most recent lockdown of the Covid-19 pandemic.
The two-year research aims to use qualitative methods and collect data using semi-structured interviews conducted online. Seven - ten clients will be interviewed for up to 90 minutes about their subjective experiences on receiving online therapy. Clients will have received a course of at least 6 sessions of CBT in Improving Access to Psychological Therapies (IAPT) in the NHS. Interviews will be audio recorded and answers to interview questions will be transcribed. Data will be analysed using interpretative phenomenological analysis (IPA), a qualitative approach which aims to provide detailed examinations of personal lived experience. The research hopes to provide insight on client experiences of online therapy to guide the future use of online therapy. Results can hopefully be used to inform and guide professionals in practice.
REC name
London - Westminster Research Ethics Committee
REC reference
23/PR/0358
Date of REC Opinion
27 Apr 2023
REC opinion
Further Information Favourable Opinion