A Systematic Review and Narrative Synthesis of Mental Health Clinicians' Attitudes Toward Online Therapy

ABSTRACT Online psychological therapy practices have increased in frequency in recent years, especially since the onset of the COVID‐19 pandemic. Recent research has proven their effectiveness; however, mental health clinicians' attitudes toward their use have been less explored. This is important as these attitudes can influence patient outcomes and the implementation of evidence‐based interventions. As such, we aimed to explore mental health clinicians' attitudes toward online therapy through a systematic review. Four electronic databases (MEDLINE, PsycINFO, Web of Science, and Scopus) were searched, as well as gray literature (PsycEXTRA and ProQuest) and manual searches of Overton, charity websites, Google Scholar, and reference lists. Themes were identified from the resulting qualitative studies, and quantitative and mixed methods studies were mapped onto these themes using a matrix. The synthesis followed a narrative approach. Thirteen themes were discovered from the 28 included studies, which highlight a range of clinicians' attitudes toward online therapy, both positive and negative. Themes consist of the therapeutic relationship, communication and relational aspects, time and space, technical aspects, professional self‐doubt, individual differences, practical aspects, patient privacy, risk, perception of patient experience, transition to online therapy, change in attitude with the pandemic, and general attitudes/future intentions. Clinicians generally had somewhat positive attitudes toward online therapy, especially since the COVID‐19 pandemic; however, they also identified key limitations. Training clinicians to use technology and online modalities might be a key direction for future clinical practice and research to improve clinicians' confidence and attitudes toward online therapy.