Counseling in the Space Between: Counselor Perceptions of Empathy and Therapeutic Alliance during Videoconferencing-Based Teleplay Therapy Sessions

Children and adolescents experienced a significant increase in mental health challenges during the COVID-19 pandemic (Czeisler et al., 2020; Hertz et al., 2022; Mpofu, 2023; Oberg et al., 2022; Wilkins et al., 2023). With health facilities closed for non-emergent patients, telemental health therapy offered the possibility of support for those experiencing mental health challenges (Chiauzzi et al., 2020; Cooke et al., 2020; Karimi et al., 2022; E. C. Lee et al., 2023; Racine et al., 2020). While numerous past studies conducted over several years confirmed the efficacy of telemental health counseling (e.g., Feijt et al., 2020; Gloff et al., 2015; Jones et al., 2014; Reese et al., 2016; Simms et al., 2011), others demonstrated that some clinicians and clients struggled to connect emotionally using this relatively new modality (Budd et al., 2022; Knowles et al., 2015; Kotera et al., 2021). The purpose of this qualitative study was to understand how clinicians experience and perceive cognitive, affective, and behavioral empathy when working with children ten years old and younger in teleplay therapy sessions. Using Interpretative Phenomenological Analysis (J. A. Smith et al., 2022), interviews from 13 participants were coded. Themes related to the Structure and Process of Empathy, the Counselor's Experience of Empathy in Teleplay Therapy Sessions, and the Counselor's Perception of the Therapeutic Alliance were explored and described in detail. From these themes, a Proposed Model of Empathic Understanding was proposed. Implications for future research and a review of the strengths and limitations of this study were also described.