Technology and the clinical encounter: a qualitative study of mental health clinician and patient experiences of telemedicine

Despite the widespread use of telehealth, particularly throughout the COVID-19 pandemic, there has been little published evidence about the effect of telehealth on the therapeutic relationship and clinician and patient interaction. This study sought to identify the divergence in this mode of communication compared with in-person interaction for both clinicians and patients. An exploratory qualitative interview study of 22 mental health practitioners (registered psychologists or psychiatrists) in Australia who have treated patients using psychotherapy in-person and using telehealth, followed by a qualitative interview study of 20 patients in Australia who have undergone psychotherapy in-person and using telehealth. Using an interpretative phenomenological analysis, this paper examines participants’ perspectives on, communication with, and reactions to telehealth when providing or receiving psychotherapy treatment. Both clinicians and patients described the benefits and detriments of clinical interactions using telehealth versus face-to-face. Both groups drew attention to the evident “convenience” inherent in the use of telephone or video contact, while also noting how the absence of a shared physical space fundamentally changed the conduct of private conversations with affective content. Many clinicians expressed the view that telehealth induced an underlying and intrinsic shift in the connection with the patient. Patients, likewise, reported a corresponding change in interpersonal interaction, although many experienced difficulties articulating a description of this change in relational connection. Patients and doctors identify both benefits and limitations of telehealth in comparison with face-to-face communication. This study has found that various factors inherent in telehealth contact affect the curative value and quality of the healthcare interaction which impacts both patient and clinician. The structure and content of the therapeutic relationship varied according to whether it occurred in a telehealth setting or in-person. These results suggest that the use of telemedicine should be tailored to the specific needs, preferences and circumstances of individual patients. The results also demonstrate that the themes identified have different implications and effects depending on the clinician, patient, and clinical situation. There are indications that telehealth overall limits or constrains the exchange of meanings in the clinic, and further research is required to explore the process by which this change occurs and its meaning.