Remote vs in-person high-level psychological support for visible difference: Insights from UK specialists

The COVID-19 pandemic accelerated use of remote communication in psychological support, increasing interest in the effectiveness and acceptability of remote interventions. However, little is known about the provision of remote versus in-person high-level specialist psychological support for individuals with a visible difference. This study aimed to explore UK-based specialists' experiences of delivering remote versus in-person high-level psychological interventions to individuals with a visible difference, focusing on perceived demand, preferences, and service provision. Thirty healthcare professionals across burns, cleft, craniofacial, and other specialties completed a mixed-methods online survey. We conducted descriptive statistical analysis. Qualitative data were analysed using Reflexive Thematic Analysis. The majority of participants (90%) reported offering both remote and in-person support, with many noting increased remote provision since the pandemic. Sixty-seven per cent reported they were 'always' able to offer patients a choice of modality, and 17% were 'sometimes' able to offer choice. Three themes were identified: "Maintaining therapeutic space", "Remote support as a bridge", and "Focus on difference". In-person support was seen as offering greater therapeutic depth and opportunities for different therapeutic exercises, particularly for appearance-related concerns. Remote support was valued for its logistical and emotional accessibility, offering access to support for those unwilling or unable to access support in-person. Whilst appearing on camera was described as a barrier to remote support, participants identified specific adaptations to mitigate this. Findings highlight the need for flexible, tailored psychological services that balance therapeutic depth with accessibility, informing future clinical practice and intervention development for individuals with a visible difference.