To what extent can remote treatment address geographic barriers to psychotherapy?

BACKGROUND: The COVID-19 pandemic led to a surge in remote psychotherapy, suggesting it might also be a good way to overcome distance barriers to treatment post-pandemic. This study examined patterns of receiving psychotherapy before and after the COVID-19 outbreak, as well as patients’ perceptions of remote care. We conducted an internet survey of 400 Israelis who received psychotherapy in 2020 and 10 in-depth interviews with patients. RESULTS: 57% of patients from Israel's geographic periphery reported receiving remote treatment, compared to 30% of patients from central Israel (p < 0.01). Among those who began treatment before the onset of the pandemic, 76% reported receiving remote treatment or combined remote and face-to-face treatment after the pandemic's outbreak. In contrast, only half of those who began treatment after the onset of the pandemic received remote treatment. The interviews indicated that it is harder to start treatment and establish a therapeutic alliance with the therapist remotely than to continue therapy that had started face-to-face. Patients who experienced remote therapy were more likely than others to rate it as effective as face-to-face therapy in terms of its ability to achieve treatment goals (44% vs. 20%), to foster dialogue on sensitive issues (48% vs. 34%) and to create a therapeutic relationship with the therapist (41% vs. 25%). Additionally, they were less likely to identify interpersonal communication difficulties as a drawback of remote therapy (55% vs. 78%) and more likely to be willing to continue using it post-pandemic (25% vs. 5%), (all p < 0.01). CONCLUSIONS: The findings suggest that for some patients, remote psychotherapy can be an effective way to address geographic barriers to psychotherapy. However, most patients still prefer face-to-face therapy. Offering remote treatment after establishing a therapeutic connection via face-to-face treatment will probably be more popular among consumers than strictly remote care. KEY MESSAGES: • For some patients, remote psychotherapy can be an effective way to address geographic barriers to psychotherapy, especially when a therapeutic alliance has already been established. • Most patients prefer face-to-face therapy. However, patients who experienced remote care were more likely to rate it as effective as face-to-face therapy and to continue using it after the pandemic.