Accepted for/Published in: JMIR Mental Health
Date Submitted: Dec 20, 2024
Open Peer Review Period: Dec 20, 2024 - Feb 14, 2025
Date Accepted: Jun 16, 2025
(closed for review but you can still tweet)
Actor and partner effects in the development of telepresence among patients and psychotherapists: A prospective study of 20 dyads from a randomized trial on video consultations in primary care
ABSTRACT
Background:
The COVID-19 pandemic has accelerated the adoption of video consultations in mental health care, highlighting the importance of therapeutic alliance for successful treatment outcomes in both face-to-face and virtual settings. Telepresence, the sense of being present with the mental health specialist (MHS) rather than feeling remote, is a critical component of building a strong therapeutic alliance in video consultations. While patients often report high telepresence levels, MHSs express concerns about whether video consultations can replicate the quality of face-to-face interactions. Despite its importance, research on telepresence development in MHSs over time and the dyadic interplay between patients and MHSs remains limited.
Objective:
This study aimed to evaluate the mutual influence within patient-MHS dyads on telepresence development during video consultations, using data from a randomized controlled trial assessing the feasibility of video consultations for depression and anxiety disorders in primary care.
Methods:
The study included 22 patient-MHS dyads (22 patients, 4 MHSs). Telepresence was measured using the Telepresence in Videoconference Scale. Dyadic data were analyzed using the Actor-Partner Interdependence Model (APIM) with a distinguishable dyad structural equation model. Actor effects refer to the impact of an individual’s telepresence at time point 1 (T1) on their telepresence at time point 2 (T2), while partner effects represent the influence of one party’s telepresence at T1 on the other’s telepresence at T2. Sensitivity analyses excluded data from individual MHSs to account for their unique effects.
Results:
A significant actor effect for MHSs (P<.001) indicated that their telepresence at T1 strongly influenced their telepresence at T2. However, actor effects for patients and partner effects for both patients and MHSs were not statistically significant, suggesting no mutual influence between dyad members. Age was a significant covariate for telepresence in both groups.
Conclusions:
Consistent with prior findings, MHSs experienced increased telepresence over time, whereas patients reported high telepresence levels from the start of therapy. The lack of dyadic influence highlights the need for further exploration into factors affecting telepresence development, such as age, technical proficiency, and prior treatment experience. Future studies with larger samples and more sessions are necessary to enhance the generalizability of these findings and to optimize the use of video consultations in mental health care. Clinical Trial: German Clinical Trials Register DRKS00015812; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812
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