JMIR Publications

ABSTRACT

Background:

Mental health care is undergoing rapid digital transformation, including video-based teletherapy, digitally delivered interventions, and increasingly, AI-mediated support. Despite growing evidence for digital mental health interventions, implementation in routine practice has often lagged technological advances. Although teletherapy is becoming more widely accepted, especially since the COVID-19 pandemic, little is known about the psychological processes through which clinicians adapt to disruptive changes in treatment delivery and how those experiences influence attitudes toward subsequent technologies.

Objective:

This study explored how therapists who had not previously adopted teletherapy interpreted, resisted, and ultimately accepted it when required during the COVID-19 pandemic. It also considered the wider implications of this adaptation process for evaluating future digital mental health technologies.

Methods:

Six accredited clinical psychologists from the UK, none of whom had previously practised video-based teletherapy, participated in semi-structured interviews following the rapid shift towards remote delivery. Data were analysed using reflexive thematic analysis to explore changes in beliefs, attribution processes, and perceptions of the therapeutic alliance.

Results:

Four themes were identified: (1) revision of anticipatory beliefs, (2) context-medium misattribution, (3) medium affordances, and (4) relational viability and selective integration. Therapists initially held strong negative expectations about teletherapy that were often not supported by later experience. Participants frequently attributed early difficulties to the digital medium but later realised they arose from broader contextual factors, including home working and pandemic conditions. With sustained practice, clinicians revised their assumptions, adapted their techniques, and came to view teletherapy as a viable mode of care. These outcomes imply a broader process of professional adaptation involving speculative concern, misattribution, and belief revision.

Conclusions:

Adaptation to teletherapy involved more than acceptance of a new tool. It required therapists to reconsider assumptions about therapeutic presence, safety, and alliance. While this process supported teletherapy uptake, it may also create a risk of overgeneralising lessons learned from one form of digital transition to qualitatively different technologies, such as AI-mediated therapy. Successful digitisation of the therapeutic medium should not be assumed to imply that automating the therapeutic agent is equivalent or safe. Implementation and training frameworks ought therefore to support clinicians in distinguishing changes in the communication medium from changes in the treatment process or therapeutic agent when evaluating emerging digital mental health tools.