Therapists’ forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists’ views and challenges with teletherapy.

We aimed to develop predictive models of three aspects of psychotherapists’ acceptance of teletherapy during the COVID-19 pandemic; attitudes towards teletherapy, concerns about using teletherapy, and intention to use it in the future.

In an international survey, therapists (N = 795) completed a survey about their experiences during the pandemic, including quality of therapeutic relationship, professional self-doubt, vicarious trauma, and telepsychotherapy acceptance. Regression decision trees machine learning analyses were used to build prediction models for each aspects of telepsychotherapy acceptance.

Attitudes toward telepsychotherapy were most positive for therapists who reported neutral or strong online working alliance, especially if they experienced little professional self-doubt and were younger than 40 years old. Therapists who were most concerned about telepsychotherapy, were those who reported higher levels of professional self-doubt, particularly if they also reported vicarious trauma experiences. Therapists who reported low working alliance were the least likely to use telepsychotherapy in the future.

Therapists’ professional self-doubt and the quality of their working alliance with their telepsychotherapy patients appear to be the most pertinent factors associated with therapists’ acceptance of telepsychotherapy during COVID-19, and should be addressed in future training and research.

No significant relationships.

During the early months of the COVID-19 pandemic, patients receiving individual psychotherapy needed to transition to telepsychotherapy (TP). Since telemental health appears to be here to stay after the pandemic ends, it is crucial to understand factors that determine whether telemental health is a good fit for patients.

The aim of the present study was to (1) explore patients’ perception of the therapeutic relationship and attitudes towards TP, and (2) identify predictors of patients’ TP acceptance.

We used a longitudinal design, where patients (N = 719) receiving individual TP during the pandemic participated in an online survey, in which they responded to demographic questions and completed measures of symptom severity, Covid-related distress, attachment style (avoidant/anxious), perceived quality of the therapeutic relationship (working alliance and real relationship), and TP acceptance.

We found that (1) patients perceived the quality of the therapeutic relationship as reasonably good, and patients’ TP acceptance was moderately high. (2) patients’ TP acceptance was predicted by their attachment avoidance and their perception of the real relationship, whereas attachment anxiety, working alliance, as well as demographic variables, symptom severity, and Covid-related distress were unrelated to TP acceptance. The final model showed that perceived strength of the real relationship mediated the relationship between attachment avoidance and TP acceptance.

Both general (attachment) and situational (therapeutic relationship) relational variables are important predictors of patient’s acceptance of TP, and should be considered during decision making about suitability of TP to patients.

No significant relationships.