Journal of Psychotherapy Integration

© 2020 American Psychological Association 2020, Vol. 30, No. 2, 238 –247
ISSN: 1053-0479 http://dx.doi.org/10.1037/int0000214

Psychotherapists’ Attitudes Toward Online Therapy During the

COVID-19 Pandemic

Vera Békés and Katie Aafjes-van Doorn

Yeshiva University

During the COVID-19 pandemic, many people across the world have been advised to
work from home in an effort to slow down the spreading of the virus. Within the field
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

of psychotherapy, this meant that many psychotherapists who were used to seeing their
This document is copyrighted by the American Psychological Association or one of its allied publishers.

patients in person transitioned to providing therapies online via videoconferencing,

regardless of their previous experience or attitudes toward online psychotherapy. This
survey study examined how psychotherapists’ attitudes toward online psychotherapy is
influenced by their characteristics and professional experiences during the sudden
transition from face-to-face to online psychotherapy because of the pandemic. We
collected real-time data from 145 psychotherapists from North America and Europe
shortly after a pandemic was declared by the World Health Organization. Participants
reported on their past experiences with online psychotherapy, their preparations of their
online psychotherapy sessions during the pandemic, the challenges they encountered in
online sessions, and their attitudes toward online psychotherapy more generally. Within
the context of this forced transition because of the global COVID-19 pandemic, most
psychotherapists identified a somewhat positive attitude toward online psychotherapy,
suggesting they were likely to use online psychotherapy in the future. Our findings
suggest that psychotherapists’ attitudes toward online psychotherapy are influenced by
their past experiences, such as psychotherapy modality, clinical experience, and pre-
vious online psychotherapy experience as well as their transition experience during the
pandemic and their geographic location. Within the limitations of this survey study,
implications and future directions for research are described.

Keywords: video conferencing, online psychotherapy, COVID-19, psychotherapists,

attitude

Since 1961 when videoconferencing was first therapeutic purposes. Psychotherapists may
trialed for group psychotherapy (Wittson, Af- choose to offer therapy sessions online to pro-
fleck, & Johnson, 1961), there has been a grad- vide easy access to patients in rural and remote
ual growth in the use of videoconferencing for areas, continue treatment with patients who
moved away, or to reduce travel cost and time
(Simpson, 2009). Despite the potential benefits
of online psychotherapy via teleconferencing,
Editor’s Note. This article received rapid review due to many psychotherapists are worried about being
the time-sensitive nature of the content, but our standard less able to communicate their empathy, to
high-quality peer review process was upheld.
build therapeutic alliance (Roesler, 2017), or
worry about the impact of technical glitches,
X Vera Békés and X Katie Aafjes-van Doorn, Clinical insufficient Internet literacy, and confidentiality
Psychology Doctoral Program, Ferkauf Graduate School of issues (e.g., Titzler, Saruhanjan, Berking, Riper,
Psychology, Yeshiva University.
The authors confirm that this article complies with the & Ebert, 2018; Topooco et al., 2017). Most
journal article reporting standards on nonexperimental ob- psychotherapists have little training and experi-
servational studies described by Appelbaum et al. (2018). ence in providing online psychotherapy, and
Correspondence concerning this article should be ad- many have the incorrect belief that online ther-
dressed to Vera Békés, Clinical Psychology Doctoral Pro-
gram, Ferkauf Graduate School of Psychology, Yeshiva
apies are less effective than sessions conducted
University, 1165 Morris Park Avenue, Bronx, NY 10461. face to ace (e.g., Topooco et al., 2017). In fact,
E-mail: vera.bekes@yu.edu recent reviews of empirical data indicate that
238
 PROVIDING ONLINE THERAPY DURING COVID-19 239

patients and psychotherapists who use online more for the switch would report more positive
psychotherapy via videoconferencing generally attitudes toward online psychotherapy. Based
develop good therapeutic alliance (e.g., Simp- on the telemental health literature, we did not
son & Reid, 2014) and that these online sessions expect any differences in attitudes across psy-
do not differ from in-person sessions in effec- chotherapist characteristics, such as age, gen-
tiveness (Backhaus et al., 2012; Simpson, der, or ethnicity (e.g., McMinn, Bearse, Heyne,
2009). Smithberger, & Erb, 2011; Perle et al., 2013).
Irrespective of the psychotherapists’ previous However, we did expect differences in psycho-
experiences and attitudes toward online psycho- therapy modality, that is, psychotherapists with
therapy, the current global coronavirus 2019 a cognitive-behavior orientation would have a
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

(COVID-19) pandemic forced many psycho- more positive attitude toward online psycho-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

therapists to abruptly halt their face-to-face ses- therapy compared with those who identify with
sions and switch to online psychotherapy. To a psychodynamic approach (Mora, Nevid, &
slow down the spread of the COVID-19 virus, Chaplin, 2008; Perle et al., 2013).
people around the world have been advised to
socially distance themselves and work from
Method
home. For many psychotherapists this meant
that they needed to make a rapid transition to We used an online survey to collect data
online psychotherapy, often without much no- about psychotherapist’s experiences and atti-
tice or preparation, and even if they might have tudes toward online psychotherapy during the
been reluctant to provide online psychotherapy pandemic. The present study reports the data
previously. Psychotherapists of all therapeutic collected between March 25 and March 30,
modalities and levels of experience had to sud- 2020. Psychotherapists were recruited via pro-
denly grapple with the implications for their fessional e-mail-lists, social media, and individ-
therapeutic technique, without much opportu- ual contacts across the United States, Canada
nity for reflective practice, carefully considering and Europe. To participate, individuals had to
their clinical, technical, rational, and academic be 18 years old or older, work as a psychother-
knowledge (Bennett-Levy, 2003). Given that apist (licensed or trainee), and currently see
attitudes and expectations toward online thera- patients online. Interested psychotherapists
pies have an important effect on the efficacy of were provided with a web link for additional
the treatment (Tonn et al., 2017; Reese et al., information about the study. The study was
2016), it is important to understand how this reviewed by the Western Institutional Review
forced transition to online psychotherapy influ- Board. After giving consent, participants were
ences psychotherapists’ attitudes toward online directed to the anonymous online battery of
psychotherapy. questionnaires. Several instruments were ad-
In this cross-sectional survey study, we ex- ministered in a fixed order, taking approxi-
amined how attitudes online psychotherapy dur- mately 15 min to complete. Of relevance to the
ing the pandemic is influenced by therapist present brief report, the following two measures
characteristics and psychotherapists’ profes- are discussed.
sional experiences during their sudden transi-
tion to online psychotherapy. Although some Measures
psychotherapists might have decided to use
other methods to deliver psychotherapy, such as Demographic and professional activity
phone sessions, in the present study we focused surveys. The demographic survey inquired
on online psychotherapy via videoconferencing about gender, age, location, race and ethnicity,
as an innovative technology in the process of educational level, clinical experience, experi-
widespread implementation. We hypothesized ence with providing online psychotherapy, em-
that psychotherapists with more previous or ployment setting, licensure, number of in-
current clinical experience of conducting online person patients, and theoretical orientation. The
psychotherapy would have more positive views psychotherapist’s professional activity during
of online psychotherapy in general. We also the pandemic was assessed with questions on
hypothesized that psychotherapists who were number of patients that transferred to online
able to get prepared and prepare their patients psychotherapy, perceived challenges of provid-
 240 BÉKÉS AND AAFJES-VAN DOORN

ing online psychotherapy, actions taken to pre- tests. Associations between psychotherapist
pare him- or herself and the patient for the characteristics and experience was assessed us-
transition to online psychotherapy, perceived ing Pearson correlations.
patients’ experience of online psychotherapy,
and psychotherapists’ immediate experience of Results
providing online psychotherapy (tiredness,
competence, confidence, sense of connection). Psychotherapist Characteristics
Attitudes toward online psychotherapy.
The Unified Theory of Acceptance and Use of Participating psychotherapists’ mean age was
Technology model (UTAUT; Venkatesh, Mor- 46.50 years (SD ⫽ 14.83, range ⫽ 23–79). The
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ris, Davis, & Davis, 2003) was used to assess majority of our respondents were female (N ⫽
This document is copyrighted by the American Psychological Association or one of its allied publishers.

attitudes toward online psychotherapy. The 106; 75.2%) and Caucasian (N ⫽ 120; 82.8%)
UTAUT framework offers a comprehensive and resided in North America (N ⫽ 105; 75%)
model of attitudes and subsequent utilization of or Europe (N ⫽ 35; 25%). The majority of
technological innovations. In line with the focus psychotherapists were licensed (N ⫽ 109;
of the present study, we adapted the phrasing of 77.3%), relatively experienced (i.e., N ⫽ 94;
the 13 items to reflect online therapy (instead of 64% had more than 9 years of clinical experi-
technology more generally used in the original ence), and worked with the adult population
UTAUT version). The items reflects the four (N ⫽ 137; 94.5%) in independent practice (N ⫽
main factors that have been found to determine 102; 69.7%) or outpatient settings (N ⫽ 31;
the future use of technology: performance ex- 21.4%). About half of the psychotherapists did
pectancy (e.g., “The quality of online psycho- not have previous experience with online psy-
therapy is the same as in-person therapy”), ef- chotherapy (N ⫽ 74; 51.3%). For a more de-
fort expectancy (e.g., “I find providing online tailed description of the psychotherapists’ char-
therapy easy”), social influence (e.g., “People acteristics, see Table 1.
who influence me think that I should use online
therapy”), and facilitating conditions (e.g., “A Transition to Online Psychotherapy During
specific person/group is available to help me if the COVID-19 Pandemic
I have difficulties with online therapy”).1 Items
are scored on a Likert scale of 1 (strongly dis- The great majority of psychotherapists pre-
agree) to 5 (strongly agree), and the internal pared for the transition to online therapy in
consistency of the UTAUT in our study was multiple ways (Mnumber of methods ⫽ 3.04, SD ⫽
␣ ⫽ .774. 1.89, range ⫽ 0 –7), and they also prepared their
patients for this transition (Mnumber of methods ⫽
Data Analysis 2.33, SD ⫽ 1.58, range ⫽ 1– 6). Most psycho-
therapists identified a multitude of challenges
The data were analyzed using IBM SPSS with regard to the therapeutic interaction, the
Statistics 25 (Armonk, NY). Of 147 respon- patients’ real-life surroundings during the ses-
dents, two individuals who did not complete the sion, and technical issues with the online plat-
whole survey were excluded from the analyses, form. See Figure 1 for a visual illustration of the
resulting in a sample size of N ⫽ 145. Because preparations as well as the perceived challenges
of the forced-choice logic of the online survey, with online psychotherapy.
no data were missing, except in demographics Psychotherapists reported that their patients
in which the forced-response requirement was had an extremely positive (N ⫽ 20; 13.8%),
not present, providing data, nage ⫽ 129, ngender ⫽ positive (N ⫽ 71; 49%), or neutral (N ⫽ 40;
141, nethnicity ⫽ 141, nlicensure ⫽ 141. Because 27.6%) experience with online psychotherapy
these variables were not the main focus of this during the pandemic. Only 7.6% of the psycho-
study, we used the responses from the sample of therapists thought that their patients experi-
145 psychotherapists in the analyses. Mean
scores of items were calculated for all variables. 1
The additional 11 items of the 24-item UTUAT have
Group differences of demographics, profes- been demonstrated not to have direct impact on usage of
sional experiences, and attitudes were analyzed innovative technology and were thus not included in this
using Pearson’s ␹2 and independent-samples t study.
 PROVIDING ONLINE THERAPY DURING COVID-19 241

Table 1
Descriptive Statistics of the 145 Psychotherapists
Variables n %
Ethnicity
European, European American 120 82.8
Asian 6 4.2
Latinx 8 5.5
African American 5 3.4
Middle Eastern 2 1.4
Profession
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Medical doctor 7 4.8

Social worker 8 5.5
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Clinical psychologist 92 63.4

Counseling psychologist 15 10.3
Graduate student 17 11.7
Other 8 5.5
Licensure status
Licensed 109 77.3
Trainee 28 19.8
Years of clinical experience
0–4 28 19.3
5–8 23 15.9
9–12 30 20.7
13–16 7 4.8
17 or more 57 39.3
Work settinga
Hospital 14 9.7
Outpatient 31 21.4
Private practice 102 69.7
University counseling center 9 6.2
Other 18 12.4
Patient populationa
Adults 137 94.5
Older adults 46 31.7
Adolescents 52 35.9
Children 31 21.4
Other 4 2.8
Number of patients per week in person previously
1–5 18 12.4
5–10 26 17.0
10–20 45 31.0
20–30 44 30.3
30–40 8 5.5
40–50 4 2.9
Number of patients that changed to online sessions
1–3 24 16.6
3–5 20 13.8
5–10 24 16.6
10–20 45 31.0
20–30 26 17.9
30–40 5 3.4
Theoretical orientationa
CBT 51 35.2
Psychodynamic 74 51.0
Psychoanalytic 23 15.0
Humanistic 28 19.3
Systemic 21 14.5
Integrative 57 39.3
Other 17 11.7
(table continues)
 242 BÉKÉS AND AAFJES-VAN DOORN

Table 1 (continued)
Variables n %
Previous experience of providing online psychotherapy
No 74 51.3
Yes, once or twice 17 11.8
Yes, several patients 17 11.8
Yes, but only after seeing them in person first 36 25.0
Note. CBT ⫽ cognitive-behavioral therapy.
a
Multiple answers were possible per respondent.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

enced online psychotherapy somewhat nega- North America also reported more positive at-
tively and none of the psychotherapists reported titudes toward online psychotherapy in general
an extremely negative patient experience. compared with psychotherapists in Europe,
t(138) ⫽ 3.53, p ⬍ .001, specifically in effort
Attitudes Toward Online Psychotherapy expectancy, t(138) ⫽ 3.32, p ⬍ .05, and social
influence, t(138) ⫽ 4.51, p ⬍ .001.
Overall in our sample, psychotherapists re-
ported somewhat positive attitudes toward on-
line psychotherapy (MUTAUT ⫽ 3.42, SD ⫽ Discussion
0.51, range: 2.15–4.69) including performance
expectation (M ⫽ 3.08, SD ⫽ 0.74, range: Our aim was to examine what factors influ-
1.33–5.00), effort expectancy (M ⫽ 3.53, SD ⫽ ence the attitudes toward online psychotherapy
0.73, range: 1.33–5.00), social influence (M ⫽ during the COVID-19 pandemic using the
3.46, SD ⫽ 0.75, range: 1.25–5.00), and facili- UTAUT framework. Our findings suggest that
tating conditions (M ⫽ 3.56, SD ⫽ 0.70, range: past experiences, such as therapy modality, clin-
1.67–5.00). Those psychotherapists who had ical experience, and online psychotherapy ex-
had previous experience with online psycho- perience, as well as experiences during the pan-
therapy, t(142) ⫽ 2.05, p ⬍ .05, and who demic, such as preparations of psychotherapist
thought that their patients experienced online and patient, perceived patient experience, expe-
psychotherapy positively, ␹2(87, N ⫽ 142) ⫽ riences of feeling tired, feeling less confident
134.05, p ⬍ .001, reported more positive atti- and competent, feeling less connected and au-
tudes. Cognitive behavioral therapy (CBT) ther- thentic in sessions influence attitudes toward
apists, compared with psychodynamic thera- online psychotherapy.
pists, had a more positive attitude toward only According to the UTAUT model, the mea-
therapy, t(104) ⫽ 3.66, p ⬍ .001. Psychothera- sured four constructs indicate the likelihood of
pists attitudes were more negative if the online future usage, and their effect may be moderated
sessions made them feel tired, r ⫽ .22, p ⬍ .01, by gender, age, experience, and voluntariness of
less confident, r ⫽ .26, p ⬍ .01, or less com- use. Similar to previous research (Hennemann,
petent, r ⫽ .20, p ⬍ .001, and if they felt less Beutel, & Zwerenz, 2017; Liu et al., 2015), in
connected, r ⫽ .33, p ⬍ .001 and the therapeutic our sample, we could not confirm the impact of
relationship less authentic or genuine, r ⫽ .21, gender and age on attitudes toward technology.
p ⬍ .01 online. However, in line with the UTUAT model, pro-
Psychotherapists from North America fessional experience and experience with online
(United States and Canada) did not significantly psychotherapy was indeed positively associated
differ from psychotherapists in Europe with re- with attitudes in our sample. This finding is also
gard to demographics, theoretical orientation in line with empirical research findings showing
(CBT vs. psychodynamic), previous experience that experience with online psychotherapy typ-
with online psychotherapy, or perceived patient ically leads to more positive attitudes toward
experience of online sessions but did appear to online psychotherapy than before (Donovan,
prepare more for the transition to online psy- Poole, Boyes, Redgate, & March, 2015).
chotherapy than their European colleagues, Given that the involuntariness of using tech-
t(138) ⫽ 2.44, p ⬍ .05. Psychotherapists in nological innovations is theorized to have a
 PROVIDING ONLINE THERAPY DURING COVID-19 243

Therapists’ Transion Towards Online Therapy During the Pandemic

How did you professionally prepare for the transit ion to online therapy? *
Spoke to colleagues 67.6%

Read posts on listservs/forums 60.0%

Read governmental guidelines 48.3%

Prepared consent forms 37.2%

Aended online trainings/webinars 32.4%

Spoke to supervisor 29.0%

Read journal arcles 19.7%

Not prepared specifically 9.7%

Already prepared by previous experience 6.2%

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Other 6.9%
This document is copyrighted by the American Psychological Association or one of its allied publishers.

How did you prepare your paent for the transion to online

Discussed during the first online sessions 64.8%

Discussed it before the switch 57.2%

Provided consent form 57.2%

Provided technical support 40.0%

therapy*

Provided informaon sheets 30.3%

Changed cancellaon policy 14.5%

Reduced session fee 5.5%

Did not prepare 2.8%

Other 6.2%

Technical/internet problems 59.3%

Difficult for paent to find suitable space 46.9%

Risk of paent geng distracted 40.7%

What are the main challenges for you using online therapy*

Difficulty feeling connected with paent 40.0%

Difficulty reading paents emoons 36.6%

Risk of me geng distracted 32.4%

Difficulty feeling/expressing empathy 21.4%

Difficulty to find professional space 17.2%

Other 13.1%

Confidenality concerns 13.1%

Difficulty keeping professional boundaries 13.1%

Scheduling difficules 8.3%

Other 13.1%

More red 58.6%

… online sessions make me feel…

Same red 33.8%

Less red 7.6%

Same competent 33.8%

Compared to in-person sessions

Less competent 7.6%

More competent 4.8%

Same authenc/genuine 66.2%

… during my online sessions I felt…

Less authenc/genuine 29.7%

More authenc/genuine 3.4%

Same confident 65.5%

Less confident 23.4%

More confident 10.3%

How do your paents experience

Somewhat posive 49.0%

Neutral 27.6%
online therapy?

Extremely posive 13.8%

Somewhat negave 7.6%

Extremely negave 0.0%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

Figure 1. Psychotherapists’ transition toward online psychotherapy during the pandemic.

The asterisk indicates that multiple answers were possible per respondent.
 244 BÉKÉS AND AAFJES-VAN DOORN

negative impact on users’ attitudes, the psycho- and confident, and less authentic or genuine as
therapists’ slightly positive attitude toward on- well as feeling less connected during the online
line psychotherapy is remarkable. Psychothera- sessions, and unlike the technical and commu-
pists, outside crisis situations, generally also nication challenges that did not impact their
hold neutral or positive views of web-based attitudes toward online psychotherapy, these
interventions (Damianakis, Climans, & Mar- negative feelings were associated with more
ziali, 2008; van der Vaart et al., 2014; Wang- negative attitudes to online psychotherapy.
berg, Gammon, & Spitznogle, 2007). This ap-
pears to indicate that despite the forced and Limitations
abrupt transition and the stress associated with
First, this was a cross-sectional research de-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

the global crisis situation, psychotherapists had

sign that relied on survey data. Future research
This document is copyrighted by the American Psychological Association or one of its allied publishers.

a reasonably good experience with online psy-

designs may benefit from the inclusion of a
chotherapy. This may be especially true for
qualitative approach. Second, our sample was
psychotherapists in North America, who, in
small and predominantly Caucasian, living in
comparison with their European counterparts,
North America and Europe, and thus, we do not
thought that providing online psychotherapy
know how these results would generalize to
was expected by others and would be relatively
ethnic minority psychotherapists, or those resid-
easy.
ing in Asia or South America. Although the
Among the psychotherapist characteristics,
characteristics of the participating psychothera-
similarly to previous studies (Mora et al., 2008;
pists were comparable with previous large-scale
Perle et al., 2013), we found that psychothera-
international psychotherapist-survey results
pists who identified with the cognitive-behav-
with regard to age, gender, patient population,
ioral approach reported more positive attitudes
and theoretical orientation (Orlinsky et al.,
toward online psychotherapy compared with
1999), the fact that we used a convenience
those who identified with the psychodynamic
sample of psychotherapists who were interested
approach. One might speculate that this differ-
in completing the survey might also limit the
ence may relate to the views on mechanisms of
generalizability of our findings. The fact that we
change in therapy (Perle et al., 2013). In psy-
used a convenience sample of psychotherapists
chodynamic therapy there is strong focus on
who were interested in completing the survey
in-session relational processes and nonverbal
might also limit the generalizability of our find-
communication, and these subtle processes may
ings. Although this survey study focused on
be harder to capture and work with via video-
psychotherapists, patients’ attitudes will also be
conferencing.
important to examine, especially because the
The extent to which psychotherapists pre-
online interventions are designed for and paid
pared themselves and their patients for the tran-
by patients and might have been especially cru-
sition to online psychotherapy during the pan-
cial in this time of global distress. It is possible
demic also impacted psychotherapist attitudes
that the online psychotherapy experience, even
toward online psychotherapy. Preparing for the
if perceived positively by psychotherapists and
switch with colleagues and patients in multiple
patients, does not translate to a reduction of
ways may have provided practical help and
patients’ symptoms to the same extent that in-
guidance in the transition as well as a sense of
person therapy does (e.g., Chavooshi, Moham-
anxiety regulation, reassurance, and control for
madkhani, & Dolatshahee, 2017). In other
the psychotherapists themselves, especially in
words, the proof of the pudding will be in the
North America. Moreover, psychotherapists’ at-
ultimate effect of online psychotherapy on pa-
titudes were also associated with perceived pa-
tients’ symptom reduction.
tient experience, which was mostly positive.
This suggests that despite the multiple technical Conclusions
and communication challenges identified by
psychotherapists, they perceived their patients Overall, our results show that, despite the
to have a good therapy experience and thus stressful contextual factors of the COVID-19
might be inclined to consider online psycho- pandemic, attitudes toward online psychother-
therapy again in the future. Many psychothera- apy were reasonably positive. Many of the fac-
pists reported feeling more tired, less competent tors that we found to be related to psychother-
 PROVIDING ONLINE THERAPY DURING COVID-19 245

apists’ attitudes toward online psychotherapy, Donovan, C. L., Poole, C., Boyes, N., Redgate, J., &
such as previous online psychotherapy experi- March, S. (2015). Australian mental health worker
ence, preparations of psychotherapist and pa- attitudes towards cCBT: What is the role of knowl-
tient, and in-session experiences of feeling tired, edge? Are there differences? Can we change them?
Internet Interventions: the Application of Informa-
less confident and competent, less connected tion Technology in Mental and Behavioural
and authentic, might be usefully addressed in Health, 2, 372–381. http://dx.doi.org/10.1016/j
further training and peer support on providing .invent.2015.09.001
online psychotherapy. Given that online psy- Fisher, P., Chew, K., & Leow, Y. J. (2015). Clinical
chotherapy experience has been found to lead to psychologists’ use of reflection and reflective prac-
more positive attitudes toward it, it is possible tice within clinical work. Reflective Practice, 16,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

that once the initial stress subsides and psycho- 731–743. http://dx.doi.org/10.1080/14623943
This document is copyrighted by the American Psychological Association or one of its allied publishers.

therapists gain more experience and more train- .2015.1095724

ing, they will feel more at ease using online Hennemann, S., Beutel, M. E., & Zwerenz, R.
(2017). Ready for EHealth? Health professionals’
psychotherapy via videoconferencing. Also,
acceptance and adoption of ehealth interventions
peer support and supervision during (reflection in inpatient routine care. Journal of Health Com-
in action) and after (reflection on action) this munication, 22, 274–284. http://dx.doi.org/10
pandemic might increase psychotherapists’ .1080/10810730.2017.1284286
ability for reflective practice and making sense Liu, L., Miguel Cruz, A., Rios Rincon, A., Buttar, V.,
of this global crisis as well as the resulting Ranson, Q., & Goertzen, D. (2015). What factors
changes in their therapeutic work (Fisher, determine therapists’ acceptance of new technolo-
Chew, & Leow, 2015). Thus, we like to think gies for rehabilitation—A study using the Unified
that this forced transition to online psychother- Theory of Acceptance and Use of Technology
(UTAUT). Disability and Rehabilitation, 37, 447–
apy caused by the COVID-19 epidemic might
455. http://dx.doi.org/10.3109/09638288.2014
turn out to have some silver lining. .923529
McMinn, M. R., Bearse, J., Heyne, L. K., Smith-
berger, A., & Erb, A. L. (2011). Technology and
References independent practice: Survey findings and impli-
cations. Professional Psychology, Research and
Appelbaum, M., Cooper, H., Kline, R. B., Mayo- Practice, 42, 176–184. http://dx.doi.org/10.1037/
Wilson, E., Nezu, A. M., & Rao, S. M. (2018). a0022719
Journal article reporting standards for quantitative Mora, L., Nevid, J., & Chaplin, W. (2008). Psychol-
research in psychology: The APA Publications and ogist treatment recommendations for Internet-
Communications Board task force report. Ameri- based therapeutic interventions. Computers in Hu-
can Psychologist, 73, 3–25. http://dx.doi.org/10 man Behavior, 24, 3052–3062. http://dx.doi.org/10
.1037/amp0000191 .1016/j.chb.2008.05.011
Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Orlinsky, D., Ambühl, H., Rønnestad, M., Davis, J.,
Ross, B., Zuest, D., . . . Thorp, S. R. (2012). Gerin, P., Davis, M., . . . Aapro, N. (1999). De-
Videoconferencing psychotherapy: A systematic velopment of psychotherapists: Concepts, ques-
review. Psychological Services, 9, 111–131. http:// tions, and methods of a collaborative international
dx.doi.org/10.1037/a0027924 study. Psychotherapy Research, 9, 127–153. http://
Bennett-Levy, J. (2003). Reflection: A blind spot in dx.doi.org/10.1080/10503309912331332651
psychology? Clinical Psychologist, 27, 16–19. Perle, J. G., Langsam, L. C., Randel, A., Lutchman,
Chavooshi, B., Mohammadkhani, P., & Dolatshahee, S., Levine, A. B., Odland, A. P., . . . Marker, C. D.
B. (2017). Telemedicine vs. in-person delivery of (2013). Attitudes toward psychological telehealth:
intensive short-term dynamic psychotherapy for Current and future clinical psychologists’ opinions
patients with medically unexplained pain: A 12- of internet-based interventions. Journal of Clinical
month randomized, controlled trial. Journal of Psychology, 69, 100–113. http://dx.doi.org/10
Telemedicine and Telecare, 23, 133–141. http://dx .1002/jclp.21912
.doi.org/10.1177/1357633X15627382 Reese, R. J., Mecham, M. R., Vasilj, I., Lengerich,
Damianakis, T., Climans, R., & Marziali, E. (2008). A. J., Brown, H. M., Simpson, N. B., & Newsome,
Social workers’ experiences of virtual psychother- B. D. (2016). The effects of telepsychology format
apeutic caregivers groups for Alzheimer’s, Parkin- on empathic accuracy and the therapeutic alliance:
son’s, stroke, frontotemporal dementia, and trau- An analogue counselling session. Counselling &
matic brain injury. Social Work with Groups, 31, Psychotherapy Research, 16, 256–265. http://dx
99–116. .doi.org/10.1002/capr.12092
 246 BÉKÉS AND AAFJES-VAN DOORN

Roesler, C. (2017). Tele-analysis: The use of media Topooco, N., Riper, H., Araya, R., Berking, M.,
technology in psychotherapy and its impact on the Brunn, M., Chevreul, K., . . . the E-COMPARED
therapeutic relationship. Journal of Analytical Psy- Consortium. (2017). Attitudes towards digital
chology, 62, 372–394. http://dx.doi.org/10.1111/ treatment for depression: A European stakeholder
1468-5922.12317 survey. Internet Interventions: the Application of
Simpson, S. (2009). Psychotherapy via videoconfer- Information Technology in Mental and Behav-
encing: A review. British Journal of Guidance & ioural Health, 8, 1–9. http://dx.doi.org/10.1016/j
Counselling, 37, 271–286. http://dx.doi.org/10 .invent.2017.01.001
.1080/03069880902957007 van der Vaart, R., Witting, M., Riper, H., Kooistra,
Simpson, S., & Reid, C. L. (2014). Therapeutic alli- L., Bohlmeijer, E. T., & van Gemert-Pijnen,
ance in videoconferencing psychotherapy: A re- L. J. (2014). Blending online therapy into regu-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

view. The Australian Journal of Rural Health, 22, lar face-to-face therapy for depression: content,
This document is copyrighted by the American Psychological Association or one of its allied publishers.

ratio and preconditions according to patients and

280–299. http://dx.doi.org/10.1111/ajr.12149
therapists using a Delphi study. BMC psychiatry,
Titzler, I., Saruhanjan, K., Berking, M., Riper, H., &
14, 355.
Ebert, D. D. (2018). Barriers and facilitators for
Venkatesh, V., Morris, M. G., Davis, G. B., & Davis,
the implementation of blended psychotherapy for F. B. (2003). User acceptance of information tech-
depression: A qualitative pilot study of therapists’ nology: Toward a unified view. Management In-
perspective. Internet Interventions: the Applica- formation Systems Quarterly, 27, 425– 478. http://
tion of Information Technology in Mental and Be- dx.doi.org/10.2307/30036540
havioural Health, 12, 150–164. http://dx.doi.org/ Wangberg, S. C., Gammon, D., & Spitznogle, K.
10.1016/j.invent.2018.01.002 (2007). In the eyes of the beholder: exploring
Tonn, P., Reuter, S. C., Kuchler, I., Reinke, B., psychologists’ attitudes towards and use of e-ther-
Hinkelmann, L., Stöckigt, S., . . . Schulze, N. apy in Norway. CyberPsychology & Behavior, 10,
(2017). Development of a questionnaire to mea- 418– 423.
sure the attitudes of laypeople, physicians, and Wittson, C. L., Affleck, D. C., & Johnson, V. (1961).
psychotherapists toward telemedicine in mental Two-way television in group therapy. Mental Hos-
health. JMIR Mental Health, 4, e39. http://dx.doi pitals, 12, 22–23. http://dx.doi.org/10.1176/ps.12
.org/10.2196/mental.6802 .11.22

Actitudes de los psicoterapeutas hacia la terapia en línea durante la pandemia de COVID-19

Durante la pandemia de COVID-19, se ha aconsejado a muchas personas en todo el mundo a que trabaje desde casa en un
esfuerzo por frenar la propagación del virus. Dentro del campo de psicoterapia, esto significo que muchos psicoterapeutas
que estaban acostumbrados a ver sus pacientes en persona transicionaron a proveer terapias en línea a través de
videoconferencia, independientemente de su experiencia previa o actitudes hacia la psicoterapia en línea. Este estudio de
encuesta examinó cómo las actitudes de los psicoterapeutas hacia la psicoterapia en línea está influenciado por sus
características y experiencias profesionales durante la repentina transición de la psicoterapia presencial a la psicoterapia en
línea debido a la pandemia. Nosotros colectamos datos en tiempo real de ciento cuarenta y cinco psicoterapeutas de América
del Norte y Europa poco después de que la Organización Mundial de la Salud declarara una pandemia. Participantes
reportaron sobre sus experiencias pasadas con la psicoterapia en línea, preparativos de sus sesiones de psicoterapia en línea
durante la pandemia, los desafíos que encontraron en las sesiones en línea y sus actitudes hacía psicoterapia en línea en
general. Dentro del contexto de esta transición forzada debido a la pandemia global de COVID-19, la mayoría de los
psicoterapeutas identificaron una actitud poco positiva hacia la psicoterapia en línea, lo que sugiere que probablemente
usarían psicoterapia en línea en el futuro. Nuestros hallazgos sugieren que las actitudes de los psicoterapeutas hacia la
psicoterapia en línea están influenciadas por sus experiencias pasadas, como modalidad de psicoterapia, experiencia clínica,
y experiencia previa de psicoterapia en línea, así como su experiencia de transición durante la pandemia y su ubicación
geográfica. Dentro de las limitaciones de este estudio de encuesta, implicaciones y direcciones futuras son describidas.

videoconferencia, psicoterapia en línea, COVID-19, psicoterapeutas, actitud

在 COVID-19全球大流行期間，心理治療師對在線治療之態度
在COVID-19大流行期間，世界各地的許多人被建議在家工作，以減慢病毒的傳播速度。在心理治療領域，這意味著
許多習慣於親自會談的心理治療師轉而透過視頻會議在線提供治療，無論他們以前的經驗或對在線心理治療的態度
如何。這個調查研究檢查了因為大流行，在突然從面對面治療轉換到在線心理治療的時候，治療師對在線心理治療
的態度如何受到他們的特性和專業經驗的影響。在世界衛生組織宣布大流行後不久，我們收集了來自北美和歐洲的
 PROVIDING ONLINE THERAPY DURING COVID-19 247

一百四十五名心理治療師的即時數據。參與者報告了他們過去在線心理治療的經驗，在大流行期間對在線心理治療
療程的準備，他們在在線療程中遇到的挑戰以及他們對更普遍的在線心理治療之態度。在這種因為全球COVID-19大
流行而被迫轉換的情境下，大部分的心理治療師都多少對在線心理治療持有正面的態度，表明他們在未來可能會使
用在線心理治療。我們的發現表明，心理治療師對在線心理治療的態度會受他們過去經驗的影響，像是心理治療的
形式、臨床經驗、之前的在線心理治療經驗，以及他們在大流行期間的轉換經驗及其地理位置。本調查研究描述了
研究限制、研究結果的應用和未來研究方向。

視頻會議, 在線心理治療, COVID-19, 心理治療師, 態度

Received April 3, 2020

Revision received April 23, 2020
Accepted April 24, 2020 䡲
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Members of Underrepresented Groups:

Reviewers for Journal Manuscripts Wanted
If you are interested in reviewing manuscripts for APA journals, the APA Publications
and Communications Board would like to invite your participation. Manuscript reviewers
are vital to the publications process. As a reviewer, you would gain valuable experience
in publishing. The P&C Board is particularly interested in encouraging members of
underrepresented groups to participate more in this process.

If you are interested in reviewing manuscripts, please write APA Journals at

Reviewers@apa.org. Please note the following important points:

• To be selected as a reviewer, you must have published articles in peer-reviewed

journals. The experience of publishing provides a reviewer with the basis for preparing
a thorough, objective review.

• To be selected, it is critical to be a regular reader of the five to six empirical journals

that are most central to the area or journal for which you would like to review. Current
knowledge of recently published research provides a reviewer with the knowledge base
to evaluate a new submission within the context of existing research.

• To select the appropriate reviewers for each manuscript, the editor needs detailed
information. Please include with your letter your vita. In the letter, please identify
which APA journal(s) you are interested in, and describe your area of expertise. Be as
specific as possible. For example, “social psychology” is not sufficient—you would
need to specify “social cognition” or “attitude change” as well.

• Reviewing a manuscript takes time (1– 4 hours per manuscript reviewed). If you are
selected to review a manuscript, be prepared to invest the necessary time to evaluate
the manuscript thoroughly.

APA now has an online video course that provides guidance in reviewing manuscripts. To
learn more about the course and to access the video, visit http://www.apa.org/pubs/
journals/resources/review-manuscript-ce-video.aspx.