Therapists’ self-efficacy and experiences managing clinical risk in teletherapy: a mixed methods exploration

ABSTRACT

Before teletherapy usage grew dramatically during COVID-19, clinicians considered it less suitable for patients experiencing high-risk behaviours and related psychopathology (e.g., self-injurious thoughts and behaviours). This mixed methods study assesses clinicians’ concerns by quantitatively and qualitatively exploring their experiences, satisfaction, and self-efficacy using teletherapy for high-risk patients. Mental healthcare providers (N = 75) completed a survey assessing teletherapy usage, attitudes, and risk assessment/management self-efficacy. Nine providers then completed semi-structured interviews on these topics. Clinicians reported more confidence assessing and managing risk in-person as compared to teletherapy, and they reported being more likely to treat high-risk patients face-to-face than virtually. Still, attitudes toward teletherapy were generally positive, and clinicians who confidently managed risk in-person also tended to be confident virtually, often reporting that they could administer evidence-based therapeutic interventions regardless of therapy modality. Qualitative analyses revealed both general and person-specific factors that conferred increased or diminished confidence when managing risk.

KEYWORDS:

• teletherapy
• clinician attitudes
• telehealth
• risk assessment
• self-injurious thoughts and behaviours

SDG KEYWORDS:

• SDG 3: Good health and well-being
• SDG 9: Industry, innovation and infrastructure
• SDG 10: Reduced inequalities

Acknowledgements

The authors would like to thank Lea Elton for her assistance transcribing and coding interviews. The authors are also grateful to the individuals who participated in this study.

Data availability statement

Anonymized data that support the findings of this study are available from the corresponding author, N.M.J., upon reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by funding from the Roche & Gomez Student Research Program, awarded by Williams College to the corresponding author.

Notes on contributors

Nigel Jaffe

Nigel Jaffe is a Clinical Research Assistant at McLean Hospital, where he studies adolescent depression, neuroimaging, and psychotherapy.

Stephanie Jarvi Steele

Stephanie Jarvi Steele is an Assistant Professor of Psychology at Smith College, where she runs the Behavioral Assessment of Self-Injury Lab (BASIL), which aims to further elucidate risk factors and preventive interventions for self-injurious thoughts and behaviours.