Narrative Clinical Review. This page provides the verified citation, abstract, and full-text PDF for the journal article.
Clinical boundary: Evidence for video psychotherapy does not establish suitability or equivalence for every person, treatment, risk state, or setting. Privacy, location, emergency contacts, failed connections, recording rules, and a route to change format should be agreed in advance.
Publication Details
- Author: Christian Jonathan Haverkampf
- Journal: The Journal of Psychiatry Psychotherapy and Communication
- Publication date: 2022-03-31
- Volume, issue, pages: 11(1), 21–30
- Article type: Narrative Clinical Review
Recommended citation: Haverkampf, C. J. (2022). Presence at a Distance: Therapeutic Alliance, Silence, and Nonverbal Communication in Video Psychotherapy. The Journal of Psychiatry Psychotherapy and Communication, 11(1), 21–30.
Abstract
Video psychotherapy is neither an attenuated copy of office work nor a clinically neutral change of address. It preserves an encounter while altering gaze, bodily visibility, silence, privacy, turn-taking, and the meaning of interruption. This narrative clinical review considers evidence available through 28 February 2022 and asks how therapists can sustain presence when communication is technologically mediated. Meta-analytic findings suggest that video treatment can achieve outcomes broadly comparable with in-person care for several studied conditions, and alliance ratings are often strong. Those aggregate findings do not establish equivalence for every patient, intervention, risk state, or social setting. Clinical quality depends on more than connection speed. Therapist and patient need an explicit frame for location, privacy, emergencies, failed connections, recordings, household intrusions, and movement between video and in-person work. On screen, the therapist must read partial nonverbal information without pretending that what lies outside the frame is known. Lag may imitate hesitation; silence may deepen reflection or become ambiguous absence. Metacommunication therefore becomes a central technique: observable changes are named tentatively and their meaning is checked. Video can increase access, continuity, and patients' agency, while excluding others through cost, disability, digital literacy, surveillance, or lack of private space. The defensible question is not whether video therapy is simply as good, but for whom, for what work, under which safeguards, and with what route to change format.
Keywords
video psychotherapy; therapeutic alliance; therapeutic presence; nonverbal communication; silence; telepsychology
Full Text
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