Similar to the working alliance, the perceived quality of the real relationship was related to using more methods to prepare the patients to the transition (r = .18, p < .05) and perceived positive patient experience (r = .24, p < .01). Age, years of clinical experience, number of patients seen weekly before the pandemic, previous video therapy experience, and views of video therapy before the pandemic were not associated with the perceived quality of alliance or the real relationship in online sessions.

Top-notch care about-doubt and you will stress

On average, therapists experienced professional self-doubt sometimes or frequently (M = 2.41, SD = .67, range: 1.11–4.78) in video therapy during the pandemic, which is higher than the level of self-doubt experienced by therapists in a prior naturalistic study of PSD (Nissen-Lie et al., 2013 ; t(136) = , p < .0001), but still on the lower end of the 5-point Likert scale. Therapists felt less competent (M = 2.28, SD = .52, range: 1.00–3.00) and less confident (M = 2.15, SD = .56, range: 1.00–3.00) about their professional skills during online compared to in-person sessions. Higher levels of reported professional self-doubt were related to several demographic variables, such as younger age (r = ?.34, p < .001), less clinical experience (r = ?.33, p < .001), and worse perceived patient experience (r = ?.36, p < .001).

Therapists' anxiety about using video therapy was moderate (M = 2.87, S.D. = .86, range: 1.00–4.83).