Telephone versus face-to-face psychological therapy in an improving access to psychological therapies (IAPT) low-intensity service: an exploration of practitioners' and patients' experiences and its effectiveness

Abstract

Over-the-Telephone (OTT) delivered therapies as an alternative method to face-to-face (F2F) therapy are becoming more prevalent in mental healthcare. This mixed methods project explored the differences between OTT and F2F low-intensity therapies within the Improving Access to Psychological Therapies (IAPT) programme. The views and experiences of IAPT service users and practitioners were collected using questionnaires and interviews. Service user psychometric outcome data were also collected. Established research documents a range of benefits of OTT use in psychotherapies but there are growing concerns over its potential effects on the therapeutic relationship. The results from this project raised five topics for discussion: (1) The effectiveness of OTT versus F2F therapy: Symptom score reductions were found across both modalities, but OTT users showed significant improvements which were not evident with F2F users. (2) The impact of OTT versus F2F on the therapeutic relationship: The therapeutic relationship is central to recovery in therapy and the absence of visual and non-verbal communication in OTT use contributed to a potential loss of ‘humanness’ in the experience of therapy. (3) Improving access to psychological therapies: OTT use was commended by patients and practitioners for removing barriers to access psychotherapies. (4) Patient attitudes to telephone use: Patients were initially sceptical about OTT because of their view that F2F is the ‘norm’ in psychotherapies. (5) Practitioner views on telemedicine use and the IAPT process: Practitioners expressed wariness towards OTT use, particularly in the context of the IAPT services’ quantitatively driven goals. Overall, these results support previous research in telemedicine. However, this project is unique in providing data on the patient and practitioner experiences of OTT and F2F in IAPT and contributes new understanding to an emerging research area. Possibilities for future research are outlined including ideas about how to develop and apply theoretical models which are relevant to the experience of therapy in an IAPT service.

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ORCID for Joanne Brown: orcid.org/0000-0002-3383-8809

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