@Article{info:doi/10.2196/66904,
author="Cataldo, Francesco
and Chang, Shanton
and Mendoza, Antonette
and Buchanan, George
and Van Dam, Nicholas",
title="Exploring Technical Features to Enhance Control in Videoconferencing Psychotherapy: Quantitative Study on Clinicians' Perspectives",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="1",
volume="27",
pages="e66904",
keywords="videoconference psychotherapy; control; therapeutic relationship; therapeutic alliance; videoconference technologies; technological features; video; telepsychiatry; videoconferencing; psychotherapy; mental health; mental; therapy; therapist; videoconference; platform; psychology; psychologist",
abstract="Background: The COVID-19 pandemic required psychologists and other mental health professionals to use videoconferencing platforms. Previous research has highlighted therapists' hesitation toward adopting the medium since they find it hard to establish control over videoconferencing psychotherapy (VCP). An earlier study provided a set of potential features that may help enhance psychologists' control in their videoconference sessions, such as screen control functionality, emergency call functionality, eye contact functionality, zooming in and out functionality, and an interactive interface with other apps and software. Objective: This study aims to investigate whether introducing technical features might improve clinicians' control over their video sessions. Additionally, it seeks to understand the role of the video in therapists' VCP experience from a technical and relationship point of view. Methods: A total of 121 mental health professionals responded to the survey, but only 86 participants provided complete data. Exploratory Factor Analysis was used to scrutinize the data collected. A total of three factors were identified: (1) ``challenges in providing VCP,'' (2) ``features to enhance the therapeutic relationship,'' and (3) ``enhancing control.'' Path analysis was used to observe the relationship between factors on their own and with adjustment to participants' areas of expertise and year in practice. Results: This study highlighted a relationship between the three identified factors. It was found that introducing certain features reduced therapists' challenges in the provision of VCP. Moreover, the additional features provided therapists with enhanced control over their VCP sessions. A path analysis was conducted to investigate the relationships between the factors loaded. The results of the analysis revealed a significant relationship between ``challenges in VCP'' and ``features to enhance the therapeutic relationship'' (adjusted beta [Adj$\beta$]=--0.54, 95{\%} CI 0.29-0.79; P<.001). Additionally, a significant positive relationship was found between ``features to enhance the therapeutic relationship'' and ``enhancing control'' (Adj$\beta$=0.25, 95{\%} CI 0.15-0.35; P<.001). Furthermore, there was an indirect effect of ``challenges in providing VCP'' on ``enhancing control'' (Adj$\beta$=0.13, 95{\%} CI 0.05-0.22; P=.001) mediated by ``features to enhance TR.'' The analysis identified the factor ``features to enhance TR'' (effect size=0.25) as key for improving clinicians' performance and control. Conclusions: This study demonstrates that technology may help improve therapists' VCP experiences by implementing features that respond to their need for enhanced control. By augmenting therapists' control, clinicians can effectively serve their patients and facilitate successful therapy outcomes. Moreover, this study confirms the video as a third agent that prevents therapists from affecting clients' reality due to technical and relational limits. Additionally, this study supports the general system theory, which allowed for the incorporation of video in our exploration and helped explain its agency in VCP. ",
issn="1438-8871",
doi="10.2196/66904",
url="https://www.jmir.org/2025/1/e66904",
url="https://doi.org/10.2196/66904",
url="http://www.ncbi.nlm.nih.gov/pubmed/40168042"
}