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

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.