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  • Stephen Greggo

Making quality connections via telemental health

Remote delivery of mental health services is a new reality. Recent controversy addresses consent and payment as services move from the office to online. As regulations loosen and delivery options open, it’s time to shift the focus. Beyond what is permissible or practical, let’s ponder how to have the most impact. What ensures a quality connection in telemental health?

When introducing the notion of quality, one immediate reaction might be to launch into a discussion over cable types, HD vs SD, bandwidth, reliable signals, or delivery platforms. Hardware and software are worthy of consideration. The means of delivery that mediates this human encounter determine its security, safety, reliability, and, ease of communication. After all, sessions get choppy when the sound fades, a critical sentence is dropped, or there is a two-minute delay to step out and reenter the cyber meeting space. There is nothing more frustrating for both parties than heading into sensitive material with potential for growth only to watch the picture begin to flutter or facial expression freeze. The quality of technology for telehealth is important.


Nevertheless, the connection that demands our highest attention is the human one: the therapeutic alliance. This critical domain is where our acquired listening skills and holistic attending must be recalibrated to perform not only across personal space but cyberspace. How many hours of videotape did I once review to notice the subtlest client responses? These come not from what is said but by breathing, muscle tension, blushing, skin flickering, eye movement, and body posture. Our total encounter awareness schema must find ways to operate with a flat-screen portrait of the fully embodied person. Participate in any training on telemental health and reference will be made to the matter of ‘competency.’ My contention is that no matter how comfortable or agile one is with digital collaboration, the working relationship in therapy is special, powerful, and central. This is an area where MHPs can acquire competency in digitally mediated psychotherapy by incorporating assessment.


The Counseling Partnership Alliance Check (CPAC) [1] is a short, use on the fly measure designed to track the alliance across sessions. It builds on a valid model to operationalize the alliance but also ties these concepts to a Christian theological perspective. [2] The session is reviewed on the CPAC by rating three broad categories: Hope for Change, Hospitality and Connection, and Cultivating Character.


Here is a great strategy to adopt to acquire competency in maximizing the alliance in digital sessions: Invite clients into this area by requesting specific feedback on the quality of the connection. This can be done by providing the CPAC to secure ratings after a session. Or, as an alternative, give them the CPAC in advance. As the session draws to a close, point them to its three items and ask for a rating (1-9). Record these in your clinical notes and attend with a new awareness of these dynamics in the following session. After practice, clients will learn that discussing the quality of the alliance with us, even remotely, is a realistic approach to deepen the partnership and bring the presence of our Lord into online sessions. That, after all, is the ultimate quality alliance that our efforts aspire to bring to life.

[1] The CPAC is available for download at no charge on this website https://www.stephenpgreggo.com/resources. [2] See Chapter 10 “Therapeutic Alliance and the Significant Self” in Assessment for Counseling in Christian Perspective, pp. 186-195.

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