Sensing Through the Keyhole: Psychotherapists’ Experience of Attunement in Online Video Therapy

Abstract

Attunement is central to psychotherapy; it facilitates emotional sensing and empathy, guides therapist interventions, and supports therapy outcomes for clients (Erskine et al., 2022). An interpretative hermeneutic literature review was chosen to examine the research question “How do psychotherapists experience and understand attunement in online video therapy (OVT)?”. The findings indicate therapists encounter spatial, technical, and relational challenges and limitations working in OVT which impact the experience of attunement. Many therapists notice difficulties with the perception and qualitative experience of empathic, affective, and embodied attunement in OVT. Notably, many therapists notice less silence in OVT, that attuning to silence is difficult, and communicating attunement in silent moments and times of intense client affect is challenging.

The capacity for attunement is not lost in OVT; it is transformed and requires therapists to adapt and evolve the thinking and practice of psychotherapy in this therapeutic space. When therapists accept the differences of OVT and gain technological confidence and competency, their attunement is enhanced. Attunement involves therapists intentionally preparing the ‘outer space’—the technology and physical setting from which they work, alongside their ‘inner space’ for attunement. This research highlights that the possibility for attunement exists regardless of therapeutic space and the psychotherapist’s capacity for attunement can be enhanced in OVT. Future primary research would be helpful to investigate therapist experiences of attunement, silence, and effective communication of attunement in OVT. A hermeneutic literature review is not primary research and has limited generalisability and transferability; nevertheless, the findings may offer a useful contribution to the wider body of psychotherapeutic knowledge.