Therapeutic rapport in telehealth
Therapeutic rapport or the therapeutic relationship between the clinician - establishes a strong foundation for effective therapy. Therapeutic rapport influences how motivated clients feel, how engaged they remain throughout the process, and ultimately how successful therapy outcomes can be.
Summary
- A strong clinician–client relationship improves motivation, engagement, and therapy results even in teletherapy.
- Technical issues, reduced nonverbal cues, and distractions can make building rapport harder than in-person sessions. Enrolling in a teletherapy course for therapists can help providers enhance their knowledge.
- Research shows therapeutic rapport and outcomes in teletherapy are comparable to face-to-face therapy when clinicians are intentional.
- Using empathy, nonverbal cues, authenticity, direct check-ins, and technology tools helps clinicians strengthen rapport online. Download my free teletherapy worksheets.
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In the teletherapy setting, where sessions take place over a screen rather than in person, extra care and intentionality is required to cultivate a strong therapeutic rapport. Clinicians can help clients feel supported, understood, and ready to participate in therapy by focusing on connection first.
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Why therapeutic rapport matters in teletherapy
A positive therapeutic rapport is essential in any setting. By creating a connection built on mutual respect, trust, and shared goals, the client and clinician can effectively collaborate throughout the therapy journey.
By building a strong client-clinician connection, teletherapy clients can achieve outcomes comparable to in-person therapy.
For example, a 2024 study showed that clients receiving teletherapy reported noninferior therapeutic alliance and clinical outcomes compared with clients in face-to-face psychotherapy.
Challenges of building therapeutic rapport online
Therapy held over a virtual platform presents unique challenges for establishing rapport:
- Technical barriers: Issues such as poor audio/video quality, lag, or dropped sessions can create distractions or lack or presence, interfering with connection.
- Physical separation: Environmental cues offered by in person sessions, including the therapist’s office, ambiance, and nonverbal cues (e.g., body language) are reduced or lost during teletherapy. Some nonverbal signals may not be seen due to the reduced visibility from screens.
- Distraction and engagement: Clients may feel that it is more difficult to be fully present and engaged during online therapy sessions. “Zoom fatigue” can set in when clients stare at a screen for extended periods of time. Interruptions from family members or pets in the client’s home can be naturally distracting during teletherapy.
Despite these challenges, developing a positive therapeutic rapport over teletherapy is possible. A recent (2023) meta-analysis of 18 studies (Seuling et al., 2023) reported no statistically significant difference in the therapeutic rapport between teletherapy and in-person therapy for alliance ratings by patients.
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6 practical strategies to build therapeutic rapport in teletherapy
Developing a strong therapeutic rapport can directly impact therapy outcomes. According to Saxler et al. (2024) in a study published by Frontiers in Psychology, “Even in online treatment, the strength of the therapeutic alliance remains a robust predictor of positive outcomes – across orientations and modalities.”
Here are six strategies for building a strong therapeutic rapport in teletherapy, with insight on how to apply them.
Build therapeutic rapport early
Set the tone from the first session when starting a new teletherapy client, and during the first few minutes of each session.
This helps build a sense of safety, trust, and dependability that can make clients and caregivers more likely to engage and attempt therapy targets.
For children, this might mean playing a preferred game or having a conversation about one of their interests.
When working with parents and caregivers, engaging in a brief, genuine moment of small talk, such as asking about their week, can go a long way.
Acknowledge some of the potential challenges of teletherapy if this is a new modality, and discuss what they can expect from therapy. Ensure audio and visual features are working well.
Use nonverbals intentionally
Remember to use nonverbal communication cues that clients can see over remote sessions, since many cues (subtle gestures and body language) may be harder to see. Nonverbal cues help communicate attention, attunement, and empathy.
Nodding or leaning in toward the camera when the client is speaking can show that you are actively listening. Use facial expressions that match what you are saying, like smiling or showing concern. Be sure your camera is positioned at eye level and that the lighting allows your face to be visible.
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Demonstrate empathy
Empathy is a critical component of therapeutic rapport, and must be conveyed clearly and with purpose in a virtual setting. The teletherapy space should not be a one-sided interaction, but instead, should feel more like a partnership.
Use minimal encouragers like “right” or “I hear you” to show you are actively listening and engaged in what the client is saying.
Practice reflective listening by summarizing or restating what the client says, to ensure you’ve correctly understood them. This validates the clients feelings and deepens trust between you.
Digitally show authenticity and warmth
Be your authentic self to build a genuine connection, as clients can sense insincerity. Within professional boundaries, show genuine warmth and kindness. This makes therapists appear more human and approachable, not just a voice on the screen.
Some short, relevant self-disclosures where appropriate can also convey authenticity (e.g., “Basketball is my favorite sport to play, what’s yours?”). Use small talk at the beginning and throughout the session to maintain a calm, unhurried undertone. This creates a safe space where the client feels comfortable to be themselves in return.
Address the relationship directly
Sometimes openly discussing how therapeutic rapport is going is the most effective way to build it. Check in with your client by asking direct questions about how they feel the sessions are going.
For example, “how do you feel like working over the computer is going?” or “is there anything about our sessions you’d like to see change?”.
If a parent expresses concerns with their child’s ability to form rapport with the clinician over teletherapy, validate that and problem-solve.
Periodically check in, invite feedback, and engage in an ongoing discussion about expectations. This allows clients to voice concerns and prevents drift or disengagement over time.
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Use technology to your advantage
Teletherapy can present unique challenges. Instead of seeing technology as a barrier, use it to your advantage to enhance the therapeutic alliance.
Incorporate tech tools like screen sharing (for watching relevant videos together), interactive games (making therapy fun and hands-on), and share visuals (drawings and slides) to make sessions more dynamic and interactive.
Using high-quality equipment, such as a good camera, lighting, and microphone, enhance the sense of presence during remote sessions.
Building a strong, positive therapeutic relationship in the teletherapy modality is possible with intention, skill, and the use of unique strategies. Rapport with clients and caregivers directly influences motivation, participation, and outcomes.
Remember to show authenticity, be attentive to nonverbal cues, and lean into technology as something that connects you with teletherapy clients, not create separation.
Choosing the best HIPAA-compliant platform
Telehealth use has expanded over the last several years, with teletherapy emerging as a trusted, convenient, and secure alternative to in-person care for both children and adults.
Therapists and clients report high satisfaction, and teletherapy now accounts for 13–17% of U.S. healthcare visits.
To protect privacy, providers must use HIPAA-compliant video platforms. The top platforms not only secure sessions with encryption but also support scheduling, billing, documentation, and client portals to streamline practice management.
The best teletherapy platforms go beyond video conferencing. By combining compliance, reliability, stable video, resources, games and practice management tools, they help therapists deliver care that’s safe, effective, and adaptable to modern client needs.
Why therapists choose TheraPlatform as their teletherapy platform
Whether for solo practice or larger clinics, therapists choose TheraPlatform for its blend of usability, flexibility, and robust telehealth tools.
Here are top reasons why therapists choose TheraPlatform for teletherapy:
- Efficiency and convenience: Everything down to payments, scheduling, documentation, and insurance claims is managed in one integrated platform, saving time and reducing friction.
- Security and compliance: TheraPlatform is fully HIPAA and PIPEDA compliant, with encrypted video sessions, secure data storage, and 24/7 monitoring for peace of mind.
- Engagement tools: Built-in interactive features like whiteboards, games, media sharing, screen annotation, and therapy-specific “apps” enhance client engagement especially useful in pediatric and speech therapy.
- Client-centered functionality: The secure client portal empowers clients to book sessions, complete forms, submit documents, and make payments, reducing admin work for the therapist.
- Customization and flexibility: Therapists can create and customize templates for notes, treatment plans, and intake forms allowing them to tailor workflows to their practice style.
- All-in-one practice management: Combines telehealth, EHR, billing, insurance, scheduling, and documentation, eliminating the need for multiple tools or software.
- Therapy-specific design: Unlike generic telehealth platforms, TheraPlatform is purpose-built for mental health, speech therapy, OT, PT, and more with features tailored to each specialty.
- Professional credibility: Recording features, branded portals, and compliance tools help therapists present a more professional, trustworthy experience to clients.
- Positive user experience: Therapists appreciate having everything in one place and often report a smoother workflow, fewer tech issues, and faster onboarding.
What therapists are saying about TheraPlatform
Therapists praise TheraPlatform for its ease of use, seamless scheduling, and built-in billing tools like superbills. They value the platform’s features including intuitive charting, customizable notes, and interactive telehealth tools as well as the responsive support team, which listens to feedback and implements updates.
Many highlight that the platform offers the best of all worlds, combining excellent video conferencing with resource sharing and an engaging, client-centered teletherapy experience.
"There's seriously no better platform out there! Easy to use … syncs to your personal schedule, provides superbills …"- Jacqueline S. (Source)
“It is not just the platform, it is the team behind TheraPlatform, always willing to help and receptive to feedback to bring updates requests to live,” Orly, Smarty Therapy PC (Source)
"The video conferencing is excellent and the ability to share resources and the interactive screen make Telehealth a rich experience."- Kathy J. (Source)
"TheraPlatform has been the best of all worlds! … intuitive charting, in-system billing, customizable notes …"-Kendrah B. (Source)
Streamline your practice with One EHR
- Scheduling
- Flexible notes
- Template library
- Billing & payments
- Insurance claims
- Client portal
- Telehealth
- E-fax
Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports mental and behavioral health, SLPs, OTs, and PTs in group and solo practices.
More resources
- Top-to-bottom approach to launching teletherapy on-demand video academy
- Teletherapy worksheets
- Teletherapy blog
References
Davis, K. A., Zhao, F., Janis, R. A., Castonguay, L. G., Hayes, J. A., & Scofield, B. E. (2024). Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic. Psychotherapy Research, 34(5), 589-600. DOI: https://www.tandfonline.com/doi/abs/10.1080/10503307.2023.2229505
Saxler, E., Schindler, T., Philipsen, A., Schulze, M., & Lux, S. (2024). Therapeutic alliance in individual adult psychotherapy: a systematic review of conceptualizations and measures for face-to-face-and online-psychotherapy. Frontiers in psychology, 15, 1293851. DOI: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1293851/full
Seuling, P. D., Fendel, J. C., Spille, L., Göritz, A. S., & Schmidt, S. (2024). Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person: A systematic review and meta-analysis. Journal of telemedicine and telecare, 30(10), 1521-1531. DOI: https://journals.sagepub.com/doi/10.1177/1357633X231161774
FAQs for therapeutic rapport in teletherapy
Can therapeutic rapport really be built through teletherapy?
Yes. Studies show teletherapy can achieve rapport and outcomes equal to in-person therapy when clinicians use intentional strategies like empathy, nonverbal communication, and active engagement.
What are the biggest barriers to building rapport in teletherapy?
Common challenges include technical issues (poor audio/video), fewer visible nonverbal cues, and client distractions at home. These can be overcome with preparation and creativity.
What strategies help strengthen rapport with clients online?
Clinicians can build rapport by setting a welcoming tone early, using visible nonverbals (smiles, nods), showing warmth and authenticity, checking in directly about the relationship, and leveraging technology tools like screen sharing and interactive activities.
