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    Ben Mullings

    The reasoning in the above article that a ‘therapeutic relationship’ is something to be established during an initial face-to-face appointment, but then left as-is for subsequent appointments, reflects some misunderstandings about how therapeutic alliances function in mental health care. It is widely known that the alliance tends to build over the first 5 sessions and that it develops right across the treatment period. For some people it will be enough, but for others, offering just one appointment in person will be nowhere near sufficient. My concern is for vulnerable people who are experiencing complex mental health issues, particularly in cases where that may not be obvious in a single face-to-face appointment. It would be a very difficult situation in cases where somone asks for treatment in person, is given an initial face-to-face assessment, and is then only offered videoconferenced services.

    The other problem I can see is the notion that telehealth wont replace face-to-face treatment, but rather, is meant to expand access. That sounds fair enough in principle, but the difficulty lies with the delivery of face-to-face services in regional, rural and remote locations. If people living in such areas would prefer face-to-face treatment, then every effort should be made to make that available for their care, as is the case for their suburban counterparts. This raises the issue of PREFERENCE for treatment. When a patient is comfortable receiving treatment on-line there is no problem and one can therefore rightly say that equitable access has been expanded. However, where the patient really would prefer face-to-face treatment and has merely tolerated the fact that they had to settle on telehealth instead, we end up running the risk of selling people short on the basis that they live too far away from town.

    People might say “it’s better than nothing”, but is that really true? And should we be offering services to people in regional, rural, and remote regions on the basis that it is better than nothing?


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