Building the Therapeutic Alliance: Perspectives of Speech-Language Pathologists on Telehealth Practices

Purpose: Advancements in technology and the expansion of telehealth have reshaped service delivery in speech-language pathology, yet concerns about building therapeutic alliance in virtual environments persist. This study explores the factors influencing speech-language pathologists' (SLPs) attitudes toward using telehealth, with a particular focus on how their perceptions of telehealth's benefits, barriers, and ability to build therapeutic alliance influence their intention to use telehealth. Method: A convergent mixed methodology design was implemented, with 183 SLPs completing the quantitative survey and 25 engaging in qualitative semistructured interviews. Results: A one-way analysis of variance revealed a statistically significant difference in attitude across three groups of SLPs based on telehealth usage. Post hoc analysis using the Tukey–Kramer test identified significant differences among the groups: telehealth users, limited users, and nonusers, indicating that the level of telehealth use is associated with differing perceptions of building therapeutic alliance. To further explore these perceptions, 65 coded statements from participant interviews were analyzed and organized into six thematic categories: person-centered approach, recognizing ways to build trust, enhancing relationship dynamics, setting expectations, upfront preparation and readiness, and perceived barriers. Collectively, these themes reflect the complex dynamics of the client–clinician relationship in telehealth contexts and illustrate how therapeutic alliance is shaped both in practical strategies and relational factors. Conclusions: Findings showed that experienced telehealth users reported greater confidence in establishing therapeutic alliance through intentional, person-centered approaches. The integration of results suggests that fostering therapeutic alliance is both a facilitator and outcome of telehealth acceptance. Implications for clinical training include emphasizing person-centered competencies, such as collaborative goal setting, empathetic communication, individualized care planning, and leveraging peer mentorship to support clinician confidence. This study underscores the central role of therapeutic alliance in delivering effective, relationship-centered care via telehealth.