# Assessing therapeutic alliance and client satisfaction across teletherapy, in-person, and hybrid modalities in clients with depression and anxiety disorders: a cross-sectional study

## TL;DR

This study compares teletherapy, in-person, and hybrid therapy for depression and anxiety, finding similar therapeutic alliances but varying client satisfaction.

## Contribution

The study provides empirical evidence on therapeutic alliance and satisfaction across different therapy modalities for mental health treatment.

## Key findings

- Therapeutic alliance scores were similar across teletherapy, in-person, and hybrid modalities.
- Client satisfaction varied significantly by therapy type, though specific differences remain unclear.
- Most participants preferred in-person therapy, while a quarter favored teletherapy.

## Abstract

The swift growth of teletherapy has sparked discussions about its effectiveness in comparison to traditional in-person therapy, especially in building a robust therapeutic alliance among those with anxiety and depressive disorders. The study aimed to compare the therapeutic alliance and client satisfaction across teletherapy, in-person, and hybrid modalities in the management of depression and anxiety disorders. A cross-sectional study was conducted using snowball sampling, involving 377 participants from various cities in Saudi Arabia, with a significant proportion residing in the Makkah Region (79.6%). The sample was predominantly female (69.5%), single (60.2%), and young adults aged 18–24 (53.1%). Three validated instruments were used: the Working Alliance Inventory-Short Revised (WAI-SR) to measure therapeutic alliance, and the Client Satisfaction Questionnaire (CSQ-8) to assess satisfaction. ANOVA results indicated no statistically significant difference in WAI-SR scores among the treatment groups (face-to-face, remote, and hybrid) (F = 2.804, P = .062), suggesting a similar therapeutic alliance across the modalities. However, ANOVA revealed significant differences in client satisfaction by therapy type, though further post hoc analyses are needed to identify specific group differences. Preferences varied: 52.5% favored face-to-face therapy, 24.1% preferred teletherapy, and 23.3% had no choice. Both face-to-face and teletherapy are effective in establishing a strong therapeutic alliance. Given the notable differences in satisfaction levels, mental health services should consider individual preferences to enhance treatment engagement and outcomes.