"Can you see what I am saying?": An action-research, mixed methods evaluation of telepsychology in rural Western Australia

Lisa Richardson

Rural communities have been recognised as uniquely challenging environments for mental health care delivery. Telepsychology, or clinical psychology services delivered via videoconferencing, may be one response to overcoming the obstacles of regional and remote health care delivery. However, despite telepsychology’s widespread appeal and existing infrastructure, few services appear to provide telepsychology as a routine service component for psychotherapeutic exchanges. The thesis’ primary research goal was to explore and explain the disconnect between research and practice in this field. Five major research questions were raised: 1) Is telepsychology effective?; 2) How do you effectively research a complex health interaction like telepsychology?; 3) How do you make telepsychology research clinically meaningful and user friendly for practitioners?; 4) If telepsychology is so good, why don't clinicians use it more?; 5) When they do use telepsychology, how does it change the clinician's usual practice or the client's behaviour? To answer these questions a non-traditional, mixed method approach was chosen in preference to a more traditional, experimental, or mono-method, quantitative one, because it includes a focus on micro-processes which may reveal the causes or maintaining factors in the disconnect between research and practice. This thesis also uniquely draws together data from multiple clinically relevant sources: the research and clinical literature; expert telepsychology clinicians; mental health clients in rural locations; and a practitioner-researcher who has expertise as a clinician in the field of rural mental health. Taken together, this rich dataset illuminates the potential for psychotherapy by video in rural and remote Australia and provides a conceptual, clinical and practical framework for fulfilling this potential. It makes explicit the challenges and gaps in knowledge about telepsychology but also, unexpectedly, through micro-analysis of the telepsychology process, illuminates the fundamental active ingredients of the psychotherapeutic process more broadly. The component studies of this thesis fill several research gaps by 1) comprehensively synthesising the available knowledge of tele-mental health via videoconferencing as a whole, clarifying what is known, and what remains unknown, about telepsychology; 2) providing a mixed methods approach to evaluating the human dimensions of implementation of a clinical telepsychology service (indeed any psychotherapeutic service) under naturalistic conditions; 3) identifying the unique conditions or phenomena in telepsychology interactions that influence both therapeutic process and outcome, at the largest (across-subjects data) and smallest (the communication dyad) units of analysis; 4) implementing and evaluating a trial of telepsychology in a depressed community sample; and 5) triangulating the findings into meaningful, clinical practice based recommendations and conclusions. This thesis is the first research to apply a mixed-method, integrative, sequentially-triangulated research design to an investigation of telepsychology. Despite the implicit complexity of telepsychology as a healthcare system, the current research contributes in an original way by describing whole-field methodological trends, providing a comprehensive integrative review of findings, and evaluating an applied implementation of the findings, from a unique researcher-participant perspective. This contribution is of pragmatic and intellectual value to the field, and offers a unique review of the practices and specific changes to therapeutic techniques and approaches from expert consumers of telepsychology.

"Can you see what I am saying?": An action-research, mixed methods evaluation of telepsychology in rural Western Australia

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