In a country as vast as Australia the provision of adequate physical and mental health services has always been challenging and those in rural and remote areas, 27% of our population, remain significantly under-resourced. The National Rural Health Alliance (2021) reported that while prevalence of mental health disorders were similar to those in the city, the lack of services saw self-harm and suicide increase with remoteness. Isolation, financial strain and natural disasters are significant stressors for country families fueling family relationship difficulties which in turn escalate individual symptoms. If it is difficult to find an individual therapist in the country it is even more challenging to find a family therapist.
Enter Online Therapy
Even before the COVID-19 pandemic practitioners in Australia were developing skill in delivering mental health services online. However, it was clear that this was a very different medium and one that required the development of a new skill set which some declared was ‘not for me’. COVID-19 changed that with practitioners forced to decide to take the risk of continuing to work with families or cease therapy. Many chose the former and post-pandemic, continue to deliver services either fully online or as a hybrid model. We have learned a lot about the risks, benefits and adaptations required but what is this like for families?
Families’ Experience of Therapy During Lockdown
Barge-Chanty et al (2025) were interested to explore the experience of families who had been patients in a department of adolescent medicine and psychiatry in France whose therapy was continued through teleconferencing during lockdown. 10, semi-structured interviews were conducted with 8 families and the results analysed revealing both positive and negative consequences.
Some Negative Consequences
Families found that the removal of the need to travel to sessions limited engagement and that conducting sessions at home meant that ‘daily life disrupted immersion, close proximity censored conversations, and therapists’ virtual presence was perceived as intrusive or alliance-reinforcing.’ A disruption to the therapeutic relationship whereby the practitioner was experienced as excluded from the system and not fully participating was also of concern.
And Some Positives
However, this form of therapy was experienced as providing ‘crucial support during the crisis, encouraged initiative-taking, enabled participation of typically absent members, and allowed for experimentation with new formats.’ Some families suggested that alternating between in person and virtual formats would be welcome in the future.
What Can We Learn from This?
The pandemic has passed but the need for family therapy services to rural and remote communities remains. While some of the negative effects appear to be a function of an abrupt and unexpected shift from face-to-face therapy, others point to preparation that should be done with families before therapy commences. This includes establishing agreements between all parties about how the session is embedded in ordinary family life in a way that differentiates it and rules that will apply in that space. It also requires strong screening measures to ensure safety during and after sessions.
The fact that even in these difficult circumstances, clients noted the benefits of online delivery and even suggested it continue is heartening. The challenge is for practitioners to develop new skills in engagement and participation in a fair and even-handed way that allows all families to access high quality and effective family therapy wherever they live. It’s just another challenge for how we manage inequality.
Barge-Chanty, R., S., Hellier, E., Radjack, R., Grandclerc, S., Moro, M. Families’ Experience of Family Therapy by Videoconference During the First Lockdown: A Qualitative Study Family Process, 2025; 64:e70073 https://doi.org/10.1111/famp.70073
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