Building Therapeutic Relationships with Your Clients: Face-to-Face or Telehealth in the Age of COVID

By Stacey R. Lav, OTR/L

As occupational therapists, we provide opportunities over prescriptions. Therapeutic relationships are key in the overall success of our clients and are a big part in motivating the client to participate in their plan of care, and better improve client outcomes.

Occupational therapists facilitate finding the meaning in the day-to-day and help people find ways to do the things they want or need to do to live a successful life.

In therapeutic relationships, the occupational therapist acknowledges his or her position of power, recognizes that the client’s trust is both delicate and a privilege, demonstrates respect for the client, and ensures that the occupational therapist’s personal opinions, beliefs, and values do not affect the care provided.

Build Rapport

Just as in traditional therapy, your first step towards building the therapeutic relationship will be to establish and maintain a rapport with the client. Show up to your teletherapy sessions with a professional but relaxed and friendly appearance. Keep your gaze sometimes towards the camera to simulate eye contact and sometimes towards your screen to show you are paying attention to the client.

Some of the elements that promote the therapeutic relationship translate directly to the online therapy model and some do not. For example, your client will not be exposed to your therapeutic setting and office space, which might typically provide the foundation for building the therapeutic relationship and the subsequent therapy work. Additionally, just being behind a screen can make both the therapist and the client feel less connected or most distant during the therapeutic process.

Empathy goes a long way

Validating feelings before doing anything else goes a long way, or even validating that I have no idea what they’re going through goes a long way, too. Asking the right questions helps, as well as educating yourself on which questions are the right questions. In the traditional therapy space, empathy may be shown through nonverbal behaviors, including facial expressions and gestures. Although you cannot show all those same gestures in the teletherapy space, minimal encouragers and small statements can be used to convey your empathy towards the client. The key is also to stay engaged with the client and remain responsive to the person, not just the screen.


To empower our patients is to give them the tools they need in order to support their occupational performance versus implying that we have all the answers. In order for clients to be put in the driver’s seat, clients must feel empowered to make choices and decisions. One excellent way to do this is to provide choices, and to advocate for clients–the basis of client-centered care.

Use Nonverbals

In traditional therapy, you might help build rapport and the therapeutic alliance by using your body language to show attention and even to mirror the client’s posture. Although the teletherapy format will allow for less display and reading of nonverbal language, some can still be seen and shown. Lean in, tilt your head to match the client’s, nod, and display facial expressions congruent to the current discussion.

Teletherapy does not have to be so different from the traditional model. With today’s video-conferencing technology and the right telehealth platform, you can conduct therapy sessions with anyone, anywhere in the world. By being attentive to the therapeutic relationship and the therapeutic alliance, you can make that session work productive to help your client reach their goals.