A literature review on the potential of computer-mediated communication (CMC) as a medium for conducting psychotherapy via the Internet revealed that CMC may mediate interpersonally rich interactions if participants are allowed sufficient time and repeated opportunities (anticipate future communications) to exchange information and build relationships. To examine the extent to which the process of online therapy resembles face-to-face therapy, online therapy transcripts were examined through a molecular approach and the results were compared to the extant, psychotherapy processes literature.

The participants were six dyads formed by college graduate students enrolled in a clinical practicum course and their online adolescent clients. The clients were high-school freshmen and sophomores referred by their school counselors through the Gulf Coast GEAR UP Partnership Project. Trained undergraduate psychology majors coded therapist and client online behavior according to two well established and validated coding methods, the Helping Skills System (HSS) and the Client Behavior System (CBS; Hill & O'Brien, 1999). Although levels of client overall output (grammatical units) remained fairly constant throughout the course of therapy, the ratio of productive to non-productive output per session increased as a function of number of sessions. Using hierarchical linear modeling (HLM) methodology, the results revealed that therapist facilitating skills (approval and reassurance, restatements and rephrasing, and reflection of feelings) predicted higher client productive output, whereas interpretations and informative statements predicted lower client productive output. The results confirmed that online therapy can lead to productive therapist-client interactions and that the associations between these interactions are similar to the associations found in face-to-face therapy interactions.