Therapists' experiences with non-verbal communication in videopsychotherapy: a qualitative interview study.

Background: Videopsychotherapy (VPT) has gained in importance since the Corona pandemic. As non-verbal communication (NVC) differs from the face-to-face (FtF) therapy, its practical assessment is crucial for long-term quality improvement. Objective: The aim of the study is to investigate how psychotherapists perceive specific aspects of NVC in VPT, in order to derive practical insights and lay the groundwork for future research approaches to improve treatment quality. Methods: Semi-structured expert interviews were conducted with twelve psychotherapists in Germany. The interviews took place from October 2024 to March 2025 and were analyzed using qualitative content analysis according to Mayring. Results: Certain aspects of NVC, such as facial expression, gestures, eye contact, body posture and self-view, were perceived as limited or altered in VPT, which increased the risk of misinterpretation. Having a self-view led to more control over one's own non-verbal behavior. Therapists reported adapting their behavior by smiling and nodding more frequently, as well as making more eye contact with the camera. Conclusion: The study shows that NVC in VPT is experienced as limited, but can also offer potential. To ensure long-term improvement in treatment quality, further practical studies and development of specific interventions to improve NVC in video settings are required.