A therapeutic alliance can exist without face-to-face contact.

We examined the therapeutic alliance in 64 parents who completed treatment with a non-professional telephone coach in a paediatric psychosocial and behavioural intervention study called Family Help. The mean total Working Alliance Inventory score was 242.7 (95% confidence interval [CI]: 240.2, 245.2). Overall, the total scores were very high regardless of coach/parental age or gender, socioeconomic class/educational level of the parent, severity or type of the child's mental health disorder or modality of treatment delivery. The results were compared with normative data reported from other studies, which suggested that the distance therapeutic alliance scores were at least similar to face-to-face therapeutic alliance scores. The present study provides evidence that a strong, positive therapeutic alliance can exist in the absence of face-to-face contact using non-professional telephone coaches.