“Digital tools are now firmly embedded in psychotherapeutic practice. Video sessions, apps, online modules and digital monitoring tools are no longer on the margins of innovation; they are an integral part of the everyday work of many therapists. This combination of face-to-face psychotherapy and digital interventions is often called Blended Care Psychotherapy (BCP). But which competencies do psychotherapists actually need to deliver BCP? In our recently accepted systematic review in Clinical Psychology: Science and Practice, we set out to address this question.
Competencies in Blended Care Psychotherapy Psychotherapists report lower self-rated clinical competence in BCP compared with face-to-face sessions (e.g. Lin et al., 2025; Messina & Löffler-Stastka, 2021). Digitalization introduces new opportunities, but also new challenges. Therapists should decide when and how to integrate digital components, how to maintain a strong therapeutic alliance across modalities, how to respond to digitally collected data, and how to handle ethical and safety issues in hybrid settings. Therefore, competencies are needed to address these challenges and to maintain effective psychotherapeutic work. We conducted a systematic review to synthesize and conceptually organize previously published literature on psychotherapeutic competencies in digital contexts and apply it coherently to BCP.
Key Findings
This systematic review revealed psychotherapeutic competencies defined as knowledge, skills, and attitudes in the context of blended care in Psychotherapy. Across the 35 studies included, we identified and synthesized competence domains that are considered relevant for effective blended care delivery.
Our review identified six overarching competence domains that appear consistently across existing models and empirical studies as well as other emerging themes that weren’t fitting to one of those domains:
1. Therapeutic Relationship in BCP – create an alliance between therapist and client in blended care settings, characterized by acceptance, empathy and trust.
2. Creation of Setting and Infrastructure – establish a structured therapeutic environment that ensures privacy, boundaries, and stability while accommodating the flexibility and accessibility of digital modalities.
3. Technological Competence – utilize and manage digital tools to guarantee stable and secure communication. This encompasses technical proficiency, an understanding of digital tools, the capacity to resolve technical issues, and the ability to integrate technology into therapeutic processes.
4. Transfer of Communication and Methods – adapt communication as well as therapeutic methods and interventions to fit BCP, considering patient characteristics, technological limitations, and the appropriateness of interventions for online or face-to-face delivery.
5. Self-Regulation, Self-Confidence and Self-Care – to manage workload, cope with stress, and maintain self-awareness in BCP.
6. Data Security, Legal Issues, Ethics and Safety – patient data security, ensuring safety, adhering to legal and ethical standards, managing risk, and effectively addressing emergency or crisis situations within digital and blended care contexts.
Further, we have synthesized the identified domains in larger clusters of competencies.
First, the Foundational Cluster includes domains of Data Security, Legal Issues, Ethics and Safety and Technological Competence, as well as Creation of Setting and Infrastructure. These domains are strongly supported by existing competence models and provide the structural, technical, and legal conditions necessary for BCP.
Second, the Psychotherapeutic Process Cluster encompasses the domains of Therapeutic Relationship and Transfer of Communication and Methods. These are central to the core therapeutic process and capture how psychotherapists adapt relational, communicative, and methodological practices to BCP.
Third, the Reflexive Cluster incorporates the domain Self-Regulation, Self-Confidence and Self-Care and extends previous existing competence models in digital contexts and gains relevance in BCP due to additional demands.
Implications for training and practice
Our findings suggest that competencies in BCP should not be treated as a purely technical add-on. Instead, it should be understood as a set of competencies that are relevant to conducting BCP in an appropriate way.
For the professional training of psychotherapists this means:
• identified competence domains regarding BCP should be included in existing training curricula for psychotherapists
• specific training addressing competencies in BCP should be offered for licensed psychotherapists
• supervision opportunities should be offered for psychotherapeutic practice in BCP
For practicing clinicians, it highlights the value of ongoing reflection and training, not just on how to use digital tools, but on when, why, and for whom they are appropriate.
Limitations
Although all the studies included in the review addressed psychotherapeutic competencies in BCP, not all of them provided a clear definition of competencies which might have resulted in conceptual inconsistencies of the studies included in the review. However, in the papers included there were several definitions used and different competence aspects highlighted. Furthermore, it was observed that the usage of the terms ‘competence’, ‘knowledge’, ‘skills’, and ‘attitudes’ is inconsistent across literature. Moreover, it should be noted that not all models included in the systematic review were explicitly labeled as competence models, however, they did encompass certain competence aspects.
What’s next?
The competence domains identified in this systematic review provide a comprehensive structure of important and necessary competencies that psychotherapists need for effective practice in the field of blended care psychotherapy. Further research might include the empirical testing of the domains identified as well as development of targeted training. Moreover, future research on how to practically include digital content in face-to-face settings would be important. The field of BCP is developing very fast and including AI-tools and handling big data could become more important in the future. Therefore, there is a need for continuous adaptation of psychotherapeutic competencies to keep pace with technological innovation.”
Reference/Target Article:
Psychotherapeutic Competencies for Blended Care Psychotherapy: A Systematic Review of Knowledge, Skills, and Attitudes
Discussion Questions:
“1. Which of the identified competence domains in BCP do you find most challenging, which do you think are most important, and why?
2. Are you missing any competence aspects?
3. How should clinical training be conceptualized to support the development of these competencies in BCP?”
About the Authors:
“Mirjam N. Woide is a licensed psychotherapist and a research associate at the Department of Educational Psychology at Goethe University Frankfurt, Germany. Her work focuses on psychotherapeutic competencies, blended care psychotherapy, and the integration of digital technologies into clinical training and practice.
Gerald M. Weiher, PhD, is a licensed psychotherapist and researcher with a focus on digital psychotherapy, therapist competencies, and the implementation of blended care approaches in clinical settings.
Maria Zirenko, PhD, is a postdoctoral researcher at the Department of Educational Psychology at Goethe University Frankfurt, Germany. She has a background in general and educational psychology as well as experience in the development of digital mental health applications.
Michael Tremmel is a psychologist and doctoral candidate at the Bender Institute of Neuroimaging at Justus Liebig University Gießen, Germany, with interests related to clinical psychology, AI and digital technologies. His research focuses on adverse and unexpected effects of meditation.
Sonja Scherer, PhD, works in the field of psychology with interests related to psychotherapy, AI and digital technologies, and training.
Monika K. Ochmann is a licensed psychotherapist with clinical experience in psychotherapy and an interest in competence development and professional practice.
Viktoria Ritter, PhD, is a licensed psychotherapist and researcher and currently holds an acting professorship in psychotherapy research at Justus-Liebig-Universität Gießen.
Ulrich Stangier, PhD, is a professor of clinical psychology at Goethe University Frankfurt, Germany. His research focuses on psychotherapy research, particularly cognitive-behavioral approaches, emotional disorders, and mechanisms of change in psychotherapy.
Holger Horz, PhD, is a professor of educational psychology at Goethe University Frankfurt, Germany. His research interests include learning and instruction, professional competencies, and the use of digital technologies to support education and training.”
References Cited:
“Lin, T., Aafjes-van Doorn, K. A. V., Heckman, T. G., Antebi‐Lerman, E., & Anderson, T. (2025). Are Therapists Less Skilful in Teletherapy Than In‐Person Therapy Scenarios? A Latent Profile Analysis of Facilitative Interpersonal Skills. Clinical Psychology & Psychotherapy, 32(1), e70047.
Messina, I., & Löffler-Stastka, H. (2021). Psychotherapists’ perception of their clinical skills and in-session feelings in live therapy versus online therapy during the COVID-19 pandemic: A pilot study. Research in Psychotherapy: Psychopathology, Process and Outcome, 24(1), 53–59. https://doi.org/10.4081/ripppo.2021.514”