Third-Party Observation in Psychotherapy: Playing to the Audience.

Objective: The aim of this report is to describe how trainees and instructors skew their performance of psychotherapies when sessions are observed by third parties and to discuss approaches to mitigate potentially adverse consequences.

Methods: To supplement clinical observations, a selective narrative literature review was conducted by searching PubMed and PsycInfo.

Results: When third-party observers were involved, therapists were likely to skew how they conducted psychotherapy. Skewing occurred regardless of whether the third parties observed in vivo or remotely, observed synchronously or asynchronously, or were instructors or trainees. Such skewing may have resulted from conscious, preconscious, or unconscious decisions by therapists as well as by patients. Despite the benefits of observed psychotherapy for therapists and patients, deleterious consequences have sometimes emerged.

Conclusions: Benefits of third-party observation of psychotherapy are substantial. Nevertheless, therapists must recognize how being observed may adversely affect themselves and their patients. Mitigation strategies are available to address potential harms.