In general, the intention to do something is a basic mechanism and prerequisite for performing a behavior (Fishbein and Ajzen, 1975). Therefore, we focused on intention as an indicator of psychology students’ future behavior in terms of offering VPT. Specifically, intention to offer VPT was defined as psychology students’ intention to offer VPT in the treatment of patients (in addition to traditional face-to-face psychotherapy) once they become licensed psychotherapists. Since psychology students have not yet performed treatments themselves and may not have experience with VPT, some variables from known predictive models were not applicable (e.g., perceived behavioral control, ease of use). Furthermore, at the time of the study, it has been unclear how the legal regulations and infrastructure regarding VPT will develop in Germany. These circumstances also explain why we did not investigate actual behavior, but only the intention to offer VPT in relation to person-related variables. In addition to intention as the main dependent variable, our research model incorporated a set of several person-related (independent) variables assumed to explain variance in psychology students’ intention to offer VPT (see Figure 1).

The first model invoked was the Theory of Planned Behavior (Ajzen, 1991), which postulates three conceptually independent determinants of intention: Attitudes toward the behavior, subjective norm, and perceived behavioral control. According to Ajzen (2006), perceived behavioral control represents previous experiences that facilitate or hinder users to perform a behavior. Since the psychology students of the present study had no experience with the performance of VPT, we excluded the variable behavioral control. The second model that we considered was the Technology Acceptance Model by Davis (1989), which postulates three variables affecting the intention to use a technology: attitude, perceived usefulness, and perceived ease of use. According to Davis (1989), perceived ease of use affects perceived usefulness and attitudes toward the technology, but only indirectly affects intention to use. Therefore, perceived ease of use was excluded in our study. Both models were repeatedly used to predict intention of a behavior. Nevertheless, some other variables do not appear in any of the models but showed effects on behavioral intentions in other studies. For this reason, we included four additional person-related variables in our research model: Satisfaction with video conferencing, general self-efficacy, self-efficacy in video conferencing, and current study stage. The following paragraphs provide additional information on the variables included in our research model, as well as the corresponding hypotheses and research questions.

Intention is one of the most important variables for behavioral predictions (Fishbein and Ajzen, 1975) and standardized questionnaires are effective in predicting it. However, when it comes to identifying underlying values, beliefs, and assumptions, qualitative methods are more appropriate (Choy, 2014). Especially in fields where standardized questionnaires are lacking and limited knowledge exists. Qualitative methods offer a broad and open-ended inquiry, allowing participants to address the themes that matter most to them (Yauch and Steudel, 2003). Such exploratory methods can provide valuable insights into new issues emerging in the rapidly changing field of information systems (Choy, 2014). Hence, we complemented the quantitative research approach of our research model with a qualitative study section. We focused on psychology students’ perceptions of the advantages and disadvantages of VPT as well as their desired learning opportunities. The findings from this section can contribute to the preparation of the next generation of psychotherapists in offering VPT.

The following paragraphs summarize the current research on perceived advantages and disadvantages among patients and in-service psychotherapists, as well as on desired learning opportunities.

The final data set included 255 German-speaking psychology students of legal age (218 women, 85.5%) with a mean age of 25.74 years (SD = 5.60, range = 18–52). One participant was previously excluded because they asked not to consider the given answers. Non-psychology students and psychology students who planned not to become psychotherapists after graduation were not permitted to participate and were immediately directed to the final page of the survey. The final data set consisted of 140 (54.9%) psychology students in bachelor’s program and 115 (45.1%) in master’s program of psychology. The most frequently selected psychotherapy approach that the psychology students intended to offer as licensed psychotherapist was behavioral psychotherapy (n = 152, 59.6%), followed by depth-psychology oriented psychotherapy (n = 45, 17.6%), systemic psychotherapy (n = 34, 13.3%), analytical psychotherapy (n = 15, 5.9%), and others (n = 9, 3.5%).

Participants were recruited through convenience and snowball sampling. The link to the online study was disseminated to psychology students via mailing lists of German universities, social media, the survey platform of a national journal (Psychologie Heute), and via lecturers in psychology courses. Participation in the study was voluntary and no incentives were provided. No identifying data were collected to guarantee the anonymity of participants. At the beginning of the study, participants were informed about the study’s aim, the anonymity of their data, that all data would be processed only for research purposes, and that they could stop the study at any time. The participants provided informed consent. The online study ran for 103 days, beginning July 13, 2021.

We collected the data using an online survey software “Unipark” (Tivian XI GmbH). First, participants indicated whether they were studying psychology and whether they intended to become a psychotherapist after graduation. Subsequently, they provided their age, gender, which psychotherapy approach they plan to offer as licensed psychotherapist, study stage, and how many semesters they have studied psychology to date. Then, they read our definition of VPT and what they should consider when answering the questions to ensure the validity of responses. We highlighted the following five aspects:

VPT was defined as psychotherapy conducted online using a video platform with a video display and an audio connection. The psychotherapist and the patient would not be sitting in the same room. The patient would usually be at home. However, both could see and hear each other via the medium used.

Afterwards, participants were asked several questions about their attitudes toward VPT, perceived subjective norm, expected usefulness of VPT, satisfaction with video conferencing, general self-efficacy, self-efficacy in video conferencing, and the intention to offer VPT when they become licensed psychotherapists. In the qualitative part of the study, open-ended questions were asked about perceived advantages and disadvantages of VPT, as well as desired learning opportunities regarding VPT in the study program. The median study duration was 10.92 minutes.

Due to lack of availability of validated scales in this under-researched topic, we had to adapt some scales to the context of our study. Additionally, we translated some established scales into German (translate-translate back method). The following sections describe the measures used in detail.

A qualitative approach was used to investigate advantages and disadvantages of VPT, as well as desired learning opportunities for VPT. Therefore, the quantitative measures were followed by open-ended questions to assess participants’ perceived advantages and disadvantages of VPT (“Please list up to five aspects that you perceive as advantages of video psychotherapy” and “Please list up to five aspects that you perceive as disadvantages of video psychotherapy”), as well as desired learning opportunities (“Please list up to five learning opportunities (learning content and/or experiences) that you would want to have in your psychology studies to feel well prepared for video psychotherapy as a licensed psychotherapist”). The participants could write down up to five statements per question. Responses were limited to 150 characters per statement in order to support the formulation of the quintessence of each response. Following the method outlined by Hoss et al. (2021), participants additionally indicated how relevant the named advantage or disadvantage is in relation to their personal intention to offer VPT as licensed psychotherapists, and how relevant a named learning opportunity is to feeling well-prepared to perform VPT (1 = “hardly relevant” to 5 = “very relevant”). Only if a relevance rating referred to a valid statement, we included it in further analyses. The order of the qualitative questions regarding perceived advantages and disadvantages of VPT was randomized across participants to counteract order effects. The question on desired learning opportunities was always asked last to enable the participants to transfer their mentioned advantages and disadvantages directly into concrete desired learning opportunities.

We analyzed the qualitative data using content analysis based on the standard approach developed by Mayring (2015) and following a previous work of Hoss et al. (2021): First, we read all qualitative statements and condensed them to extract the key messages, if necessary. If multiple statements were provided in one answer field, only the first statement was considered, and the others were disregarded for further analyses. Second, we inductively created a category system based on about 10% of the given data for each of the three topics. Subsequently, we calculated the inter-coder reliability between the two raters after coding approximately 10% of the material to identify any potential sources of error and to optimize the category system accordingly. In this sense, an iterative process based on all qualitative data led to the final category system. Using the final category system, two independent coders coded all the data, and inter-coder reliability was calculated using Kappa (Cohen, 1960). In cases of disagreement between coders, a mutually agreeable solution was subsequently found via discussion between the two coders. The category system for perceived advantages of VPT contained 17 categories (κ = 0.96), perceived disadvantages of VPT were assigned to 18 categories (κ = 0.95), and desired learning opportunities for VPT in psychology studies were assigned to 14 categories (κ = 0.97). There was an additional residual category for each topic for statements that did not fit into any of the other categories.

We conducted a multiple regression analysis to test the seven hypotheses regarding psychology students’ intention to offer VPT. All statistical assumptions were checked before calculating the analyses (cf. Poole and O’Farrell, 1971). We found no outliers, multicollinearity, or autocorrelation, but linearity and normality in the regression model. Because of small hints for heteroscedasticity, we applied bootstrapping method (5,000 iterations; bias-corrected and accelerated) for significance testing (cf. Hayes and Cai, 2007). The multiple regression model comprised intention to offer VPT as the dependent variable and attitudes toward VPT (H1), subjective norm (H2), expected usefulness of VPT (H3), satisfaction with current video conferencing (H4), general self-efficacy (H5), self-efficacy in video conferencing (H6) and study stage (bachelor’s or master’s program; H7) as independent variables. Although we formulated the hypotheses mostly one-sided, two-sided p-values are reported (cf. Kimmel, 1957; Koch, 1991).

First, we calculated correlations between all independent variables. As shown in Table 1, these correlations were low to medium with few exceptions. The two highest positive correlations were between expected usefulness of VPT and attitudes toward VPT (r = 0.66, p < 0.001), and between satisfaction with video conferencing and attitudes toward VPT (r = 0.61, p < 0.001). We found no significant negative correlations between the independent variables. Altogether, the strength and direction of the correlations were as expected, indicating construct validity.

Table 2 shows the results of the multiple regression analysis and the bivariate correlations between independent variables and the dependent variable of the research model. All independent variables, except for study stage, showed a significant positive correlation with the intention to offer VPT. The strongest positive correlation was between attitudes toward VPT and intention to offer VPT (r = 0.80, p < 0.001). The multiple regression model explained 73.0% of inter-individual variance, F(7, 247) = 95.64, p < 0.001. Four of the seven independent variables were significant in the regression model: Attitudes toward VPT (β = 0.45, p < 0.001) was positively related to intention to offer VPT and it was the most relevant independent variable as indicated by the standardized regression coefficient. Moreover, subjective norm (β = 0.16, p < 0.001) showed a significant positive relationship with the intention to offer VPT, as well as expected usefulness of VPT (β = 0.25, p < 0.001), and satisfaction with video conferencing (β = 0.17, p < 0.001). In contrast, self-efficacy in video conferencing (β = 0.05, p = 0.294), general self-efficacy (β = −0.06, p = 0.128) and study stage (β = −0.03, p = 0.348) were not significantly related to intention of offer VPT. Although both self-efficacy variables did not become significant in the multiple regression, they showed a significant bivariate correlation with intention to offer VPT (Table 2). In sum, the four variables taken from the two established models (Theory of Planned Behavior and Technology Acceptance Model) explained a considerable amount of variance in the intention to offer VPT.

In total, the participants provided 2,314 statements regarding advantages and disadvantages of VPT and desired learning opportunities. We categorized these statements via content analysis (cf. Mayring, 2015). Detailed definitions and explanations of the category system can be found in the Supplementary material, elucidating the specific criteria that guided the classification process. These definitions serve as a reference point for understanding the inclusion criteria for statements within their respective categories. The following section provides an explanation of the results regarding the advantages and disadvantages (Section 3.2.1) and the desired learning opportunities (Section 3.2.2).

Using a quantitative approach, our research model explains a total of 73% of the inter-individual variance in the intention of psychology students to offer VPT. This amount of variance explanation is very high for psychological studies (cf. Cohen, 1988). In this context, the attitude toward VPT showed the strongest relationship with intention, followed by expected usefulness, subjective norm, and satisfaction with video conferencing. In contrast, both self-efficacy variables and study stage showed no significant relation to intention in the multiple regression analysis.

Attitudes toward VPT showed divergent results in the literature. For example, Monthuy-Blanc et al. (2013) found that in-service psychotherapists’ attitudes toward telemental health were not a significant predictor of intention. However, Gidenko (2017) found that attitudes toward telemental health are the most important determinant of the intention of primary care physicians to use technology for care services. This is consistent with the finding that the intention of healthcare professionals to use e-health technology applications is significantly related to their attitudes, among other variables (Zayyad and Toycan, 2018). In line with these findings, we observed that attitude showed the largest positive relation with intention to offer VPT (H1) in our study. Expected usefulness of VPT showed the second-largest relation with intention (H3), which aligns with the findings of Monthuy-Blanc et al. (2013), whose model showed that perceived usefulness had the strongest relation to the intention of psychotherapists to offer VPT. Therefore, the perceived usefulness of VPT plays a critical role in the intention of both in-service psychotherapist and psychology students. Additionally, subjective norm (H2) and satisfaction with video conferencing (H4) were both positively related to the intention to offer VPT. These findings are consistent with previous studies that showed a positive relationship between these variables and intention in the context of e-learning (Liaw, 2008; Hussein, 2018). Social norm was previously shown to be an important predictor of behavior, particularly in novel situations (Hill et al., 1996). Because VPT is a novel experience for psychology students, the importance of subjective norm for intention was hypothesized. Interestingly, intention to offer was not significantly associated with either general self-efficacy (H5) or specific self-efficacy (H6) in our multiple regression. This lack of significance contrasts with the bivariate correlations observed between these variables and the intention to offer VPT, which demonstrated small to moderate relations. This suggests that self-efficacy loses its individual importance when included simultaneously with other variables in a multiple regression model. However, Aggelidis and Chatzoglou (2009) found that computer self-efficacy, along with other commonly used variables derived from the Technology Acceptance Model, made a significant contribution to explaining the variance in intention. Hence, further research is warranted to better understand the intricate interplay between (general and specific) self-efficacy, technology acceptance, and the intention to offer VPT, particularly in the context of varying sample characteristics. Lastly, we did not find any relation between study stage and the intention to offer VPT (H7). However, given that VPT is a relatively new subject with limited integration into university curricula, it is plausible that there are no significant differences in knowledge between undergraduate and graduate psychology students regarding VPT. Furthermore, Ajzen (1985) suggested that intention may vary depending on the temporal interval to actual behavior. As of the current system, psychology students in Germany require 3 to 5 years of training after graduation to become licensed practitioners, the long period until actual behavior may also explain why there was no significant difference in the level of intention to provide VPT between psychology students in bachelor’s and master’s programs. In summary, our data supports four out of the seven hypotheses, and the regression model demonstrated a remarkably high ability to explain the variance in the intention to offer VPT among individuals.

The results from the quantitative analysis have both theoretical and practical implications. The integration of variables from two distinct theoretical models, the Technology Acceptance Model and the Theory of Planned Behavior, in our study highlights the need for a tailored theoretical model specifically designed for the context of VPT among psychology students. The unique characteristics and considerations associated with VPT warrant the development of a comprehensive model that combines specific elements from existing models. By creating a hybrid model, researchers and practitioners can better capture the multifaceted nature of intention formation in the context of VPT. As shown by the present study, this model should incorporate factors such as attitudes, perceived usefulness, subjective norms, satisfaction with video conferencing, and potentially other relevant variables specific to VPT. It should also account for the potential interplay between these factors and their combined impact on the intention to offer VPT. For this purpose, the model of the present study could serve as a valuable starting point for future research, allowing for the exploration of additional variables and the examination of potential interactions and mediating factors that may further enhance our understanding of VPT intention formation.

In addition to these theoretical implications, the results from the multiple regression analysis also provide practical insights that hold relevance for educational institutions and universities being responsible for training psychotherapists. Promoting positive attitudes toward VPT among psychology students is essential for its successful integration into their practice. Educational institutions can play a pivotal role by incorporating coursework and training modules that create a conducive environment for exploring and understanding attitudes toward VPT and that highlight the advantages of VPT. These modules can involve discussions, case studies, and reflective exercises that allow students to analyze the formation of attitudes and engage in critical reflection on their own attitudes toward VPT. By providing opportunities for self-reflection and open dialogue, educational programs can effectively shape and cultivate positive attitudes toward VPT among psychology students. In addition to emphasizing the practical benefits and advantages of VPT, educational interventions can incorporate interactive methods to enhance students’ perception of its expected usefulness. Two effective approaches could involve incorporating role-playing exercises to provide firsthand experience and facilitating discussions that involve sharing and analyzing patient experiences. By engaging students in simulated VPT sessions, they can gain practical insights into the benefits and challenges associated with this mode of therapy. This immersive approach allows students to develop a deeper understanding of how VPT can effectively address psychological concerns. In addition, first-hand reports from patients who have benefited from VPT can provide valuable insight and real-life examples of the positive effects and outcomes of VPT. Through these interactive methods, educational institutions can effectively enhance students’ understanding and perception of the usefulness of VPT, thereby positively influencing their intention to adopt and provide it in their future practice. Recognizing the influence of social norms, educational programs should create an environment that stimulates a balanced reflection on the individual and societal meaning of VPT as well as on different expectations. Encouraging peer discussions and providing training on VPT within a social context can effectively reinforce normative beliefs and enhance students’ intention to offer VPT. By facilitating group discussions where students openly share their thoughts, experiences, and perspectives, educational programs can foster a supportive social context that cultivates a shared understanding of the significance of VPT. These peer discussions can serve as a platform for students to learn from one another, challenge existing norms, and collectively shape their intention to embrace VPT as a valuable therapeutic approach. Recognizing the relation of students’ past experiences with video conferencing on their intention to offer VPT, it is important to address any potential negative experiences and enhance general satisfaction with this mode of communication.

Educational institutions can implement two strategies to achieve this. Firstly, conducting best practice sessions for video conferencing (e.g., Rubinger et al., 2020) can provide students with practical guidance on optimizing their use of the technology. These sessions can cover topics such as optimizing audio and video quality, managing technical issues, and utilizing interactive features effectively. By equipping students with the necessary skills and knowledge, institutions can contribute to more positive experiences with video conferencing. Secondly, creating a space for open discussion and critical reflection on students’ past experiences with video conferencing can be beneficial. Facilitating group discussions in which students openly share their experiences, raise concerns, and analyze the reasons behind challenges encountered (such as technical issues or difficulties in mass conferences) can help identifying areas for improvement. This collaborative approach allows for the exploration of potential solutions and the development of strategies to address any barriers or concerns related to video conferencing. By considering these practical implications, institutions can better equip students with the knowledge and skills necessary to navigate the evolving landscape of mental health services.

Using a qualitative approach, we were able to identify major advantages and disadvantages of VPT perceived by psychology students (RQ1).

Our qualitative content analysis yielded two major categories of perceived advantages: firstly, easier access and delivery of psychotherapy (low inhibition threshold, reduced mental and physical barriers, protection against disease and pandemic, accessibility, availability of the psychotherapist, lower costs, simplicity, anonymity, distance-related benefits and documentation capabilities) and secondly, flexibility in psychotherapeutic care (flexibility in terms of location, no travel necessary, psychotherapeutic care in rural areas, psychotherapeutic care worldwide, general flexibility and time-related benefits). In addition to these two main categories, a small number of statements did not fit into any specific category and were assigned to a residual category. These statements may represent unique perspectives or additional benefits of VPT that were not captured by categories that required a minimum frequency of statements. Furthermore, a distinct category termed spirit of the age was identified, which encompassed statements related to the alignment of VPT with contemporary trends and societal expectations. It reflects the acknowledgment that VPT resonates with the current era and captures the evolving needs and expectations of individuals seeking mental health care.

When examining the results of each specific category in more detail, we observe that low inhibition threshold and flexibility in terms of location emerged as the two most frequently mentioned advantages of VPT. The category of low inhibition threshold encompasses the perceived ease and accessibility of initiating psychotherapy through VPT, removing barriers that may exist in traditional face-to-face settings. This includes the convenience of receiving therapy in the comfort of one’s own familiar environment, without the need to leave home. Additionally, it encompasses statements emphasizing that clients may feel more at ease and find it easier to open up during therapy sessions. Moreover, the category flexibility in terms of location highlights the convenience and accessibility of receiving psychotherapeutic care without the constraints of travel or geographical limitations. This includes the ability to continue therapy with the same therapist even after relocating and the freedom to choose a therapist regardless of location. Indeed, a meta-synthesis by McPherson et al. (2020) showed that patients reported improved flexibility and reduced barriers to access in VPT. In a study conducted by Eichenberg et al. (2021), patients in VPT reported a lower inhibition to discuss difficult topics. The authors also suggested that the physical distance between patients and therapists in VPT could be advantageous for individuals with attachment disorders and potentially improve the therapeutic relationship. Furthermore, in-service psychotherapists described the ability to address difficult issues more quickly, reduced shame and fewer inhibitions of patients, and increased focus on the therapeutic event (Eichenberg et al., 2021). Although psychotherapeutic care in rural areas and worldwide were not frequently mentioned by psychology students, it is noteworthy that these categories were rated as highly relevant. Notably, psychotherapeutic care in rural areas had the highest mean value in terms of relevance ratings among all advantage categories. Certain psychology students whose statements were classified under flexibility in terms of location may have also included rural or international flexibility, even if they did not explicitly state it. Consequently, this category may have been expanded at the expense of the two smaller categories. According to Donaghy et al. (2019), VPT has the potential to improve accessibility for individuals with limited mobility or mental illness, who may have trouble leaving their homes. Other advantages cited by psychology students are comparable with results of a qualitative study that asked in-service psychotherapists about benefits of VPT, such as better work-life balance, efficient use of time, the possibility of recordings, and no need for a therapy room (Buckman et al., 2021).

In terms of perceived disadvantages, we identified the following three major categories: firstly problems during psychotherapy sessions (lack of closeness between patient and psychotherapist, lack of nonverbal cues, problems with technology or internet connection, therapeutic relationship suffers, no safe space for patients, communication problems and misunderstandings, more distraction possible, showing and recognizing empathy and emotions is difficult), secondly limited application possibilities (technology as a prerequisite, not appropriate for all disorders and patients and for all therapeutic methods, lower efficacy and less effectiveness, less opportunities for intervention), and lastly other concerns (lower commitment and motivation of patients, no benefits from leaving home, risk for data privacy, higher cognitive effort, and more difficult organization and bureaucracy).

When examining the results of each specific category, the three most frequently mentioned disadvantages were lack of closeness between patient and psychotherapist, lack of nonverbal cues, and problems with technology or internet connection. Lack of nonverbal cues was also a perceived disadvantage of VPT by in-service psychotherapists (Eichenberg et al., 2021). A similar observation was made by Van der Vaart et al. (2014), who noted that VPT provides only a partial view of the other person, making it difficult for psychotherapists to respond to patients in the same way as they would during face-to-face sessions. Moreover, in-service psychotherapists described technological issues, poor internet connections and problems with online platforms as difficulties in providing treatment (Buckman et al., 2021). Patients also reported technical difficulties that disrupted VPT (Donaghy et al., 2019; McPherson et al., 2020). In addition to the technical difficulties that may arise during a VPT session, one of the disadvantages identified by psychology students is the requirement that patients have the necessary technical equipment and skills. This issue was found in other studies as well. Ghaneirad et al. (2021) reported that older age and lower levels of education were associated with lower use of VPT, which was also described by the students in the category not appropriate for all disorders and patients. Uscher-Pines et al. (2020) highlighted that the lack of internet access among underprivileged patients can lead to their exclusion from utilizing VPT. Furthermore, the found category lower commitment and motivation of patients is consistent with the results of a study by Eichenberg et al. (2021), in which in-service psychotherapists reported that patients who have difficulty establishing a stable therapeutic relationship are more likely to drop out of therapy. Lastly, psychology students fear a lack of a protected place and the lack of data security, which was also described as a barrier to VPT by McPherson et al. (2020).

Psychology students expressed many aspects that were consistent with those of practicing psychotherapists and patients regarding the advantages and disadvantages of VPT. In both the advantages and disadvantages, the students predominantly focused on aspects from the perspective of patients. Only a few categories specifically addressed advantages and disadvantages for therapeutic work (e.g., lower costs, documentation capabilities, more difficult organization and bureaucracy), indicating that the students have limited concrete knowledge about working as therapists and thus these aspects are less salient to them. Further research could be conducted by investigating individuals currently undergoing therapist training to gain a better understanding of their perspectives. This would shed light on which aspects they emphasize and whether the role of the therapist is given more prominence. Such insights could contribute to a more balanced understanding of the benefits and drawbacks of psychotherapy from both patient and therapist perspectives.

The results obtained from the qualitative content analysis also provide practical implications for the training of future psychotherapists. Firstly, the inclusion of VPT modules within the curriculum would provide specific instruction on the utilization of VPT in psychotherapy. This would encompass theoretical knowledge regarding effectiveness, ethical guidelines, and practical skills in navigating platforms. Secondly, practical exercises involving VPT could be incorporated, wherein students assume the roles of both therapist and patient within a virtual environment. Through this experiential approach, students would gain hands-on experience and become familiar with the challenges associated with VPT. Furthermore, the use of case studies and subsequent discussions could deepen understanding of specific VPT scenarios and facilitate analyses of the associated advantages and disadvantages. Group discussions would encourage the exploration of diverse perspectives and the development of various problem-solving approaches. To gain practical experience, students could engage in internships that involve the supervised application of VPT under the guidance of experienced therapists. Supervision sessions could specifically address the challenges and opportunities associated with VPT. Additionally, instructors could create an inclusive and open learning environment, where students are encouraged to engage in discussions and critically reflect upon the advantages and disadvantages of VPT in comparison to other therapeutic modalities. Encouraging dialogue and debate about different approaches will facilitate a comprehensive understanding of the strengths and limitations of each method. By promoting an atmosphere of open-mindedness and critical thinking, students can develop a balanced perspective on VPT and its role in psychotherapy. This approach will enable them to make informed decisions when considering the implementation of VPT in their future practice. A more detailed look at such learning opportunities is provided in the following section.

Our study identified desired learning opportunities that psychology students would like to have in their studies (RQ2). Here, we have identified two major categories of learning opportunities that psychology students desire in order to be equipped to offer VPT in their future practice. Firstly, various forms of practical training (for technical skills, for conversational techniques, to build therapeutic relationships, to recognize and showing nonverbal cues and to increase motivation and compliance of patients, practical application as role-playing or self-experience and insights into the practice), and secondly, diverse information on aspects of VPT (information on (health insurance) legal requirements, on appropriate methods, on handling difficult situations during VPT sessions, on efficacy studies, on opportunities and limitations, on appropriate disorders and patients, as well as general information about VPT).

Buckman et al. (2021) studied the perceptive of in-service psychotherapists and asked them what training and support they would need regarding VPT. Desired learning opportunities about research evidence for the effectiveness of VPT, training on the functions of the platforms used for VPT sessions and differences between platforms, as well as technical support and role-playing were mentioned among others. These findings are consistent with the results of our study, which focused on a younger and less experienced sample of psychology students. When examining the most frequently mentioned learning opportunities, we found that training for technical skills was the most mentioned category, followed by practical application (role-playing/self-experience). It is noteworthy that the third most mentioned category was general information about VPT. This points to weaknesses in the current curriculum, in which little to no information about VPT is anchored. Consistent with this finding, we found no significant differences between psychology students enrolled in bachelor’s or master’s programs (RQ3) with regard to the number of statements made and the relevance ratings assigned to these statements. However, there was a slight variation in the order of the most frequently mentioned learning opportunities between the two groups. Specifically, the top five opportunities differed slightly, with bachelor’s students expressing a greater desire for additional training in conversational techniques via video conferencing, whereas master’s students more frequently expressed a desire for information on appropriate methods for VPT. The high relevance rating given by psychology students to all learning opportunities indicates their desire to acquire proper knowledge and skills for offering VPT.

We can derive practical implications for universities and training institutes from our findings regarding the desired learning opportunities. However, integrating these opportunities into the curriculum poses several challenges and difficulties. Nevertheless, the results of our study, as well as research showing the effectiveness of VPT (Backhaus et al., 2012; Hilty et al., 2013; Norwood et al., 2018; Berryhill et al., 2019a,b), highlight the importance of integrating VPT into the curriculum. Therefore, we propose a five-step plan: Firstly, as addressed in our study, it is important to determine whether VPT should be integrated at all. Our study provided an affirmative answer to this question, which is further supported by research demonstrating the effectiveness of VPT (Backhaus et al., 2012; Hilty et al., 2013; Norwood et al., 2018; Berryhill et al., 2019a,b). Secondly, universities and training institutes should assess the inclusion of these learning opportunities and examine the available capacity within the curriculum. This may involve considering the feasibility of incorporating a dedicated seminar on the topic or offering an optional supplementary course. Thirdly, it is crucial to determine the content to be delivered. Although our study has identified various desired learning opportunities, prioritization is necessary. Faculty members or trainers may hold different perspectives on priorities compared to the students in our sample. Fourthly, it is essential to explore the didactic implementation of the content and to identify any additional training needs for instructors in the field of computer-mediated communication. Moreover, the establishment of infrastructure is vital to facilitate targeted training. This includes ensuring reliable internet connections, providing an adequate number of high-quality computers, headsets, and microphones, and considering any other necessary resources to support effective implementation. Lastly, the fifth step involves conducting formative evaluation of the implemented program. This includes assessing its effectiveness, examining its impact on personal variables (pre-post), evaluating student satisfaction, and monitoring changes in intentions.

The present study stands out due to its innovative focus, mixed-method design, and sample of psychology students. The findings have significant implications for the development of psychology study programs. However, some limitations should be noted.

First, the quantitative data in this study is limited to correlational and cross-sectional analyses. Therefore, the available data does not allow for any conclusive statements about the causal relationships between independent and dependent variables in the multiple regression model. However, this is a common approach in many studies that aim to explain the relative importance of several characteristics on behavioral intentions, as seen in previous studies (Balakrishnan, 2017; Rüth et al., 2022; Shahzalal and Adnan, 2022). In the future, it would be desirable to transform the study design to test for causality.

Second, the generalizability of the findings from this study to other countries and educational systems remains uncertain. The German system of psychotherapy training is distinct from others (Kaufmann et al., 2012), and it is likely that psychology students from different countries would consider different aspects of VPT than those in the present study. Moreover, legal requirements and healthcare insurance solutions for VPT vary across countries (cf. Kaufmann et al., 2012), which could influence participants’ responses. Nonetheless, given the widespread use of VPT during the pandemic, it is likely that VPT will continue to play a crucial role in psychotherapy training worldwide.

Third, it should be noted that this study only assessed psychology students’ intention to use VPT after graduation, which can take several years. The continuous development of their intention over time was not examined in this study. While intention is considered a key predictor of behavioral performance according to Fishbein and Ajzen (1975), it is not a guarantee. Whether these psychology students will actually offer VPT when they become licensed psychotherapists cannot be determined from the current results and requires further investigation. A longitudinal study could provide valuable insights into this question.

Fourth and last, it should be noted that the study ran during the COVID-19 pandemic, so responses could have been influenced by this extreme situation. For example, it can be assumed that the category protection against disease and pandemic would have been smaller, and that the keyword “pandemic” would not have been mentioned at all. The focus of the participants could have been on a different topic under different circumstances. In addition, results from Doran and Lawson (2021) indicated that attitudes toward VPT have become significantly more positive during the pandemic, as it was perceived as important, necessary, and effective during the pandemic. Therefore, it is important to examine whether these results will persist beyond the acute phase of the pandemic. It is possible, however, that the relevance of VPT will continue as the next generation of psychotherapists realize that digital mental health care continues to be of great importance.