Table 2: Themes from ‘Client Change Interview’

Practicalities of Video Therapy (VT)	Therapeutic Rapport	Experience of Schema Therapy by VT	Behavioural Change	Self Description
Mid-therapy + “VT does not infringe on my kids’ [needs], as I don’t need someone to [baby]sit with them long” + “VT can reach people who can’t get to Aberdeen” Post-therapy + “Its been really good [to use telephone & email as an adjunct to VT] – if I had problems I just emailed & she got back to me. I didn’t feel closed off just because [our communication wasn’t entirely] via video link” + “Given the choice of VT or face-to-face again, I would choose VT. Without VT I would have had to come to [Aberdeen] and wouldn’t have been able to come weekly. By the time I had driven there & back I would have been rushing about to pick up my little one. I would have been totally stressed. To be honest, with that stress I probably would have given up.”	Mid-therapy +/- “At first I was a bit apprehensive…I didn’t know what to expect...but now it’s fine” +/-“If you get upset the therapist isn’t in the room to pat you on the back. But Susan has manner that makes you feel better” Post-therapy + “I think it [VT] was easier than face-to-face [would have been] …I think I would have been more embarrassed if I knew she was in the same room. In face-to-face therapy I would have held back but [as I was] in a separate room I was able to say anything. I get shy when I’m face-to-face & that might have made it more difficult”	Mid-therapy “Role play & [mode work] were weird to start off with. It wasn’t upsetting doing it, but it put me in touch with what the different parts of me were saying and that [made me] upset” Post-therapy “The most difficult part was letting myself get into the role-plays. It was uncomfortable trying to think back. After the first time it was a breeze.” “I was conscious of seeing myself on the TV. But …I was there to get my eating disorder under control and one of my goals was to overcome that fear [of looking at myself]. I think that VT has made me less self-conscious about my body. I would sit in front of the screen [before linking up] at the start of my sessions & talk to myself the way Susan has taught me to – pushing the negative [mode] aside.”	Mid-therapy + “I can tell when I’m starting to go downwards & try to use new coping mechanisms” +“I talk more to my husband” + “Before I was negative about myself but now I am making these changes for me” + “I’m not as scared to eat out now” + “It’s been a shock to see how quickly [these changes] have happened” -“I still have… negative thoughts, but now I have arguments between the negative & positive thoughts”. Post-therapy +”I would still like to lose weight but its not the ‘be-all-and-end-all’ now. Before it was an obsession. Now its nice to take [the weight] off naturally instead of doing it with fads & diets. I want to keep doing what I’m doing now.”	Pre-therapy +/- “I’m fat. I hide feelings behind a ‘mask’. Not pretty. A good kind person, helpful.” Mid-therapy +/-“I aim to please & help everyone else. I’m there all the time if anyone needs me. I give good advice but cant take my own advice. I’m a good friend.” Post-therapy +“I’m more confident. I don’t see myself as fat now, I see myself as big. I’m more assertive & I don’t get ‘stepped on’. People [make demands] on me,but I took a step back and said ‘no’. My husband describes me as “confident, positive & sexy”.