The Loss of the Shared Space: Process Issues in Telepsychotherapy

International Journal of Psychology and Psychoanalysis, 2021

We conducted an international survey to better understand both the negative and positive reactions of distance treatment during the pandemic. We received 1,490 survey responses from practitioners from 56 regions and countries who remotely treated patients psychoanalytically during the beginning months of the Covid-19 pandemic. Eighty-nine percent of the practitioners agreed or strongly agreed that distance treatment is valuable when the patient is house-bound or when travel would be difficult or impractical. They also expected to treat about 47% of their patients via teletherapy in the future. A minority group (17%) with mainly negative opinions do not feel that distance analytic treatment is effective with exploring mental life. Those with mainly negative opinions had more difficulty with the technology, had little value for teletherapy even for the patient who is homebound or when travel would be impractical, and considered bodily presence as very important to outcome. The majority of respondents who have mainly positive opinions feel that they can work effectively with transference, resistance and relational problems in distance analytic treatment.

Psychotherapy, 2021

The coronavirus disease (COVID-19) pandemic has resulted in a rapid transition from in-person therapy to teletherapy. This study examined mental health providers' perceptions of the differences between in-person therapy and teletherapy in common therapeutic attributes and identified therapist characteristics that predicted differences. A sample of 440 therapists and trainees completed an online survey that assessed their provision of clinical services since the outbreak of COVID-19. Therapists provided ratings for having used 28 therapeutic attributes (e.g., empathy, emotional expression) and skills for in-person therapy and teletherapy. Those attributes were clustered into three factors via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA): common therapeutic skills (e.g., warmth), extra-therapeutic influence (e.g., providing resources), and perceived outcome (e.g., symptom reductions). Therapists perceived poorer common therapeutic skills, decreased outcomes, and reduced extra-therapeutic influence when conducting teletherapy compared to in-person therapy. Therapists who reported poorer common therapeutic skills in teletherapy tended to be male, younger, utilize experience-based and relational therapies, have smaller caseloads, and had little training and no prior experience in teletherapy. Additionally, being male, utilizing experience-based and relational therapies, and having no training in teletherapy were associated with therapists' perception of reduced outcome in teletherapy. More intensive training and support in these attributes/skills are needed to improve therapists' confidence and ability to use therapeutic skills during teletherapy and ultimately improve the quality of psychological services in the era of teletherapy. Clinical Impact Statement Question: How do therapists perceive telepsychology differently from face-to-face therapy during the COVID-19 pandemic? Findings: Therapists felt less skilled in most therapeutic attributes when conducting teletherapy compared to face-to-face therapy. Meaning: Training and support are needed to improve therapists' abilities to use therapeutic skills in telepsychology, particularly those therapists who have little experience with and training in telepsychology. Next Steps: It is important to examine whether and how therapists being less skilled in teletherapy versus face-to-face therapy may result in diminished client outcomes.

2020

The past 20 years have seen a gradual rise in research about and practice of video- or tele-psychotherapy. With the worldwide lockdown imposed in response to Covid-19, the practice of face-to-face systemic psychotherapy using the approaches, methods and techniques that have been carefully developed over the past five decades has become impossible. With an unbelievable rapidity, new methods of providing therapeutic services have been devised and implemented to ensure service continuity. This practice paper describes what has been learnt in the first stages of a rapid quality improvement project exploring the delivery of remote systemic psychotherapy since the lockdown. Reflections were gathered from early-adopter clinicians, based on 21 remote systemic psychotherapy sessions completed during March and April 2020. These responses suggest that that remote systemic psychotherapy has been acceptable and indeed welcomed by clinicians and families and that robust therapeutic work can be do...

Research in psychotherapy, 2023

E-publishing ahead of print is increasingly important for the rapid dissemination of science. The Early Access service lets users access peer-reviewed articles well before print/regular issue publication, significantly reducing the time it takes for critical findings to reach the research community. These articles are searchable and citable by their DOI (Digital Object Identifier). Our Journal is, therefore, e-publishing PDF files of an early version of manuscripts that undergone a regular peer review and have been accepted for publication, but have not been through the typesetting, pagination and proofreading processes, which may lead to differences between this version and the final one.

Psychoanalytic Perspectives, 2021

The disaster of the COVID-19 pandemic abruptly forced nearly the entire psychoanalytic community to move treatment, supervision, and classes online, leaving many feeling uncentered, unprepared, and vulnerable. The authors, members of the APsaA COVID-19 Advisory Team and longtime researchers in screen relations-based psychoanalytic care, recount lessons learned from their pandemic experience. As both disaster victim and mental health responder, they start with the cultural context for pandemic-specific mental health practice. Going deeper into the technological context for psychoanalytic care, they describe clinically-relevant differences between screen relations and physical co-presence, highlighting risk and trust, richness, and relational embodiment as key influences on clinical process and outcome. Common adaptions and responses that helped make pandemic-specific screen relations-based treatment work emerged from their own work and discussions and consultations with numerous coll...

Frontiers in Psychology, 2022

The COVID-19-pandemic brought massive changes in the provision of psychotherapy. To contain the pandemic, many therapists switched from face-to-face sessions in personal contact to remote settings. This study focused on psychodynamic therapists practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation and their subjective experiences with psychotherapy via telephone and videoconferencing during the first COVID-19 related lockdown period in March 2020 in Austria. An online survey completed by 161 therapists produced both quantitative and qualitative data with the latter being subject to a qualitative content analysis. Our research suggests that telephone and videoconferencing are considered valuable treatment formats to deliver psychodynamic psychotherapy. However, therapists’ experiences with remote psychotherapy are multifaceted and ambiguous. In particular, the findings raise questions concerning the maintenance of the therapeutic alliance, the development of the ana...

Frontiers in Psychology, 2023

Background: Worldwide, psychotherapists' clinical experience went through rapid developments with transition to teletherapy during the COVID-19 pandemic. Literature on the use of remote psychoanalysis was not conclusive, leaving the issue of the consequences of the necessary setting alternation open. This study aimed to investigate the psychoanalysts' experiences of shifting to remote work and then returning to in-person setting, considering the effect of the patients' attachment styles and personality configurations. Method: Seventy-one analysts of the Italian Psychoanalytic Society were asked to fill out an online survey about patients who found the transition easier and patients who found it more difficult. General questions on therapeutic work, ISTS (Interpretive and Supportive Technique Scale) for interpretive and supportive aspects of technique, WAI-S-TR (Working Alliance Inventory-Short Revised-Therapist) for therapeutic alliance, RQ (Relationship Questionnaire) for attachment style, and PMAI (Prototype Matching of Anaclitic-Introjective Personality Configuration) for personality configurations were administered. Results: All of the analysts chose to continue the treatment using audiovisual tools. Patients with difficult transitions had a significantly higher frequency of insecure attachment and a higher score on RQ Dismissing scale than patients with easy transitions. No significant differences were found between the two groups in personality configurations, psychotherapeutic alliance, and psychotherapeutic technique. Moreover, a higher level of therapeutic alliance was positively correlated to RQ Secure scale and was negatively correlated to RQ Dismissing scale. Patients with easy transition both to remote work and back to in-person setting had higher scores of therapeutic alliances than those with difficult transition both to remote work and back to in-person setting. Conclusion: Online psychoanalytic therapy was widely used during the COVID-19 pandemic. Patients with insecure attachment styles had greater difficulties in adapting to setting alternations, thus confirming that insecure attachment is a vulnerability factor not only for psychopathological problems but also for a well-functioning therapeutic collaboration. Patient's personality configuration did not influence their adaptation to the setting alternation. The supportive and

Psychoterapia, 2022

During pandemic, what was offered to patients on a large scale was psychotherapy in the form of video interviews. The psychotherapeutic community, however, seems to be convinced of the inferiority of this form of work with patients. We undertook research to verify the rationality of this belief by asking whether the difference between remote psychotherapy and psychotherapy with direct client contact is relevant, i.e. whether it concerns the essence of what psychotherapy is. Methods: In the research we used a phenomenological analysis of our own experiences of conducting psychotherapy in the form of video interviews and participating in psychotherapy training in the form of meetings using audiovisual channels. We explored in detail two phenomena that potentially distinguish these two forms of psychotherapy practice, namely the indirectness of person-to-person contact and long-distance communication. Results: We conclude that the crucial difference between remote psychotherapy and psychotherapy with direct client contact is that in case of the former one, the patient's immersion in virtual reality, where the meeting with the therapist occurs, must be accompanied by an anchoring in a real-life space, where s/he is exposed to others. The fact that the therapist offers his/her office as a safe haven to the patient is, in principle, a way of creating better conditions for the healing process. Nevertheless, offering remote psychotherapy in a pandemic situation-with the therapist's office no longer a physically safe space-is in accordance with the essence of psychotherapy. Conclusions: At a time of "high-risk office", the provision of opportunities for psychotherapy in the form of video interviews is an expression of concern for patient which, together with an attitude of openness and hospitality, constitutes the essence of psychotherapy, while the form of psychotherapy appears to be secondary importance in this respect.

2007

In the last ten years many researchers have set out to investigate the existence of a common factor that is transversal to various treatment models, in order to explain most of the effectiveness of the psychotherapies. The relationship, or more precisely that aspect of the patient-therapist relationship that goes by the name “therapeutic alliance”, has been identified as this common factor (Horvath & Symonds, 1991; Horvath & Bedi, 2002; Lingiardi, 2002; Martin, Garske, & Davis, 2000). Although the concept of therapeutic alliance has a relatively short history (Zetzel, 1958), its roots lie in the psychoanalytic tradition (Freud, 1912; Sterba, 1934) and it was in the 1970s that it started its shift into the field of empirical research. After an initial period (1912-1965) of psychoanalytic theorizations (starting with the “irreprehensible positive transference” of Freud 1912) and a second period of empirical research with the construction of ad hoc instruments and studies aimed at the ...

Frontiers in Psychology, 2021

Aims: Research conducted prior to the onset of the COVID-19 pandemic indicates that remote psychotherapy is as effective as in-person treatment. At that time, it usually was the therapist’s individual choice to work remotely, whereas the pandemic pushed psychotherapists, including previous skeptics, to incorporate remote work methods into their routine due to limited face-to-face contact. There is little knowledge of the way therapists experienced this sudden and forced transition to remote psychotherapy as the only treatment option. The present study aims to assess psychotherapists’ experience and proficiency delivering remote psychotherapy as well as to investigate perceived changes in the psychotherapeutic relationship.Methods: An online survey was administered to psychotherapists of the Austrian Association for Group Therapy and Group Dynamics (ÖAGG). Three test periods (t) were set (t1: April, 2020 with N = 175; t2: May–June, 2020 with N = 177; t3: November–December, 2020 with ...

Frontiers in Psychology

Driven by the theory-building around the role of the non-verbal components to communication, we aimed to understand how therapists experience the therapeutic process using a facial mask. The empirical evidence of the power of non-verbal communication to engage therapists and clients in therapeutic work, develop a positive and collaborative relationship between them, and display empathy is quite large. A mixed-methods approach was adopted, drawing from the therapists’ participation in an online survey. A sample of 137 psychotherapists with different therapy orientations and years of clinical practice participated in the study. Therapists conducted face-to-face therapy wearing face masks with existing and/or new clients. We performed an exploratory analysis, using descriptive statistics, to explore the psychotherapists’ evaluations regarding perceived impact of face masks on different therapy quality dimensions. In a complementary rationale, we analyzed the therapists’ perspectives on...

Frontiers in Psychiatry, 2023

There is a growing interest in delivering videoconferencing psychotherapy (VCP) due to the enormous impact of the COVID-19 pandemic on our lives since the beginning of severe restrictions worldwide in March 2020. Scientific literature has provided interesting results about the transition to remote sessions and its implications, considering different psychotherapy orientations. Less is known about whether and how VCP affects psychodynamic psychotherapeutic approaches and reports on remote work with severe and complex mental health problems such as severe personality disorders are still scarce. The aim of the study was to examine the experiences of psychodynamic psychotherapists, mainly delivering Transference-Focused Psychotherapy (TFP), with the transition and delivery of VCP during the first wave of the COVID-19 pandemic. Four hundred seventy-nine licensed psychotherapists completed an online survey during the peak of the pandemic. Survey data were analyzed using qualitative analysis. Results are presented and discussed concerning advantages and disadvantages regarding the access to psychotherapy, the specificity of the online video setting, bodily aspects, the quality of the therapeutic relationship, the therapeutic process including technical aspects and therapist's experience. Furthermore, we analyzed and discussed the statements concerning transference and countertransference reactions differentiating between high-level borderline and neurotic patients and low-level borderline patients. Our results support the importance to identify patients who potentially benefit from VCP. Further research including more prospective randomized controlled trials are needed to investigate the therapeutic implications of the findings.

Re-visiting Psychotherapy During the Pandemic: Personal & Professional Reflections, 2020

The pandemic has changed the way we live and the way we practice psychotherapy. The complete shift to online work has challenged all aspects of psychotherapy and training. It is time to learn new things and new ways of doing them. This article offers some reflections on the personal and professional changes psychotherapists are called to make.

Psychoanalytic Social Work, 2018

Clinical Psychology & Psychotherapy, 2021

Objective: First, to investigate how psychotherapists and patients experience the change from in-person to remote psychotherapy or vice versa during COVID-19 regarding the therapeutic interventions used. Second, to explore the influence of therapeutic orientations on therapeutic interventions in in-person versus remote psychotherapy. Method: Psychotherapists (N = 217) from Austria were recruited, who in turn recruited their patients (N = 133). The therapeutic orientation of the therapists was psychodynamic (22.6%), humanistic (46.1%), systemic (20.7%) or behavioural (10.6%). All the data were collected remotely via online surveys. Therapists and patients completed two versions of the 'Multitheoretical List of Therapeutic Interventions' (MULTI-30) (version 1: in-person; version 2: remote) to investigate differences between in-person and remote psychotherapy in the following therapeutic interventions: psychodynamic, common factors, person-centred, process-experiential, interpersonal, cognitive, behavioural and dialectical-behavioural. Results: Therapists rated all examined therapeutic interventions as more typical for in-person than for remote psychotherapy. For patients, three therapeutic interventions (psychodynamic, process-experiential, cognitive interventions) were more typical for in-person than for remote psychotherapy after correcting for multiple testing. For two therapeutic interventions (behavioural, dialectical-behavioural), differences between the four therapeutic orientations were more consistent for in-person than for remote psychotherapy. Conclusions: Therapeutic interventions differed between in-person and remote psychotherapy and differences between therapeutic orientations in behaviouraloriented interventions become indistinct in remote psychotherapy.