Relational Work Through Technology: Understanding the Impact of Telemental Health on the Therapeutic Alliance

The rapid shift to telemental health (TMH) during the COVID-19 pandemic left mental health providers scrambling to adapt, raising concerns about the effect on the quality of the therapeutic alliance. This article explores the impact of TMH on the therapeutic alliance and how relational psychotherapists can support their patients and engage best practices in a way that helps all participants feel connected to the work. It defines the therapeutic alliance, explores the concepts of tasks, goals, and therapeutic bonds, and highlights the importance of developing a positive bond in the context of relational therapy. The paper also describes common challenges encountered while providing psychotherapy virtually, provides guidance on what contributes to a more positive attitude toward TMH interventions, offers a list of recommendations for improving the therapeutic alliance in TMH, and makes recommendations for future study.

Predictors of 1-Year Perceived Recovery, Absenteeism, and Expenses Due to Low Back Pain in Workers Receiving Mechanical Diagnosis and Therapy: A Prospective Cohort Study.

This multicenter prospective cohort study aimed to preliminarily explore statistically relevant modifiable and predetermined factors for 1-year perceived recovery, absenteeism, and personal expenses in workers who received Mechanical Diagnosis and Therapy (MDT) for low back pain (LBP). Three stepwise multiple regression models were explored with 42 independent variables, including (1) socio-demographic factors; (2) risk stratification; (3) pain-related variables, psychological variables, and behavioral variables at baseline and changes after a month; (4) therapeutic alliance and exercise adherence at 1-month follow-up; and (5) MDT classification and therapist levels. Data from 58 participants were analyzed, after which a model with a medium effect size was developed for 1-year perceived recovery only. Consequently, patients with derangement syndrome were expected to have improved 1-year perceived recovery, with expected predetermined prognostic factors including shorter symptom duration, self-management skills to lead a healthy life, and less pain catastrophization at baseline. A stronger therapeutic alliance between patient and therapist during the 1-month MDT intervention was identified as an expected modifiable prognostic factor. It may be difficult to accurately predict the annual absenteeism and personal expenses due to LBP given the weak to low effect sizes of the developed models.

Keeping connected: Family therapists' experiences of working online during the COVID‐19 pandemic

For this qualitative study, eight family therapists were interviewed about their experiences of practising online during the pandemic. Findings are organised using a framework of problems, possibilities, resources and restraints (PPRR, Neden & Burnham, 2007). Despite variation in therapist confidence in online practice, all participants found new possibilities in this way of working, including connecting family members across distance, increased co‐construction within therapeutic relationships and engaging clients who would not usually attend appointments. Therapeutic alliance was generally possible to establish online, though felt more challenging with whole families than individuals. Problems and restraints included therapist fatigue, risk and safety management, and attuning to nuanced expression of emotion. Implications for practice and future research are proposed. It is suggested that systemic practice has unique qualities to offer the field of online psychotherapy.

Examining the impact of COVID-19 on supervisees' experiences of clinical supervision

The global pandemic, COVID-19, changed the clinical supervision landscape in professional psychology. Supervisees transitioned from in-person supervision, to virtual, or telesupervision, in some cases, with limited preparation. We used a mixed methods approach to evaluate supervisee experiences during the transition to telesupervision precipitated by the global pandemic and to provide a historical record of the impact of the pandemic on clinical training. We also assessed the relationship between the supervisory working alliance and attitudes toward telesupervision. Authors used consensual qualitative research-modified to analyze qualitative data from 324 participants. Data revealed categories of technology, organization and productivity, and communication and connection, as the top three challenges experienced by clinical supervisees. Supervisees reported flexibility and convenience and saving time and money, as the top two benefits of engaging in telesupervision during the pandemic. Quantitative data from 310 participants suggested a moderate, positive, relationship between supervisee perception of the working alliance and attitudes toward telesupervision. Implications for research, practice, and theory are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The global pandemic of COVID-19 shifted the clinical training of professional psychology students from in-person, to virtual, or telesupervision. Studying this particular historical event provides us with insights about the challenges and benefits of conducting telesupervision (a) on a wide scale, (b) for the first time for many professional psychology trainees, and (c) within the context of a global crisis that disrupted everyday protocols. By investigating the experiences of professional psychology trainees during this rare crisis, we are provided not only a starting point for developing best telesupervision practices overall but also best practices for clinical supervision during crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

How telehealth has impacted the therapeutic alliance during the COVID-19 pandemic

In 2019, the COVID-19 pandemic rapidly spread from one region to the world. Efforts to mitigate the spread of COVID-19 included government lockdowns, teleworking, vaccine development, mask-wearing, and social distancing. Before the COVID-19 pandemic telehealth was not widely utilized in the United States and most insurance companies limited reimbursement. In 2020, when the U.S. government waived some of the Medicare limitations to telehealth the CEOs of insurance companies also agreed to allow for increased coverage of telehealth during the pandemic. During the beginning of the COVID-19 pandemic, the safest way for mental health providers to meet patients was telehealth pending the time that vaccines would be developed and it was safe to resume in-person sessions. The limitations of the pandemic resulted in therapists having to establish therapeutic alliance virtually. Therapeutic alliance is the bond between providers and patients traditionally established during in-person office visits. This phenomenological qualitative study sought to understand the lived experiences of psychotherapists establishing therapeutic alliance using telehealth during the COVID-19 pandemic. There were 22 semi-structured interviews conducted to understand these experiences. The results of this study indicated that despite initial technical challenges with web-based platforms and limited access to nonverbal communication, providers were able to establish therapeutic alliance using telehealth. Clients responded positively to the reduction in commute time to see their providers, increased statewide accessibility to more providers, and additional scheduling options. As telehealth continues to be used increasingly, further research is needed to equip clinicians with additional strategies for successfully establishing therapeutic alliance virtually. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The development of therapeutic relationships during the pandemic: Perceptions of professional counselors using telemental health apps in rural areas

During the COVID-19 pandemic, it became increasingly important to understand how licensed professional counselors used telemental health applications (apps) to establish therapeutic relationships in rural areas. In the past decade, technology has undergone significant changes in its purpose and design. During the COVID-19 pandemic, telemental health was a tool that provided access to mental health services by developing and sharing innovative and effective treatments. The literature suggested that telemental health apps are effective for providing counseling services to clients living in rural areas. Therefore, this technology provided added support to individuals who faced treatment barriers. In this generic qualitative study, data were collected and analyzed regarding the perceptions of therapeutic relationship development among licensed professional counselors using telemental health apps in rural areas during the COVID-19 pandemic. The data collected from the semi-structured interview were analyzed using inductive analysis, through which six themes emerged: (a) relational components of therapy, b) methods and approaches used to guide sessions, (c) client concerns about ethical and privacy issues, (d) barriers to engaging clients in the sessions, (e) the value of videoconferencing platforms to help connect with clients, and (f) evolving new roles and responsibilities. The themes that emerged helped answer the research question: "How have professional counselors used telemental health apps in rural areas to develop the therapeutic relationship during COVID-19?" Counselors may better understand, empathize, support, engage, connect, and develop therapeutic relationships with clients when utilizing these applications. In future research, it would be worthwhile to examine clients' viewpoints, since telemental health applications are designed with clients in mind. Also, associate-level professionals used telemental health to work with clients, and this experience may be useful to gain a perspective from counselors in training. Finally, when it comes to participation recruitment, it may be beneficial to reach out to various social networks, Listservs, and other professional organizations. Counselors may report different experiences regarding their engagement with clients. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Addressing concerns and adapting psychological techniques for videoconsultations: A practical guide

Objective: The 2020 coronavirus pandemic required many psychologists to rapidly transition to telehealth services to reduce virus exposure. Telepsychology services expanded quickly in Australia. This article seeks to provide simple and practical recommendations for clinicians who are changing their practice. Method: A narrative literature review focusing on psychologists' concerns regarding telehealth-facilitated psychology or telepsychology was undertaken. Results: Research literature and guidelines from peak professional bodies such as The Australian Psychological Society and the American Psychological Association, inform two sections of the article: Common Concerns about Videoconsultations and;Practical Considerations for Effective Videoconsultations. Telepsychology, has numerous benefits, especially during emergency situations. However, concerns regarding efficacy, therapeutic alliance, and the digital divide have contributed to psychologists' unwillingness to use telepsychology. Evidence suggests that efficacy and therapeutic alliance is comparable between telepsychology and in-person services. Simple evidence-based adjustments to therapeutic practice can optimise videoconsultations and increase the effectiveness of telepsychology. Despite the rapid change to videoconsultations, evidence suggests that Australian psychologists need not be concerned about clinical efficacy or therapeutic alliance related to telepsychology. However, it is acknowledged that transitioning to telehealth models of care is disruptive. Conclusion: This paper can assist clinicians in selecting appropriate clients for telepsychology, increase effectiveness and mitigate risks. Key Points: What is already known about this topic: (1) Research supports the clinical efficacy and establishment of therapeutic alliance related to telepsychology services and highlights that concerns regarding the digital divide need to be evidence-based, not based on assumptions. (2) As outlined in this paper, it is important to consider client suitability and ethical considerations prior to delivering telepsychology services. (3) The adaptations to psychological techniques, as highlighted in this paper, can increase the effectiveness of videoconsultations. What this topic adds: (1) An examination of common concerns related to videoconsultations including: efficacy, therapeutic alliance and the digital divide. (2) A practical evidence-based checklist for pre-therapy videoconsultation considerations. (3) An evidence-based checklist of practice adaptations that can increase effectiveness in videoconsultation. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Integrating Mindfulness and Acceptance Into Traditional Cognitive Behavioral Therapy During the COVID-19 Pandemic: A Case Study of an Adult Man With Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) can be chronic and impairing, highlighting the need for effective treatments. Although Cognitive Behavior Therapy (CBT) is an effective treatment for GAD, a number of patients continue to report GAD symptoms treatment. Integrating evidenced-based treatment components into CBT treatments, such as mindfulness- and acceptance-based treatment components found in Acceptance and Commitment Therapy (ACT), may help improve the efficacy of treatment. Emerging interventions and research suggest that the cognitive restructuring aspect of CBT and acceptance stance of ACT (e.g., cognitive defusion) can be implemented into treatment concurrently from a stance of increasing a patient's coping skills repertoire and psychological flexibility. This systemic case analysis examined the efficacy and clinical utility of integrating ACT into a manualized CBT treatment for GAD. Furthermore, this study examined treatment efficacy and therapeutic alliance as the treatment rapidly and unexpectedly transitioned from in-person to telehealth due to the COVID-19 pandemic. Pre- to post-treatment and time-series analyses showed significant decreases in anxiety symptoms, worry, depressive symptoms, and emotion dysregulation. Although there was an initial increase in depressive and anxiety symptoms, worry, and emotion dysregulation following the switch from in-person to telehealth services, these quickly subsided and resumed a downward trend. The therapeutic relationship did not deteriorate during the transition to telehealth. This case study provides evidence of feasibility and efficacy of an integrated CBT/ACT approach in treating GAD. It also suggests that despite some temporary increase in symptoms, therapeutic alliance and treatment efficacy were not impacted by the switch to telehealth.Copyright © The Author(s) 2022.

Biopsychosocial therapy of generalized anxiety disorder. Integrative treatment concept

The corona pandemic has led many people to experience an existential threat and has triggered different forms of coping with this persistent stress situation. The risk for the development of a generalized anxiety disorder (GAD) in particular has significantly increased. The established concepts of cognitive behavioral therapy (CBT) are only moderately effective in the treatment of GAD. Therefore, an integrative therapy concept is developed with reference to the biopsychosocial approach. This mediates a reference to early influences in the primary family (insecure ambivalent attachment, suppression of curiosity behavior) even during the psychoeducation as the cause of a permanent worrying and the underlying intolerance of uncertainty. The initial priority is on establishing a sustainable therapeutic relationship (alliance) in which the patient's autonomy and self-efficacy are promoted. Of central importance to therapeutic progress is the promotion of experiences that enhance self-efficacy and the reduction of avoidance behavior through exposure and behavioral experiments. The reduction of maladaptive anxiety coping through worry chains and reassurance behavior occurs through the development of an increasingly greater tolerance of uncertainty in actual daily life. Essential for the prognosis are the consideration of metacognitions and dysfunctional relationship patterns in the couple relationship as well as carrying out relaxation procedures and correctly dosed exercises. Finally, it is a matter of the processing of dysfunctional coping strategies, which promote chronification. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (German) Die Coronapandemie hat bei vielen Menschen zum Erleben einer existenziellen Bedrohung gefuhrt und unterschiedliche Formen der Bewaltigung dieser anhaltenden Stresssituation ausgelost. Besonders stark gestiegen ist das Risiko fur die Entwicklung einer generalisierten Angsterkrankung (generalized anxiety disorder", GAD). Die etablierten Konzepte der kognitiven Verhaltenstherapie (cognitive behavioral therapy", CBT) sind in der Behandlung einer GAD nur masig wirksam. Daher wird unter Bezugnahme auf den biopsychosozialen Ansatz ein integratives Therapiekonzept entwickelt. Dieses vermittelt bereits im Rahmen der Psychoedukation einen Bezug zu fruhen Pragungen in der Primarfamilie (unsicher-ambivalente Bindung, Unterdruckung von Neugierverhalten) als Ursache eines permanenten Sichsorgens und der dahinter stehenden Intoleranz fur Ungewissheit. Zunachst steht der Aufbau einer tragfahigen therapeutischen Beziehung (alliance") im Vordergrund, bei der die Autonomie und Selbstwirksamkeit des Patienten gefordert werden. Eine zentrale Bedeutung fur den therapeutischen Fortschritt haben die Forderung von Erfahrungen, die die Selbstwirksamkeit erhohen, sowie die Reduktion von Vermeidungsverhalten durch Exposition und Verhaltensexperimente. Der Abbau der maladaptiven Angstbewaltigung durch Sorgenketten und Ruckversicherungsverhalten geschieht durch die Entwicklung einer wachsenden Toleranz von Ungewissheit im jeweils aktuellen Lebensalltag. Prognostisch wesentlich sind die Berucksichtigung von Metakognitionen und dysfunktionalen Beziehungsmustern in der Paarbeziehung sowie die Durchfuhrung von Entspannungsverfahren und richtig dosierter Sporttherapie. Schlieslich geht es um die Bearbeitung dysfunktionaler Coping-Strategien, die die Chronifizierung fordern. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Clinicians' Reflections of the Therapeutic Relationship in Videoconferencing: A Qualitative Study

Introduction: In recent years the use of distance psychotherapy has been gaining in popularity (Hollis et al., 2015), especially due to the Covid-19 pandemic, which has forced many clinicians to use online interventions to comply with social distancing rules, enabling them to experience the resources and the limitations of online tools and consultations (Van Daele et al., 2020). Among the different ways of providing online psychotherapy, videoconferencing psychotherapy has many advantages (e.g., reaching people who have conditions that hinder the carrying out of a face-to-face treatment, the possibility of improving the integration network between the different territorial services, facilitating access to them) and its effectiveness was demonstrated in the literature (Thomas et a., 2021;Backhaus et al., 2012). Despite these advantages, for clinicians, one of the biggest concerns about videoconferencing psychotherapy is its potential negative influence on the therapeutic relationship with clients in terms of strategies, quality and emotion detection by the online communication modality, especially because of the lack or reduction of conventional, non-verbal signs and clues typical of a traditional clinical setting (Cipolletta & Mocellin, 2018). Many clinicians report feeling insecure about their ability to communicate their empathy and build a therapeutic alliance online as well as to feel more tired, less competent and confident, less authentic or genuine, and less connected with clients during online video sessions (Bekes & Aafjes-van Doorn, 2020). Moreover, recent studies seem to suggest that different relational aspects may intervene in the video-mediated relationship than in the presence, such as the necessity of an extensive use of ostensive cues (Fisher et al., 2020), a greater disinhibition and openness in videoconferencing or an increased flexibility;these elements could have a different role in online than face-to-face interventions (Simpson et al., 2020;Cipolletta et al., 2017). According to these considerations, the aim of this work is to further explore which are the peculiar aspects involved in the video-mediated clinical relationship and its differences from face-to-face interventions. Method(s): We involved in the study 32 psychotherapists (85.2% female;Mage=35.07) affiliated to an Italian agency that provides online psychotherapy, which were divided into three groups based on their levels of clinical experience. Each group attended an online 2-session focus group conducted by two psychotherapists who administered an ad hoc semi-structured interview to the participants based on the core issues of this study and the evidence presented in the literature about the characteristics of video-mediated relationship. In the focus groups the experiences of the therapists were investigated through 4 areas: (1) therapeutic relationship;(2) personal and professional background;(3) non-verbal communication and (4) management of therapeutic boundaries. All sessions were video-recorded and transcribed. Transcripts were coded using the inductive thematic analysis method (Braun & Clarke, 2012) by three coders supervised at regular intervals by two experts. Each of the coder independently coded the transcripts and each discrepancy was discussed in group until obtaining agreement among coders. Result(s): Preliminary results show that clinicians refer how the relationship in videoconferencing has distinctive characteristics that differed from face-to-face setting. These characteristics are related to four main areas, which emerged from the analysis: (1) emotional and relational aspects of psychotherapy;(2) motivation and beliefs;(3) corporeity and movement and (4) management of therapeutic boundaries. Regarding emotional and relational as- pects, clinicians reported the presence of some elements that differ from face-to-face therapy, such as the establishing of the therapeutic alliance, the level of intimacy and safety of the therapeutic relationship and the drop-out rates. About the second area, principal themes pointed out by clinicians regarding the presence of differences in levels of motivation and urgency in the request of psychological intervention expressed by patients who choose online psychotherapy;furthermore, both clinicians and patients (as referred by their therapist) initially have some prejudices about the effectiveness of videoconferencing psychotherapy. There is a general agreement among therapists about the lack of non-verbal signals and corporeity in videoconferencing that forced clinicians to focus on facial movements, eye contact and tone of voice;furthermore, also the use of silence is different in online psychotherapy. Lastly, concerning the management of therapeutic boundaries, therapists affirmed that technical problems (internet connection, device use.), the possibility of maintaining privacy, the increased responsibility of the patient in the setting construction and the consequent need to educate the patient on how to be in therapy are the principal characteristics of the videoconferencing therapy. Further and more detailed results will be presented. Conclusion(s): The preliminary results of this study suggest that in the therapist's perception the therapeutic relationship in videoconferencing has peculiar characteristics and is different from the face-to-face context, but there is no agreement on what. Perception is highly variable from therapist to therapist and the critical aspects identified vary from prejudice to technical problems, from the setting to the quality of the relationship.

Examining the impact of COVID-19 on supervisees' experiences of clinical supervision

The global pandemic, COVID-19, changed the clinical supervision landscape in professional psychology. Supervisees transitioned from in-person supervision, to virtual, or telesupervision, in some cases, with limited preparation. We used a mixed methods approach to evaluate supervisee experiences during the transition to telesupervision precipitated by the global pandemic and to provide a historical record of the impact of the pandemic on clinical training. We also assessed the relationship between the supervisory working alliance and attitudes toward telesupervision. Authors used consensual qualitative research-modified to analyze qualitative data from 324 participants. Data revealed categories of technology, organization and productivity, and communication and connection, as the top three challenges experienced by clinical supervisees. Supervisees reported flexibility and convenience and saving time and money, as the top two benefits of engaging in telesupervision during the pandemic. Quantitative data from 310 participants suggested a moderate, positive, relationship between supervisee perception of the working alliance and attitudes toward telesupervision. Implications for research, practice, and theory are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The global pandemic of COVID-19 shifted the clinical training of professional psychology students from in-person, to virtual, or telesupervision. Studying this particular historical event provides us with insights about the challenges and benefits of conducting telesupervision (a) on a wide scale, (b) for the first time for many professional psychology trainees, and (c) within the context of a global crisis that disrupted everyday protocols. By investigating the experiences of professional psychology trainees during this rare crisis, we are provided not only a starting point for developing best telesupervision practices overall but also best practices for clinical supervision during crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Quality of the therapeutic relationship and nonverbal interaction in videoconferencing psychotherapy. Systematic review

Background: Due to the coronavirus disease 2019 (COVID-19) pandemic the importance of videoconferencing psychotherapy (VCP) has considerably increased. Although the effectiveness of VCP is well documented by numerous therapy outcome studies, reservations from clinicians' perspectives are still common. They relate in particular to the limited possibilities for the formation of a relationship and the absence of a physical co-presence in the video setting. Objective: This article provides an overview of the empirical findings on the quality of the therapeutic relationship as well as on the nature of nonverbal interaction in VCP. Methods: The MEDLINE, APA PsycArticles, APA PsycInfo, and PSYNDEX databases were searched for controlled studies that examined the therapeutic relationship in VCP compared to face-to-face therapy. Another literature search was conducted for studies of nonverbal interaction in VCP. Results: The results show that the quality of the therapeutic relationship in VCP is comparable to that in face-to-face therapy. The interaction in VCP has so far only been described in qualitative studies. In interviews patients and therapists report an increase in verbal and nonverbal activity in VCP. For therapeutic work, changes with respect to being silent and understanding of body language are highlighted. Conclusion: To the best of our knowledge no studies exist that explain why a comparatively successful relationship structure can be established, despite the changes and limitations associated with the mediation of interaction in VCP. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (German) Hintergrund: Die Bedeutung der videobasierten Psychotherapie (VBT) hat unter dem Einfluss der COVID-19-Pandemie erheblich zugenommen. Obwohl die Wirksamkeit der VBT inzwischen gut belegt ist, bestehen bei klinisch tatigen Psychotherapeut*innen Vorbehalte, die sich auf die eingeschrankten Moglichkeiten der Beziehungsgestaltung und den Entzug der physischen Koprasenz beziehen. Ziel der Arbeit: Der vorliegende Beitrag bietet eine Ubersicht uber die empirischen Befunde zur Qualitat der therapeutischen Beziehung sowie zur Beschaffenheit der nonverbalen Interaktion in der VBT. Methoden: In den Datenbanken MEDLINE, APA PsycArticles, APA PsycInfo und PSYNDEX wurde nach kontrollierten Studien, die Unterschiede in der therapeutischen Beziehung zwischen VBT und Face-to-Face-Therapie zum Thema hatten, gesucht. Eine weitere Literatursuche wurde uber Studien zur nonverbalen Interaktion in der VBT durchgefuhrt. Ergebnisse: Die Qualitat der therapeutischen Beziehung in der VBT ist der in Faceto- Face-Therapien vergleichbar. Die Interaktion in der VBT wurde bis dato nur durch qualitative Studien beschrieben. In Interviews berichten Patient*innen und Therapeut*innen von einer Steigerung der verbalen und nonverbalen Aktivitat in der VBT. Fur die therapeutische Arbeit werden Veranderungen in Bezug auf das Schweigen und das Verstehen der Korpersprache herausgestellt. Schlussfolgerung: Es existieren noch keine Studien, die erklaren, weshalb trotz der Veranderungen und Einschrankungen, die mit der medialen Vermittlung der Interaktion in der VBT einhergehen, dennoch eine vergleichsweise erfolgreiche Beziehungsgestaltung moglich ist. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Online Group Therapeutic Relationships during the Covid-19 Pandemic: An International Survey

Background: In 2020, due to the COVID-19 pandemic, most group therapists moved their practice to online platforms. Surveys of psychotherapists indicate that many intend to maintain at least part of their practices online after the pandemic. This survey-based study aimed to identify therapist experiences with doing group therapy online, and to examine factors that are associated with therapist-rated outcomes. Method(s): 307 group therapists were surveyed about their ratings of the ease or difficulty in conducting group therapy online versus in-person, and indicators of patient outcomes in online groups. A confirmatory factor analysis resulted in a good fitting three latent factor solution: group therapeutic process factor (therapist ratings of ease to foster therapeutic alliance, group cohesion, and patient self-disclosure), group therapist factor (therapist presence, empathy, and focus in online therapy), and group therapeutic challenges factors in online work (related to the difficulty of working through conflict, managing avoidance, observing nonverbal communication, and discomfort during the online session). An online group therapy outcome factor was the dependent variable modeled as a latent factor of therapists' perception of patient outcomes and their own satisfaction with online groups. Results showed that higher levels of the group therapeutic processes and group therapist factors, and lower group challenges were associated with higher online group therapy outcomes. Conclusion(s): The present study suggests that online groups operate based on many of the same factors that have been supported in in-person group treatment. These factors were associated with the therapist's perceptions of online group effectiveness. However, difficulties in managing relationships in the online session may represent a barrier to enacting group therapeutic factors.

Understanding mental health professionals' perspective of therapeutic alliance in working with unaccompanied children: A Grounded theory approach

The number and trends of unaccompanied children immigrating to the U.S. has drastically changed throughout the years and many are placed in shelters while they remain in the custody of the Office of Refugee Resettlement (ORR). Unaccompanied children subject to traumatic experiences in their country of origin or throughout their journey present with high levels of adverse mental health. Despite this, there is limited literature exploring the mental health concerns of unaccompanied children or the experiences of mental health professionals serving unaccompanied children specifically unaccompanied children in ORR care. This study aimed to understand the perception of mental health professionals of establishing therapeutic alliance with unaccompanied immigrant children in an ORR shelter. Grounded theory methods were utilized to identify elements vital to the process of building therapeutic alliance with unaccompanied immigrant children. In this qualitative study data was drawn for 6 participants providing mental health services to unaccompanied immigrant children in ORR shelters in South Texas. The pressing elements identified were, policy impacts treatment, boundaries, limitations due to setting, cultural competency, creating a safe environment and impacts of COVID-19. Understanding how these elements present themselves and how to address them in the process of developing therapeutic alliance is crucial. Future research should include a specific focus on building therapeutic alliance in other ORR settings. More work can be done to educate communities and other mental health professionals about the efforts and practices necessary in building therapeutic alliance with unaccompanied immigrant children and addressing their unique needs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists' Technological Perspective.

BACKGROUND: The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised. OBJECTIVE: This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists' therapeutic work through augmented VCP. METHODS: In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model. RESULTS: The analysis resulted in the generation of 9 themes (input themes: psychologists' attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship. CONCLUSIONS: Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions.

Psychotherapy with the Use of Ict Systems - Advantages and Controversies. The Perspective of Patients of the Department of Psychotherapy of the University Hospital in Krakow and a Review of the Latest Literature

Objectives: The article presents the results of a survey carried out with a group of 38 patients of the Department of Psychotherapy of the University Hospital in Krakow. Due to the national quarantine at the time when the research was conducted, respondents participated in therapy remotely. The research mainly focused on the attitudes of respondents to this form of treatment and its perceived effectiveness. Methods: The research took the form of a questionnaire administered via email with the patients' consent. Results: The first experience with remote psychotherapy turned out positive for 55% of survey participants. Patients appreciated this formula because it helped them preserve the continuity of treatment, save time related to transport or it gave them a greater sense of security that enabled breaking barriers with speaking about themselves and their problems. The predominant disadvantages were technical constraints, problems with focusing on the content of the conversation or achieving privacy and a deficit in therapeutic interventions based on non-verbal aspects of communication. Conclusions: Psychotherapy based on the use of ICT methods has its advantages and disadvantages. After one month of participation in this form of treatment, 55% of the participants perceived its effectiveness as equivalent to therapy carried out in direct contact. 34% of respondents were of the opinion that this therapy was less effective than the traditional one. It still remains open what determines such perception of a specific person. At present, research on the evaluation of selected variables which may affect the assessment of attractiveness of remote treatment is in progress.

Editorial Perspective: The digital divide - inequalities in remote therapy for children and adolescents.

COVID-19 has triggered a shift towards remote delivery of therapy and, despite a number of benefits, it risks discriminating against young people already marginalised due to adverse early life experiences, poverty or ethnicity. This editorial perspective considers challenges for remote therapy, focusing on: the financial burden of telehealth; the necessity of safety to speak; and, how telehealth may exacerbate difficulties in therapeutic alliance formation by interfering with epistemic trust and mentalising. As well as compounding the inaccessibility for children who are subject to abuse, the implicit assumptions behind telehealth risk disproportionately excluding from therapy those from a low socioeconomic status, and who are from ethnic minorities. Suggestions are made for how these challenges may be addressed. It is argued that service design and delivery should seek to proceed with the practicalities and principles of engagement in mind and use this as an opportunity to improve parity of access, rather than risk further entrenching inequalities.

Telepsychology in an University Psychological Care Center during COVID-19: Consultants and Students' Experiences

During the last decades, the use of Telepsychology as a tool for mental health care has experienced a significant rise worldwide. Despite the existence of teleconsultation services in Colombia, few studies about it have been published. As a result of the health crisis caused by the COVID-19 pandemic, the Telepsychology care service was implemented in a university psychological care center. The goal of this study is to characterize the care experiences of the Telepsychology modality from the point of view of the consultants and students in their clinical practice. This with the purpose of enhancing the knowledge in this area and contributing to the evaluation of the viability of these services. A descriptive characterization study was carried out, with a cross-sectional design. The research team elaborated a questionnaire, that was answered by 253 consultants and 77 students. The information obtained evidenced that Telepsychology care achieved high levels of satisfaction with the treatment received, the possibility of establishing a therapeutic bond and the development of clinical skills in students. Therefore, this care modality was an alternative to remove boundaries to health care. Follow-up studies at different times of the process are suggested for greater reliability of the results.

Resilience, well-being and informal and formal support in multi-problem families during the Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic may have had negative effects on youth and parental mental health, especially in high-risk populations such as multi-problem families (i.e., families that experience problems in multiple domains, such as mental health and social network problems). Using one to four assessments during all phases of the Covid-19 pandemic up until January 2022, we examined the associations between pandemic-related stress and mental health (resilience and well-being) of youth and parents from multi-problem families. We also investigated whether experienced informal (i.e., youth informal mentoring) and formal support (i.e., therapist support) served as protective factors in this association. METHODS: A total of 92 youth aged 10-19 years (46.7% girls; mean age 16.00 years) and 78 parents (79.5% female; mean age 47.17 years) filled in one to four questionnaires between March 2020 and January 2022. Multi-level analyses were conducted to account for the nested structure of the data. RESULTS: For youth, pandemic-related stress was associated with lower well-being, but not with resilience. Perceived support from both mentors and therapists was positively associated with youth mental health. Furthermore, high perceived therapist support protected youth from the negative effect of pandemic-related stress on resilience. For parents, pandemic-related stress was not related to mental health, irrespective of therapist support. Yet, therapist support was directly and positively associated with parental mental health. CONCLUSIONS: Youth from multi-problem families who experience pandemic-related stress are at risk of (elevated) mental health problems during the pandemic, specifically if they have no or weak therapist support. The mental health of parents, however, was minimally affected by pandemic-related stress, indicating strength and flexibility. Youth and parents who experienced support during the pandemic reported higher levels of resilience and well-being, demonstrating the importance of support for individuals' mental health during stressful times such as a pandemic.

THERAPEUTIC ALLIANCE AND WELL-BEING FROM USE OF A GLOBAL DIGITAL MENTAL HEALTH BENEFIT DURING THE COVID-19 PANDEMIC

Background: Digital mental health services leverage technology to increase access to care, yet less is known about how quality therapeutic relationships form in a virtual setting. This study examined therapeutic alliance (a mechanism underlying successful treatment) and its association with well-being among registrants of a digital mental health platform. Method: Adults (n=3,087, M age=36±9 years, 54% female) engaged in videoconference sessions with a licensed therapist (18%), certified coach (65%), or both (17%) between 9/29/20-10/12/21. Members completed 2 adapted items of the Working Alliance Inventory (goal and bond) after each session and we averaged ratings across visits (?=.72). We used the WHO-5 to measure changes in well-being. We performed Mann-Whitney U tests, Kruskal-Wallis tests, paired samples t-tests, and linear regressions to examine: (1) average alliance ratings;(2) differences in alliance by member demographics and provider type;and (3) if alliance was related to changes in well-being over time. Results: Members completed a median of 3 digital sessions over a median of 28 days. Median therapeutic alliance was 4.8 (range=1-5) and did not differ by age, country, or baseline well-being (ps>.07). Females reported higher alliance than males (4.88 vs. 4.67, p=.01). Members in coaching reported higher alliance than those in therapy or both modalities (4.83 v. 4.75, p=.004), though effect sizes were negligible. Members reported an average WHO-5 increase of 4.14 points (95% CI [3.44, 4.83], p<.001), a 10% improvement in well-being (d=0.22). Therapeutic alliance predicted greater well-being at follow-up (b=2.17, 95% CI [1.07, 3.28]) after controlling for age, sex, and baseline WHO-5 (R2=.22, p<.001). This association did not differ by provider type (p=.78). Conclusion: Members of a global digital mental health benefit formed a high therapeutic alliance with their providers, both coaches and therapists. Higher alliance was associated with greater well-being improvements, providing evidence that it is a key mechanism in virtual care outcomes as it is in face-to-face care. Continued focus on the quality of therapeutic relationships will ensure digital mental health services are patient-tailored as these platforms expand equitable access to evidence-based care.