Case study on psychological first aid on Italian COVID-Hospital

Coronavirus disease had an enormous impact on public health by affecting millions of people who have either fallen ill or died as a result of this disease. The pandemic resulted in several short- and long-term psychological effects, while restrictive measures adopted resulted in challenges in terms of support and counselling meetings, demonstrating the need to move to a digital health care system. In this context, the Psychological First Aid Service at Sant'Andrea, a service for COVID-19 patients and their loved ones, was set up in the Lazio region (Italy). The service provides two free telephone interviews, and if necessary, people are directed to other free support services in the region. In this article, we report a case study of two brothers who contacted the service during the second pandemic wave in Italy. The case has been discussed according to the recent literature, taking the practical and operational aspects of psychological first aid into account. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Implementation Science of Telepsychotherapy for Anxiety, Depression, and Somatization in Health Care Workers Dealing with COVID-19.

Introduction: Cognitive behavioral therapy (CBT) has proven to be effective in treating affective and somatic symptoms, which are among the leading mental health problems of health care workers (HCWs) dealing with COVID-19 (HCW-COVID-19). However, efforts to develop and evaluate the strategies required to promote its implementation in clinical practice are still scarce, particularly in low- and middle-income countries. Objective: To describe and evaluate the implementation process and clinical impact of a brief, remote, manualized CBT-based intervention for moderate anxiety, depressive, and somatic symptoms among Mexican HCW-COVID-19 ≥18 years old. Methods: The implementation process comprises community engagement, intervention systematization and education, leadership engagement, and team-based coaching as main strategies. A total of 26 participants completed self-report measures of symptoms before and after treatment, and a subsample of 21 answered a final questionnaire on the acceptability of the intervention. Therapists registered the techniques used in each case, regardless of whether they were part of the intervention manual. Results: The number of sessions was 4.6 (2.43). The most frequently employed techniques were those included in the intervention manual, especially identifying and modifying maladaptive thoughts, used to treat 70% of HCW-COVID-19. Supplementary techniques were implemented to enhance treatment or meet HCW-COVID-19s special needs (such as workplace issues, insomnia, COVID-19 status, and bereavement). The intervention had a significant effect (delta Cohen's coefficients ≥1), and the majority of HCW-COVID-19 were "totally satisfied" with its contents and considered it "not complex" (95.2% and 76.1%, respectively). Conclusions: Telepsychotherapy for anxiety, depression, and somatization in HCW coping with health emergencies in middle-income countries is a feasible, clinically valuable, and acceptable form of treatment.

Preliminary Efficacy of Remote, Brief Telepsychotherapy for Covid-19 Patients and Their First-Degree Relatives

Introduction: Over the last two years, the COVID-19 pandemic has negatively impacted the mental health of both COVID-19 patients and the general population. Adults with COVID-19 risked their lives, lost their loved ones, struggled with comorbid clinical conditions to manage, and have been unable to enjoy the physical presence of their families during the infection, quarantine, and lockdown periods. During hospitalization and discharge, family members often did not receive clinical updates from providers and patients, were unable to offer in-person assistance, and to receive psychological support. Incidence and prevalence of depression and anxiety among COVID- 19 older adults and their family members skyrocketed beyond the possibilities of any mental health system to address psychological aftermath of this pandemic and intervene with in-person services. In response to the urgent need for treatments that could be remotely delivered at a large scale, we designed DigiCOVID, a digital mental health approach that offered remote brief tele-psychotherapy to COVID-19 patients and/or their first-degree relatives. The main goal of this single arm, naturalistic study was to evaluate the feasibility, acceptability and usability of DigiCOVID. Additionally, we assessed the impact of DigiCOVID on psychopathology by means of self-report questionnaires. Method(s): Participants underwent an initial phonebased screening to of inclusion and exclusion criteria. Inclusion criteria were: 18-80 years old;positive nasopharyngeal swabs or serology to COVID-19 (for the patients' subgroup);absence of visual/ motor deficits that might interfere with study participation;good level of Italian;and adequate tech literacy. Participants were excluded if they had a previous or actual DSM-5 diagnosis of bipolar disorder, psychotic disorder, or substance use disorder;if they had a diagnosis of dementia;or if they presented suicidal ideation assessed through the Columbia Suicide Severity Rating Scale. Next, they completed a neuropsychological test over video to assess IQ (if lower than 70 participants were excluded), and filled out online gold-standard selfreports for depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), post traumatic symptoms (IES-R) and general wellbeing (GHQ-12). Participants were then assigned to a psychotherapist who remotely conducted eight remote tele-psychotherapy sessions. After treatment, online questionnaires were filled out again to collect data on preliminary efficacy. Result(s): Since November 2021, 138 patients were recruited, 83 completed the intervention (57 patients, 26 fist-degree relatives), and 55 dropped out. At a group level, participants showed significant improvements on all clinical outcomes (PHQ-9: R2=0.12, p=.0019;ISI: R2=0.15, p=.0004;IES-R: R2=0.11, p=.0003;GHQ- 12: R2=0.23, p<.0001;GAD-7: R2=0.12, p=.0011). Given the high heterogeneity in illness severity and psychopathology, we conducted clustering on baseline data coming from the five online questionnaires: 55% of the whole sample had no psychopathology (Cluster 1), whereas 45% showed severe psychopathology (Cluster 2). When clustering was conducted on post-treatment data, three clusters emerged: no psychopathology, residual psychopathology and severe psychopathology. 71% of Cluster 1 participants remained asymptomatic;25% of Cluster 2 participants showed full symptom remission, while 48% and 28% of Cluster 2 participants showed partial symptom remission and no significant effect of treatment, respectively. Conclusion(s): Remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and preliminary efficacious at reducing COVID-related psychopathology. Further research is needed to investigate distinct profiles of treatment response.

Lessons Learnt from Delivering a Brief Telepsychotherapy Intervention for Covid-19 Patients and Famili Members: Between Limits and Possibilities of Novel Care Delivery Models

Introduction: The implementation of a brief tele-psychotherapy intervention for COVID-19 patients and family members by a team of psychotherapists with different orientations (psychodynamic, phenomenological, cognitive behavioral) led to a shared reflection on the possibilities as well as on the therapeutic and technical limits of this treatment. Because the brief tele-psychotherapy intervention is designed to have a targeted focus on the COVID-19 experience and how this has affected the patient's life, it allows to read COVID-19 related suffering as a guide to diagnosis: medical comorbidities and unprocessed psychological suffering interplay with the experience of COVID-19 illness - with symptomatic severity ranging from absence to hospitalization in intensive care depending on the case. The interplay among these elements produces psychopathological scenarios that are at times evident and complex, at other times apparently less serious and difficult to connect to the suffering that the patient endorses and to their COVID-19-related medical symptoms. Method(s): This work summarizes qualitative data produced by a team of ten psychotherapists involved for 18 months in a brief tele-psychotherapy service for COVID-19 patients and family members, and engaged in a weekly group supervision/ intervision experience. Result(s): The remote nature of the brief tele-psychotherapy intervention made it possible to overcome the distance caused by the barriers imposed by social isolation, and to provide psychological assistance to patients who were ill, were sheltered in place because they tested positive, were elderly at risk, or young people who lost contact with their peers. Cases in which the consequences of COVID- 19 undermined self-esteem, sleep quality, induced anxiety and depression, and emotional dysregulation have been treated with impactful Results: The brief tele-psychotherapy experience allowed patients to mitigate the risks and negative consequences of the COVID-19 experience on physical and mental health, and to restore goal-setting abilities in light of the traumatic experience. Patients in need of psychiatric assistances were referred to the relevant services thanks to an interdisciplinary network. Based on the group supervision/ intervision experience, three areas of discussion were identified: the remote nature of the setting, the relationship between illness severity and treatment seeking, and patients' intrinsic motivation towards psychotherapy. (i) Therapists with different orientations agreed that the 'remote' setting had advantages and disadvantages. The meaning of the setting encompasses symbolic aspects such as 'pre-', 'during-', and 'post'-session moments, because a well-defined place implies the presence, attention, active participation of therapist/client as well as the typical rules such as timeliness. We observed that the 'remote' setting impoverishes the shape and meaning of the typical mental and physical state associated with in-person psychotherapy, as it induces the therapist to manage the session within a client's life space-time that is very often improvised, corrupted by intermittent connectivity issues, lacking privacy or populated with unpredictable environmental circumstances. As such, the conceptual value each theoretical orientation assigns to the psychotherapeutic setting is, on all accounts, contaminated. (ii) Patients with overt traumatic experiences (long hospitalization in COVID-19 wards, intensive care units, rehabilitation facilities) responded better to CBT-oriented psychotherapy. For example, CBT initiates the therapeutic process with case formulation - which aims to describe the problems presented by the patient and to make theoretical inferences about its causes and its maintenance factors. This formulation serves as the basis of a strategically oriented psychotherapeutic intervention, and accompanies all phases of therapy until its Conclusion(s): Conversely, psychodynamic therapists read COVID-related psychopathology as a window into intrapsychic mechanisms that can hardly be orked through in the context of eight sessions. Interestingly, patients lacking frank COVID-19 related medical or psychological symptoms were those for whom a psychodynamic process seemed more indicated, in that it oriented the clinical work towards awareness building, and exploration of intrapsychic and interpersonal goals that transcended current circumstances. (iii) A third, notable point concerns patients' motivational attitudes towards therapy. Because therapists were operating in the context of a research protocol, therapy was presented as a free service that was seeking patients, rather than vice versa. Here, therapists took on an unusual role as they attempted to psychologically transform patients' availability into a request for psychological assistance, even when this was - at least in some cases - consciously absent. In such cases, the transformational processes that are typical of therapy evolved without a clear initial direction, shedding doubts on actual patients' motivation, and leading therapists to offer a final restitution that was limited to the phase of therapy during which an actual psychological goal was voiced by the patient. Conclusion(s): We illustrated the possibilities and limits of brief tele-psychotherapy with regard to the factors that are common to the various theoretical orientations. We noticed that the remote delivery alters conceptual properties, roles, and symbolic connotations of the setting. Similarly, the seek for help, often not defined, can hardly find adequate space within eight sessions, while the severity of COVID-19 related psychopathology seems to be associated with greater efficacy. Future research should examine how brief remote psychotherapy adjusts to emerging clinical difficulties, and should incorporate a prospective design to better establish causality between expected efficacy and interfering occurrences. Further examination on the mechanisms of these interferences is also needed. Ultimately, this line of research can provide precious information about the dissemination of remote tele-psychotherapy above and beyond COVID-19-related psychopathology.

Brief tele-psychotherapy for COVID-19 patients and their family members

Since the COVID-19 pandemic onset, researchers and clinicians have attempted to characterize a heterogeneous cluster of psychopathological symptoms that typically emerge when patients are no longer positive to SARS-CoV-2 infection, and can persist for weeks if not months. These symptoms include depression, anxiety, acute/posttraumatic stress, and sleep disturbances, and are frequently observed in COVID-19 patients as well as in their first-degree relatives. COVIDrelated symptomatology seems to map onto well-established psychopathological macro-areas: 1) trauma and post-traumatic symptoms, mainly for those who have experienced hospitalization or loss;2) adaptation and functional reorientation due to physical complications or sequelae;3) identity reorientation following the experience of illness/isolation/lockdown;and 4) exacerbation of premorbid psychopathological traits solicited by the COVID-19 experience. Notably, the severity of COVID-19 related psychopathology ranges from mild to more disabling conditions and seems to affect youth, adults, and elders irrespectively of the severity of the acute COVID-19 illness. Nonetheless, it unequivocally affects wellbeing, quality of life, and real-world functioning. In response to the urgent need for treatments that could be offered safely, without burdening an already strained mental health system, an interdisciplinary group of psychotherapists and researchers based in Milan, Italy has undertaken the first national attempt to create a research-informed infrastructure to study the feasibility and efficacy of a remote tele-psychotherapy free service for COVID-19 patients and their first-degree relatives. The process initially leveraged clinical experiences with COVID-19 patients and family members remotely referred to the Ospedale Maggiore Policlinico in Milan for psychological assistance from various intensive care units and hospital wards. Next, the research group reviewed the scientific literature on psychotherapeutic approaches designed to remotely treat psychopathology. The harmonization of techniques and strategies deriving from several psychotherapeutic orientations (psychodynamic therapy, constructivist therapy and hermeneutic-phenomenological therapy) culminated in the development of the first brief psychotherapy service for COVID-19 related psychopathology. The service, designed to easily integrate with the workflow of the national health system, consists of 8 remote, 50-minute, individual psychological sessions that are offered weekly using secure video conferencing software. The feasibility and evidence base for this treatment have been investigated thanks to a research project funded by Fondazione Cariplo and Regione Lombardia that has recruited as of June 2022 more than 140 participants, between COVID-19 patients and firstdegree relatives. Results from this study will be presented during the symposium and indicate that remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and efficacious at significantly reducing anxiety, depression, post-traumatic symptoms, and sleep disturbances. Interestingly, statistical analyses suggest distinct profiles of treatment response among participants with severe COVID-19 related psychopathology, in that 25% showed full symptom remission, 48% showed partial symptom remission, and 28% showed no significant effect of treatment. 30 months after the pandemic onset, the same interdisciplinary group of psychotherapists and researchers summarizes reflections from the weekly experiences of group supervision/intervision, and offers a retrospective on the possibilities and limits of this brief tele-psychotherapy service, with an emphasis on the conceptual properties, roles, and symbolic connotations of the remote setting, and on the relationship between patients' illness severity and intrinsic motivation. Above and beyond COVID-19-related psychopathology, the novel quantitative and qualitative data presented at this symposium will provide insightful information about the implementation potent al of remote brief tele-psychotherapy - a promising treatment model that can change clinical practice, enhance cost-effectiveness, and lead to better wellbeing and quality of life for patients.

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.

Developing a Brief Tele-Psychotherapy Model for Covid-19 Patients and Their Family Members

Introduction: While many studies are available on the psychological impact that the pandemic has had on the general population, few studies have considered survivors of COVID-19 and their first-degree relatives. The incidence and prevalence of psychological distress in COVID-19 patients greatly vary by country and by study methodology, and go beyond the current possibilities of any mental health system to offer in-person services, with the result that most users fail to receive the necessary support. There exists an urgent need to intervene on the psychological suffering of COVID-19 patients and their family members with treatments that can be offered safely and on a large scale, without burdening an already strained health system. We leveraged the ongoing clinical experiences with COVID-19 survivors and family members to design a clinical intervention model that could be remotely administered and could easily integrate with the workflow of the regional health system. The result of this process was the development of a brief remote psychotherapy program to be delivered via telemedicine. Method(s): We first reviewed the scientific literature on psychotherapeutic interventions that were designed to treat psychopathology among COVID-19 patients and family-members. Based on this evidence, we harmonized techniques and strategies deriving from several psychotherapeutic orientations into a brief psychotherapy program that was developed along three main theoretical trajectories: psychodynamic therapy, constructivist therapy and hermeneutic-phenomenological therapy. Result(s): The program consists of 8 remote, 50-minute, individual psychological sessions offered weekly using secure video conferencing software. The severity of the clinical conditions of COVID-19 patients has largely influenced the sequencing of the intervention both for patients themselves and for their family members dealing with the COVID-19 hospitalization/discharge/loss of a loved one. We considered it appropriate to circumscribe the exploration of the different psychological targets within each session, given the unpredictable nature of the course of illness, and the possible onset of events that could radically change the psychological state of patients and family members. During the initial phase of treatment, the therapist highlights the patient's ways of suffering and coping, in hopes to identify together with the patient which ones are already familiar and which ones are novel. In the context of the patient's textual refiguration, the therapist makes room for interpretative cooperation by sharing clinical objectives: a commonality of intents that brings therapist and patient to accept the challenge of the clinical work. During all phases of the clinical work, suffering is contextualized both in the light of the recent traumatic experience (bereavement, hospitalization in intensive care, fear for one's life or that of a relative), and in the light of historical ways of suffering, so that the patient is able to recognize the meaning of the currently experienced symptom. Session 1 includes introductions and exploration of the patient's current experience space as well as identification of the areas of suffering and brief recapitulation of the patient's psychological functioning pre- COVID. Session 2 attempts to define shared goals for the therapeutic process and creates an initial diagnostic framework to identify unprocessed or unregulated emotions. Session 3 aims to validate the intrapsychic and interpersonal resources associated with a greater degree of adaptation to the stressful situation, including: a flexible personality;positive beliefs about the self;identity roles and acceptance and commitment skills;work functioning;s solid network of friends;family/loved ones. In Sessions 4 through 6, areas of clinical concern are addressed and defense mechanisms are examined. Session 7 aims to integrate the lived experience in the cohesive narrative of the self. In Session 8, internal working models or relational patterns that have emerged during ther py closure are discussed and psychoeducation on relapse prevention is offered. Conclusion(s): We described a newly designed remote psychotherapeutic approach to tackle the COVID-19 pandemic psychological aftermath. We believe that the intervention model described here has great innovation potential in that: (1) it offers immediate psychotherapeutic support to all those who experience psychological suffering associated with COVID-19;(2) helps therapists to operate in acute and subacute settings, overcoming the barriers imposed by public health and prevention measures;and (3) contributes to study and determine the procedures by which tele-psychotherapy can be best implemented. In doing so, this treatment model could provide a blueprint for future tele-psychology wide-scale interventions.

Therapeutic encounters at the onset of the COVID-19 pandemic: psychodynamic therapists' experiences of transition to remote psychotherapy

The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists' experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Tele-Drama Therapy with Community-Dwelling Older Adults: A Field Training Project.

OBJECTIVES: This paper explores a field training project of tele-drama therapy with community-dwelling older adults during COVID19. It merges three perspectives: the older participants' perspective, the students engaged in the field training, who conducted this remote therapy, and social workers. METHODS: Interviews were conducted with 19 older adults. Focus groups were conducted with 10 drama therapy students and 4 social workers. The data were thematically analyzed. RESULTS: Three themes emerged: the role of drama therapy methods in the therapeutic process, attitudes toward psychotherapy for older adults, and the phone as a therapeutic setting. These themes coalesced into a triangular model associating dramatherapy, tele-psychotherapy and psychotherapy with the older population. A number of obstacles were identified. CONCLUSIONS: The field training project made a dual contribution to the older participants and the students. In addition, it promoted more positive attitudes among the students toward psychotherapy with the older population. CLINICAL IMPLICATIONS: Tele-drama therapy methods appear to promote the therapeutic process with older adults. However, the phone session should be planned in advance in terms of time and place to ensure the participants' privacy. Field training of mental health students with older adults can promote more positive attitudes toward working with the older population.

Telepsychology for psychotherapists: lessons learned in times of Covid-19

The necessary health measures proposed to mitigate the viral spread of SARS-CoV-2, such as physical distancing and quarantines, have had an impact not only on the mental health of the population but have also forced changes in the provision of psychological services. The present study aims to gather essential information on the concept, advantages, disadvantages, uses and recommendations of telepsychology in times of COVID-19. To this end, a systematic review of the scientific evidence available in the Scopus, PubMed and Web of Science databases was carried out. Among the results, accessibility, reduction of stigma and flexibility in its application are highlighted. Limitations such as insecurity of data privacy, access barriers and low clinical training in the competencies required for this format are also mentioned. On the other hand, favorable evidence was found for its use in the treatment of post-traumatic stress disorder, panic and agoraphobia, generalized anxiety, and trauma. It is concluded that psychotherapeutic intervention through telepsychology, in consideration of certain recommendations and critical suggestions, can offer satisfactory results for the patient and therapist and be suitable for various age ranges and disorders. © 2022, Sociedad Interamericana de Psicologia. All rights reserved.

A change in frame and countertransference experiences: Transitioning from face-to-face to telepsychotherapy

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID-19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face-to-face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face-to-face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face-to-face and online meetings;however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face-to-face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.

Relational factors predict telepsychotherapy acceptance in patients: The role of therapeutic relationship and attachment

Introduction: During the early months of the COVID-19 pandemic, patients receiving individual psychotherapy needed to transition to telepsychotherapy (TP). Since telemental health appears to be here to stay after the pandemic ends, it is crucial to understand factors that determine whether telemental health is a good fit for patients. Objective(s): The aim of the present study was to (1) explore patients' perception of the therapeutic relationship and attitudes towards TP, and (2) identify predictors of patients' TP acceptance. Method(s): We used a longitudinal design, where patients (N = 719) receiving individual TP during the pandemic participated in an online survey, in which they responded to demographic questions and completed measures of symptom severity, Covid-related distress, attachment style (avoidant/anxious), perceived quality of the therapeutic relationship (working alliance and real relationship), and TP acceptance. Result(s): We found that (1) patients perceived the quality of the therapeutic relationship as reasonably good, and patients' TP acceptance was moderately high. (2) patients' TP acceptance was predicted by their attachment avoidance and their perception of the real relationship, whereas attachment anxiety, working alliance, as well as demographic variables, symptom severity, and Covidrelated distress were unrelated to TP acceptance. The final model showed that perceived strength of the real relationship mediated the relationship between attachment avoidance and TP acceptance. Conclusion(s): Both general (attachment) and situational (therapeutic relationship) relational variables are important predictors of patient's acceptance of TP, and should be considered during decision making about suitability of TP to patients.

Psychotherapists' Acceptance of Telepsychotherapy: A Machine Learning Approach

Introduction: Therapists' forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists' views and challenges with teletherapy. Objective(s): We aimed to develop predictive models of three aspects of psychotherapists' acceptance of teletherapy during the COVID-19 pandemic;attitudes towards teletherapy, concerns about using teletherapy, and intention to use it in the future. Method(s): In an international survey, therapists (N = 795) completed a survey about their experiences during the pandemic, including quality of therapeutic relationship, professional self-doubt, vicarious trauma, and telepsychotherapy acceptance. Regression decision trees machine learning analyses were used to build prediction models for each aspects of telepsychotherapy acceptance. Result(s): Attitudes toward telepsychotherapy were most positive for therapists who reported neutral or strong online working alliance, especially if they experienced little professional self-doubt and were younger than 40 years old. Therapists who were most concerned about telepsychotherapy, were those who reported higher levels of professional self-doubt, particularly if they also reported vicarious trauma experiences. Therapists who reported low working alliance were the least likely to use telepsychotherapy in the future. Conclusion(s): Therapists' professional self-doubt and the quality of their working alliance with their telepsychotherapy patients appear to be the most pertinent factors associated with therapists' acceptance of telepsychotherapy during COVID-19, and should be addressed in future training and research.

Changes in Clinical Process as a Result of Online Therapy: Findings from a Single Case Study.

Introduction: This study examined changes in the clinical interaction in a single clinical dyad between sessions conducted in person and sessions conducted remotely, applying linguistic indicators based on multiple code and referential process theory. Methods: Sessions from an ongoing psychotherapy of a male patient in his late 30s were audio-recorded and transcribed. Linguistic indicators, including the Weighted Referential Activity Dictionary (WRAD), were scored, and graphed using the Discourse Attributes Analysis Program (DAAP). The sessions included 8 sessions immediately before online work, 10 sessions immediately following the implementation of online work, and 12 sessions collected several months after the clinical dyad had been working remotely. Results: A comparison of in-person sessions to telehealth sessions shows that the patient spoke more in post-telehealth sessions but with decreased emotional engagement, as evidenced by a decrease in WRAD. The therapist appeared to be working harder to communicate that he was listening as evidenced by an increase in the measure of non-turn vocalizations (interjections such as hmm). Discussion: It appears that both patient and therapist were working harder to remain connected and communicate that they were present but with limited emotional engagement. This pattern remained unaltered at a 2-month followup. The findings address empirically the subjective experience of many clinicians who have switched to remote treatment. Implications for the future of remote therapy are discussed.

User experience reevaluation and diffusion of technology in the context of compulsory usage illustrated by the example of telepsychotherapy-a literature review.

Objective: Models explaining technology acceptance fail to recognize the influence temporary, compulsory usage, meaning forced usage due to external factors, may have on user evaluation and continued diffusion. However, in context of the Covid-19 pandemic, a highly infectious respiratory disease, the significance of this factor is evident. Triggered by legal contact restrictions and extended reimbursement capacities, usage of telepsychotherapy increased drastically, thereby influencing therapists' attitude and increasing the technology's maturity. In this comprehensive literature review, we aim to outline the current state of research toward telepsychotherapy adoption and identify potential influences of the compulsory usage on the reevaluation of technology as well as barriers inhibiting and factors promoting future use. Methods: The review was conducted on the five databases ScienceDirect, Web of Science, PubMed, PubPsych, and IEEE up to April 2022. Results: Out of 685 identified references, a final selection was made of 22 papers, discussing experiences with telepsychotherapy in the context of the Covid-19 pandemic. Satisfaction and intention to use are universally high, further increasing with time and use experience, while perceived challenges decrease. Barriers include mostly contextual factors, such as technical issues, reimbursement issues, strict regulations, insufficient infrastructure, and lack of organizational support, but also concerns regarding efficacy. Promoting factors are training, guidelines, and organizational support. Conclusions: Telepsychohtherapy has become an integral part of psychotherapeutic care. A hybrid system in close coordination between provider and patient may prevail, addressing individual needs of both parties to achieve optimal care and provider well-being. This requires transparent regulations, guidelines, and standards.

Ethical dilemmas in online psychotherapy - a review of selected ethical codes and recommendations of psychotherapeutic and psychological associations

Until recently, only some psychotherapists have used a remote form of contact with their patients. The COV-ID-19 pandemic Has changed this situation, as the experience of life and health threats has resulted in many therapists choosing to work remotely with patients. Working online for psychotherapists poses new challenges and ethical questions. Many practitioners, when looking for answers to bothering questions arising from the clinical practice of working with patients remotely, look for answers in Professional codes of ethics or in the guidelines of therapeutic associations. This article is a review of 52 codes of ethics from different countries on five continents in terms of looking for norms and principles that provide an ethical framework for online psychotherapeutic work. Additionally, the guidelines and recommendations of selected Professional psychotherapeutic associations were analyzed. These societies, in additional Communications or statements, also introduce temporary ethical criteria, guidelines and good ethical practices that remotely working therapists should take into account in their work. Copyright © 2022 Polish Psychiatric Association. All rights reserved.

Online psychotherapy during COVID-19 pandemic - experiences of psychotherapists Research review

In 2019, mass infections caused by the SARS-CoV-2 coronavirus and the disease caused by it became the reason for global social, economic and health crises. This situation required changes, also in the field of psychotherapeutic practice and the implementation of new solutions. One of the possibilities of continuing services provision was to start the Internet usage Aim: The purpose of this paper is to review the latest research related to the experiences of psychotherapists working online during the pandemic. An additional goal is to present the broadest possible analysis of the literature based on research conducted in various countries around the world. Materials: Google Scholar, PubMed, Scopus and PsycNet were searched for a review. From among the search results that met the general criteria, those related to psychotherapeutic practice in the given countries were selected. Conclusion(s): Online psychotherapy has become a significant component of psychotherapeutic practice during a pandemic. Earlier expectations and concerns could be verified. The presented results of selected studies create a picture of the functioning of psychotherapists in many countries and constitute the basis for future research and forecasts for the development of psychotherapy after the pandemic. Copyright © 2022 Polish Psychiatric Association. All rights reserved.

Psychotherapy in times of the COVID-19 pandemic in Argentina: Factors associated with the use of telepsychotherapy during social isolation

In Argentina, social isolation during the COVID-19 pandemic has had an impact on the practice of psychotherapy. The goal was to describe factors associated with the use of telepsychotherapy during social isolation. An online survey was conducted among 978 psychologists and psychiatrists from different provinces and the city of Buenos Aires. 77.7% of the participants started using online psychotherapy for the first time at the beginning of social isolation;62.6% of the participants treated half or more of their patients online. Significant relationships were detected between online psychotherapy and various factors that characterize psychotherapeutic practice, but these are weak effects. Participants with a higher percentage of patients in telepsychotherapy reported fewer treatment interruptions and similar or higher levels of income compared to those prior to social isolation. Drastic changes in psychotherapeutic practice during social isolation need to be studied in depth.