Lost and Found in Psychotherapy During COVID-19.

The authors discuss the loss of the traditional setting for psychotherapy caused by the COVID-19 pandemic, a natural experiment lasting 2 years, and the finding of new channels of communication for therapy using video and telephone platforms as well as outdoor therapy spaces. The manuscript explores the experience of both patients and therapists with these new channels and investigates how the external features of the therapy frame can be subjectively experienced by different people and within different therapeutic relationships. Through patient surveys, case vignettes, and discussions with colleagues, the authors conclude that for a large group of psychotherapy patients the new channels worked as well as and sometimes even better than the old in-person appointments and that an occasional in-person "booster" session can strengthen the therapeutic alliance of ongoing teletherapy.

The psychiatry of light.

Bright light therapy and the broader realm of chronotherapy remain underappreciated and underutilized, despite their empirical support. Efficacy extends beyond seasonal affective disorder and includes nonseasonal depression and sleep disorders, with emerging evidence for a role in treating attention-deficit/hyperactivity disorder, delirium, and dementia. A practical overview is offered, including key aspects of underlying biology, indications for treatment, parameters of treatment, adverse effects, and transformation of our relationship to light and darkness in contemporary life.

A phenomenology of closeness and its application to sexual boundary violations: a framework for therapists in training.

Sexual boundary violations remain a persistent problem in psychiatry despite increased attention, disciplinary activity, and educational efforts. Currently, therapists in training are often overwhelmed by a sense of danger in every direction, including the risk of false accusation. The authors present a framework for understanding experiences of closeness that can help overcome a trainee's paralyzing bewilderment and attendant longing to retreat from the practice of psychotherapy. Eight characteristics of ordinary psychotherapeutic engagement effectively maximize the intensity of interpersonal closeness between patient and psychotherapist while simultaneously reducing the experience of closeness outside the treatment setting for both patient and clinician. An important consequence is that drifts toward sexual boundary violations can arise from the everyday dynamics of closeness, even in the absence of individual pathology or intent. The implications for the practice of psychotherapy and personal lives of psychotherapists are explored.