Psychodynamic Therapist’s Subjective Experiences With Remote Psychotherapy During the COVID-19-Pandemic—A Qualitative Study With Therapists Practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation

The COVID-19-pandemic brought massive changes in the provision of psychotherapy. To contain the pandemic, many therapists switched from face-to-face sessions in personal contact to remote settings. This study focused on psychodynamic therapists practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation and their subjective experiences with psychotherapy via telephone and videoconferencing during the first COVID-19 related lockdown period in March 2020 in Austria. An online survey completed by 161 therapists produced both quantitative and qualitative data with the latter being subject to a qualitative content analysis. Our research suggests that telephone and videoconferencing are considered valuable treatment formats to deliver psychodynamic psychotherapy. However, therapists’ experiences with remote psychotherapy are multifaceted and ambiguous. In particular, the findings raise questions concerning the maintenance of the therapeutic alliance, the development of the analytic process, the sensitivity to unconscious communication, and the indication for certain types of patients that still need further investigation. Our research indicates that the long-standing reticence toward remote treatments offers among psychodynamic therapists is becoming more differentiated and partially dissolves as therapists gain experiences in their use. Attitudes are becoming more open. At the same time, the way is being prepared to take a closer look at the specific processes and dynamics of remote psychotherapy and to examine them critically in future studies.

When and for whom do psychodynamic therapists use guided imagery? Explicating practitioners’ tacit knowledge

Guided imagery psychotherapy (GIP) is an established therapeutic method using creative mental imagery within a psychodynamic frame of reference. Although there is evidence for the method’s general effectiveness, it is yet unclear under which conditions and for which patients it should be used. The aim of this study was therefore to empirically identify indication criteria for the use of guided affective imagery (GAI) as part of psychodynamic therapies. We conducted semi-structured interviews with N=15 psychodynamic therapists also qualified as GAI training therapists. We asked them to recollect cases in which they had decided either for or against the use of imagery. The therapists described a complex interplay of different factors. Using grounded theory coding supplemented by elements of Consensual Qualitative Research we reconstructed from their accounts a sequential model of their indicative decisions. First, there is a consideration of clear contraindications related to reality testing and destructiveness. Second, there are aspects requiring a modified application of GAI such as emotional instability and post-traumatic stress disorder symptoms. In a final step, there are a number of characteristics of the patient, the therapist, the therapeutic relationship, the patients’ initial imagery and different therapeutic goals and foci which are weighed relatively to each other in order for therapists to reach an indication decision. We end by discussing ways in which the indicative decision model may be used to improve GAI training as well as the method’s differential efficacy and effectiveness.

Assessment of Guided Affective Imagery: Methods for Extracting Quantitative and Categorical Variables from Imagery Sequences

There are many methods available for quantifying and categorizing the stream of images reported by participants and clients in guided imagery. Projective methods, methods for assessing individual differences in imagery, and methods developed for the analysis of dreams and literature can be adapted for the study of guided imagery; and, in addition, researchers have developed scales for characterizing the images encountered specifically in Guided Affective Imagery. These have been shown to possess high interrater reliability. A GAI Rating Instrument is described, along with the results of its application in a preliminary investigation. Interrater reliabilities of selected scales, which were designed to assess changes in imagery, including responses to experimental cues, range from good to workable. Dreamlike transformations of waking dreams are shown to be common and to be frequently spontaneous, whereas increases in imaginal detail occur most often in response to the guide's interventions.