Remote Psychotherapy During the COVID-19 Pandemic. Experiences With the Transition and the Therapeutic Relationship. A Longitudinal Mixed-Methods Study

Aims: Research conducted prior to the onset of the COVID-19 pandemic indicates that remote psychotherapy is as effective as in-person treatment. At that time, it usually was the therapist’s individual choice to work remotely, whereas the pandemic pushed psychotherapists, including previous skeptics, to incorporate remote work methods into their routine due to limited face-to-face contact. There is little knowledge of the way therapists experienced this sudden and forced transition to remote psychotherapy as the only treatment option. The present study aims to assess psychotherapists’ experience and proficiency delivering remote psychotherapy as well as to investigate perceived changes in the psychotherapeutic relationship.Methods: An online survey was administered to psychotherapists of the Austrian Association for Group Therapy and Group Dynamics (ÖAGG). Three test periods (t) were set (t1: April, 2020 with N = 175; t2: May–June, 2020 with N = 177; t3: November–December, 2020 with N = 113). Research was conducted longitudinally using a mixed-methods research design.Results: While psychotherapists’ levels of experience with telephone-based psychotherapy remained similar across all test periods, they became slightly more experienced using video therapy over the test period observed. However, they continued to feel less experienced compared to the use of telephone-based psychotherapy. The therapeutic relationship appeared to improve over the course of the first two test periods, while the third period showed a slight decline. No general deterioration of the psychotherapeutic relationship was found in the timespan studied.Conclusion: Despite many challenges and concerns, psychotherapists seem to adapt and enhance their skills in remote psychotherapy over time. The present paper confirms and enhances previous findings in the field due to its longitudinal approach. Remote psychotherapy can be a credible and trustworthy alternative to in-person treatment to be adopted and implemented on principle by a majority of psychotherapists regardless of their orientation. Furthermore, it sheds light on chances, problems und general observations regarding the comprehensive provision of remote psychotherapy in a pandemic situation.

“Like I’m Talking to a Real Person”: Exploring the Meaning of Transference for the Use and Design of AI-Based Applications in Psychotherapy

AI-enabled virtual and robot therapy is increasingly being integrated into psychotherapeutic practice, supporting a host of emotional, cognitive, and social processes in the therapeutic encounter. Given the speed of research and development trajectories of AI-enabled applications in psychotherapy and the practice of mental healthcare, it is likely that therapeutic chatbots, avatars, and socially assistive devices will soon translate into clinical applications much more broadly. While AI applications offer many potential opportunities for psychotherapy, they also raise important ethical, social, and clinical questions that have not yet been adequately considered for clinical practice. In this article, we begin to address one of these considerations: the role of transference in the psychotherapeutic relationship. Drawing on Karen Barad’s conceptual approach to theorizing human–non-human relations, we show that the concept of transference is necessarily reconfigured within AI-human psychotherapeutic encounters. This has implications for understanding how AI-driven technologies introduce changes in the field of traditional psychotherapy and other forms of mental healthcare and how this may change clinical psychotherapeutic practice and AI development alike. As more AI-enabled apps and platforms for psychotherapy are developed, it becomes necessary to re-think AI-human interaction as more nuanced and richer than a simple exchange of information between human and nonhuman actors alone.

Η θεραπευτική σχέση στην υπαρξιακή-ανθρωπιστική προσέγγιση

This article intends to highlight the importance of the psychotherapeutic relationship and the way with which it is viewed by the Existential-Humanistic approach to psychotherapy and counseling. The introduction includes a brief overview of the various existential approaches and the common way with which they all view therapy. The article continues by relating the basic premises of the Existential-Humanistic approach as well as its understanding of human beings and of the process of psychotherapy. Furthermore, the factors that contribute to the establishment of the psychotherapeutic relationship are being analyzed. The Existential-Humanistic approach to psychotherapy gives emphasis to the value of a true dialogue between two human beings who are there serving the interests of the one. In order for the therapeutic relationship to be effective there needs to be a clear framework that helps the members feel safe. In this “sanctuary” the two individuals have an “I-Thou” encounter. The “presence” of both parties serves as the catalyst for change through this mutual and honest way of relating.

Θεραπευτική σχέση: δυναμικές αλληλεπιδράσεις και ο ρόλος του φύλου

The article emphasizes, first of all, the importance of various aspects of the psychotherapeutic relationship -such as the therapeutic alliance, the cooperation, the empathy, the goal agreement-, which have been proven to influence the therapeutic outcome and are consistently linked with the mental health improvement of the patient, regardless of the different theoretical conditions and principles of the psychotherapeutic approaches. On the other hand, it is recognized that identifying the quality characteristics that contribute to and influence the psychotherapeutic relationship and process is a difficult task, as it depends on the therapeutic boundaries of this relationship, the characteristics of the therapist, but also on factors related with the patient, such as his/her attitudes, expectations, motivations and commitment to a process of change. One element that seems to characterize the identity of each member individually, but also the dynamic processes of interaction between the therapeutic dyad, is gender. For this reason, the article underlines the importance of gender in shaping the communication and cooperation between therapists and patients, while stating also that awareness of the gender dynamics, in combination with other identity characteristics, is a prerequisite for an effective and ethical practice.

Sexual Feelings Toward Clients in the Psychotherapeutic Relationship: The Taboo Revealed

Talking about sexual feelings toward clients is still difficult for many mental health professionals. This is unfortunate, because exploring and talking about these feelings with peers (especially senior ones) or supervisors can help professionals to recognize, acknowledge, accept, and handle these feelings well. This focus group study explores the various factors that contribute to psychotherapists’ hesitancy to talk about these feelings. The analysis revealed two important impeding factors: the psychotherapists felt discomfortable and a safe environment was lacking. Young, less experienced psychotherapists and psychiatrists seemed to be most vulnerable. Furthermore, more profound sexual feelings were “disguised” in some cases by using a more acceptable narrative, such as “ intimate feelings,” which possibly also impeded acknowledgment and discussion of these feelings. These insights might help to open up the way for psychotherapists to explore and come forward with their sexual feelings and experiences.

Psychotherapists’ attitudes to intimate and informal behaviour towards clients

Background To avoid harming or exploiting a client, sexual and non-sexual dual relationship is generally considered as unacceptable in the psychotherapeutic relationship. However, little is known about what therapists themselves constitute as (un)acceptable intimate and informal behaviour (IIB). Methods A survey among psychotherapists in Flanders (Belgium) was conducted. Opinions about the acceptability of IIB were asked. Based on these opinions attitude groups could be determined. Results In total, 786 therapists completed and returned the questionnaire (response rate: 39.8%). Therapists could be divided into three attitude groups. Almost half of the therapists belonged to the ‘rather restrictive group’, a third to the ‘rather socially permissive group’ and a fifth to the ‘rather sexually permissive group’. Being categorised as ‘rather sexually permissive’ is predominantly related to being male and non-heterosexual, whereas being ‘rather restrictive’ or ‘rather socially permissive’ is mainly due to the type of psychotherapy training. The ‘rather sexually permissive’ therapists more often found a client sexually attractive during the last year and fantasised more often about a romantic relationship with a client, but they did not more often started a sexual relationship. Conclusions Most therapists in Flanders are rather restrictive in their attitude to IIB, pointing to a high sense of morality. Having a rather sexually permissive attitude is predominantly related to more personal characteristics of the therapists, but these therapists did not start a sexual relationship more often.

The Moral Significance of Recovery

Given the loss of a sense of self long-associated with psychosis, this chapter argues that preserving and helping to reconstruct the person’s sense of personhood becomes a primary objective, and ethical imperative, of the psychotherapeutic relationship. Not to do so serves to perpetuate both the negative effects of the illness and its stigmatized status in society, adding to, rather than counteracting, the damage that is already being done to the person by this combination of factors. Drawing inspiration from Desmond Tutu’s use of the African concept of Ubuntu, this chapter argues that psychotherapy for psychosis should embody an appreciation of how persons only become persons through other people. Based on first-person accounts and qualitative research on recovery, it then describes ways in which the person’s sense of self can be restored and reconstructed through small steps in everyday life activities and with the loving support of others, including psychotherapists.

Queer as a Bell

Musical co-creation between the client and the therapist can be used as a means of skewing the dominant paradigms of the historically hierarchal psychotherapeutic relationship. This process, known as queering, opens the possibility for new ways of being in therapy space that may support empowerment of both the client and the therapist. Music engagement contributes to an intersubjective dynamic where the therapist's material may enter the session space more vulnerably and authentically than through a purely verbal process. When viewed critically through a queered perspective, this intersubjectivity may allow for a decrease in the power differential traditionally associated with the client–therapist dyad. In this article, a queer theoretical perspective is used to examine the unique role music and creativity play in this therapeutic relationship. Current queer, linguistic, and creative arts therapy theory are examined to support the hypothesis.

The Psychotherapeutic Relationship in Massage Therapy

Background: Psychotherapy and massage therapy (MT) are effective treatments for depression and anxiety. Little is certain about the mechanisms behind these effects in MT, but in psychotherapy they are attributed to a combination of common and specific factors, at the heart of which lies the therapeutic relationship. Research into the psychotherapeutic relationship in MT, therefore, may advance understanding of its impact on depression and anxiety.Purpose: This research seeks to elucidate the components of the psychotherapeutic relationship in MT to inform training, research, and practice.Participants & Setting: Two participants—a therapist and a client—from Melbourne, Australia. Research Design: A qualitative methodology was employed whereby one therapeutic relationship was observed over the course of three massage treatments. After each treatment, the participants commentated recordings of the sessions. The recordings were transcribed and analyzed using Interpretative Phenomenological Analysis (IPA) and Conversation Analysis (CA). Themes and subthemes were extracted from the analysis.Results: Four overarching themes emerged: Separateness, Pleasure, Merging, and Internalization. Separateness is associated with the subthemes of Boundaries, Performance of Roles, and Power. Pleasure is associated with the subthemes of Safety, Comfort and Communication. Merging is associated with the subthemes of Contact and Empathy. Internalization has no subthemes.Conclusions: The results suggest that a clearer conceptualization of the therapeutic relationship in MT may help massage therapists more pur-posefully treat depressed and anxious clients. A greater emphasis on self-awareness in the professional development of massage therapists may also foster this. Additionally, the role of pleasure in the therapeutic relationship in MT warrants closer examination.