For decades, the prototypical psychotherapy setting has been the in-person meeting that promotes a level of security and intimacy between patient and therapist. Communication in in-person therapy includes a complex mix of both verbal and nonverbal modes. The social restrictions caused by the COVID-19 virus changed the context of providing psychotherapy for many of us. Working remotely often means that communication is through a two-dimensional screen in which we see only the shoulders and head of the patient or therapist. Recent reviews indicate that remote therapy is as effective as in-person therapy. However, whereas remote therapy provides opportunities it also has its challenges. For example, some patients feel working remotely resulted in a more impersonal experience, and therapists often report remote work to be more cognitively challenging. Many therapists and patients still work remotely even though the pandemic is over. Much of this is driven by the convenience and accessibility offered by working remotely. In this qualitative interview study of 10 experienced therapists who work remotely with their patients, Werbart and colleagues explored therapists’ long-term experiences of providing remote psychotherapy after the COVID-19 pandemic. The thematic analysis of the interviews yielded four over-arching themes. The first theme was “A new and different interaction” in which therapists reported needing to adjust their way of working to the altered relational dynamic. That is, therapists reported that not all patients were suited to remote work, in some cases the session could not be protected from interruptions, and therapists had to become much more watchful of nonverbal cues. The second theme was “Advantages of remote psychotherapy” in which therapists were surprised at how well the remote format worked. Many therapists reported that remote therapy facilitated the work for some patients who struggle with experiencing too high a level of emotional intimacy. The third theme was “Challenges of remote therapy” in which therapists described technological limitations and problems with equipment that hindered therapeutic collaboration. Therapists were particularly sensitive to the obstacles to nonverbal communication and how much more cognitively demanding it was for therapists to continuously assess patients’ reactions. The fourth theme was “Changed attitudes and new skills” in which therapists’ opinions and attitudes toward remote therapy evolved from being skeptical to being more open to its uses and possibilities.
Practice Implications
Therapists can always rely on their already established skills when providing remote psychotherapy. However, they also must adapt their interpersonal stances in some ways. Therapists cannot rely so easily on channels of implicit communication and nonverbal cues when working remotely. They sometimes must increase their activity and interventions. This might include explicitly asking patients about the meaning of verbal and nonverbal behaviours, making their gestures more explicit, putting much more into words, using shorter interventions, and being more explicit in what they say or mean.
Werbart, A., Jonsson, M., Jankowski, B., & Forsström, D. (2024). New skills for distance regulation: Therapists’ experiences of remote psychotherapy following the COVID-19 pandemic. Journal of Psychotherapy Integration, 34(1), 27–44. https://doi.org/10.1037/int0000310
To learn more about the Psychotherapy Practice Research Network, visit www.pprnet.ca.
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