Videoconferencing versus face-to-face psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance,empathy and treatment characteristics

Objective

Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face-to-face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy.

Method

An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID-19 pandemic and a resulting transition from F2F to VCT for most participants.

Results

While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy.

Conclusion

The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.     

Adapting Strauss and Corbin's grounded theory in clinical case study research in the field of counselling

Case study can be adopted when aiming to understand an individual's lived experience. Such experience produces rich and complex qualitative data for analysis, conducive to counselling and psychotherapy research. Furthermore, grounded theory (GT) can be adopted to produce a theory from qualitative data, fitting well with case study research that explores complex experiences regarding social, psychological and phenomenological processes. This paper aims to guide the counselling researcher to incorporate Strauss and Corbin's model into the main arena of qualitative counselling research. In addition, this paper draws on a multiple case study that adopted Strauss and Corbin's method and identified various phases in the GT process. The aim is to inform the reader how to put the iterative process and pragmatic theoretical sampling into practice to produce a robust theory from clinical case study data.     

Beyond Emotional Intelligence at Work:: Adding Insight to Injury Through Group Psychotherapy

The author applies the popular concept of Emotional Intelligence (EQ) to the group treatment of work problems. Adding psychodynamic insight to the existing EQ dimension of understanding emotions and utilizing emotional awareness, helps patients improve their reactions to problematic situations and individuals. By focusing on discordant episodes that arise in group, the author employs a systematic approach to identifying unconscious contributors to diminished job performance. Methods for assessing deficits in EQ and for processing relevant group discords are described. Clinical illustrations are provided.     

Perceived Barriers to Treatment Participation and Treatment Acceptability Among Antisocial Children and Their Families

This study examined the role of perceived barriers to participation in treatment and the acceptability of treatment among children and parents. Children (N = 144, ages 6–14) referred for outpatient treatment for oppositional, aggressive, and antisocial behavior and their families participated. The main findings were that: (a) perceived barriers to participation in treatment predicted treatment acceptability as rated by children and parents; (b) the effect was not accounted for by socioeconomic disadvantage, parent psychopathology and stress, and severity of child dysfunction; and (c) treatment acceptability was related to therapeutic change in the children over the course of therapy but the relation was small. Overall, the findings indicate that families vary considerably in the barriers they perceive in coming to treatment and that these barriers influence the extent to which they and their children evaluate the acceptability of the treatments they receive. The implications of treatment acceptability for evaluation and delivery of psychotherapy are discussed.     

Cyclical Maladaptive Patterns: Interpersonal Case Formulation for Psychotherapy with Children

This paper proposes the use of Hans Strupp's case formulation method, Cyclical Maladaptive Patterns, with child clinical cases. While Strupp's case formulation method was developed for use with adults in Time-Limited Dynamic Psychotherapy, this interpersonally-based model is viewed as consistent with recent literature in child development and psychopathology which emphasizes the centrality of peer relationships, interpersonal schema, and social attribution biases in the development of maladaptive interpersonal behavior. Application of this method underscores the interpersonal nature and context of childhood problems as well as their cyclical and self-perpetuating quality. Use of this case formulation method with children is proposed as a basis for individually tailoring treatment plans with children who have problems with aggression, rejection, and other maladaptive interpersonal patterns.     

Parent as Saboteur in the Therapeutic Treatment of Children

Children present some unique challenges to the therapist regarding treatment. Unlike adult patients, they are obviously still dependent upon the parent for transportation, the payment of fees, and the success or failure of treatment. Thus the parents make the ultimate decision to continue or terminate treatment. But sometimes a parent's characterological problems are activated by their child's treatment. These diagnostic problems can be classified as envy, jealousy, competition, and narcissism. When any or all of these unresolved parental issues are touched by the treatment of their child, some parents become determined to sabotage therapy, despite the necessity of the treatment for their child. The author's intent is to identify the parental characterological issues for sabotaging therapy through both a theoretical analysis and a discussion of the particular methods parents employ to achieve this end. Identification of the various strategies for handling hostile parents and elaboration of various methods that the therapist may employ are discussed when parental sabotaging of treatment becomes a problem. Recommendations for particular interventions are suggested to illuminate the challenges the therapist faces with those parents whose intent is to sabotage treatment.     

The Relationship Between Client Emotional Expressions, Therapist Interventions, and the Working Alliance: An Exploration of Eight Emotional Expression Events

The relationship between client emotional expression and therapist interventions was studied in two working alliance conditions. An events-focused methodology was used to examine a total of 8 events taken from a variety of therapeutic orientations. Results indicated that, in the presence of a good client–therapist relationship, therapists showed higher levels of empathy and effectively focused on the immediately expressed feelings; in turn, their clients were engaged in exploration of feelings. In poor-relationship dyads, clients expressed negative feelings toward the therapists. Interventions rated as effective by clinical judges were characterized by accurate therapist understanding of clients' emotional expressions and working with strains in the therapeutic relationship. Ineffective interventions were associated with inaccurate assessments of clients' emotional states. Intensive analysis of these sessions led to three distinct models of in-session emotional expression events. Theoretical and practical implications of these models will be discussed.     

The Michigan infant mental health home visiting model

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent–child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.