Behavioral Activation Treatment for Depression in Older Adults Delivered via Videoconferencing: A Pilot Study

Depression affects up to 25% of older adults. Underdetection and subsequent undertreatment of depression in older adults has been attributed in part to difficulties in older adults being able to access treatment. This uncontrolled pilot study, N = 3, explored the acceptability and efficacy of a brief behavioral activation treatment delivered via videoconferencing to 3 participants, aged 64 to 73 years, diagnosed with major depressive disorder. The results indicate that a 5-session behavioral activation treatment delivered via videoconferencing produced clinically significant and reliable decreases in depression. The results also showed clinically significant and reliable decreases in negative affect and clinically significant and reliable increases in positive affect. Treatment gains were maintained at 1-month follow-up. Videoconferencing can be a valuable and effective tool in increasing accessibility to psychological treatment for older adults.     

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.     

Tele‐web Psychology in Rural South Australia: The Logistics of Setting Up a Remote University Clinic Staffed by Clinical Psychologists in Training

There is a significant shortage of clinical psychology services in rural and remote Australia. It is proposed that tele‐web psychology may provide one potential solution to this inequity in health provision. A tele‐web psychology project was developed through a partnership between a university and country health service setting in rural South Australia. Tele‐web psychology was conducted by Provisional Psychologists on their first clinical placement, with patients attending sessions in a community mental health team hub in a regional centre north of Adelaide. This article describes the logistics of setting up a collaborative tele‐web psychology service and makes recommendations on how to expedite the success of this type of venture.     

A change in frame and countertransference experiences: Transitioning from face-to-face to telepsychotherapy

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID-19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face-to-face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face-to-face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face-to-face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face-to-face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.