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Coşkun A, Halfon S, Bate J, Midgley N. The use of mentalization-based techniques in online psychodynamic child psychotherapy. Psychother Res 2024; 34:1005-1017. [PMID: 37594025 DOI: 10.1080/10503307.2023.2245962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
Objective: Psychodynamic child psychotherapy is an evidence-based approach for a range of child mental health difficulties and needs to constantly adapt to meet the needs of children. This study is the first to investigate whether the use of mentalization-based interventions (i.e., a focus on promoting attention control, emotion regulation, and explicit mentalization) predicted a good therapeutic outcome in online psychodynamic child therapy sessions conducted during the COVID-19 pandemic. Methods: The sample included 51 Turkish children (Mage = 7.43, 49% girls) with mixed emotional and behavioral problems. Independent raters coded 203 sessions from different phases in each child's treatment using the Mentalization-Based Treatment for Children Adherence Scale (MBT-CAS). Results: Multilevel modeling analyses showed children with higher emotional lability benefited more from attention control interventions compared to those with lower emotional lability. Discussion: Interventions that focus on developing the basic building blocks of mentalizing may be effective components of therapeutic action for online delivery of psychodynamic child psychotherapy, especially for children with greater emotional lability.
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Affiliation(s)
- Ayşenur Coşkun
- Department of Psychology, Istanbul Bilgi University, Turkey
| | - Sibel Halfon
- Department of Psychology, Istanbul Bilgi University, Turkey
| | - Jordan Bate
- Ferkauf Graduate School of Psychology, Yeshiva University, USA
| | - Nick Midgley
- Anna Freud Centre, University College London, UK
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Elliott KS, Nabulsi EH, Sims-Rhodes N, Dubre V, Barena E, Yuen N, Morris M, Sass SM, Kennedy B, Singh KP. Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review. Front Psychiatry 2024; 14:1265087. [PMID: 38375514 PMCID: PMC10876001 DOI: 10.3389/fpsyt.2023.1265087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/27/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used. Methods To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review. Results Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail. Discussion Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.
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Affiliation(s)
- Kimberly S. Elliott
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Eman H. Nabulsi
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
| | - Nicholas Sims-Rhodes
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
| | - Vandy Dubre
- Robert R. Muntz Library, The University of Texas at Tyler, Tyler, TX, United States
| | - Emily Barena
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Nelly Yuen
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Michael Morris
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Sarah M. Sass
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Bridget Kennedy
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Karan P. Singh
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
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von Below C, Bergsten J, Midbris T, Philips B, Werbart A. It turned into something else: patients' long-term experiences of transitions to or from telepsychotherapy during the COVID-19 pandemic. Front Psychol 2023; 14:1142233. [PMID: 37251023 PMCID: PMC10213395 DOI: 10.3389/fpsyg.2023.1142233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The shift from in-person therapy to telepsychotherapy during the COVID-19 pandemic was unprepared for, sudden, and inevitable. This study explored patients' long-term experiences of transitions to telepsychotherapy and back to the office. Methods Data were collected approximately two years after the declaration of COVID-19 as a pandemic. Eleven patients were interviewed (nine women and two men, aged 28 to 56, six in psychodynamic psychotherapy, five in CBT). Treatments switched between in-person and video/telephone sessions. Interview transcripts were analyzed applying the qualitative methodology of inductive thematic analysis. Results (1) The patients experienced the process in telepsychotherapy as impeded. Interventions were difficult to understand and lost impact. Routines surrounding the therapy sessions were lost. Conversations were less serious and lost direction. (2) Understanding was made more difficult when the nuances of non-verbal communication were lost. (3) The emotional relationship was altered. Remote therapy was perceived as something different from regular therapy, and once back in the therapy room, the patients felt that therapy started anew. The emotional presence was experienced as weakened, but some of the patients found expressing their feelings easier in the absence of bodily co-presence. According to the patients, in-person presence contributed to their security and trust, whereas they felt that the therapists were different when working remotely, behaving in a more easygoing and familiar way, as well as more solution-focused, supportive and unprofessional, less understanding and less therapeutic. Despite this, (4) telepsychotherapy also gave the patients an opportunity to take therapy with them into their everyday lives. Discussion The results suggest that in the long run, remote psychotherapy was seen as a good enough alternative when needed. The present study indicates that format alternations have an impact on which interventions can be implemented, which can have important implications for psychotherapy training and supervision in an era when telepsychotherapy is becoming increasingly common.
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Aisbitt GM, Nolte T, Fonagy P. Editorial Perspective: The digital divide - inequalities in remote therapy for children and adolescents. Child Adolesc Ment Health 2023; 28:105-107. [PMID: 35179284 DOI: 10.1111/camh.12545] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 01/18/2023]
Abstract
COVID-19 has triggered a shift towards remote delivery of therapy and, despite a number of benefits, it risks discriminating against young people already marginalised due to adverse early life experiences, poverty or ethnicity. This editorial perspective considers challenges for remote therapy, focusing on: the financial burden of telehealth; the necessity of safety to speak; and, how telehealth may exacerbate difficulties in therapeutic alliance formation by interfering with epistemic trust and mentalising. As well as compounding the inaccessibility for children who are subject to abuse, the implicit assumptions behind telehealth risk disproportionately excluding from therapy those from a low socioeconomic status, and who are from ethnic minorities. Suggestions are made for how these challenges may be addressed. It is argued that service design and delivery should seek to proceed with the practicalities and principles of engagement in mind and use this as an opportunity to improve parity of access, rather than risk further entrenching inequalities.
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Affiliation(s)
- Georgina M Aisbitt
- Newham Personality Disorder Service, East London NHS Foundation Trust, London, UK
| | - Tobias Nolte
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, UCL, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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Morgan A, Davies C, Olabi Y, Hope-Stone L, Cherry MG, Fisher P. Therapists' experiences of remote working during the COVID-19 pandemic. Front Psychol 2022; 13:966021. [PMID: 36591020 PMCID: PMC9802664 DOI: 10.3389/fpsyg.2022.966021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives To explore the experiences of therapists who delivered remote psychological therapy during the COVID-19 pandemic. Design This was a qualitative, phenomenological study. Interpretative Phenomenological Analysis elicited themes from semi-structured interviews. Methods A purposive sample of eight therapists was recruited from breast cancer services in the United Kingdom. Results Analysis identified three superordinate themes. Participants spoke about how their experience of remote working changed over time from an initial crisis response to a new status quo. They adapted to the specific practical and personal challenges of remote working and struggled to connect with clients as the use of technology fundamentally changed the experience of therapy. Conclusion Consideration should be given to the impact of remote working on therapists and the quality of their practise. Adjustments to ways of working can help to maximize the advantages of remote working while minimizing potential issues.
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Affiliation(s)
- Andrew Morgan
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Cari Davies
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom,*Correspondence: Cari Davies,
| | - Yasmine Olabi
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Laura Hope-Stone
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mary Gemma Cherry
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Peter Fisher
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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Haun MW, Hoffmann M, Wildenauer A, Tönnies J, Wensing M, Szecsenyi J, Peters-Klimm F, Krisam R, Kronsteiner D, Hartmann M, Friederich HC. Health providers' experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial. BMJ Open 2021; 11:e047829. [PMID: 34753752 PMCID: PMC8578962 DOI: 10.1136/bmjopen-2020-047829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers' experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care. METHODS A qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data. RESULTS Considering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients' improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention's context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier. CONCLUSIONS MHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes). TRIAL REGISTRATION NUMBER DRKS00015812; Results.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Alina Wildenauer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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Conversano C, Di Giuseppe M, Miccoli M, Ciacchini R, Gemignani A, Orrù G. Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic. Front Psychol 2020; 11:1900. [PMID: 33013503 PMCID: PMC7516078 DOI: 10.3389/fpsyg.2020.01900] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Mindfulness disposition is associated with various psychological factors and prevents emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining. METHODS An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relationship between mindfulness and psychiatric symptoms. RESULTS Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = -0.504; p < 0.0001). High negative correlations were found between mindfulness disposition and the overall Global Severity Index (r = -0.637; p < 0.0001), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales. DISCUSSION Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem post-traumatic psychopathological beginnings and prevent the onset of chronic mental disorders.
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Affiliation(s)
- Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rebecca Ciacchini
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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Ventura Wurman T, Lee T, Bateman A, Fonagy P, Nolte T. Clinical management of common presentations of patients diagnosed with BPD during the COVID-19 pandemic: the contribution of the MBT framework. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1814694] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tamara Ventura Wurman
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Halliwick Unit, St Ann’s Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Tennyson Lee
- DeanCross Personality Disorder Service, East London Foundation NHS Trust, London, United Kingdom
- Centre for the Understanding of Personality Disorder (CUSP), London, United Kingdom
| | - Anthony Bateman
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Tobias Nolte
- Halliwick Unit, St Ann’s Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, UCL, London, United Kingdom
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Di Giuseppe M, Zilcha-Mano S, Prout TA, Perry JC, Orrù G, Conversano C. Psychological Impact of Coronavirus Disease 2019 Among Italians During the First Week of Lockdown. Front Psychiatry 2020; 11:576597. [PMID: 33192713 PMCID: PMC7554332 DOI: 10.3389/fpsyt.2020.576597] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022] Open
Abstract
Pandemics and government-mandated quarantining measures have a substantial impact on mental health. This study investigated the psychological impact of the coronavirus disease 2019 (COVID-19) crisis on Italian residents during the first week of government-imposed lockdown and the role of defense mechanisms as protective factors against distress. In this cross-sectional study, 5,683 Italians responded to an online survey assessing socio-demographics, overall psychological distress, post-traumatic symptoms, and defense mechanisms using validated measures as the Symptom Checklist-90 (SCL-90), the Impact of Event Scale-Revised (IES-R), and the Defense Mechanisms Rating Scale-Self-Report-30 (DMRS-SR-30). Data were collected from March 13 to March 18, within the first week of lockdown in Italy. Results showed that younger age and female gender were associated with increased psychological distress. Having positive cases nearby, more days on lockdown, and having to relocate were also associated with greater distress. Higher overall defensive functioning (ODF) was associated with lower levels of depression (r = -.44, 95% CI -0.48, -0.40), anxiety (r = -.38, 95% CI -0.42, -0.35), and post-traumatic stress symptoms (PTSS) (r = -.34, 95% CI -0.38, -0.30). Conversely, less adaptive defensive functioning was related to greater affective distress across all domains. Each increased unit of ODF decreased the chances of developing post-traumatic stress symptoms (PTSS) by 71% (odds ratio = 0.29, p < 0.001, 95% CI.026,.032). The psychological impact of COVID-19 among Italians during the early weeks of government lockdown has been significant. The pandemic continues to have extraordinary mental health impact as it moves across the globe. Given the salience of defensive functioning in psychological distress, consideration of interventions that foster the use of more adaptive defenses may be an important component of building resilience amidst a pandemic.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | | | - Tracy A Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | - John Christopher Perry
- Institute of Community and Family Psychiatry, JGH, McGill University, Montreal, QC, Canada
| | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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