"It's splendid once you grow into it:" Client experiences of relational teletherapy in the era of COVID-19

Call me maybe? In-person vs. teletherapy outcomes among married couples

Objective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance.Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators.Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction.Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality.

Feeling safe in the context of digitalization in healthcare: a scoping review

BACKGROUND

Digitalization in healthcare and society can be challenging, particularly for people who have limited digital experiences. New digital technologies can influence individuals' perceived safety and well-being. In this study, we aimed to identify and analyze the literature on needs and influencing factors in the context of emotional and psychological safety and digitalization in healthcare.

METHODS

A scoping review was conducted based on the PRISMA-ScR standard. The literature was searched based on the databases Medline via PubMed, PsycINFO via Ovid, and CINAHL via EBSCO. Literature was included after a review of the titles, abstracts, and full texts published in English or German in the last 5 years (October 2017-September 2022). Eligible literature included definitions and descriptions of emotional and/or psychological safety and was related to digitalization in healthcare and was analyzed qualitatively via inductive content analysis. The findings were analyzed from ethical, psychosocial, legal, economic, and political perspectives.

RESULTS

A total of 32 publications were finally included thereof qualitative (n = 20), quantitative (n = 3), and mixed methods (n = 2) studies. Other included publications were systematic integrative reviews, scoping reviews, narrative reviews, white papers, and ethical statements. Of these publications, four qualitative studies focused on emotional or psychological safety in the context of digital technology use in healthcare as a primary research aim. Most literature has shown that perceived safety is influenced by perceived changes in healthcare, digital (health) literacy, the design of digital technology, and need orientation. The needs identified in this context overlap strongly with the influencing factors. A low or high perceived safety has an impact on users' thoughts and actions.

CONCLUSION

The importance of emotional safety in the context of digital technologies in healthcare is growing, while psychological safety seems to be underrepresented. The interaction between the influencing factors and the need to feel safe leads to considerations that can affect user behavior and have far-reaching outcomes for the implementation of digital technology in healthcare.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Registries on 16 December 2022 https://doi.org/10.17605/OSF.IO/HVYPT .

Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review

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.

Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review

PURPOSE

This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19.

METHOD

Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence.

RESULTS

Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners.

DISCUSSION & CONCLUSION

The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients' and practitioners' suitability, the need for provision of training and ongoing support to optimize practitioners' well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.

Ethics of Technology Practice: Beliefs and Behaviors of Certified Rehabilitation Counselors During the COVID-19 Pandemic

The coronavirus (COVID-19) pandemic represented a critical moment for technology use within rehabilitation counseling. This study explored trends in the beliefs and behaviors of certified rehabilitation counselors (CRCs) regarding the ethical use of technology before and during the pandemic. Specifically, this study compared two groups of CRCs regarding the degree to which they engaged in 59 technology behaviors and whether they viewed each behavior to be ethical. Overall, group comparisons suggested an increased use of telephone, videoconferencing, and email to deliver counseling, assessment, and supervision services during the pandemic. Furthermore, supervision via videoconferencing and email in the pandemic were rated as more ethically appropriate than before the pandemic. As a general trend, synchronous modes of communication such as the telephone and video conferencing were rated as more ethically appropriate than asynchronous modes such as social networking and text messaging. Indicating a high degree of congruence between beliefs and behaviors, the technology practices viewed as most ethical were used the most often. Implications address the revisions to the Code of Professional Ethics for Rehabilitation Counselors regarding the ethical use of technology in rehabilitation counseling.

Frontline experiences of delivering remote mental health supports during the COVID-19 pandemic in Scotland: innovations, insights and lessons learned from mental health workers

COVID-19 restrictions drove rapid adaptations to service delivery and new ways of working within Scotland's mental health sector. This study explores mental health workers' (MHWs') experiences of delivering their services remotely. Twenty participants, who had worked in mental health professions in the National Health Service (NHS) in Scotland throughout the COVID-19 pandemic, took part in online semi-structured interviews. Data was transcribed then analysed using an inductive thematic analysis. Two major themes are reported: (1) 'Improved Flexibility for both MHWs and Service Users' and (2) 'Teletherapies Challenge Therapeutic Boundaries'. In relation to (1) virtual platforms were seen as vital in maintaining patient care throughout the COVID-19 pandemic and a valuable resource for service users (SUs) who had previously struggled with mobility or social anxieties when accessing face-to-face services. Some MHWs' also noted benefits for their productivity and comfort. Regarding (2) MHWs highlighted that whilst conducting teletherapies from home, work-life boundaries became blurred and, in some instances, typically comforting spaces became associated with the traumatic content discussed by SUs. These stressors seemed to be compounded by MHWs' isolation, as they were less able to draw upon their colleagues for support. Further, confidentiality could not be assured, as MHWs and SUs alike had to accommodate their family members. These findings highlight important insights from MHWs in adapting to rapid changes in mental health working practices, particularly in relation to the challenges of delivering quality, safe and equitable services and the increased use of teletherapies. Such insights are vital in informing service developments and supporting future pandemic preparedness across a range of healthcare contexts and countries seeking to adopt hybrid models of mental health service delivery.

Leveraging Symptom Search Data to Understand Disparities in US Mental Health Care: Demographic Analysis of Search Engine Trace Data

BACKGROUND

In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals.

OBJECTIVE

We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web.

METHODS

We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons.

RESULTS

We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03%, SD 0.44%), depression (mean 1.15%, SD 0.27%), fatigue (mean 1.21%, SD 0.28%), and headache (mean 1.03%, SD 0.23%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02%, SD 0.02%), psychosis (mean 0.37%, SD 0.06%), and attention-deficit/hyperactivity disorder (mean 0.77%, SD 0.10%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05%, SD 0.04%) than in nonshortage areas (mean 0.10%, SD 0.03%; Q<.0003), more so when a shortage area is rural (mean 0.024%, SD 0.029%; Q<2 × 10^-12).

CONCLUSIONS

This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care.

The Feasibility of Providing Remote Functional Family Therapy with Adolescents During the COVID-19 Pandemic: A Mixed-Method Study

Background

Due to the recent COVID-19 pandemic, mental health care has largely transferred its services to online platforms, using videoconferencing (VC) or teletherapy. Within the field of family therapy, however, there is little evidence on the feasibility of using VC, especially when working with whole families at the edge of care.

Objective

This study investigated the feasibility of remote Functional Family Therapy (FFT), using a mixed-method approach.

Method

Study 1 consisted of semi-structured interviews with 23 FFT professionals (18 female) about their experience of providing remote FFT during the COVID-19 pandemic. Study 2 included monitoring data of 209 FFT clients (46% female, M _age  = 14.00) who participated in FFT during the pandemic. We compared families who received mainly in-person, mainly remote or a mix of remote and in-person on client-reported alliance, drop-out, therapist-rated outcomes, and treatment intensity using MANCOVA's and chi-square tests.

Results

In Study 1 two themes emerged around experienced challenges, namely 'Feeling in control' and 'Engagement and alliance'. Two other themes emerged around adaptations, namely 'Being more on top' and 'Connecting in different ways'. In Study 2, we found that the therapeutic alliance was not related to using VC. Also, families had less between-session contact during the Engagement and Motivation Phase when receiving mainly VC, but had more sessions and longer therapy when receiving a mix of in-person and remote therapy.

Conclusions

The current study suggests that providing systemic family teletherapy to families on the edge of care is feasible. Further development of systemic family teletherapy is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-022-09692-y.

Online clinical supervision in couple and family therapy: A scoping review

Online clinical supervision, or telesupervision, is a growing practice in couple and family therapy. This scoping review aims to identify and synthesize the existing body of knowledge regarding the utilization, experiences, and perceptions of telesupervision among the couple and family therapists and to highlight gaps in the literature. The review followed the five-step approach proposed by Arksey et al. (2005). Fifteen articles were included and their analysis yielded four themes: 1. telesupervision competence; 2. setting and boundary management; 3. advantages of telesupervision; and 4. challenges of telesupervision. Our review clearly demonstrates the dearth of available conceptual and empirical work. The rapidly growing use of online therapy and telesupervision in couple and family therapy has created a critical need to expand this body of knowledge by collecting evidence that can later be translated into practice. Moreover, we identified several gaps in the existing body of knowledge, including a lack of reports on the efficacy of telesupervision and on the experiences, processes, and ascribed meanings of the supervisors and supervisees. We also noted a lack of practice and ethical guidelines for telesupervision. We conclude our analysis by suggesting areas and directions for further investigation.

"There is Just a Different Energy": Changes in the Therapeutic Relationship with the Telehealth Transition

The therapeutic relationship (TR), including its therapeutic frame, is the foundation of the therapeutic endeavor. In response to the COVID-19 pandemic and the rapid transition to videoconferencing for therapeutic encounters, we employed a cross-sectional exploratory survey with 1490 respondents to understand how practitioners adapted to the changes. In this secondary analysis focused on the TR, we analyze the clinicians' (N = 448) spontaneous narratives about facets of the TR. Temporally, we focused on how these adaptations occurred during the initial part of the pandemic before vaccination was available and while the TR was still adapting to teletherapy videoconferencing under the duress of pandemic crises. We find three broad themes: (1) It is a "much more remote relationship"; (2) The "connection…remains surprisingly strong"; and (3) It is "energetically taxing." Each reflects clinicians' views of the TR as altered, but surprisingly resilient. Although grateful for the safety of virtual therapeutic encounters, clinicians mourned the loss of an embodied encounter, experienced depletion of energy beyond Zoom fatigue, and nonetheless recognized their clients' and their own abilities to adapt.

Embracing Technological Possibilities in the Telehealth Delivery of Interactive Music Therapy

INTRODUCTION

Given how many music therapists have shifted their practice to telehealth in accordance with COVID-19 public safety precautions, it is essential for clinicians not only to adjust to the virtual platform, but to embrace the therapeutic potential of technological tools. Just as music is considered a therapeutic agent in music therapy sessions, the authors assert that technology may also be conceptualized and utilized as a means of enhancing therapeutic outcomes.

METHOD

Referencing an interactive music therapy protocol adapted for telehealth as part of a pain management study, the authors examine ways in which different aspects of telehealth technology can be used by music therapists to support client goals and bolster the therapeutic relationship. Generalized clinical examples drawn from virtual sessions are incorporated to demonstrate the unique therapeutic possibilities for client agency, client self-efficacy, and the client-therapist relationship afforded by the telehealth platform.

RESULTS

Among the possibilities afforded by telehealth are enriched opportunities for client choice, reinforcement of learning and implementing new transferrable skills, and enhancing the therapeutic relationship through collaborative troubleshooting and adapted interactive music experiences.

DISCUSSION

Specific recommendations for music therapists are included to advance the conversation around best practices regarding telehealth. The authors discuss actionable items for music therapists such as utilizing screen-sharing options to enhance musical interactions, validating and exploring clients' use of technology for self-disclosure, and other strategies for harnessing the therapeutic potential of technology in virtual music therapy sessions.