A Psychodynamic Perspective on a Systematic Review of Online Psychotherapy for Adults

Abstract

A variety of new psychotherapy modalities has arisen in which the contact between patient and therapist takes place via the internet. The main objective of this systematic review is to investigate the types of online psychotherapy (OP) conducted nowadays, and to describe their main characteristics to psychodynamic psychotherapists who may wish to better understand the current scientific literature on the subject. The review used two databases, EMBASE and PsycINFO. Fifty-nine studies were retrieved and the main online psychotherapy modalities identified were self-therapy programmes using contact via email or chat; videoconference; and therapy exclusively via chat or email. The result of these studies suggests that OP is more effective than a waiting list control group. When compared with face-to-face therapies, OP showed similar effects. Most studies involved cognitive behavioural therapy; only two studies involved a form of psychodynamic psychotherapy. Different forms of communication allow patient and therapist to establish different relationships and therapeutic possibilities. OPs may be feasible treatment alternatives; however, it remains unclear, especially in relation to psychodynamic treatments, if therapeutic technique in OP, which involves changes in comparison with face-to-face therapies, would be useful in severe cases. Psychodynamic psychotherapists should adopt a posture of constant reflection on the changes taking place in the world and their impact on the minds of individuals, without, nevertheless, idealizing the 'new'. the therapist's location. Many people with mental health disorders fail to seek assistance or cannot afford to visit a doctor's office or mental healthcare centre, and the internet offers access to different therapeutic interventions.These studies throw light on the phenomenon, but online psychotherapies are considered new treatment modalities and are a rapidly expanding field. Most of the data presented in the aforementioned studies are contradictory and inconclusive. Systematic reviews on the subject assist the clinician and the researcher in knowing the state of the art on the subject and in positioning themselves more critically in terms of incorporating online treatment modalities in their practices. For psychodynamic psychotherapy in particular, it is necessary to critically discuss the effect of these technologies on the pillars of this theoretical approach, such as transference, countertransference and the analytic field. These concepts constitute the basis of psychodynamic practice and may be profoundly affected by a virtual relationship (Sfoggia et al., 2014). Therefore, we need to keep questioning the impact of online treatments in a psychodynamic psychotherapy setting.The main objective of this systematic review was to investigate the types of OP conducted nowadays, and to describe their main characteristics to psychodynamic psychotherapists who may wish to better understand the current scientific literature on the subject. The secondary objective was to describe the mai...

Psychotherapists’ perception of their clinical skills and in-session feelings in live therapy <em>versus</em> online therapy during the COVID-19 pandemic: a pilot study

“…Online therapy can be defined as 'any type of professional therapeutic interaction that makes use of the Inter-net to connect qualified mental health professionals and their clients' (Rochlen et al, 2004). The efficacy of online therapy is supported by clinical trials in which it has been compared to waiting-list control groups (Klein & Richards, 2001;Lange et al, 2000;Lange, van de Ven, Schrieken, & Emmelkamp, 2001) and to traditional faceto-face therapies (Cohen & Kerr, 1999;Day & Schneider;2002), and it has been documented for a variety of clinical conditions including post-traumatic stress disorder (Poletti et al, 2020;Backhaus et al, 2012), anxiety disorders (Poletti et al, 2020), depression (de Bitencourt Machado et al, 2016), obsessive-compulsive disorder (Simpson, 2009), panic attacks and agoraphobia (Poletti et al, 2020), bulimia nervosa (Simpson, 2009, de Bitencourt Machado et al, 2016 and mixed diagnoses (Backhaus et al, 2012). Moreover, a number of studies have investigated various aspects of the therapeutic relationship in online therapy, such as therapeutic alliance (Cook & Doyle, 2002;Reynolds et al, 2013) and trust (Fletcher-Tomenius & Vossler, 2009), and have provided qualitative description of online therapy processes William et al, 2009).…”

Developing a reflective self in cyber space.

“…The majority of research examining ICT and therapy has examined formal online/e-therapy interventions. The most frequently studied therapeutic use of ICT involves clinical trials of CBT, and it is unclear the extent to which ICT has been incorporated into therapeutic settings across theoretical approaches (de Bitencourt Machado et al, 2016). The primary concern 6 identified in the use of ICT in psychoanalysis is the loss of direct physical context or non-verbal feedback in the communication, potentially influencing the interpreted meaning of an exchange (de Bitencourt Machado et al, 2016).…”

Terapia On-line com Casais e Famílias: Prática e Formação na Pandemia de Covid-19

“…Muitos terapeutas acreditam incorretamente que as terapias on-line são menos efetivas do que as sessões realizadas presencialmente (Bekés & Doorn, 2020). Machado et al (2016) conduziram uma revisão sistemática sobre terapia individual on-line e observaram que essa, quando comparada à terapia presencial, mostra efeitos similares. Constataram também que as diversas formas de comunicação entre cliente e terapeuta permitem o estabelecimento de diferentes relações terapêuticas e possibilidades clínicas.…”