COVID-19 Related Traumatic Distress in Psychotherapy Patients during the Pandemic: The Role of Attachment, Working Alliance, and Therapeutic Agency

Abstract

The early months of the COVID-19 pandemic have been a challenging time for many psychotherapy patients. To understand why certain patients were more resilient, we examined the role of patients’ attachment anxiety and attachment avoidance, as well as collaborative therapy experiences (perceived working alliance and therapeutic agency) in their online sessions on their COVID-related traumatic distress over a three-month period. A total of 466 patients in online psychotherapy completed a survey during the first weeks of the pandemic, and 121 of those completed a follow-up survey three months later. Lower distress at follow-up was predicted by patients’ lower attachment anxiety and higher therapeutic agency in their online sessions after controlling for baseline distress and time of survey completion. Higher working alliance predicted less distress at follow-up only for patients with high attachment anxiety. For patients with low attachment avoidance (i.e., more securely attached), higher therapeutic agency predicted less distress. These findings suggest that patients’ attachment anxiety and therapeutic agency may play significant roles also in online therapy during COVID-19 in patient’s experienced traumatic distress, and that working alliance and therapeutic agency may be differentially important for patients with different levels of attachment anxiety and avoidance.

Being real in therapy.

“…First, therapists did not report being more real in in-person than in teletherapy. Research on the impacts of teletherapy has increased in the last few years because improved technology has enabled teletherapy and because many therapeutic dyads were unable to meet in person due to the COVID-19 pandemic (Aafjes-van Doorn, 2022; Aafjes-van Doorn, Békés, & Luo, 2021; Aafjes-van Doorn, Békés, & Prout, 2021; Békés et al, 2020, 2021; Burgoyne & Cohn, 2020). Although this work has generated reasons to think that therapy format might impact the capacity of therapists to be real with their clients, this was the first study to test this hypothesis directly.…”

The complexity of teletherapy: Not better or worse, but different.

“…Indeed, recent empirical studies appear to confirm the multitude of teletherapy experiences; not better or worse per se, but different. Patient and therapist responses in international longitudinal surveys and in-depth interviews that we conducted (Aafjes-van Doorn, Békés, & Luo, 2021; Aafjes-van Doorn, Békés, Luo, Prout, et al, 2021; Békés et al, 2021, 2022) suggest that the teletherapy process reflects a complex amalgamation of potentially helpful and unhelpful therapeutic experiences. Many therapists and patients reported difficulties with emotional connection, distractions, and privacy when they transitioned to teletherapy.…”

Therapist self‐disclosure in teletherapy early in the COVID‐19 pandemic: Associations with real relationship and traumatic distress

“…As part of a large-scale international longitudinal online survey, study data were collected from therapists who transitioned to teletherapy sessions in spring 2020 (March to May 2020). Recruitment details for this study have been reported previously (Aafjes-van Doorn et al, 2021). In brief, participants were recruited across North America, Asia and Europe via professional e-mail lists, social media and individual contacts.…”