On the difficulties of building therapeutic relationships when wearing face masks

Hüfner, Katharina; Hofer, Alex; Sperner‐Unterweger, Barbara

doi:10.1016/j.jpsychores.2020.110226

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…Overall, clinicians reported that the use of facemasks in clinical encounters significantly reduced their confidence to communicate with patients, but also the perceived capacity to build a good relationship with them; moreover, the use of facemasks reduced the satisfaction in the relationship with patients. These results confirm the concerns expressed by many clinicians in some commentaries about the impact of facemasks in clinical encounters (Hüfner et al, 2020 ; Mehta et al, 2020 ; Thirthalli et al, 2020 ; Veluri, 2020 ) and gives empirical support to them. Recently, some authors have shown that a low perception of depth and quality in therapeutic relationships contributes to burnout (Zarzycka et al, 2022 ) highlighting the need of a monitoring of the clinicians' perception of therapeutic relationships when wearing facemasks.…”

Section: Discussionsupporting

confidence: 88%

Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition

et al. 2022

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Objectives Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions. Methods In this cross‐sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self‐perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2‐Adult Faces including 24 faces representing anger, fear, sadness, and happiness. Results Facemasks impaired the self‐perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation. Conclusion Facemasks reduced clinicians' self‐confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.

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Section: Discussionsupporting

confidence: 88%

Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition

et al. 2022

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“…While questions relating to the potential effects wearing face masks might have on therapy sessions and the therapeutic relationship have been discussed in recent Letters to the Editor [ 9 – 12 ] and discussion papers [ 13 ], little is known about their actual impact. A randomised controlled trial from Hong Kong in 2011, which examined patients’ reaction to their general practitioner wearing a face mask during the consultation, found negative effects on patients’ perception of the general practitioner’s empathy, an effect that was more pronounced for more established general practitioner-patient relationships [ 14 ].…”

Section: The Use Of Face Masks In Face-to-face Treatmentmentioning

confidence: 99%

Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions

et al. 2021

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Background Maintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or using face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study’s aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing. Methods In this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients’ evaluation of the session, their treatment satisfaction, and patients’ and therapists’ ratings of therapeutic alliance. We also collected qualitative comments on both sides’ experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for the N = 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses. Results No statistically significant differences regarding session flow, post-session positivity, satisfaction and therapeutic alliance were observed. The only exception was that telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that may decline over time, especially in the videoconferencing group. Patients and therapists identified similar facilitating and complicating aspects, but differed in their emphasis of specific elements. Conclusions Both settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.

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“…On health professional side, masks lead to louder, more clearly and kindly communication. In line with this, Hüfner et al (2020) conclude that raising emotional awareness in patients with mental disorders (and perhaps in the healthcare professionals themselves) occurs by addressing the “masked emotions” directly and explicitly. Nevertheless, the majority of healthcare professionals stated that the mask did not have a great impact on the content of their sessions as that they do not consciously work in a more resource-oriented or less confrontational or exposed way, except for particularly sensitive patient groups and in conflict situations.…”

Section: Discussionmentioning

confidence: 64%

The role of face masks within in-patient psychotherapy: Results of a survey among inpatients and healthcare professionals

Erschens¹,

Adam²,

Weisshap³

et al. 2022

Front. Neurosci.

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IntroductionFace-to-face medical and psychotherapeutic treatments during the Corona pandemic often involve patients and health care providers wearing face masks. We performed a pilot survey assessing the subjective experience of wearing face masks during psychotherapy sessions regarding (i) feasibility, (ii) psychotherapeutic treatment and (iii) communication, emotion and working alliance in patients and healthcare professionals.MethodsA total of n = 62 inpatients (RR = 95.4%) and n = 33 healthcare professionals (RR = 86.8%) at an academic department of Psychosomatic Medicine and Psychotherapy participated in this survey anonymously. The items of the questionnaire were created by the interprofessional expert team and were based on existing instruments: (i) the Therapeutic Relationship Questionnaire and (ii) the German translation of Yalom’s Questionnaire on Experiencing in Group Psychotherapy.ResultsThe majority of patients rate their psychotherapy as highly profitable despite the mask. In individual therapy, face masks seem to have a rather low impact on subjective experience of psychotherapy and the relationship to the psychotherapist. Most patients reported using alternative facial expressions and expressions. In the interactional group therapy, masks were rather hindering. On the healthcare professional side, there were more frequent negative associations of face masks in relation to (i) experiencing connectedness with colleagues, (ii) forming relationships, and (iii) therapeutic treatment.DiscussionInformation should be given to patients about the possible effects of face masks on the recognition of emotions, possible misinterpretations and compensation possibilities through alternative stimuli (e.g., eye area) and they should be encouraged to ask for further information. Especially in group therapy, with patients from other cultural backgrounds and in cases of need for help (e.g., hearing impairment) or complex disorders, appropriate non-verbal gestures and body language should be used to match the intended emotional expression.

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On the difficulties of building therapeutic relationships when wearing face masks

Cited by 9 publications

References 9 publications

Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition

Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition

Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions

The role of face masks within in-patient psychotherapy: Results of a survey among inpatients and healthcare professionals

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