Zoomed Out: Trainee Psychotherapist Perspectives on Online Clinical Work During the COVID-19 Pandemic

Abstract

During lockdown in response to COVID-19, students in the Master of Psychotherapy at Auckland University of Technology were required to rapidly move their clinical work online. We surveyed these students about their experience of working clinically online. We used a mixed-methods approach and analysed qualitative data using grounded theory methods. Students found the move online challenging in terms of the technological challenges, lack of professional clinical space, and establishing and maintaining the therapeutic alliance. Students showed a strong preference for in-person (or, face-to-face) clinical work, along with scepticism about the efficacy of online therapy, though some acknowledged its convenience and others its currency and relevance. Most expressed a need for more specific training in online therapy. The literature finds equivalence between the effectiveness of in-person and online therapy. However, it acknowledges that online therapy can impose increased strain on clinicians and finds that clinician expectations directly impact their capacity to manage online clinical work.

Online psychotherapy as a first clinical experience during the Covid-19 pandemic: A new generation of psychotherapists in the digital age

“…These findings are consistent with previous research considering the various circular phases and processes of psychotherapy training [ [30] , [31] , [32] , [33] , 69 , 70 ]. There is a massive uncertainty at the beginning of a professional training that requires space, structure and a foothold.…”

“…Despite the challenging situation, the hurdles were still successfully overcome by reflection and the creation of ritualized behavior, as well as increased conscious self-care. Adapting to the new conditions, not only that of professional practice, but additionally, the dissolution of boundaries in the online space, required an increased expenditure of energy [ 18 , 30 , 33 , 54 ]. This effort enabled the acquisition of new and otherwise rarely experienced skills that would not have been possible in the regular setting.…”

“…Nor will they become acquainted with the pre-existing therapeutic field, as their experience set has already been shaped from the beginning by the perceptions of online therapy. A generation that has grown up with the technical know-how and digital networks of the modern world, knowing the potential in clinical work, cannot be denied further exposure to online therapy [ 8 , 33 ]. The media age has already begun for psychotherapy [ 65 , 71 , 72 , 75 , 76 ].…”

“…This circumstance makes it necessary to continue to investigate the field of online therapy, especially the importance of the body in the digital space. Setting training priorities and adapting method-specific techniques adequately for online treatment is now a requirement [ 8 , 27 , 33 , 77 ]. Sensitizing psychotherapists in training to the indications and possibilities of using online therapy as a targeted intervention is no longer a goal for the future, especially when the current generation of psychotherapists in training and the majority of clients have already arrived and are in the midst of it.…”

“…Studies have shown that psychotherapists who are at the beginning of their professional development have increased levels of anxiety [ [30] , [31] , [32] ]. Uncertainty and doubt are typical in this stage of professional education and were now combined with the anxiety-evoking challenges of the pandemic [ 33 ]. Sigmund Freud Private University (SFU) offers academic training in psychotherapy science, and psychotherapists in training who start their clinical practice with patients in the clinic are usually 24 years old and have no previous experience in working with psychotherapy patients one-on-one.…”