Videoconferencing psychotherapy from a psychodynamic point of view. A qualitative analysis.

There is a growing interest in delivering videoconferencing psychotherapy (VCP) due to the enormous impact of the COVID-19 pandemic on our lives since the beginning of severe restrictions worldwide in March 2020. Scientific literature has provided interesting results about the transition to remote sessions and its implications, considering different psychotherapy orientations. Less is known about whether and how VCP affects psychodynamic psychotherapeutic approaches and reports on remote work with severe and complex mental health problems such as severe personality disorders are still scarce. The aim of the study was to examine the experiences of psychodynamic psychotherapists, mainly delivering Transference-Focused Psychotherapy (TFP), with the transition and delivery of VCP during the first wave of the COVID-19 pandemic. Four hundred seventy-nine licensed psychotherapists completed an online survey during the peak of the pandemic. Survey data were analyzed using qualitative analysis. Results are presented and discussed concerning advantages and disadvantages regarding the access to psychotherapy, the specificity of the online video setting, bodily aspects, the quality of the therapeutic relationship, the therapeutic process including technical aspects and therapist's experience. Furthermore, we analyzed and discussed the statements concerning transference and countertransference reactions differentiating between high-level borderline and neurotic patients and low-level borderline patients. Our results support the importance to identify patients who potentially benefit from VCP. Further research including more prospective randomized controlled trials are needed to investigate the therapeutic implications of the findings.

Conversion to Transference-Focused Psychotherapy from Other Treatments by the Same Therapist: Pitfalls and Benefits.

Borderline personality disorder and broadly speaking, borderline personality organization, including narcissistic personality disorder, can be effectively treated by transference-focused psychotherapy (TFP), which is a modern object relations-based structured psychoanalytic psychotherapy. TFP can be taught successfully to therapists from a wide array of backgrounds, not only to psychoanalysts, provided they have a basic grasp of psychodynamic concepts, including object relations theory. We initially thought that starting with a new patient would always be easier than conversion to TFP from a different method. Our supervisory experience supported this only partially. To learn more, we distributed a survey among therapists who completed formal TFP training or participated in supervision for at least 1 year. Only four of the 36 respondents felt that starting with a new case was easier. Conversion was a lot more common than we had expected (in fact, it seemed to be an almost inevitable part of training), and it often took place without appropriate supervision of the process. Moving from supportive therapy to TFP was the most difficult for the therapist, and often for the patient. All respondents felt that they would treat all new patients with borderline personality organization with TFP from the outset or, if indicated or necessary, begin with a preliminary treatment using TFP elements. Our findings strongly suggest that conversion needs to be taught in training seminars, and should not be left to be dealt with entirely in supervision.