Psychodynamic Psychiatry and the Therapeutic Space in the Era of COVID-19.

Psychodynamic psychiatric practice during the COVID-19 pandemic has required most clinicians to conduct treatment online or by telephone. The result is a natural experiment that appears to endorse the efficacy of distance therapy. Consequently, the brick-and-mortar consulting room is no longer the presumptive therapeutic space for the conduct of psychodynamic psychiatric or other treatment approaches. The therapeutic space is reconceived as the place or medium intended for treatment and is distinguished from both the therapeutic relationship and conduct of treatment that occurs within that space. How different therapeutic spaces impact treatment is discussed with specific application to psychodynamic psychiatry and virtual venues. The "digital object" becomes a new presence; the patient's freedom to disclose mental contents is retained though empathic attunement is diminished; a shift in power dynamics may occur; timing of sessions gains greater precision in the online environment. Beyond the pandemic, practicing online is likely to become an accepted supplementary therapeutic space for evaluation and treatment by psychodynamic psychiatrists.

Vicissitudes of Death Anxiety During the COVID-19 Pandemic.

The author, an experienced psycho-oncologist, offers clinical insights that consider the importance of death anxiety in psychodynamic psychotherapy treatments during the COVID-19 pandemic. He reviews the contributions of Ernst Becker, Wilfred Bion and Sheldon Solomon, and formulates ideas of his own based on decades of experience treating patients with cancer. This short essay focuses on how to help patients during the COVID-19 pandemic work through fear and uncertainty while developing adaptive skills.

Five Months Later: The Psychodynamic Psychiatrist and Psychiatric Care in the Era of COVID-19.

Five months following an earlier report on the initial impact of COVID-19, the same 24 contributing psychodynamic psychiatrists reported on how matters have shifted in their experience. Spread of the virus, lockdowns, politicization of all aspects of the pandemic, massive unemployment, and social justice frustrations have characterized the interim. The initial burst of acute uncertainty and worry has shifted into a more adaptive but still destabilizing long-term apprehension: distance treatment and its ramifications have become somewhat normalized, training now incorporates virtual treatment approaches, psychodynamically informed counseling has taken a larger role in the content of care. New theories of clinical practice are emerging that address these changes. As before, contributors' narratives are considered from the perspective of administration and training, structure and content of treatment, and the impact of the pandemic both on patients and psychiatrists.