Telepsychology in Europe since COVID-19: How to Foster Social Telepresence?

All over the world, measures were taken to prevent the spread of COVID-19. Social distancing not only had a strong influence on mental health, but also on the organization of care systems. It changed existing practices, as we had to rapidly move from face-to-face contact to remote contact with patients. These changes have prompted research into the attitudes of mental healthcare professionals towards telepsychology. Several factors affect these attitudes: at the institutional and organizational level, but also the collective and personal experience of practitioners. This paper is based on an original European survey conducted by the EFPA (European Federation of Psychologists' Associations) Project Group on eHealth in 2020, which allowed to observe the variability in perceptions of telepsychology between countries and mental healthcare professionals. This study highlights different variables that contributed to the development of attitudes, such as motivations, acquired experience, or training. We found the "feeling of telepresence"-which consists of forgetting to some extent that we are at a distance, in feeling together-and social telepresence in particular as main determinants of the perception and the practice of telepsychology.

Online consultations in mental healthcare: Modelling determinants of use and experience based on an international survey study at the onset of the pandemic.

Introduction: While online consultations have shown promise to be a means for the effective delivery of high-quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative standstill and created a unique turning point, with a massive amount of both professionals and clients having first hands-on experiences with technology in mental healthcare. Objective: The current study aimed to document the uptake of online consultations and explore if specific characteristics of mental health professionals across and beyond Europe could predict this. Methods: An international survey was designed to assess mental health professionals' (initial) experiences with online consultations at the onset of the pandemic: their willingness to make use of them and their prior and current experiences, alongside several personal characteristics. Logistic mixed-effects models were used to identify predictors of the use of online consultations, personal experience with this modality, and the sense of telepresence. Results: A total of 9115 healthcare professionals from 73 countries participated of which about two-thirds used online consultations during the initial COVID-19 outbreak. The current study identifies multiple determinants relating to the use and experience of online consultations, including the professionals' age, experience with the technology before the outbreak, the professional context, and training. Conclusions: Despite strong evidence supporting the relevance of training in digital mental health, this is clearly still lacking. Nevertheless, the COVID-19 pandemic presented a first, and potentially transformative, experience with online consultations for many healthcare professionals. The insights from this study can help support professionals and, importantly, (mental) healthcare organisations to create optimal circumstances for selective and high-quality continued use of online consultations.

Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers.

INTRODUCTION: While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks. OBJECTIVE: This study investigates the uptake of online consultations provided by mental health professionals during lockdown measures in the first wave of the COVID-19 pandemic in the participating countries, with a specific focus on professionals' motivations and perceived barriers regarding online consultations. METHODS: An online survey on the use of online consultations was set up in March 2020. The Unified Theory of Acceptance and Use of Technology (UTAUT) guided the deductive qualitative analysis of the results. RESULTS: In total, 2082 mental health professionals from Austria, Belgium, Cyprus, France, Germany, Italy, Lebanon, Lithuania, the Netherlands, Norway, Portugal, Spain, and Sweden were included. The results showed a high uptake of online consultations during the COVID-19 pandemic but limited previous training on this topic undergone by mental health professionals. Most professionals reported positive experiences with online consultations, but concerns about the performance of online consultations in a mental health context (e.g., in terms of relational aspects) and practical considerations (e.g., relating to privacy and security of software) appear to be major barriers that hinder implementation. CONCLUSIONS: This study provides an overview of the mental health professionals' actual needs and concerns regarding the use of online consultations in order to highlight areas of possible intervention and allow the implementation of necessary governmental, educational, and instrumental support so that online consultations can become a feasible and stable option in mental healthcare.

Leaders' smiles reflect cultural differences in ideal affect.

Cultures differ in the emotions they teach their members to value ("ideal affect"). We conducted 3 studies to examine whether leaders' smiles reflect these cultural differences in ideal affect. In Study 1, we compared the smiles of top-ranked American and Chinese government leaders, chief executive officers, and university presidents in their official photos. Consistent with findings that Americans value excitement and other high-arousal positive states more than Chinese, American top-ranked leaders (N = 98) showed more excited smiles than Chinese top-ranked leaders (N = 91) across occupations. In Study 2, we compared the smiles of winning versus losing political candidates and higher versus lower ranking chief executive officers and university presidents in the United States and Taiwan/China. American leaders (N = 223) showed more excited smiles than Taiwanese/Chinese leaders (N = 266), regardless of election outcome or ranking. In Study 3, we administered self-report measures of ideal affect in college student samples from 10 different nations (N = 1,267) and then 8 years later, coded the smiles that legislators from those nations showed in their official photos (N = 3,372). The more nations valued excitement and other high arousal positive states, the more their leaders showed excited smiles; similarly, the more nations valued calm and other low-arousal positive states, the more their leaders showed calm smiles. These results held after controlling for national differences in democratization, human development, and gross domestic product per capita. Together, these findings suggest that leaders' smiles reflect the affective states valued by their cultures.

Presence at a distance.

Nowadays in the context of the cyberculture, computer-mediated inter-subjective relationships are part of our everyday lives, in both the professional and personal spheres, and for all age groups. In the clinical field, many applications have been developed to facilitate the exchange of informations and mediate the relationship between patient and therapist. In psychology, more or less immersive technologies are used, to encourage the feeling of presence among the users, and to trigger certain psychological processes. In our research, we have explored the remote clinical interview through videoconferencing, with the development and utilisation of the iPSY platform, totally focused on this objective. In this context, we have considered the notion of intersubjectivity, despite the physical absence. This research is leading us today to envision the notions of distance and presence, and possibly to redefine them. Thus, can we still oppose physical distance to psychological distance? Can we still affirm that the physical absence does not permit a psychological co-presence in certain interactions, like this observed in video interviews? The results show that the psychological processes, activated in this context, are similar to those observed in "traditional" clinical consults between the patient and the therapist. However, certain specifics have led us to consider the concept of distance, here influenced by the framework, and to observe its effects. This distance could possibly constitute a therapeutic lever for some patients, notably for those who have difficulties establishing the right psychological distance in their relationships with others. According to these results, can "distance" still be opposed to "presence", or could it be re-defined? This also opens up questions on the more general concept of digital relationships, and the definition of their specificities.

Intersubjectivity in video interview.

The concept of relationship has rapidly evolved over the past few years, since the emergence of the internet network and the development of remote communication and exchanges. The emergence of cyberculture with the development of the internet has led to a new representation of the social link, in which communication never stops. In this context, computer mediated intersubjective relationships represent a main line of thinking and research. Thus, can we consider for example that relationship is only composed of an informational exchange? Would there be other dimensions possibly missing in computer mediated relationships? In this case, how could we re-introduce these aspects, "re-humanize" the remote relationships? New practices in psychology emerge with the ICT usage, both in the fields of research and for therapeutic purposes. Some fields like medicine already use remote health platforms that have proven useful in certain situations. In the field of remote clinical psychology, different media are used that contribute to the framework definition of the remote clinical interview, where the concept of relation holds a central place. Videoconference enables the introduction of an important element from the point of view of sensoriality: the body image, which engages the subjects' interaction in a different way than in a written or verbal exchange. But is the use of videoconference sufficient to establish a clinical framework comparable to the traditional one? How can the computer-mediated relationship enable and establish a potential object relation, rather than a mirrored one? Thinking through an online adaptation of the clinical interview framework led to the elaboration of a specific tool dedicated to this purpose and to research into the access to intersubjectivity in clinical video interview. This study's encouraging results have fostered the pursuit of this experience in the form of a platform dedicated to the conduction of clinical interviews through videoconferencing for psychotherapists and patients at large. A methodological analysis accompanies this research work, in order to continuously observe this specific clinical practice, which can be used in different fields of psychology and different psychotherapeutic methods.

A video interview experience.

This article discusses a possible use of information and communication technologies (ICT) to interact with another person remotely in a psychotherapeutic framework. We herewith present a tool specifically created for our study using the Internet. This tool is a Web site, which enables professional psychologists to conduct video interviews with their patients in a secure framework that resembles as much as possible the classical one, in order to "rehumanize" the interactions. However, specificities of such a framework have been analyzed in order to think about a methodology adapted to our use. A clinical case will present a narcissistic problem, and show us that the use of the Web site can enable the classical psychotherapeutic relationship to exist in a similar transference and countertransference process.