An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid–19 pandemic

Background In addition to having a negative impact on the physical and emotional health of the population, the global Covid–19 pandemic has necessitated psychotherapists moving their practice to online environments. This service evaluation examines the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) Therapy delivered via the internet. Methods A real–world service evaluation was conducted from a self–selecting group of EMDR therapists that subscribe to either a JISCMail discussion list or either the UK or All Ireland National EMDR Associations. Author designed questionnaires were used to gather information on the efficacy of EMDR delivered online as well as client and therapist characteristics. Results Thirty-three therapists provided efficacy data on a total of 93 patients. Statistically significant and clinically meaningful reductions were found in all four-psychometrics used both in adult and children and young people populations. Client outcome was not related to therapist experience. Conclusions EMDR delivered via the internet can be an effective treatment for clients experiencing mental health issues.

A Pilot Study of a Sensor Enhanced Activity Management System for Promoting Home Rehabilitation Exercise Performed during the COVID-19 Pandemic: Therapist Experience, Reimbursement, and Recommendations for Implementation

Adherence to home exercise programs (HEPs) during physical rehabilitation is usually unmonitored and is thought to be low from self-reports. This article describes exploratory implementation of a Sensor Enhanced Activity Management (SEAM) system that combines HEP management software with a movement sensor for monitoring and motivating HEP adherence. The article also presents results from attempting to gain reimbursement for home use of the system with therapist oversight using Remote Physiologic Monitoring (RPM) codes. Four therapists used the system in their regular practice during the first six months of the COVID-19 pandemic. Therapists filled out surveys, kept notes, and participated in interviews. Billing and reimbursement data were obtained from the treatment facility. Exercise data from the SEAM system were used to understand HEP adherence. Patients were active for a mean of 40% (26% SD) of prescribed days and completed a mean of 25% (25% SD) of prescribed exercises. The therapists billed 23 RPM codes (USD 2353), and payers reimbursed eight of those instances (USD 649.21). The therapists reported that remote monitoring and the use of a physical movement sensor was motivating to their patients and increased adherence. Sustained technical support for therapists will likely improve implementation of new remote monitoring and treatment systems. RPM codes may enable reimbursement for review and program management activities, but, despite COVID-19 CMS waivers, organizations may have more success if these services are billed under supervision of a physician.

Empirically Supported Treatment for Obsessive-Compulsive Disorder

This chapter assesses which treatment should be chosen as the first-line intervention for obsessive-compulsive disorder (OCD). Cognitive Behavioral Therapy (CBT) involving Exposure Plus Response Prevention (ERP) is the treatment with the most empirical support, and its effects appear to be both robust and durable. The chapter then reviews the data on predictors and moderators of differential ERP outcomes. Contemporary ERP manuals emphasize the following core procedures: (1) psychoeducation; (2) hierarchy development; (3) in vivo and imaginal exposure; (4) response prevention; and (5) relapse prevention. The chapter looks at situations in which clinical circumstances dictate a deviation or modification of the protocol from the way these procedures are described in the manual or customarily implemented—being flexible while maintaining fidelity. Therapist experience appears to play a role in how comfortable clinicians are in being flexible, and how successful they are likely to be when they do so.

Taking the therapeutic community outside in the COVID-19 pandemic

Purpose The COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience. Design/methodology/approach A total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors. Findings There were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment. Research limitations/implications The authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work. Originality/value This study describes a novel way that a TC has adapted to the COVID-19 pandemic.

Measuring therapist cognitions contributing to therapist drift: a qualitative study

Therapist beliefs have been identified as a contributing factor to ‘therapist drift’ in cognitive behavioural therapy (CBT). Scales have been developed to measure therapist beliefs, but none explicitly measure ‘therapy-interfering cognitions’, and there is no research on their usage. The aim of this study was to explore how best to conceptualise such a scale’s content and usage, based on clinicians’ perceptions and experiences of current scales. Three focus groups were conducted, involving 12 participants who were either qualified or trainee CBT therapists. Transcripts were analysed using thematic analysis. Four main themes were generated: (1) The Awareness and Importance of Cognitions, (2) Factors Fuelling Therapist Cognitions, (3) Addressing Therapist Cognitions, and (4) Using the Scale. Participants thought it important to be aware of and address therapist cognitions (not underlying beliefs). Participants emphasised that therapist cognitions are not just products of the individual, but are influenced by external factors. A scale could enable therapists to do better work through reflective practice, as long as it was used not just to identify cognitions but also to support changes in therapist behaviour. A scale could also meet a perceived need for making this part of routine practice. However, participants discussed how therapists might have reservations about disclosing cognitions in this way. Recommendations for current practice, and future research developing such a scale, are made. Key learning aims (1) To describe the phenomenon of therapist drift, and the contributions of therapist beliefs to this. (2) To explore the usage of current scales for measuring therapist beliefs. (3) To understand, based on therapist experience, how to address therapist beliefs in current practice using scales.

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

BackgroundMaintaining 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 the use of 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.MethodsIn 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.ResultsTelepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that was mainly driven by lower ratings in the videoconferencing group and, as suggested by further analyses, may decline over time. No other statistically significant differences were observed. Elements that were mentioned as facilitating or complicating a session differed markedly between patients and therapists.ConclusionsBoth 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.

Psychotherapists’ altered states of consciousness

The majority of research that has been conducted around counselling and psychotherapy has been directed towards the evaluation of client outcome and client experience. Studies concentrated solely on therapist experience during the therapeutic encounter are largely in the minority. The purpose of this study was to explicate a deeper understanding of the unusual and unforgettable events that led to dramatic shifts in consciousness experienced by some counsellors and psychotherapists during the therapeutic hour. A study group of six participants was assembled via open invitation. The group comprised of three student counsellors nearing the end of their studies and three qualified therapists of varying degrees of experience. A semi-structured interview process provided transcriptions of the participant experiences, and an interpretative phenomenological analysis was conducted. This study found that the willingness to be open to the presence and essence of another, on both sides of the therapeutic dyad, had the potential to contribute to the intense, powerful and profound experiences arising in the therapist. In all cases, the unusual events and altered states led to the deepening of the healing potential within the therapy whilst simultaneously providing developmental propulsion for each practitioner.