Exploring the Question: “Does Empathy Work in the Same Way in Online and In-Person Therapeutic Settings?”

Providing remote psychotherapy using technology is a growing practice, especially since the outbreak of the COVID-19 pandemic. Even if in numerous studies video conferencing psychotherapy (VCP) was found to be clinically effective, some doubts continue to exist about how the psychotherapeutic alliance works in the online setting, and the characteristics of the empathic process are still poorly understood. This is an exploratory study aimed at analyzing the degree of empathy between the psychotherapist and client pair, and the degree of support perceived by the client who shall be referred to as the patient interchangeably in this study, comparing the sessions in person with those online, during the current pandemic, in order to discriminate the impact of empathy in the digital setting. The sample analyzed was composed of 23 patients with different severity of pathology engaged in online and in-person therapeutic sessions with five psychotherapists of different theoretical leanings. The scores of the support and empathy scale, obtained by both members of the psychotherapeutic couple in the two settings, were analyzed and compared. The test used belongs to an Italian adaptation of the Empathic Understanding (EU) of the Relationship Inventory. What emerged from comparing the scores was interesting: Unlike the psychotherapists, the patients perceived their therapists as significantly more empathic and supportive in the remote setting. These are rather important data, because the literature documents that client empathic perception measures represent a more accurate measure of the empathic relationship and, in general, can predict a good treatment outcome. Although these results need further investigation, they represent an important contribution in filling the scientific gap in the understanding of digital empathy. Also, this study provides new insights for future research on the characteristics and impact empathy has on the practice of remote psychotherapy.

Ethics of the Psychotherapeutic Alliance, Shared Decision Making and Consensus on Therapy Goals

The ethics of the psychotherapeutic alliance (a), shared decision making (b), and consensus on therapy goals (c) is discussed in the context of a legal overview in three German-speaking countries. Particular ethical challenges are identified in different settings. Clinical Ethics Support (CES) has gained importance beyond acute medical patient care, but is still new in psychotherapy. Three examples present ethical issues underlying the basic concepts of psychotherapy (a, b, and c) that often go unnoticed or remain implicit. Addressing ethical questions in a practical psychotherapy context may lead to acknowledging more complexity than expected. At the same time, meta-level ethical reflection can help to coordinate previously diverging interests and efforts and remove obstacles towards problem-solving. Complexity as well as problem solving will be illustrated by referring to problems with confidentiality concerning sexual abuse, coercion in treating dependency disorders, and responding to wishes of assisted suicide.

Introducing an Observational Rating System for Studying Concordance in Patient–Physician Relationships

We developed the System for Observing Medical Alliances (SOMA) to study relationships between medical providers and patients with medically unexplained symptoms (MUS). Based on literature in health psychology, medicine, and the psychotherapeutic alliance, the SOMA operationalizes three medical alliance dimensions: Engagement in the Consultation Process, Trust in the Provider, and Concordance of Illness Beliefs and Treatment Recommendations. Specific behavioral indicators, tallied as observed by trained judges, are used as the basis for rating each dimension. In a sample of 33 medical consultations with veterans who had MUS, interrater reliabilities ranged from .79 to .94. Notably, the other dimension ratings accounted for 40% of the variability in Concordance, with Trust in the Provider contributing unique variance. In addition to research, psychologists in integrated health settings can use the SOMA to consult and train medical providers on communication skills that enhance concordance.

Trust, Between Tacit Self-Confidence and Self-Opacity: Some Clinical Phenomenology Issues

A large amount of research in mental health care relates to the notion of trust, as a possible common factor in psychopathology, and as a common dimension of psychotherapeutic alliance, underlying the various therapeutic methods. Such hypotheses call for a more detailed analysis of this notion of trust. The paper seeks to shed light on this issue by confronting the clinical and phenomenological approaches. We propose to focus on three issues at stake: 1/ the issue of the existence of a tacit or pre-reflective trust, which can be defined by a phenomenological method. 2/ the issue of a foundation of trust in empathy, which questions the debates about empathy in phenomenological works. 3/ the issue of a structural self-opacity, brought to light through the paradoxical structure of trust, and that we propose to tackle with the notions of attestation and narrative identity.

Interview and therapeutic rapport in diagnostic process

Diagnostic assessment in psychiatry, as a formulation and as a joint re-construction process between the clinician and the patient, is essential in clinical care. Clinical interview is the crucial tool of the clinician in this process. Accordingly, a two-fold task is faced. On one hand, the clinician is in need of making a comprehensive diagnostic assessment to construct a valid and working formulation of the patient's situation and a treatment plan.On the other hand, the bases for a psychotherapeutic alliance and rapport should be established. A comprehensive diagnostic assessment aims to bridge the current scientific evidence and knowledge with the uniqueness of the specific person who presents for care. The clinician facing the complexities of the human existence in health and ill mental health constructs working hypotheses in the context of the interview, to understand and formulate the psychopathological state. Clinical interview serving as a practical channel in constructing these hypotheses, also serves as the main tool in establishing a therapeutic alliance. The theory and practice of different schools of psychotherapies offer considerable contributions to the clinician in managing these tasks.Understanding the meaning of the human suffering through empathy in a judgment free milieu is essential in the establishment of rapport, compliance and a better clinical outcome. This presentation will discuss the complexity of diagnostic process in psychiatry and emphasize the contributions of psychotherapeutic theory and skills and humanistic approaches in this process. Brief clinical vignettes from the authors’ clinical practice will be used to broaden the scope of discussion.Disclosure of interestThe author has not supplied his declaration of competing interest.

Women and a Changing Society: Implications for Transference/Countertransference

The word feminism conveys a variety of definitions, attitudes, and behaviours in contemporary society. Thus, the psychotherapist must clarify the woman's definition of this term and examine personal knowledge regarding the changing roles of women and men. Three categories of factors are discussed that affect the woman's self-determination, creativity, cooperativeness in therapy and her decision about goals. These factors include female identity formation within the family, level of autonomy development, and transference / counter transference issues. Four case histories illustrate the complex interactions of these factors. The vignettes emphasize the crucial importance of the psychotherapeutic alliance in a changing society where conflict exists about appropriate ways to express authenticity.