Psychotherapy During COVID-19: How the Clinical Practice of Italian Psychotherapists Changed During the Pandemic

Abstract

Aims: Italy was one of the first countries to be significantly affected by the coronavirus disease 2019 (COVID-19) pandemic, determining a unique scenario for Italian psychotherapists to consider changing the modality in which they deliver treatment. The present study aimed at studying which factors related to psychotherapists and their clinical practice had a major role in predicting two main outcomes: (1) the rate of interrupted treatments during lockdown and (2) psychotherapists' satisfaction with the telepsychotherapy modality. Methods: An online survey was administered to licensed psychotherapists (n = 306), who worked mainly as private practitioners, between April 5 and May 10, 2020 (i.e., the peak of the pandemic in Italy). Results: Psychotherapists reported that 42.1% (SD = 28.9) of their treatments had been interrupted, suggesting that Italy faced an important undersupply of psychotherapy during the lockdown. Using the Akaike information criterion (AIC) model selection, we identified three predictors of the rate of interrupted treatments: (1) psychotherapists' lack of experience with telepsychotherapy prior to the lockdown, (2) their theoretical orientation (with cognitive behavioral psychotherapists reporting a higher rate of interrupted treatments), and (3) patients' lack of privacy at home, as reported to the psychotherapists. Furthermore, we found four predictors of psychotherapists' satisfaction with the telepsychotherapy modality: (1) the rate of interrupted treatments, (2) psychotherapists' previous experience with telepsychotherapy, (3) their beliefs about the compatibility of telepsychotherapy with their theoretical orientation, and (4) their use of a video-conferencing modality, rather than telephone. Conclusion: The following recommendations can help policy makers, professional associations, and practitioners in promoting the continuity of psychotherapy treatments during the COVID-19 outbreak and in future emergencies: (i) disseminating training programs for practitioners on telepsychotherapy, (ii) supporting patients to pragmatically access a private space at home, (iii) encouraging practitioners to use video-conferencing (instead of telephone) to deliver remote therapy, and (iv) increasing the acceptance of telepsychotherapy among both clinicians and the general public.

Keywords: COVID-19; psychotherapy; public health; remote psychotherapy; telepsychotherapy.

Figure 1

The respective plots depict (A) the number of patients in treatment during the month prior to lockdown as a function of psychotherapists’ work settings (i.e., independent practices, hospitals, public mental health, and housing services) and patient orientation (i.e., family and couples, individual, and group); (B) psychotherapists’ theoretical orientations [i.e., psychodynamic, cognitive behavioral therapy (CBT), and “other”]; and (C) the proportion of patients in treatment in the month prior to lockdown, as a function of clinicians’ theoretical orientation (i.e., psychodynamic, CBT, and “other”) and patient orientation (i.e., family and couples, individual, and group).

Figure 2

The plots depict the parameters selected as the best predictors of the rate of interrupted treatments. In particular, they represent differences between (A) theoretical orientations (i.e., psychodynamic, CBT, and “other”); (B) psychotherapists’ use of telepsychotherapy prior to the lockdown (i.e., none, rare, and frequent); and (C) patients’ lack of privacy at home, as reported to psychotherapists (i.e., yes, no).

Figure 3

The plots depict the parameters selected as the best predictors of differences in psychotherapists’ satisfaction with telepsychotherapy. In particular, the respective plots represent the variation in perceived satisfaction according to (A) the rate of interrupted treatments; (B) the use of video-conferencing to deliver sessions; (C) psychotherapists’ use of telepsychotherapy prior to the lockdown (i.e., none, rare, and frequent); and (D) psychotherapists’ beliefs about the compatibility of telepsychotherapy with their theoretical orientation (i.e., yes, no).