The transition to online psychotherapy during the pandemic: a qualitative study on patients’ perspectives

Submitted: June 20, 2022
Accepted: September 19, 2022
Published: November 4, 2022
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The coronavirus disease 2019 (COVID-19) pandemic has substantially increased online psychotherapies due to the impossibility of participating in vis-a-vis settings. In the last years, research about online therapy has been quickly growing. However, until now, few studies investigated patients’ perspective about the transition to online psychotherapy and, specifically, no qualitative research in group therapy has been done on this topic. This study aimed to explore the experience of 51 patients (39 group patients and 12 from individual psychotherapies) who continued psychotherapy in the online setting during the COVID-19 outbreak. A structured online questionnaire with open answers investigated the following topics: setting online, effectiveness, psychotherapy relationship, specific dynamics of online psychotherapy. Patients’ answers were analysed by means of Consensual Qualitative Research, modified version (CQRM), an inductive method that allows analysing a large sample and relatively brief written answers. The results show the impact of shift to online platforms on patients and explore how easy or difficult it is for them to adapt to therapeutic processes are in online therapy (vs in-person therapy), by highlighting potential barriers and resources to practice implementation. Participants’ responses have been arranged into three main domains: setting online, content/effectiveness of online therapy and therapeutic relationship. A fourth domain, specific for online group therapy, collected responses referred to the changes perceived regarding the group dynamics. From the patient’s perspective, online therapy is effective and satisfying. Patients perceived a positive quality of therapeutic relationship in online setting, whereas produced more controversial judgments concerned the changes due to the online setting. Finally, patients in group therapy gave more attention and importance in showing and seeing private personal spaces than the ones in individual therapy.

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Alldredge, C. T., Burlingame, G. M., Yang, C., & Rosendahl, J. (2021). Alliance in group therapy: A meta-analysis. Group Dynamics, 25(1), 13-28. doi:10.1037/gdn0000135.
Andrade, C. (2020). The limitations of online surveys. Indian Journal of Psychological Medicine, 42(6), 575-576. doi:10.1177/0253717620957496.
Asmundson, G., & Taylor, S. (2020). Coronaphobia: Fear and the 2019-nCoV outbreak. Journal of Anxiety Disorders, 70, 102196. doi:10.1016/j.janxdis.2020.102196.
Barak, A., Klein, B., & Proudfoot, J. G. (2009). Defining internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38(1), 4-17. doi:10.1007/s12160-009-9130-7.
Beaunoyer, E., Dupéré, S., & Guitton, M. J. (2020). COVID-19 and digital inequalities: Reciprocal impacts and mitigation strategies. Computers in Human Behavior, 111, 106424. doi:10.1016/j.chb.2020.106424.
Beaunoyer, E., Dupéré, S., & Guitton, M. J. (2020). COVID-19 and digital inequalities: Reciprocal impacts and mitigation strategies. Computers in Human Behavior, 111, 106424. doi:10.1016/j.chb.2020.106424.
Békés, V., Aafjes-van Doorn, K., Luo, X., Prout, T. A., & Hoffman, L. (2021). Psychotherapists’ challenges with online therapy during COVID-19: concerns about connectedness predict therapists’ negative view of online therapy and its perceived efficacy over time. Frontiers in Psychology, 12, 705699. doi:10.3389/fpsyg.2021.705699.
Boldrini, T., Schiano Lomoriello, A., Del Corno, F., Lingiardi, V., & Salcuni, S. (2020). Psychotherapy during COVID-19: how the clinical practice of Italian psychotherapists changed during the pandemic. Frontiers in Psychology, 11, 591170. doi:10.3389/fpsyg.2020.591170.
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet (London, England), 395(10227), 912-920. doi:10.1016/S0140-6736(20)30460-8.
Brusadelli, E., Ferrari, L., Benetti, M., Bruzzese, S., Tonelli, G. M., & Gullo, S. (2020). Online Supportive Group as social intervention to face COVID lockdown. A qualitative study on psychotherapists, psychology trainees and students, and community people. Research in Psychotherapy: Psychopathology, Process, and Outcome, 23(3), 501. doi:10.4081/ripppo.2020.501.
Burlingame, G. M., McClendon, D. T., & Yang, C. (2018). Cohesion in group therapy: A meta-analysis. Psychotherapy: Theory, Research, & Practice, 55(4), 384-398. doi:10.1037/pst0000173.
Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1-18. doi:10.1080/16506073.2017.1401115.
Connolly, S. L., Miller, C. J., Lindsay, J. A., & Bauer, M. S. (2020). A systematic review of providers’ attitudes toward telemental health via videoconferencing. Clinical Psychology: Science and Practice, 27(2), Article e12311. doi:10.1111/cpsp.12311.
Cook, J. E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: preliminary results. Cyberpsychology & behavior: the impact of the Internet, multimedia and virtual reality on behavior and society, 5(2), 95-105. doi:10.1089/109493102753770480.
Di Blasi, M., Gullo, S., Mancinelli, E., Freda, M. F., Esposito, G., Gelo, O. C. G., Lo Coco, G. (2021). Psychological distress associated with the COVID-19 lockdown: A two-wave network analysis. Journal of Affective Disorders, 284, 18-26. doi:10.1016/j.jad.2021.02.016.
Faustino, B., Vasco, A. B., Delgado, J., Farinha-Fernandes A., & Guerreiro, J. C. (2020). Exploring the impacts of COVID-19 related social distancing on loneliness, psychological needs and symptomatology. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(3), 222-230. doi:10.4081/ripppo. 2020.492.
Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108-1122. doi:10.1037/ccp0000044.
García, E., Di Paolo, E. A., & De Jaegher, H. (2022). Embodiment in online psychotherapy: A qualitative study. Psychology and Psychotherapy, 95(1), 191-211. doi:10.1111/papt.12359.
Gentry, M. T., Lapid, M. I., Clark, M. M., & Rummans, T. A. (2019). Evidence for telehealth group-based treatment: A systematic review. Journal of Telemedicine and Telecare, 25(6), 327-342. doi:10.1177/1357633X18775855.
Giansanti, D., & Veltro, G. (2021). The Digital Divide in the Era of COVID-19: an investigation into an important obstacle to the access to the mHealth by the citizen. Healthcare (Basel, Switzerland), 9(4), 371. doi:10.3390/healthcare9040371.
Goldberg, S. B., & Hoyt, W. T. (2015). Group as social microcosm: Within-group interpersonal style is congruent with outside group relational tendencies. Psychotherapy (Chicago, Ill.), 52(2), 195-204. doi:10.1037/a0038808.
Gullo, S., Misici, I., Teti, A., Liuzzi, M., & Chiara, E. (2020). Going through the lockdown: a longitudinal study on the psychological consequences of the coronavirus pandemic. Research in Psychotherapy: Psychopathology, Process, and Outcome, 23(3). doi:10.4081/ripppo.2020.494.
Gullo, S., Lo Coco, G., Leszcz, M., Marmarosh, C. L., Miles, J. R., Shechtman, Z., Weber, R., & Tasca, G. A. (2022). Therapists’ perceptions of online group therapeutic relationships during the COVID-19 pandemic: A survey-based study. Group Dynamics: Theory, Research, and Practice, 26(2), 103-118. doi:10.1037/gdn0000189.
Hill, C. E. (2015). Consensual qualitative research (CQR): Methods for conducting psychotherapy research. In O. C. G. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy research: Foundations, process, and outcome (pp. 485-499). Springer-Verlag Publishing. doi:10.1007/978-3-7091-1382-0_23.
Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: a 2013 review. Telemedicine and e-Health, 19(6), 444-454. doi:10.1089/tmj.2013.0075.
Johnson, J. E., Burlingame, G. M., Olsen, J., Davies, D. R., & Gleave, R. L. (2005). Group climate, cohesion, alliance, and empathy in group psycho- therapy: Multilevel structural equation models. Journal of Counseling Psychology, 52(3), 310-321. doi:10.1037/0022-0167.52.3.310.
Kivlighan, D. M., Gullo, S., Giordano, C., Di Blasi, M., Giannone, F., & Lo Coco, G. (2021). Group as a social microcosm: The reciprocal relationship between intersession intimate behaviors and in-session intimate behaviors. Journal of Counseling Psychology, 68(2), 208-218. doi:10.1037/cou0000495.
Kocsis, B. J., & Yellowlees, P. (2018). Telepsychotherapy and the Therapeutic Relationship: Principles, Advantages, and Case Examples. Telemedicine journal and e-health: the official journal of the American Telemedicine Association, 24(5), 329-334. doi:10.1089/tmj.2017.0088.
Knight Z. G. (2021). Living under lockdown in the shadow of the COVID-19 pandemic in South Africa: anxious voices from the unplanned shift to online therapy. Research in Psychotherapy (Milano), 23(3), 487. doi:10.4081/ripppo.2020.487.
Lamb, T., Pachana, N. A., & Dissanayaka, N. (2019). Update of recent literature on remotely delivered psychotherapy interventions for anxiety and depression. Telemedicine and e-Health, 25(8), 671-677. doi:10.1089/tmj.2018.0079.
Lewis, Y. D., Elran-Barak, R., Grundman-Shem Tov, R., & Zubery, E. (2021). The abrupt transition from face-to-face to online treatment for eating disorders: a pilot examination of patients’ perspectives during the COVID-19 lockdown. Journal of Eating Disorders, 9(1), 31. doi:10.1186/s40337-021-00383-y.
Marazziti, D., Pozza, A., Di Giuseppe, M., & Conversano, C. (2020). The psychosocial impact of COVID-19 pandemic in Italy: A lesson for mental health prevention in the first severely hit European country. Psychological Trauma: Theory, Research, Practice and Policy, 12(5), 531-533. doi:10.1037/tra0000687.
Markowitz, J. C., Milrod, B., Heckman, T. G., Bergman, M., Amsalem, D., Zalman, H., Ballas, T., & Neria, Y. (2021). Psychotherapy at a Distance. The American Journal of Psychiatry, 178(3), 240-246. doi:10.1176/appi.ajp.2020.20050557.
Naik, S. S., Manjunatha, N., Kumar, C. N., Math, S. B., & Moirangthem, S. (2020). Patient’s Perspectives of Telepsychiatry: The Past, Present and Future. Indian Journal of Psychological Medicine, 42(5 Suppl), 102S-107S. doi:10.1177/0253717620963341.
Norwood, C., Moghaddam, N. G., Malins, S., & Sabin-Farrell, R. (2018). Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis. Clinical Psychology & Psychotherapy, 25(6), 797-808. doi:10.1002/cpp.2315.
Poletti B., Tagini B., Brugnera A., Parolin L., Pievani L., Ferrucci R., Compare A., & Silani V. (2021). Telepsychotherapy: a leaflet for psychotherapists in the age of COVID-19. A review of the evidence, Counselling Psychology Quarterly, 34(3-4), 352-367. doi:10.1080/09515070.2020.1769557.
Probst, T., Haid, B., Schimböck, W., Reisinger, A., Gasser, M., Eichberger-Heckmann, H., Stippl, P., Jesser, A., Humer, E., Korecka, N., & Pieh, C. (2021). Therapeutic interventions in in-person and remote psychotherapy: Survey with psychotherapists and patients experiencing in-person and remote psychotherapy during COVID-19. Clinical Psychology & Psychotherapy, 28(4), 988-1000. doi:10.1002/cpp.2553.
Puspitasari, A. J., Heredia Jr, D., Gentry, M., Sawchuk, C., Theobald, B., Moore, W., & Schak, K. (2021). Rapid adoption and implementation of telehealth group psychotherapy during COVID 19: practical strategies and recommendations. Cognitive and Behavioral Practice, 28(4), 492-506. doi:10.1016/j.cbpra.2021.05.002.
Rajkumar, R. P. (2020). COVID-19 and mental health: a review of the existing literature. Asian Journal of Psychiatry, 52, 102066. doi:10.1016/j.ajp.2020.102066.
Rees, C. S., & Stone, S. (2005). Therapeutic alliance in face-to-face versus videoconferenced psychotherapy. Professional Psychology: Research and Practice, 36(6), 649-653. doi:10.1037/0735-7028.36.6.649.
Rochlen, A. B., Zack, J. S., & Speyer, C. (2004). Online therapy: review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60(3), 269-283. https://doi.org/10.1002/jclp.10263
Roesler C. (2017). Tele-analysis: the use of media technology in psychotherapy and its impact on the therapeutic relationship. The Journal of Analytical Psychology, 62(3), 372-394. doi:10.1111/1468-5922.12317.
Shklarski, L., Abrams, A., & Bakst, E. (2021). Will We Ever Again Conduct in-Person Psychotherapy Sessions? Factors Associated with the Decision to Provide in-Person Therapy in the Age of COVID-19. Journal of Contemporary Psychotherapy, 51(3), 265-272. doi:10.1007/s10879-021-09492-w.
Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: a review. The Australian Journal of Rural Health, 22(6), 280-299. doi:10.1111/ajr.12149.
Simpson, S., Richardson, L., Pietrabissa, G., Castelnuovo, G., & Reid, C. (2021). Videotherapy and therapeutic alliance in the age of COVID-19. Clinical Psychology & Psychotherapy, 28(2), 409-421. doi:10.1002/cpp.2521.
Smith, J., & Gillon, E. (2021). Therapists’ experiences of providing online counselling: A qualitative study. Counseling and Psychotherapy Research, 21 (3), 545-554. doi:10.1002/capr.12408.
Spangler, P. T., Liu, J., & Hill, C. E. (2012). Consensual qualitative research for simple qualitative data: An introduction to CQR-M. In C. E. Hill (Ed.), Consensual qualitative research: A practical resource for investigating social science phenomena (pp. 269-283). American Psychological Association.
Sperandeo, R., Cioffi, V., Mosca, L. L., Longobardi, T., Moretto, E., Alfano, Y. M., Scandurra, C., Muzii, B., Cantone, D., Guerriera, C., Architravo, M., & Maldonato, N. M. (2021). Exploring the question: ‘Does empathy work in the same way in online and in-person therapeutic settings?’. Frontiers in Psychology, 12, 671790. doi:10.3389/fpsyg.2021.671790.
Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical issues in online psychotherapy: a narrative review. Frontiers in Psychiatry, 10, 993. doi:10.3389/fpsyt.2019.00993.
Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547-559. doi:10.1037/a0028226.
Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., McKay, D., & Asmundson, G. (2020). COVID stress syndrome: Concept, structure, and correlates. Depression and Anxiety, 37(8), 706-714. doi:10.1002/da.23071.
Thomas, N., McDonald, C., de Boer, K., Brand, R. M., Nedeljkovic, M., & Seabrook, L. (2021). Review of the current empirical literature on using videoconferencing to deliver individual psy- chotherapies to adults with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, 94(3), 854-883. doi:10.1111/papt.12332.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health, 17(5), 1729. doi:10.3390/ijerph17051729.
Weinberg, H. (2021). Obstacles, challenges, and benefits of online group psychotherapy. American Journal of Psychotherapy, 74(2), 83-88. doi:10.1176/appi.psychotherapy.20200034.
Xiang, Y. T., Yang, Y., Li, W., Zhang, L., Zhang, Q., Cheung, T., & Ng, C. H. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry, 7(3), 228-229. doi:10.1016/S2215-0366(20)30046-8.
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.
Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C. (2020). The role of telehealth in reducing the mental health burden from COVID-19. Telemedicine and e-Health, 26(4), 377-379. doi:10.1089/tmj.2020.0068.

How to Cite

Giordano, C., Ambrosiano , I. ., Graffeo, M. T., Di Caro, A., & Gullo, S. . (2022). The transition to online psychotherapy during the pandemic: a qualitative study on patients’ perspectives. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(3). https://doi.org/10.4081/ripppo.2022.638

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