Everything we know about online therapy three years into the pandemic: ‘If I need to cry, cry even with a screen in between’ | technology

Once a week, during lunchtime, Juan Acosta, 33, takes a break from work and prepares for his online therapy session. He finds a quiet place in the house, gets comfortable with coffee by his side, opens Zoom and starts talking with his psychiatrist, who he’s been working with for three years now. Acosta met her shortly before the pandemic began, and the sessions, which were initially face-to-face, quickly became online due to the long and strict confinement in Argentina. But even when people were able to get out again, Acosta continued his treatment the same way, through a screen, as the end of confinement coincided with his move to Spain from Buenos Aires. “He helped me a lot at a very difficult time in my life. I wouldn’t change my online sessions with her for any face-to-face treatment,” says the Argentinian.

Through video calls, phone or WhatsApp platforms, online therapy sessions have doubled in the past three years due to the pandemic that has worsened the mental health of citizens. In fact, four out of 10 Spaniards say they do not have good mental health and about 75% of the population is convinced that it has worsened for all of them in recent years, according to a recent study by the Spanish Mental Health Confederation and Fundación Mutual Madrid. Professionals were the first to notice this increase in demand, and one of the immediate results was the need to adapt their work to new requirements. Marina Granizza, a 40-year-old psychologist, had not conducted online sessions before 2020, but once she found herself confined to home like all her patients, she had no choice. At first, he admits, it was hard to get used to. “The level of connection is toned down a bit. There are moments, perhaps more emotional, where a face-to-face encounter is missing,” Granizza explains, though she adds that none of this makes the treatment incomplete.

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On the contrary: Dozens of psychologists and patients consulted for this report agree that not only has online therapy been a very viable alternative to face-to-face treatment during the worst of the pandemic, but it is here to stay. A recent study by the American Medical Association estimated that 69% of mental health professionals have incorporated online therapy into the services they provide regularly. “For me, the end of childbirth coincided with my mother’s, and being able to do sessions online from my home helps me a lot with matchmaking,” says Graniza, who works more online than in person on a daily basis.

Although some of his patients did actually return to the office once the mask was no longer mandatory indoors — “between going online and seeing our faces, and being in the same room, but with their mouth covered, they preferred the former,” he notes — he ensures that many others have decided to continue. on the Internet. There are two factors that this professional finds decisive. “Patients positively value the ability to connect from anywhere, at any time throughout the day. Some even do it from the office,” he explains. Also, the fact that one of his online sessions costs less than a face-to-face session makes it possible for more people to afford the treatment.

Another positive aspect for both parties is the lack of geographical boundaries. It does not matter if the psychiatrist and the patient are in different cities, countries or continents, they will always be able to follow the treatment. This emergency made Lucia Martín, 41, start conducting online sessions ten years before the pandemic. Many of his patients are Spaniards who have had to move abroad for work and who, when it comes to taking care of their mental health, would rather seek out a psychiatrist in their country of origin, even at the expense of having to adjust to a different time zone. “I think we as professionals have to adapt a little bit to the needs of the patient. Our job is to make it easier for them so that they can continue with treatment.”

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Other times it is the professionals themselves who change their residence. Mario Fiorentino, a 33-year-old Peruvian, brings inquiries from Spain, Miami, Mexico and other Peruvian cities to Lima. He works from nine in the evening until three in the morning to be able to communicate with his patients on the other side of the Atlantic, and at the end of the summer – which is when he plans to move to Spain – he will do the same to take care of those in Latin America. A few years ago it would have been unthinkable to do something like this. But now you can change your life, without having to leave the recovery process to anyone up in the air, or downtime,” he explains.

Psychologist Marina Graniza during an online patient consultation.
Psychologist Marina Graniza during an online patient consultation.Santi Burgess

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Despite the relief at the time of reconciliation, there are also those who have decided to return personally, like María Dolores García, a 25-year-old Murcian who is studying in Alicante. She started going to therapy in 2019 to learn how to manage her emotions and control anxiety, and a few months after it started, she had to go online, with the same psychiatrist. “It was something completely new for both of us, we were experimenting a lot with different platforms. Sometimes we would do video calls on WhatsApp, although it wasn’t just about audio, it was very impersonal to me,” he recalls.

He acknowledges that the experience was “positive” and “hands-on from the first session,” but once they saw his face in person, he preferred to return to counseling. “I felt like it was a safer place to talk. Since I share an apartment, and sometimes a house, I felt like I didn’t have any privacy, I was afraid someone would overhear me,” she explains.

Martin agrees that some of his patients need to be able to be in a place where they feel safe, so much so that he acknowledges that some of them preferred to stop treatment during the pandemic because they didn’t have enough privacy at home to speak freely. “I always try, as far as possible, to recreate the same atmosphere that I find in the office. I ask my patients to help themselves to a cup of coffee or tea, which I offer when they come here, and I play a lot with anticipation.” “I explain that the screen might suddenly freeze, or the connection might drop, or I wouldn’t look at the camera from time to time because I’m taking notes. But none of this detracts from the value of therapy, although in some of the deeper or more emotional sessions, it’s not ideal.” These failures exist.

On the other hand, Fiorentino understands that the link that is created, especially in the case of patients who start treatment directly via the Internet, is different. “I feel that therapy for them is more hands-on. They tend to want the problem to be resolved more quickly, whereas in face-to-face consultations the pace is slower,” he highlights. This does not mean that the treatment is ineffective. I’ve seen patients that I personally probably would never see get much better.”

Hybrid model

One solution that everyone seems to agree on is hybrid therapy, alternating online and face-to-face sessions, to take advantage of the best aspects of both models. In this way, psychiatrists and patients can restore human contact, which they have missed most during the pandemic, while at the same time maintaining the comfort of staying at home.

“I support the hybrid in every way. If it works with work, I don’t see why it can’t work with therapy,” says Acosta. When he travels to Buenos Aires on business, every four or five months, he goes to his psychiatrist’s office and the two take the opportunity to talk face to face. “It helps me stay connected and be more relaxed. But, if I don’t have that possibility, nothing will happen. If I need to cry, I cry even with a screen in between,” he concludes.

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