When distance brings us closer: leveraging tele-psychotherapy to build deeper connection

ABSTRACT

In this paper, the authors describe how patients and therapists may, paradoxically, perceive a greater sense of closeness as a result of the physical distance inherent in conducting psychotherapy over synchronous video telehealth. Case material is used to illustrate ways in which tele-psychotherapy facilitated engagement, strengthened the alliance, and created unique therapeutic opportunities that may not be possible when therapy is conducted in person. This paper aims to challenge preconceived notions about the ability to develop a strong therapeutic relationship with patients and implement lasting change through tele-psychotherapy. Implications for future clinical work are discussed, with particular consideration of the recent COVID-19 outbreak’s influence on psychotherapy.

KEYWORDS:

• Telehealth
• telemental health
• tele-psychotherapy
• psychotherapy
• veterans

Acknowledgments

Acknowledgement to Adam Wolkin and Seena Mathew, for their involvement in the VA NY Harbor Health Care System Telemental Health Hub implementation and ongoing support.

Disclosure statement

The authors have no conflicts of interest or financial disclosures to report.

Additional information

Funding

This work was supported by funding provided by U.S. Department of Veterans Affairs (VA) Office of Rural Health (ORH). Visit www.ruralhealth.va.gov to learn more.

Notes on contributors

Cory K. Chen

Cory K. Chen, Ph.D. received his degree in clinical psychology from the University of North Carolina – Chapel Hill. He completed his psychology internship at NYU/Bellevue Hospital Center and psychoanalytic training at the William Alanson White Institute. He is also an Associate Clinical Professor in the NYU Department of Psychiatry. At VA New York Harbor Healthcare System, Manhattan Campus, he is the Clinical Co-Director of the Telemental Health Hub.

Nicole Nehrig

Nicole Nehrig, Ph.D. is a staff psychologist at the VA New York Harbor Healthcare System, Manhattan Campus and a clinical instructor at New York University’s medical school. She also teaches and supervises graduate students at Long Island University, Brooklyn where she got her degree. She has worked with Veterans since her internship training and enjoys the opportunity to give back to those who have served our country. She specializes in PTSD treatments and couples therapy.

Lauren Wash

Lauren Wash, M.A. received her master’s degree in Mental Health Counseling from New York University Steinhardt School’s Department of Applied Psychology. Lauren serves as the New York Harbor Telemental Health Hub’s Program Analyst and the Research Coordinator for the Psychotherapy Research and Development Program. She assists the Clinical Co-Director and NYH Hub psychologists with program management, data reporting, and NYH TMH Hub quality improvement and research efforts.

Jennifer A. Schneider

Jennifer A. Schneider, Ph.D. received her doctoral degree in clinical psychology from Fairleigh Dickinson University, completed her predoctoral internship at the Denver VA, and her postdoctoral fellowship in PTSD at the Palo Alto VA.  Jennifer has been working with the VA system since 2009 and specializes in treatment of PTSD.  She is VA-certified in a number of evidence-based treatments including CPT, PE, CBT-I, and ACT-D and can also provide Dynamic Interpersonal Therapy (DIT), Emotionally Focused Couples Therapy (EFT), and Enhanced Cognitive Behavioral Therapy (CBT-E) for eating disorders.

Sagiv Ashkenazi

Sagiv Ashkenazi, Psy.D. received his doctorate in clinical psychology from the Chicago School of Professional Psychology in 2006 after completing his clinical internship at the Brooklyn VA.  Since then, he has worked in a number of clinical settings outside of and within the VA, including inpatient psychiatry, outpatient and inpatient substance abuse services, and a PTSD clinic.  He has recently returned to the VA after living and working abroad for a few years and is very excited to join the Telehealth staff. Sagiv specializes in trauma and addiction treatment.

Elana Cairo

Elana Cairo, Ph.D. received her degree in clinical psychology (health emphasis) from Ferkauf Graduate School of Psychology, Yeshiva University.  She completed her psychology internship at the VA NY Harbor Healthcare System and her postdoctoral fellowship in PACT-Mental Health Integration at the Corporal Michael J. Crescenz VA Medical Center. She has experience in providing many evidence-based treatments including CBT for Depression, CBT for Insomnia, CBT for Chronic Pain, Cognitive Processing Therapy, Motivational Interviewing, Mindfulness-Based Cognitive Therapy, and Dynamic Interpersonal Therapy. She is currently being trained in Emotionally-Focused Couples Therapy (EFT).

Angel F. Guyton

Angel F. Guyton, B.A. is a Research Assistant in the Psychotherapy Research & Development Program at the VA New York Harbor Healthcare System, Manhattan Campus and an Assistant Research Scientist at New York University’s Center for Neural Science. She earned her BA in Psychology from St. John’s University, where she developed research interests in suicidal ideation, chemical and substance abuse and alcoholism in the family unit.

Amy Palfrey

Amy Palfrey, Ph.D. earned her doctorate in Clinical Psychology from St. John’s University in Queens, NY. She has trained at numerous hospitals around New York City, including completing a postdoctoral fellowship at the Manhattan VA, and she has specialties in geropsychology, health psychology, and Cognitive Behavioral Therapy.