Psychotherapy at a public hospital in the time of COVID-19: telehealth and implications for practice

ABSTRACT

As the crisis of global pandemic continues to unfold and alter the everyday workings of public life, early trends in the impact on mental healthcare treatment at a safety-net hospital illuminate implications for clinical work in the public sector under unprecedented conditions and beyond. While there are many important areas to consider and research to come, the current paper will explore the impact of the COVID-19 crisis on attendance of psychotherapy sessions. The authors point to early evidence from their caseloads in an outpatient psychodynamic psychotherapy training program showing a statistically significant decrease in missed appointments upon switching, in crisis, to a telehealth model. In this paper we explore possible reasons for this decrease in missed appointments, including psychological reasons (such as increased need for connection) and logistical reasons (such as eliminating barriers to attendance). Finally, we point to considerations and implications for practice during and after the crisis of the pandemic has subsided, and consider ways in which the changing approach may, in effect, increase access and remove barriers to care that pre-date our current crisis.

KEYWORDS:

• Psychotherapy during a pandemic
• COVID-19
• safety-net hospital
• missed appointments
• access to care
• psychotherapy attendance

Acknowledgments

The authors gratefully acknowledge the helpful comments of Janna Smith, MSW, LICSW.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. We have since revised our demographic questionnaire so that the item asking patients to self-identify their gender is now an open-ended question with some examples as prompts to allow patients to respond to this item in whatever way they feel best reflects their gender identity (Drill et al., 2019).

2. Similarly, we have since revised our demographic questionnaire so that the item asking patients to self-identify their race/ethnicity is now an open-ended question with some examples as prompts to allow patients to respond to this item in whatever way they feel best reflects their racial/ethnic identity.

3. Not all participants answered every demographic question in the survey; therefore, some percentages do not add up to 100.

4. We purposefully did not choose the 2 weeks before or after the transition date to buffer against the immediate effects of the crisis and transition to telehealth.

Additional information

Notes on contributors

Zoe Silver

Zoe Silver is a licensed clinical social worker and post-graduate fellow in the Department of Psychiatry at Cambridge Health Alliance in Cambridge, Massachusetts. She received a Masters in Social Work from Boston College and is currently completing extended training in psychodynamic psychotherapy. She has worked and trained clinically in public and community mental health settings with populations such as homeless young mothers, people with severe/chronic mental illness and medical comorbidities, students, and adolescents/ adults in individual, couples, and group therapy. She is presently involved in research and writing on the use of telehealth and the intersection of sociodemographics and mental healthcare.

Mikaela Coger

Mikaela Coger is a licensed clinical social worker and a post-graduate fellow in the Department of Psychiatry at Cambridge Health Alliance in Cambridge, Massachusetts. She received a Masters in Social Work from Simmons University in Boston, Massachusetts and is currently completing training as a psychodynamic psychotherapist. She has worked clinically with individuals and groups in residential, outpatient, and school settings, as well as in teaching positions in Pattaya, Thailand, and has engaged in various global service projects. She is involved in research and writing on the intersection of sociodemographics and mental healthcare.

Sebastian Barr

Dr. Sebastian Barr (he/him/his) is a second-year postdoctoral psychology fellow at the Program for Psychotherapy at Cambridge Health Alliance (CHA) and holds a clinical fellowship appointment at Harvard Medical School. Through his fellowship at CHA, he provides insight-oriented longer-term therapy to a diverse caseload. He received his doctorate in Counseling Psychology from the University of Louisville and completed his predoctoral internship at CHA and Harvard Medical School. Dr. Barr's additional clinical training and work have primarily been in trauma-focused public-sector clinics and with veterans and/or trans populations. His research primarily examines the mental health and healthcare needs of trans and gender diverse individuals, and he offers lectures and consultation on this topic, as well. Additionally, as part of his current advanced fellowship, Dr. Barr has been involved in multiple projects regarding process, outcome, and barriers in psychotherapy.

Rebecca Drill

Dr. Rebecca Drill is Clinical Director of the Program for Psychotherapy at the Cambridge Health Alliance in Cambridge, Massachusetts, and Assistant Professor of Psychology in the Department of Psychiatry, Part-time, at Harvard Medical School in Boston, Massachusetts. She received her PhD in Clinical Psychology from the Derner Institute for Advanced Psychological Studies at Adelphi University in New York and completed her internship at the Cambridge Health Alliance and two postdoctoral fellowships, one at Harvard University Health Services and one at Mt. Auburn Hospital, both in Cambridge, Massachusetts. Over the years, she has worked in both inpatient and outpatient settings, and has taught and supervised therapists-in-training for many years. Her current research focuses on studying psychodynamic psychotherapy in naturalistic settings, and from this research has published on both implementing and sustaining research in a safety-net hospital; revising psychiatric materials to reflect inclusive language regarding gender, sexual orientation, and relationship status; and patient attachment style and therapist countertransference. She has published about alternative approaches to personality diagnosis stemming from her involvement with an NIMH research project on this topic. In addition to ongoing work on papers stemming from these two research projects, she is also working on clinical papers about different aspects of the experience of using telehealth for both clinical and teaching purposes as well as the intersection of mental health and sociodemographics.