Clinician experiences of remotely delivering psychodynamic and intensive psychoanalytic psychotherapy within an NHS institution during the COVID-19 pandemic, and possible implications for future clinical practice

Abstract

When it became clear that the COVID-19 pandemic would require significant shifts in working practice, staff in the Adult Complex Needs department at the Tavistock clinic designed a study to explore the emotional impact of remote working on clinicians and patients, and to consider related clinical implications both individually and collectively. A set of semi-structured questions were designed to tap into experiences of working remotely, and clinicians were interviewed. The material arising from these interviews has been summarised into themes. The predominant theme was clinicians’ awareness of the importance of their own emotional milieu in delivering psychoanalytic psychotherapy, especially at a time of crisis, in their initial emotional responses and as they gathered further remote experience. They raised challenges around maintaining an analytic frame amid therapeutic uncertainties, and in the context of the many physical losses of a remote frame: blurred clinical boundaries, altered emotional experiences and resonance, and important impacts on holding, patient attendance, and worsening distress and risks for patients who struggled remotely. Strategies to adapt were key, particularly remaining emotionally consistent and observant amidst uncertainty, and support was paramount to do so. These experiences assist in informing clinicians about the limitations and uses of remote clinical work.

Keywords:

• COVID-19
• psychoanalytic psychotherapy
• psychodynamic psychotherapy
• remote

Acknowledgements

We thank the clinicians who took part in interviews, and all staff at the clinic who worked through the pandemic and provided additional supports so psychotherapy provision and training could continue.

Disclosure statement

The authors worked in the Adult Complex Needs department at the Tavistock and Portman NHS Foundation Trust during this project.