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Remote psychotherapy

Interview with Monica Eggert and Jouni Wilska


On 11 March 2020 The World Health Organization characterized covid-19 as a pandemic. Around the same time the incidence numbers in Finland were on the rise and on 16 March 2020 The Finnish Government announced a state of emergency. On the next day The Social Insurance Institution of Finland (Kela), that provides access and financial support to rehabilitative and intensive medical rehabilitation psychotherapies, recommended teleworking for psychotherapies. I asked two psychotherapists about their experience and thoughts of doing psychotherapy remotely.

Monica Eggert is a 61-year-old psychiatrist, psychotherapist and psychoanalyst who works as a parttime medical adviser in Kela and as a part-time psychotherapist. Jouni Wilska, a 34-year-old integrative psychotherapist and a soon-to-be psychiatrist, also splits his time between practicing psychotherapy and working in Helsinki University Hospital.

Before the pandemic Wilska had had a short experience in a telemedicine service that piloted in Finland a few years back. He describes the experience as interesting, since at the time telemedicine was not as common as it is today. Wilska says that even before the pandemic he could have considered doing psychiatric telemedicine due to certain benefits, which will be discussed later. Eggert, on the other hand, had no previous experience with telemedicine and had not considered it as a form of work for herself. Both Eggert and Wilska emphasize that psychotherapy works better and is most likely more effective faceto- face, but when there are no other options, it is an adequate alternative that eventually turned out to work better than they first expected.

Both Eggert and Wilska have mostly used video communication services when working remotely. They only had a minority of patients that preferred phone calls over video connection. Reasons for this varied from difficulties with technology to suspicion towards communication platforms’ confidentiality. None of their patients quit therapy because of working remotely. Eggert points out that because all of her psychotherapy patients were already familiar to her, working remotely was not as big of a change as one could have anticipated.

Remote psychotherapy has some downsides. “A lot of non-verbal information is left out when working remotely”, Eggert says, “Most of the body movements, smells and the patient’s presence and what it tells is not at use”. When using a video connection the therapist’s face is also much closer than normal, and Eggert wonders how the fact that the patient is able to see their therapist’s facial microexpressions affects the interaction. Then there are of course the occasional technical issues that may disrupt the fluency of communication. In addition to this, the challenges may be bigger when a patient lives in a small apartment with family or roommates. “For the communication between patient and therapist, it is important that the patient is able to communicate freely”, Wilska adds, “Also, sometimes it can act as important exposure therapy when a patient needs to leave home in order to attend face-to-face meetings”.

Yet, there are also positive sides to remote psychotherapy. In Finland there are big geographical disparities what comes to psychotherapists’ availability and remote psychotherapy may help equalize these disparities in the future. In addition to that, telework may also help with the continuation of therapy during the therapist’s or patient’s holidays or work trips. “Also, in case of a minor flu, therapy sessions can be done remotely without risk of spreading the illness”, Wilska adds.

Later on in March, instructions concerning remote psychotherapy were loosened and on 1st of June face-to-face therapy was more widely available again. Both Eggert and Wilska mostly returned back to face-to-face meetings. Eggert had a small number of patients that wished to continue remote psychotherapy due to fact that they were either working remotely themselves and/or were part of a risk group.

What comes to Eggert’s and Wilska’s own experience on working remotely, they both mention that working via computer felt physically more exhausting. “Ergonomics are not as good when working through communication platforms”, Wilska says.

Most likely, remote psychotherapy will continue to exist, at least to some extent, even after the pandemic. Both Eggert and Wilska see themselves possibly doing remote psychotherapy in the future, yet they both prefer face-to-face meetings. For example, Eggert could see herself working remotely with a patient who lives in another city. □

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