Psy-Q: What’s the best way to provide psychodynamic therapy remotely? Douglas H. Ingram, MD, answers.

Douglas H. Ingram, MD

Answer: Being aware of both the benefits and the challenges of psychodynamic therapy can help mental health professionals navigate the growing territory of teletherapy, according to Douglas H. Ingram, MD, a psychiatrist who practices in New York, NY.

Does the Therapeutic Setting Matter?

Dr. Ingram recently conducted a study on the role of therapeutic space to deliver psychodynamic psychiatry (a form of treatment that focuses on the roots of the patient’s problems and on the relationship with the treating clinician) during the COVID-19 pandemic.

“Early on, we were worried that the challenges would be enormous [when we had to move to virtual appointments due to the pandemic]. From our experience over the past year-and-a-half, that doesn’t seem to be the case. Therapists and patients have adapted,” he says.

Dr. Ingram points out that one of the biggest benefits of moving to virtual therapy sessions is the convenience both patients and therapists get, such as no commute. “Also, when therapy is remote, erotic or aggressive impulses cannot be acted upon. You can’t hit or hug the patient, and the patient can’t hit or hug you,” he stresses.

There are some barriers that therapists and patients have to overcome, however, when they are not face-to-face in a room together. They may have to try harder to make a personal connection. One of the major concerns is “the loss of empathic communion and the vitality of really being with the other person,” Dr. Ingram explains.

How to Maximize the Effects of Virtual Psychodynamic Therapy

To make the most of remote sessions, Dr. Ingram offers practitioners the following suggestions:

Be completely present for each session

“Move a little more than you might if you were with your patient in a consulting room. Don’t be shy about asking where the patient is speaking from or if the video reveals something that you think they would like to speak about. If you are working by phone, talk more. Silences can trigger anxiety far more on the phone than when your patient is right in front of you,” he adds.

Pay attention to setting

“The setting or what I call the ‘therapeutic space’ is the venue where the therapy takes place. Online, phone, in-person, the space—and whatever occurs in the space—may deserve some comment or question. There are no ‘distractions’ because whatever is going on can be brought into the conversation. Doing so says, ‘We are here together sharing a space and what occurs in this space concerns us,’” Dr. Ingram says.

Consider hybrid offerings

As things go back to a “new normal,” many patients may prefer to continue seeing their therapist from the comfort of their own homes. This is important for therapists to consider. He recommends that whenever possible, therapists consider offering a range of options so the patient can customize their sessions based on their own preferences. “We can give our patients the option to choose,” he says. “This will achieve the best of all worlds.”

Tap into the richness of psychodynamic therapy, regardless of the setting

“Psychodynamic therapy draws on the enormous literature of psychoanalysis and seeks to appreciate the fullness of meaning our lives can offer. When the immediacy of the issues that bring patients to treatment begin to relax, we may find that exploring elusive existential matters is foundational to ongoing care,” Dr. Ingram says.

Last Updated: Oct 14, 2021