This text explores the evolution, efficacy, and unique challenges of psychodynamic teletherapy, tracing its roots from historical epistolary methods to modern internet-based treatments. Psychodynamic teletherapy, particularly in its synchronous (e.g., video conferencing) and asynchronous (e.g., guided self-help) forms, has garnered increased attention due to its potential to bridge geographic barriers and enhance accessibility. Despite these advantages, concerns persist regarding the translation of psychodynamic principles—such as the therapeutic relationship and the exploration of emotions—into a virtual setting. Evidence suggests that while teletherapy can be effective, it may pose challenges in fostering deep emotional connections and replicating the in-room therapeutic experience. This text examines psychodynamic teletherapy outcome studies, therapist and patient experiences, and the necessity for adapting psychodynamic interventions to maintain therapeutic efficacy in remote formats, especially by creating tele-presence, or the feeling of a shared reality despite the remote setting. The text also highlights the need for flexibility and new skills to navigate the evolving landscape of psychodynamic treatment at a distance.

Objective: To explore young people’s perceptions of the relationship with the therapist in internet-based psychodynamic treatment for adolescent depression.

Method: As a part of a randomized controlled trial, 18 adolescents aged 15–19 were interviewed after participating in treatment. Interviews followed a semi-structured interview schedule and were analyzed using thematic analysis.

Results: The findings are reported around four main themes: “a meaningful and significant relationship with someone who cared”, “a helping relationship with someone who guided and motivated me through therapy”; “a relationship made safer and more open by the fact that we didn’t have to meet” and “a nonsignificant relationship with someone I didn’t really know and who didn’t know me”.

Conclusion: Even when contact is entirely text-based, it is possible to form a close and significant relationship with a therapist in internet-based psychodynamic treatment. Clinicians need to monitor the relationship and seek to repair ruptures when they emerge.

Patients with functional somatic symptoms or medically unexplained symptoms are very common in the healthcare system but they do not always receive adequate care or treatment. These patients struggle with a low quality of life and constitute a high cost to the healthcare system. Cognitive Behavioral Therapy is a relatively common treatment intervention and helps many patients, but not all. Short-term psychodynamic therapy has recently been evaluated in several meta-analysis and have been found to be clearly effective. A major focus of short-term psychodynamic therapy is on emotional processing of stressful or traumatic life events. At present, these psychodynamic short-term therapies are not offered in regular care, despite the solid research support that exists. Short-term psychodynamic therapy should be considered a complement to the range of treatments that already exist for patients with functional somatic symptoms. 

Introduction: The shift from in-person therapy to telepsychotherapy during the COVID-19 pandemic was unprepared for, sudden, and inevitable. This study explored patients’ long-term experiences of transitions to telepsychotherapy and back to the office.

Methods: Data were collected approximately two years after the declaration of COVID-19 as a pandemic. Eleven patients were interviewed (nine women and two men, aged 28 to 56, six in psychodynamic psychotherapy, five in CBT). Treatments switched between in-person and video/telephone sessions. Interview transcripts were analyzed applying the qualitative methodology of inductive thematic analysis.

Results: (1) The patients experienced the process in telepsychotherapy as impeded. Interventions were difficult to understand and lost impact. Routines surrounding the therapy sessions were lost. Conversations were less serious and lost direction. (2) Understanding was made more difficult when the nuances of non-verbal communication were lost. (3) The emotional relationship was altered. Remote therapy was perceived as something different from regular therapy, and once back in the therapy room, the patients felt that therapy started anew. The emotional presence was experienced as weakened, but some of the patients found expressing their feelings easier in the absence of bodily co-presence. According to the patients, in-person presence contributed to their security and trust, whereas they felt that the therapists were different when working remotely, behaving in a more easygoing and familiar way, as well as more solution-focused, supportive and unprofessional, less understanding and less therapeutic. Despite this, (4) telepsychotherapy also gave the patients an opportunity to take therapy with them into their everyday lives.

Discussion: The results suggest that in the long run, remote psychotherapy was seen as a good enough alternative when needed. The present study indicates that format alternations have an impact on which interventions can be implemented, which can have important implications for psychotherapy training and supervision in an era when telepsychotherapy is becoming increasingly common.

Varför hamnar jag hela tiden i samma roll i relationer? Vågar jag lita på att andra vill mig väl? Får jag visa att jag blir arg och ledsen? Kan andra tycka om mig? Erfarenheter från nära relationer under våra första år bevaras som kartor över hur det är att vara med andra –anknytningsmönster. De styr vår uppmärksamhet när vi möter nya människor och de formar vår självbild.

De tidiga relationerna påverkar oss – men de bestämmer inte allt. Genom att våga utveckla nya sidor, upptäcka känslor som man har undvikit och se sitt samspel med andra på ett nytt sätt kan man utvecklas. Vi kan skapa en trygg anknytning i efterhand.

Psykologen Camilla von Below berättar om de förflutna relationernas påverkan på nuet – och hur vi kan bli fria att agera på nya sätt. Forskning, exempel och reflektioner vävs ihop till berättelser om våra relationer, där du också får följa ett antal personer och se deras utveckling.

Anknytning i relationer är till dig som undrar hur dina relationer format dig. Den är till dig som anar att tidigare erfarenheter står i vägen och vill bli fri att göra på ett nytt sätt. Den är också till dig som vill hjälpa ditt barn till en trygg anknytning.

Attachment theory and research show that a patient’s attachment pattern, shaped in close relationships, affects A) the ability to describe symptoms in a structured and detailed manner, and B) the ability to trust physicians’ conclusions and concerns. If physicians are observant of patients’ unstructured, intense or avoidant communication during consultation, they can adjust their communication accordingly and avoid misunderstandings and excessive health care consumption. A patient with insecure ambivalent attachment needs initial empathic listening, whereas a patient with insecure avoidant attachment benefits from a respectful distance. Since insecure attachment is associated with lack of trust combined with difficulties understanding own psychical and psychological symptoms, physicians need to fill in the gaps more carefully than usual. Understanding attachment theory will be of help and is discussed in the article. 

Anknytningsteori kan ge perspektiv på patienter som upplevs som besvärliga då de inte tar till sig lugnande besked, underrapporterar eller ger en osammanhängande bild av sina symtom. Psykologisk forskning visar att relationserfarenheter i form av anknytning har betydelse för tillit till andras förmåga att hjälpa och förmågan att berätta om sina symtom. Intensiv, ostrukturerad symtomrapportering såväl som underrapportering och överdriven självtillräcklighet kan vara en del i ett otryggt anknytningsmönster. Om läkaren observerar patientens sätt att berätta utifrån anknytningsteori kan missförstånd, frustration och onödigt hög vårdkonsumtion potentiellt minskas.

The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.

Background: The use of remotely delivered early intervention after trauma may prevent and/or reduce symptoms of post-traumatic stress. Our research group evaluated a novel three-week therapist-guided internet-delivered intervention based on prolonged exposure (Condensed Internet-Delivered Prolonged Exposure; CIPE) in a pilot trial. The results indicated that the intervention was feasible, acceptable and reduced symptoms of post-traumatic stress at post-intervention compared to a waiting-list condition. Exposure to traumatic memories can be emotionally demanding and there is a need for detailed investigation of participants' experiences in receiving this type of intervention remotely.

Objective: Investigate participants' experiences of receiving CIPE early after trauma.

Method: In this study, qualitative thematic analysis was used and semi-structured interviews with 11 participants six months after intervention completion were conducted. All interviews were audio-recorded and transcribed verbatim.

Results: One overarching theme labelled as 'demanding and effective' was identified. Participants expressed that treatment effects could only be achieved by putting in a lot of effort and by being emotionally close to the trauma memory during exposure exercises. Participants reported CIPE to be a highly credible- and educative intervention that motivated them to fully engage in exposure exercises. The most distressing parts of the intervention was perceived as tolerable and important to do to heal psychologically after trauma. For many participants, the possibility to engage in the intervention whenever and where it suited them was helpful, although some participants described it as challenging to find a balance between their own responsibility and when to expect therapist support. The internet-based format was perceived as a safe forum for self-disclosure that helped some participants overcome avoidance due to shame during imaginal exposure.

Conclusion: CIPE was considered demanding, yet effective by the interviewed participants. The most distressing parts of the intervention was perceived to be the most important and were tolerable and feasible to provide online.

Antecedentes: El uso de una intervención temprana administrada a distancia después de un trauma puede prevenir y/o reducir los síntomas de estrés postraumático. Nuestro grupo de investigación evaluó una nueva intervención de tres semanas entregada por internet y guiada por un terapeuta, basada en exposición prolongada (Exposición prolongada condensada por Internet; CIPE por sus siglas en inglés) en un ensayo piloto. Los resultados indicaron que la intervención fue factible, aceptable y redujo los síntomas de estrés postraumático en la postintervención en comparación con una condición de lista de espera. La exposición a recuerdos traumáticos puede ser emocionalmente exigente y es necesario realizar una investigación detallada de las experiencias de los participantes al recibir este tipo de intervención de forma remota.

Objetivo: Investigar las experiencias de los participantes al recibir CIPE en forma temprana después del trauma.

Método: En este estudio se utilizó un análisis temático cualitativo y se realizaron entrevistas semiestructuradas con 11 participantes seis meses después de finalizada la intervención. Todas las entrevistas fueron grabadas en audio y transcritas textualmente.

Resultados: Se identificó un tema general etiquetado como ‘exigente y eficaz’. Los partici-pantes expresaron que los efectos del tratamiento solo se pueden lograr haciendo un gran esfuerzo y estando cerca emocionalmente del recuerdo del trauma durante los ejercicios de exposición. Los participantes informaron que CIPE era una intervención educativa y de gran credibilidad que los motivó a participar plenamente en los ejercicios de exposición. Las partes más angustiantes de la intervención se percibieron como tolerables e importantes para sanar psicológicamente después del trauma. Para muchos participantes, la posibilidad de participar en la intervención cuando y donde les convenía fue útil, aunque algunos participantes describieron como desafiante el encontrar un equilibrio entre su propia responsabilidad y cuándo esperar el apoyo del terapeuta. El formato basado en Internet se percibió como un foro seguro para la autorrevelación que ayudó a algunos participantes a superar la evitación debida a la vergüenza durante la exposición imaginaria.

Conclusión: CIPE fue considerada exigente, pero eficaz por los participantes entrevistados. Las partes más angustiantes de la intervención fueron percibidas como las más importantes y fueron tolerables y factibles de proporcionar en línea.

背景: 在创伤后使用远程早期干预可以预防和/或减轻创伤后应激症状。我们的研究组在预 试验中, 评估了一种为期三周的基于延长暴露, 有治疗师指导的新颖网络干预措施 (密集型 网络延长暴露 CIPE) 。结果表明, 干预是可行的, 可接受的并且相较于等候名单条件, 在干 预后减轻了创伤后应激症状。暴露于创伤性记忆可能在情感上是高需求的, 需要对参与者 远程接受此类干预的体验进行详细考查。

目的: 考查参与者在创伤后早期接受CIPE的体验。

方法: 在本研究中, 使用定性主题分析, 在干预完成六个月后对11名参与者进行了半结构化 访谈。所有采访均进行录音并逐字记录。

结果: 确定了一个标记为‘高需求和有效’的总体主题。参与者表示, 只有通过付出大量努力 并在暴露练习中在情感上贴近创伤记忆, 才能达到治疗效果。参与者报告说, CIPE是一种 高度可靠且具有教育意义的干预措施, 可以促使他们充分参与暴露练习。在创伤后为了治 愈心理, 干预中最痛苦的部分被认为是可以忍受且很重要的。对于许多参与者, 能够在适 合他们的时间和地点参加干预的可能性是有帮助的, 尽管一些参与者认为在其责任与何时 期望治疗师支持之间寻求平衡是一个挑战。基于网络的方式被认为是一个自我披露的安 全论坛, 可以帮助一些参与者克服在假想曝光时因羞耻感产生的回避。

结论: 受访者认为CIPE是高需求但有效的。干预中最痛苦的部分被认为是最重要的, 可以容 忍并且可以在线提供。

In the present paper we examine four cases in which the assumption that good outcome necessarily means good therapy did not hold. Cases were selected that reported good pre-post outcome (i.e., clinically reliable decrease in symptom severity) but a negative (disappointing) therapy experience, drawn from a randomized controlled trial (the Ghent Psychotherapy Study) and a naturalistic outcome study (the Stockholm Young Adults Psychotherapy Project). Analysis of these seemingly contrasting findings made it possible to identify three distinct patterns of client experience of outcome. Implications for research and practice are discussed.

Ur bokens förord:

Anknytningsteorin förenas här med klinisk praktik. Camilla von Below förmedlar aktuell forskning, visar på bredden och djupet i anknytningsteorin, men även på dess begränsningar. Med många kliniska exempel gör hon anknytningsteorin och dess empiri levande och användbar för dig som möter vuxna patienter i psykoterapi och psykologisk behandling.

Författaren beskriver anknytningsteori i relation till mentalisering och affektteori, liksom hur man kan se på anknytningsmönsters stabilitet och förändring under livet. Hon visar även hur anknytningsteori kan vara till hjälp för att skapa en terapeutisk relation, liksom hur hinder och svårigheter i det terapeutiska samspelet kan förstås. Betydelsen av terapeutens anknytningsmönster får ett särskilt fokus, med uppmuntran till självreflektion och utveckling.

Tack vare bokens breda anslag kan den kombineras med läsarens egen teoretiska och terapeutiska referensram.

Målgruppen är yrkesverksamma och studerande inom psykoterapi och psykologisk behandling. Boken kan med behållning även läsas av andra som arbetar med mänskliga relationer, samspel och samtal.

”Som psykolog och psykoterapeut har jag nytta av anknytningsteorin på flera sätt. För det första genom att jag lyssnar på hur en patient berättar och vad det säger om hennes eller hans förhållningssätt till sitt inre och sin förståelse av sina problem. För det andra bidrar teorin med en förståelse av hur svårigheter kan ha uppstått och vad som hindrar patienten från att komma vidare. För det tredje – och i mitt tycka det mest inspirerande – ger anknytningsteori en förståelse för det relationella samspelet och samskapandet i terapi. Terapeuten får hjälp att förstå alliansbrott, brister och rena haverier i den terapeutiska relationen och att utmana sig själv i att göra på nya sätt.”