As Academic Director and Didactic Analyst of the Adlerian Studies Center- IAIP Uruguay, it is my pleasure to greet and thank the IAIP authorities, President Dr Marina Bluvshtein, General Secretary Dr Gian Secondo Mazzoli and Vice President Dr Ursula Oberst, colleagues and general audience.
In Genéve, on March 11 of 2020 the general director of the World Health Organization declared that the new disease due to coronavirus (Covid-19) could be characterized as a pandemic and so that specific social distancing and isolation measures should be taken.
All psychologists believed that it would be the end of in-person therapy and the emergence of Teletherapy. But it wasn’t, rather that uncertainty, anxiety and distress traits emerged as a result of the pandemic. The face-to-face therapy is not ending, but we have to investigate psychotherapy in general and its effects on people’s mental health. We well know that psychotherapy is better than doing nothing or doing anything that has no therapeutic purpose, but we still don ́t know if its effects are specific or general, despite the theoretical framework.
Adler always taught us Adlerian Psychology in comparison, without losing sight of ensemble and integration that the psychotherapeutic science must have. Also, an ethic and human attitude to bring peace, joy and happiness to the community. In the previous meetings for this congress section “Blended Counseling y Gemeinschaftsgefühl: opportunities and boundaries.” our moderator and friend Givannis De Santis (Italy) helped us to collectively think how this topic could be approached and asked the following question: what would Adler say in the present days?
The immediate response was “To increase community feeling”, that affective-cognitive tendency of human being to orientate their behavior to coexistence, cooperation and fulfillment of life’s tasks (Love- Work- Friendship and why not, Art and Transcendence)
But i would like to put emphasis in 5 components of the community feeling described by Wexber:
(1) Objectivity: means to see and judge things as they are, putting aside personal interests and all the subjective elements that may deform perception.
(2) Logic in thinking activity: “only the one that has the courage to accept the unfavourable outcome is able to establish conclusions consequently without thinking errors.
(3) Performance capacity: not only indicates the individual’s utility to community, but mainly its personal commitment to the development and work.
(4) Self-determination (¡¡) to the experience of nature and art. The community feeling transcends the bond with human beings, it also means the union with life ́s facts and all the cosmos.
(5) Sense of responsibility through all the activity, idea, thought and feeling.
In order to develop the human ability, the therapist role through comprehension and therapeutic encouragement is the key. As Adlerians we are experts on that because we know how to give encouragement (not praise ), give options (not prescriptions) and we are emphatic as Adler would say “To see with the eyes of another, to hear with the ears of another, to feel with the heart of another.”
All in all, the tele counseling has arrived and somehow it has amplified the repertory of psychological applications. Due to that, it is adequate first of all to answer the question of what we are talking about when we speak of Telehealth and combined Counseling. Somehow these terms have transformed our clinic practices, first with a specific pandemic situation, and now, with the post- pandemia.
Until that date, I didn’t implement any online counseling, just in-person counseling in an individual or group psychotherapy format. After being in suspense for one month, with other Uruguayan colleagues we were collectively elaborating about how to offer an effective online psychotherapeutic service of quality. Moreover, we were adopting the professional skills to teleworking, and for that we made a course organized by The Pan American Health Organization (PAHO) called “Remote Provision of mental health and psychosocial interventions”.
How does the PAHO define telecounseling?
Tele counseling, sometimes defined as remote counseling or telehealth, refers to the interactions that take place between a health professional and a patient with the objective of providing diagnostic or therapeutic counsel through electronic means.
Some previous considerations provided by the WHO (World Health Organization) in order to
establish a tele mental health service are:
(1) Tele mental health services can be efficient. Tele mental health is a viable alternative to in-person attention for a wide range of mental health disorders. However, the interventions must be adapted to every context, permanent formation, support and supervisions are crucial in this matter.
(2) The telehealth may include: phone calls, video conferences and text messages and e-
mails.
(3) The key is to adapt technology to the users.
(4) The remote services supply may not be adequate to all the uses of the service; for example, it is possible that people with chronic mental disease, neurodegenerative affections or other disabilities may not receive services through telehealth or when people cannot have private conversations due to their overcrowding houses.
On the other hand, after a bibliographic revision about “Combined therapy”, these are some
international facts (APA, WHO, PAHO).
What is combined therapy?
The combined therapy, also known as combined counsel, is a combination of face to face and online components to create a dynamic treatment plan that works for both patient and provider.
Not necessarily a completely online service but any treatment plan that incorporates any remote activity.
According to the investigators, combined therapy may facilitate
(1) “An extended exposure to the therapy in an affordable and profitable format.”
(2) Allows a minor time lapse commitment for the professionals , less time travelling for the patients, more access to the content and lower general costs.
Evidence is still being researched, but until now it seems like combined therapy works as well as traditional face-to face- therapy. A recent study showed that combined attention through video was really efficient to reduce depression and anxiety symptoms (Lungu, A. Jun, J. J., Azarmanesh, O., Leykin, Y., & Chen, C. E (2020) And for some clients, the freedom to choose when, where and how to complete their “task” may have contributed to more positive therapeutic results. (Wilhelmsen et al., 2013)
This way, In Uruguay we were elaborating a protocol to practice Online Brief Adlerian Psychotherapy, which consists in 12 online sessions distributed in 3 months with the possibility to extend the treatment according to the peculiarity of each case. The first Adlerian interviewis fundamental and predicts adequately the adhesion and therapeutic goal based on the patients expectations.
These are some of the conclusions that we arrived at through our experience in Uruguay with the online therapy format, combined therapy and face-to-face therapy.
Pros
It is a way of ensuring a continuity of the assistance when, for example, some sanitary emergencies take place and people cannot move or keep close physical contact.
- It may be performed with people with health problems or disabilities that may limit their
displacement ability to a health centre. For example, people that may have immunodeficiency
disorder affections, access difficulty to transportation means adapted to those with anxiety or
disability. - It may be useful to overcome barriers such as the attendance to the health centre due to economic difficulties, long distances to go through, inaccessible roads or transport difficulties.
- Reduce time and costs associated with movement.
- Can be used to help people no matter where they are.
- Can be used to help people who live in places without any near psychological support services.
Disadvantages:
- Communication can be more complicated due to the lack of non verbal information.
- High risk situations management can be more complicated (such as the suicide risk cases)
- It can be less reliable due to the dependence of the use of technology and telecommunications.
- Not everyone counts with a smartphone or similar electronic device, so for some people it may be impossible to access to this kind of services.
- People who receive psychological counseling could not rely on the level of privacy and security of their information when it comes to the use of technology.
- According to an APA report from 2022, in 2021 50% of the psychologists had started to offer face-to face and virtual services to their patients, against the 30% from 2020. The study also showed that 25% of the adults with low incomes do not have smartphones and the 40% from this group do not have internet or computers at home, something that indicates a significant concern about equity in telehealth.
This means that psychologists must be prepared for a hybrid future, and so, a stronger need to establish an integral psychotherapy, with more collaboration between other disciplines related to psychology and common interest areas, with a strong emphasis on community feeling, social justice and environmental care.
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