A virtual frame – how does forensic psychotherapy work remotely?

Abstract

Psychotherapy has been practised via remote technology since the mid-1990s and has grown in mainstream popularity; yet, it remains controversial, particularly for psychoanalytically informed treatment, and limited research in this area has been published. However, COVID-19 provoked a necessary transition to online working across the psychotherapy profession, including clinicians providing psychoanalytic treatment to a unique forensic outpatient group remotely for the first time. This qualitative research study sought insights from this sample via grounded theory interviews and analysis to inform hypothetical future practice of remote psychotherapy via videoconferencing to forensic populations with limited access to treatment. This generated a substantive theory about how forensic psychotherapy works remotely: In the context of a forced transition to remote working, forensic psychotherapists make attempts to substitute for real by establishing an alternative frame; noticing how differently contact is mediated; adapting technique; and evaluating suitability for remote treatment. An implication of these findings may be that developing a new Virtual Frame for forensic psychotherapy, supported by specialist training and supervision, could increase its reach within settings that provide sufficient containment for the work. Further research is encouraged to support this undertaking and consider which patients, and/or clinicians, might work effectively this way.