Psychodynamic Psychiatry and the Therapeutic Space in the Era of COVID-19

Abstract

Psychodynamic psychiatric practice during the COVID-19 pandemic has required most clinicians to conduct treatment online or by telephone. The result is a natural experiment that appears to endorse the efficacy of distance therapy. Consequently, the brick-and-mortar consulting room is no longer the presumptive therapeutic space for the conduct of psychodynamic psychiatric or other treatment approaches. The therapeutic space is reconceived as the place or medium intended for treatment and is distinguished from both the therapeutic relationship and conduct of treatment that occurs within that space. How different therapeutic spaces impact treatment is discussed with specific application to psychodynamic psychiatry and virtual venues. The "digital object" becomes a new presence; the patient's freedom to disclose mental contents is retained though empathic attunement is diminished; a shift in power dynamics may occur; timing of sessions gains greater precision in the online environment. Beyond the pandemic, practicing online is likely to become an accepted supplementary therapeutic space for evaluation and treatment by psychodynamic psychiatrists.