A reading report by Salma Zreouil and Juliette Vabres
Introduction :
“There are a number of potential reasons that psychologists are getting fewer referrals and seeing fewer patients” says Jared Skillings, PhD, APA chief of professional practice. During this health crisis that the world has experienced due to Covid-19 pandemic, psychologists were among the health practitioners who totally changed the way their practice was conducted, to prevent the spread of Covid-19. Thus, in order to respect the instructions of social distancing, most practicing psychologists have stopped seeing patients in-person and opted for remote consultations using various methods.
The social isolation due to this health crisis generates various psychological distress in people, survey which could be reflected by the increase in the number of patients who consult psychologists, but is it really the case? This survey of members of the American Psychological Association, as well as other psychologists, reveal the impact of this pandemic on the practice of clinical psychologists.
The summary of the work reviewing :
This survey highlights the fact that the global health crisis due to the Covid-19 pandemic has had an impact on the course of many professions, particularly in the health sector. This crisis has changed everyone’s habits, in daily and professional life. Thus, the study on the impact of this health crisis on psychologists, which was conducted by the APA among 4,000 APA members and 1,400 non-members representing all fields of psychology states that: 76% of the clinicians who participated in the study see their patients at a distance, compared to 19% who still see their patients in person. The methods used for teletherapy are most often phone, designated Telehealth platform (e.g., WeCounsel, Thera-Link) , and videoconferencing software (e.g., Skipe, Facetime, Microsoft Teams).The survey also asserts that the crisis has an impact on the number of patients received and the number of referrals. Indeed, 55% of clinicians report seeing fewer patients and being referred to specialized services less often.
Working at home is complex for many reasons, which is why the APA has taken steps to ensure that the health crisis is managed in the best possible way, such as providing access to telehealth for all. The APA also recommends that psychologists keep in mind that the telehealth policies put in place to respond to this emergency situation are only temporary and may change.
There is no denying that telehealth is a challenge for psychologists, especially in a profession where human contact is essential, but for which it is necessary to mobilize forces to reorganize the work environment in order to adapt to this pandemic situation, according to the capacities and needs of patients.
The critical evaluation :
The profession of psychologist is characterized by the contact and meeting with a patient. This meeting is as important for the patient as for the psychologist, whether in the analysis of verbal and non-verbal, in the creation of a good therapeutic alliance and in the accompaniment and collaborative work in therapy. However, the current health situation due to the Covid 19 pandemic requires everyone to reduce physical contact to a minimum. Thus, the profession of psychologist finds itself in a paradox, between the need for physical contact and the obligation to reduce psychic contacts. The aim of this survey is therefore to study the impact of the pandemic on clinicians and their practices, and to focus on their role in reducing the spread of the pandemic.
The results of the study state that 19% of the practitioners surveyed still see their patients in person : 16% alternate between teleconsultation and physical consultations, and 3% consult only in person. 81% of the psychologists surveyed no longer see their patients in person : 5% have stopped treating all their patients, 75% are now only treating their patient remotely and 1% were treating all their patients remotely long before the pandemic.
Of the 19% of psychologists who have not or partially changed their consultation mode, 21% are at the beginning of their career, 19% are in mid-career, and 17% are at the end of their career. This shows that late career psychologists (17%) have adapted more to treating their patients remotely. This can be explained by the experience they have acquired during their years of service, which enables them to cope more easily with the constraints of teletherapy.
Indeed, it can be difficult to adapt to teletherapy due to lack of experience. This is confirmed by the results of the survey, as we note that psychologists at the beginning of their career (21%) are those who have adapted least to teletherapy.
There are several methods used for teletherapy. We note that the majority of the professionals in the study mostly use the telephone (61%), as well as specific software (58%), but there are also a few consultations (37%) that are done through video conferencing services not specific to therapeutic use such as Skype, Microsoft Teams, and FaceTime.
The results show that late career psychologists make more use of phone consultations (69%), followed by mid-career psychologists (62%), and 58% of early career psychologists.
Mid-career psychologists make the greatest use of tools specifically designed to treat patients at a distance (64%), followed by those at the beginning of their career (57%). Whereas only 47% of late career psychologists use their specific tools for teletherapy
Non-therapeutic videoconferencing services are the tools least used by psychologists (37%), but we note that professionals at the end of their career use them the most (40%), followed by early career psychologists (38%), and mid-career people (36%).
Late career psychologists make greater use of the phone for consultations (69%). This may lead us to believe that they are more comfortable with this tool than other more modern ones such as specific software to treat patients remotely. We can also think that the patients they have on the phone do not have the resources to make video consultations, or that they are patients they see often and therefore know very well, so the phone is faster and more convenient.
Mid-career psychologists use more specific software (64%) and the phone (62%). This is also the case for early career psychologists, who use specific software (57%) as much as the telephone (58%). This can be explained by their capacities and their desire to adapt to the capacities and needs of patients. We note that they make little use of non-therapeutic software, unlike late career psychologists (47% for specific software versus 40% for non-specific software). This may be due to a desire to do things well in an adapted therapeutic setting.
This survey stresses that the current epidemic situation has also had an impact on the number of patients seen in consultation, whether at distance or in person. The graph shows that 55% of the psychologists in the study are treating fewer patients than before the pandemic. This concerns 50% of early career psychologists, 56% of mid-career psychologists and 59% of late career psychologists. In fact, as the study explains, many patients stop their therapy for financial reasons because they have lost their jobs and their insurance. But also because of lack of time and to take care of their children because schools are closing. Late career psychologists are the most affected by the loss of patients. This can be explained by the fact that they already have many consultations due to their experiences and they cannot manage them all in teletherapy, in addition to the precarious situation experienced by some patients who stop therapy on their own.
However, 30% of the psychologists in the study had no difference in the number of patients and the remaining 15% saw their numbers of consultation increase. This may be explained by the fact that some people want to make an appointment with a psychologist because they feel uncomfortable due to the pandemic and social isolation.
In light of these findings, we reckon that the purpose of the survey has been achieved, as clinicians’ practices have significantly changed as a result of the epidemic, both in terms of the organization and the conduct of consultations, as well as in terms of the number of consultations, which has dropped significantly for the majority of the psychologists in the study.
We hold that it would have been interesting in this survey to investigate in more detail the characteristics of the patients in their choices of the means used for remote consultation. In order to find out whether age and financial means are among the causes that make the phone the most used means.
The authors have failed to further investigate and describe the causes of discontinuation of therapy by some patients, and to elaborate on the reasons why psychologists have seen a decrease in the number of patients.
The conclusion :
We acknowledge that the covid-19 pandemic has had a significant impact on the profession of psychology, both in the United States and in France, as we have seen for ourselves during both confinements. Since the study was conducted in the United States, the results might not be the same in France, but the way of practicing the profession has been reorganized, adapted as much as possible to the needs of patients and their resources. We know that this health crisis has led to economic crises, but not only, the various instructions to reduce the spread of the Covid-19 virus is to isolate oneself, and to reduce as much as possible any contact with people who do not live with us, its restrictions even concern the close family. This can be morally burdensome, especially over a long period of time. This situation can also lead to complications in people with vulnerabilities (professional overload, depressed people, elderly people, …).
There are therefore several paradoxes facing psychologists: continuing to work in this crisis situation, where physical human contact must be limited, when the profession is based on this contact; and the demand for consultation falling when instinctively one might think that isolation and health crisis would generate a need for patients to see professionals.
One may therefore wonder what psychological impact this pandemic will leave on the population and professionals, and whether distance therapies are as effective as those carried out face-to-face.
Words we have learned :
- Remotely : à distance
- Telehealth : télésanté
- Referrals : références
- The spread : la propagation
- Practitioners’ caseloads : la charge de travail des praticiens
- To advocat : à préconiser
American Psychological Association. (2020, June 5). Psychologists embrace telehealth to prevent the spread of COVID-19. http://www.apaservices.org/practice/legal/technology/psychologists-embrace-telehealth