The emergence of the Covid-19 pandemic at the beginning of 2020 changed psychotherapists' personal and professional realities. The necessity of delivering health care safely within the lockdown and shelter-in-place mandates compelled psychotherapists to shift their practices away from providing in-person services to offering synchronous remote psychotherapy instead. This abrupt transition presented a unique and multifaceted challenge in terms of the service location; as therapists' houses effectively became their offices, their homes no longer served as purely personal spaces. Instead, psychotherapists needed their living environments to fulfill a dual function as a clinical office space that would be shared with their clients, albeit at a distance. This mixed-method study focused on assessing psychotherapists' most significant challenges and specific adaptations to this experience of providing remote therapy from home during the Covid-19 pandemic. Findings from the study revealed that the shared trauma experienced as a result of the pandemic, the unexpected and sudden transition to the new therapeutic setting, and "Zoom fatigue" were among the most significant challenges faced by therapists. The participants also demonstrated great resilience as they found creative ways to adapt and continue their meaningful work with their clients. This was especially true for those working with children. Ultimately, the participants had mixed feelings about the possibility of returning to the office setting. Clinical Impact StatementThe Covid-19 pandemic will have a lasting impact on the delivery of psychotherapy treatment. This mixed-method study assessed psychotherapists' most significant challenges when conducting remote psychotherapy sessions from their homes. The study's findings cover both the challenges and the strategies used to navigate them.

The COVID-19 pandemic has forced a new reality on the delivery of psychotherapeutic services. Therapists have had to rapidly adapt to telehealth therapy using various video conferencing technologies while working from spaces that were not necessarily designed for delivering therapy sessions. While COVID-19 continues to be present in therapists’ lives and shapes how they provide services, answering the question of whether to meet with clients in person again is a decision laden with complexity and ambivalence. In this mixed-method study, surveys with 169 therapists and interviews with 17 therapists were used to determine the factors that currently influence their attitudes toward resuming traditional in-person psychotherapy in light of COVID-19. We focused on the therapists’ personal and professional characteristics to assess their plans to continue with telepsychotherapy or return to a traditional psychotherapy setting. Our findings suggest that positive attitudes toward telepsychotherapy, the lack of an effective vaccine, clients’ satisfaction with telepsychotherapy, insurance reimbursement for telepsychotherapy, and negative attitudes toward wearing masks during sessions influenced therapists’ decisions on whether or not to return to traditional in-person psychotherapy in the age of COVID-19.

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The threat of the Covid-19 virus is ongoing and has significantly affected the provision of mental health services, particularly psychotherapy. This quantitative study offers insight into 212 therapists’ views on whether to return to meeting clients in person by considering (a) therapists’ personal and professional attitudes, (b) safety (specifically related to vaccines and wearing masks), and (c) insurance reimbursement for telemental health (TMH). Results from this study show that participants find TMH to be as effective and as meaningful as in-person therapy and suggest that on a practice level, TMH is not only as effective as in-person psychotherapy but is even more effective than masked in-person therapy. The results also show that the participants would prefer not to provide in-person therapy while wearing masks and would be more inclined to return to seeing clients in the office if both the client and the therapist were fully vaccinated. Moving forward, the participants anticipate providing a combination of remote and in-person therapy while continuing to work from home on some days and in the office on others. More concrete guidelines are needed to ensure the safety of clients and therapists when meeting in person, and policies that reduce ambiguity surrounding insurance companies’ reimbursement of remote services must be developed.