As the crisis of global pandemic continues to unfold and alter the everyday workings of public life, early trends in the impact on mental healthcare treatment at a safety-net hospital illuminate implications for clinical work in the public sector under unprecedented conditions and beyond. While there are many important areas to consider and research to come, the current paper will explore the impact of the COVID-19 crisis on attendance of psychotherapy sessions. The authors point to early evidence from their caseloads in an outpatient psychodynamic psychotherapy training program showing a statistically significant decrease in missed appointments upon switching, in crisis, to a telehealth model. In this paper we explore possible reasons for this decrease in missed appointments, including psychological reasons (such as increased need for connection) and logistical reasons (such as eliminating barriers to attendance). Finally, we point to considerations and implications for practice during and after the crisis of the pandemic has subsided, and consider ways in which the changing approach may, in effect, increase access and remove barriers to care that pre-date our current crisis.

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Purpose This study aims to examine what patients say is helpful in psychodynamic psychotherapy by analyzing responses to an open-ended question at two time points: three months into treatment and termination. Design/methodology/approach Participants in this naturalistic study were a diverse group of patients seeking treatment at a psychodynamic psychotherapy training clinic (within a public hospital system). The authors used thematic analysis to categorize patient responses to an open-ended question about what is helpful in their treatment. Findings The authors found that a majority of patients found their psychotherapy helpful, and patient responses broke down into 16 categories. Themes that emerged from categories were what patients experience or feel, what therapists/therapy provides and what patients do in therapy. The most frequently endorsed category at both three months and termination was embedded within other categories, “mention of an other,” which captured when patients specifically mentioned another person (i.e. the therapist) in their response. The next most frequently endorsed categories were “talking/someone to talk with,” “feeling better/experiencing well-being/improved functioning” and “having regularity/structure” (at three months) and “having attention directed at experience,” “having regularity/structure” and “experiencing the professional role of the therapist” (at termination). Originality/value Findings shed light on factors contributing to helpful psychotherapy from patients’ perspectives in their own words. While previous research has shown that the therapy relationship is an important factor in effective therapy, the findings of this study highlight this ingredient in a personal, spontaneous way.