Effective and accessible telephone-based psychotherapy and supervision.

Abstract

The COVID-19 pandemic forced clinics to quickly shift service provision and supervision of students to remote operations. Mental health services for people facing barriers, including those who live in extreme poverty, remain a critical need, especially when considering the direct and indirect consequences of a global health crisis. The focus of this paper was to examine the effectiveness of psychotherapy treatment and clinical supervision, via telephone delivery (i.e., audio-only calls), from March to July of 2020 in a university training clinic, which primarily serves a low-income, community population. Participants (n = 33) were ethnically diverse, adult, outpatient psychotherapy clients from a large, urban setting and the university community. Primary diagnoses included major depressive, anxiety, and posttraumatic stress disorder. Student clinicians (n = 14) were novice psychotherapy providers, mostly in their second or third year of training. Qualitative data indicated that 1third of clients met treatment goals and successfully terminated during this period, while another third made significant progress toward these goals (operationalized as objective observations by the clinician and supervisor, self-reported changes by the client, and observations by the clinician and supervisor of in-session skill use). Smaller proportions of the sample were referred out for relocation or rotation changes, dropped out of care prematurely, or were transferred to a higher level of care. Clinician report of supervision alliance (SWAI-T), satisfaction, and other supervisory variables during remote supervision were comparable to in-person supervision and reflected good alliance and satisfaction for both modalities. These data suggest that use of audio-only calls for supervision and treatment provision can be effective for training and care, especially when clients have established therapeutic relationships with their clinicians. As telehealth services and remote training are likely to expand into the future, these findings provide preliminary support for the use of this modality as an option for clients with significant barriers to access and sufficient supervisory support to novice clinicians. Public Significance StatementMental health services for people facing barriers, including those who live in extreme poverty, remain a critical need during the COVID-19 pandemic, especially when considering the direct and indirect consequences of a global health crisis. Ensuring that a vulnerable population has access to high-quality mental health is crucial during the pandemic, as many individuals in this group do not have simultaneous access to all of the resources needed to migrate to a video telehealth platform for therapy sessions. Therefore, the aim of this paper is to contribute to the literature on the effectiveness of telephone-only telehealth service delivery by novice clinicians to provide an evidence-based approach for increasing access to needed care among community-based clients, often living in poverty.

Effectiveness of videoconferencing psychotherapy delivered by novice clinicians in a training clinic.

“…Scores on the WAI-SR started out high and approached the maximum total score by Session 24. Given the possible impact on rapport Rowen et al (2021) found when clinicians used an audio-only modality, it appears that being able to see the clinician may facilitate the ability to build strong rapport.…”

“…with flexibility to discuss new stressors, especially related to the negative impact of COVID-19. Further information about supervision processes, clinic policies, and procedures for consenting clients can be found in Rowen et al (2021). This study was approved by our university’s Institutional Review Board (Protocol #: 2020-0836).…”

“…pandemic, can be found in Rowen et al (2021). In short, due to information security and confidentiality concerns, students provided telephone-based services from March to June of 2020 for ongoing clients only.…”

Enhancing GP care of mental health disorders post-COVID-19: a scoping review of interventions and outcomes

“…A systematic review highlighted the importance of establishing an open entry system at primary care level for detection and intervention of mental health problems (Yue et al 2020). Two qualitative studies reported telemedicine was more effective when the therapeutic relationship had already been established between clinician and patient (Rowen et al 2021, Verhoeven et al 2020. Patient motivation and careful patient selection is critical, especially for specific interventions such as iCBT (Weineland et al 2020).…”

Implementing the classroom password game via telehealth among students with intellectual disabilities

“…Telehealth can be defined as the distribution of services (e.g., health services, supervision, training, and intervention) via electronic platforms and telecommunication technologies (Hames et al, 2020). Telehealth can be utilized to reach long distance patients, educate others, supervise, and reach many groups of people across the world (Hames et al, 2020; Rowen et al, 2022). Due to the COVID‐19 pandemic, many universities and school districts, as well as other providers (e.g., educators and psychological service providers) were required to teach and conduct services via telehealth using various platforms (Bell et al, 2020; Rowen et al, 2022).…”