Online psychotherapy with adolescents
The care of adolescents presupposes, in the clinic, a good dose of patience and flexibility. It is a different modality from adult therapy. What happens when it comes to online therapy?
Online counseling to teens can be difficult. Strong resistance can exist when working with teenagers due to their evolutionary transition from child to adult. To combat this, therapists must equip themselves with a variety of creative techniques that promote both verbal and non-verbal expression in a therapeutic way. All the more complicated in online sessions. This article provides appropriate clinical insights to assist therapists in increasing adolescent involvement while allowing them to communicate their thoughts, behaviors and feelings in a non-traditional way.
The care of adolescents presupposes, in the clinic, a good dose of patience and flexibility. It is a different modality from adult therapy.
In this Covid-19 health emergency Skype or Whatsapp have become the only alternatives to the setting vis à vis in their professional studio.
In the most emergent cases, psychotherapy support (Bellak, 1968) aims to alleviate the state of suffering and panic, as well as more acute states of mental suffering. Even short therapies (Burke, 1978) are often used to reduce anxious states, sexual disorders, suicidal behavior in teenagers and adults.
But what happens when it comes to conducting online therapy? It is good that the clinician is clear, well in advance, if the adolescent in question is suitable for online treatment.
Short-term dynamic therapies, characterized by shortened lengths (10–40 sessions), have become more prevalent in the past three decades (Bellak, 1992). Short-term therapies are based on a rapid psychodynamic diagnosis, a therapeutic focus, a rapidly formed therapeutic alliance, awareness of the processes of interruption and separation and the managerial position of the therapist. Many adolescents in need of therapy are resistant to long-term attachment and involvement in a relationship that can be ambiguous, living as a threat to their emerging sense of independence and separation. Short-term dynamic therapy may be the treatment of choice for many teenagers because it minimizes these threats and is more sensitive to their development needs (Bellak, 1968).
In a 2016 study of teenagers in Australia it was found that 72% of teenagers said they would have access to online therapy if they had a mental health problem. 32% said they would choose online therapy over face-to-face meetings (Sweeney et al. 2016).
A study published in the Journal of Child and Adolescent Psychopharmacology in 2016 found that while more research is needed in this area, the growing range of e-therapy programs (use of specially built platforms) for children and adolescents, shows an increase in usage. The study (Stasiak et al. 2016) in fact monitored the process of selection, by teenagers, of the portals present on the net for the request for psychological help.
In a recent study (Fitzpatrick et al., 2017), researchers assessed the effectiveness of a web-based cognitive-behavioral therapeutic app called Woebot in young adults with symptoms of depression and anxiety.
Many of the study participants reported that daily use of Woebot resulted in a significant reduction in symptoms of anxiety and depression after two weeks, measured through the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Positive and Negative Affect Schedule (PANAS).
In terms of effectiveness, online therapy, compared to offline therapy, leads to the same results in terms of care and understanding of the patient’s problems (Migone, 2003). Change the setting in the sense that in one context there is the presence of a computer and in the other not.
Adolescents seen in consultation (with the use of multimedia tools) in this context related to the pandemic flow, complain of recurrent symptoms, such as depression and anxiety. They feel a sense of constraint linked to having to stay at home and do not mentally analyze in depth what the real risks of the disease may be.
There are numerous barriers that prevent young people from accessing mental health services, including perceived stigma (Gulliver et al., 2010), an expectation or preference for self-sufficiency, concerns related to confidentiality (Gulliver et al., 2010 ) and lack of knowledge and accessibility of services (Gulliver et al., 2010). One of the most recent strategies to get around these obstacles has been the provision of online services.
In many cases, online therapy is conducted in the same way as “vis à vis” therapy. The method and therapeutic techniques remain the same. The adolescent may sometimes need an accompaniment to online therapy. The analyst must take this possibility into account in order to make it easier to overcome these impasse. In the same way, from literature it emerges (Marmor, 1979) that short therapies find more and more space within society. This does not exclude, however, that for some patients long paths must be used because they are more suitable for them.
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