The therapeutic setting in tele-psychology interventions during the covid emergency19

The therapeutic setting in tele-psychology interventions during the covid emergency19

The coronavirus emergency has inevitably compromised the practice with which normal psychological activities are directed towards users. Whether we are talking about working, associative, medical or recreational practices, the social distancing imposed by the spread of the virus and prescribed by the authorities has brought to light all the limits of a management based on closeness and human relationship, a management particularly similar to certain practices psychological.


Advertising message When we talk about psychology, which refers to psychotherapy or psychological support interviews, we approach a world based on the relationship with the patient / user and on the therapeutic alliance. These aspects are fundamental for the success of any intervention, be it of short or long duration. The therapeutic alliance is inextricably linked to good psychological practice and, regardless of the different approaches and the various forms of intervention, social distancing seems to create a real wall between the parties involved.

In the face of this condition and considering the extremely difficult situation, the sector operators found themselves having to administer emergency psychology interventions. The current request is as follows: teams of rescuers and / or workers in the health or public security or civil protection management field are emotionally and psychologically overloaded. The staff is reduced and the demand is high, therefore these teams are working as hard as possible to deal with the pandemic. The growing number of interventions for Covid19 adds to the daily life of the rescue and help operations, which due to their innovative and unpredictable nature significantly increase the individual stress threshold, increasing the risk for rescuers to develop psychological problems with dramatic consequences for their future. How to respond to these requests while maintaining social distancing? In this case the only solution is to implement interventions remotely, using online platforms or by phone call. In the specific case in which I found myself operating the online platform was particularly versatile and adaptable to the context of the intervention.

When working in emergency psychology, psychotherapy and medium or long-term therapy services are usually not provided, but individual specific interventions are implemented which serve to lower the stress threshold and help metabolize what has happened. These interventions usually include a meeting with a maximum audience of 4/5 people for an average duration of 2 and a half hours and are used to significantly lower the opportunity to develop episodes of acute stress or stress-related diseases in the future such as the PTSD. Who works in the field of psychology knows the importance of an essential factor: the therapeutic setting. Finding yourself operating remotely, you have control over almost the whole procedure and for some aspects, such as the ability to dialogue between the psychologist-assistant and the possibility of conducting the intervention, the remote setting almost becomes a surprisingly improving, if not essential, tool of practice. But the problem remains the same, how to manage a home or improvised therapeutic setting remotely? We abandon the idea of ​​the safe-place where to discuss without being interrupted, without distractions or noises; the whole environment is safe precisely because it is controlled in detail by the conductors, whose sole purpose is to investigate the user’s experience and help him in this difficult moment. All this disappears and you suddenly find yourself dealing with people in the intimacy of their home (most of the time) or in improvised public places (fortunately more rarely). This limits not only the ability of the conductors to carry out the intervention but also places an equally significant limit on the achievement of that safe-place condition which is a basic requirement for a correct use of a psychological intervention by users. They are in fact in the living room of the house, next to the family photographs, or in the bedroom, an intimate place par excellence, with the constant threat of being disturbed by the telephone, by the children or by other relatives who walk around the house. Why do not we forget that, if most users are operators forced to work, in these days of forced isolation,

Advertising message How to manage the setting? What are the limits and / or possibilities of this situation? The most obvious limitation of this setting is the impossibility on the part of the tenants to completely manage the environment in which the intervention is administered, consequently part of the control that is usually implemented in order to build and co-build with the user a safe and distraction-free place that allows you to scroll undisturbed, focusing completely on the individuals and on the progress of the intervention itself. True, this is an important limit but psychology must adapt and find new solutions even at the cost of changing its practice and agreeing to give up part of the control to the randomness of events. One possibility that emerged during these tele-psychology interventions is the possibility that the person will be more comfortable precisely because they are within the home. The elimination of the therapeutic setting from a certain point of view dilutes the prejudicial image of the psychological intervention that usually accompanies the subject and discourages him from actively participating (or not participating in it) in the intervention. From this point of view, therefore, it can be said that people feel more motivated to participate both in numerical and qualitative terms. Talking and discussing remotely, from home, for some people is an incentive to participate and this often results in a significant increase in the time spent during the interventions. This clearly does not apply to everyone:

How to solve this problem in these cases? If it is true that some people feel comfortable within the home, it is also true that the importance of a neutral and professional place transcends the simple “feeling at ease” and allows you to implement the intervention in a way standardized (as far as possible) and efficient. At this time, as already mentioned, it is necessary to implement an organizational plan that allows the use of emergency psychology interventions to the staff who find themselves working daily in the Covid emergency19. We are mainly talking about rescuers and health personnel, police forces, armed forces and civil protection personnel as well as workers from specific sectors (often forgotten) who are operating in the sector. By making these people part of organizations / institutions it could be interesting to be able to establish a suitable place for these organizations / institutions used for the therapeutic setting. Through the advice of experts it would be useful to create a room-setting within the various health, government or association structures where the staff, by connecting remotely, can freely use the service. In this way people will be able to choose, also on the basis of personal availability, which setting they prefer. Who owns a large or quiet home will be able to take advantage of the service directly within the home, while those who are unable to afford such a setting will be able to rely on the room-setting prepared by the authorities / organizations. As for psychological practice, and not only, we have to deal with the possibility that this emergency will continue (perhaps with different restrictions) for a period of months if not years and it would be irresponsible to avoid preparing for interventions long-term remotely. Establishing a place and using it as a remote setting I believe is a necessary point to start providing a service to the personnel involved in the emergency that is as democratic as possible. Under the indications of the professionals of the sector, a safe-place can be furnished in a simple and functional way that enables the administration of emergency psychology interventions, a practice necessary to allow the staff employed to continue working in physical and psychological safety,