Telepsychology: a new way to deal with relational problems associated with the COVID-19 epidemic

To the Editor,

The Covid-19 pandemic is a worldwide epidemic due to the new coronavirus SARS-CoV-2. The first cases were reported in Wuhan, China, between December 2019 and January 2020. The epidemic was declared a public health emergency of international interest by the World Health Organization on 30 January 2020.¹ In Italy, 35.262 positive cases, 33.899 deaths, and 165.837 healings have been recorded (June 7), and restrictive measures have been taken to deal with the pandemic.² Patients with Covid-19 usually experience flu-like symptoms, such as fever, dry cough, tiredness, breathing difficulty. In severe cases, pneumonia, acute renal failure, leukopenia, and lymphocytopenia can develop, even leading to death. Currently, no specific treatment is available, although anti-inflammatory agents, immunomodulators, and hyperimmune serum may be helpful.

Recently, it has been suggested that this epidemic causes a “psychological pandemic”, due to the strong impact on the mental health of the population worldwide. There has been an increase in depressive, anxious, obsessive-compulsive and post-traumatic symptoms, due to the onset of a variety of not adequately processed negative emotions, such as the fear of dying, the panic of being or staying locked at home, without any family or social contact.³ Moreover, Covid-19 has had a higher impact on the family system, which has had to face a paranormative and unexpected event, with various consequences on the psychological well-being and health of family members. Covid-19 psychological consequences impose a profound restructuring of roles, hierarchies, and relationships. Indeed, social distancing, isolation, fear of contagion, loss of work, and numbers of the deaths affect the family organization. Impulsive, frenetic, and irrational behaviors can occur and possibly result in increase of domestic violence, with a profound effect on the structure of the family. This may lead to either an “enmeshment” (i.e a greater isolation of the family members from the external environment with the onset of phobic symptoms) or a “disengagement” (i.e. a loss of the sense of protection, with a distancing within the families).⁴ Thus, if the family members cannot cope with the Covid-19, they can live in constant stress, with the possible onset of psychopathological abnormalities, including emotional exhaustion, irritability, anxiety, increased anger, and symptoms related to depression and post-traumatic stress disorder.³ It is therefore evident that “the family” plays a key role in maintaining the mental health of its members, as well as helping in the adaptation to the new condition.⁵

These balanced processes may be supported at distance by using innovative tools, including telepsychology, which is based on psychological services carried out on the Web, allowing individual, couple, or group psychotherapy.⁶ Telepsychology could be the solution to provide mental health care both during and after the pandemic period. First of all, telepsychology is easy to deliver and use: services require simple PCs, cameras, and an Internet connection, integrated into a single device, so it is also feasible via smartphone for most patients.⁷ Potentially all individuals with a basic knowledge of technology may benefit from the tool. The only contraindication ascertained to telepsychology is poor patient compliance.⁸ It has been shown that telesupport is as effective as conventional therapy and it is well accepted by both healthcare professionals and patients.⁹ The tool can offer patients a practical way to immediately share their experience during (or after) a crisis, and develop new therapeutic skills during sessions, as clinicians can use digital data to make more informed decisions about care.⁸ For this reason, healthcare professionals must develop innovative skills/competences to guarantee the quality, safety, and efficiency of care using technology.⁸ These skills present similarities and differences with respect to in-person care, with additional aspects such as support for clinical decisions, selection of technology, and management of the flow of information through an electronic platform. We believe that it would be appropriate to increase the use of telepsychology for direct assistance to families, allowing family sessions. The idea of using technology for mental health service is not new, especially during the COVID-19 pandemic, which has stimulated the use of technology by healthcare systems.⁷ However, to the best of our knowledge, telepsychology for family groups has been applied little, since the tool is generally used with individuals or couples but few authors have carried out plenary sessions with all members of the family. Keilman et al. conducted a study with similar methodology, observing that videoconferencing is a suitable approach to provide support to families. Participants expressed interest in the sessions, considering them both educational and consultative with respect to individual therapy.¹⁰ For this reason, we believe it would be helpful to encourage healthcare professionals to use the family therapy tool. Indeed, as far as we know, such kind of telesupport has not been used during the Covid-19pandemic yet. By applying telepsychology to the family, psychotherapists should promote the resilience that enables family members to face their traumas and sufferings, encouraging both coping strategies and adaptation family processes.¹¹ To manage the “psychological crisis” caused by the Covid-19 pandemic, the healthcare therapists should support the family in recognizing their resources and qualities, helping their members to recover stability and restore roles and rules. The psychotherapist could promote the creation of new connections both within and beyond the family, allowing the development of a sense of security and solidarity, to rebalance homeostasis, and restore a healthy family system.

In conclusion, we believe that it is important to support the family in the restructuring and adaptation process following the Covid-19 pandemic, preventing negative psychological consequences for its members. For this reason, each healthcare therapist has the opportunity and responsibility to connect with their patients in unconventional ways, including telepsychology,^6,7 in order to better support families during this difficult period.

Conflict of Interest

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.