Table 2.

Discussion prompts and articles for discussion

General overview of teletherapy	• Complete self-assessment as a group • Discuss importance of reviewing teaching institution’s policies regarding therapy through risk management or telemedicine offices • Discuss how fundamentals of remote therapy can be used across theoretical orientations as well as phone and video	• Shore JH, Yellowlees P, Caudill R, Johnston B, Turvey C, Mishkind M, et al. Best Practices in Videoconferencing-Based Telemental Health April 2018. Telemed J E Health 2018 11;24(11):827-832. • Markowitz JC, Milrod B, Heckman TG, Bergman M, Amsalem D, Zalman H, et al. Psychotherapy at a Distance. Am J Psychiatry 2020 -09-25:appiajp202020050557.
Telepresence	• Practice orienting the person to the virtual environment (tell them about what to expect for eye contact, if you will be typing notes, what might be happening if you are quiet, etc.). • Practice talking about an emotionally positive experience. Ask if the conversation seemed to make the other person almost “forget” they were in a virtual environment. • Practice expressing emotions and using nonverbal forms of communication. Ask if the interaction seemed natural. Was something missing? • Check in to see if anything seemed distracting from the interaction. Ask if there were there any behaviors, noises, visual items that pulled away from being present. Consider how close or far from the screen one should be to optimize the experience of presence while being close enough to be heard. Are all computer based distractions closed (e.g., email, chat, etc.)? • Was there something missing from the interaction? (Although an in person interaction cannot be exactly duplicated, something might be fine-tuned to more closely assimilate an in-person environment).	• Hilty D, Randhawa K, Maheu M, McKean A, Pantera R. Therapeutic Relationship of Telepsychiatry and Telebehavioral Health: Ideas from Research on Telepresence, Virtual Reality and Augmented Reality. Psychology & Cognitive Sciences 2019;5(1):14-29.
Boundaries	• Discuss whether residents have done therapy in an office setting or only virtually to assess their thoughts on similarities/differences, comfort/discomfort with each setting. • Plan and problem solve decisions to see patients only within business hours or flex hours in certain situations • Have residents consider and discuss their use of video calls prior to COVID-19 and after COVID-19 and ways to ensure that calls are professional and not social in nature. • Role-play a discussion with a patient about how to ensure the setting is private and any personal objects are outside the view of the webcam. • Consider and discuss • safety planning and role play how to conduct these discussions remotely.	• Drum KB, Littleton HL. Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Prof Psychol Res Pr 2014 Oct;45(5):309-315.
Therapeutic alliance	• Role-play a conversation with a patient to generate treatment goals to practice making goals less complex, and more achievable and collaborative • Discuss steps to increase therapeutic presence such as positioning of patient and therapist in the monitor and how one would facilitate this discussion • Reinforce self-activation and assertiveness on the part of the patient and role play how this would be done in a session	• Norwood C, Moghaddam NG, Malins S, Sabin-Farrell R. Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis. Clin Psychol Psychother 2018 Nov;25(6):797-808.
Transference	• Broadly define transference both in the context of psychodynamic and non-dynamic therapies to ensure that all residents feel comfortable with the terminology used in the course of didactics. • Have residents discuss differences and similarities in transferences developed in online and offline settings. • Role-play various transference interpretations that might be used in online setting. Consider discussing handling positive and negative transference in different therapies: CBT, supportive and psychodynamic.	• Migone, P. Psychoanalysis on the internet: A discussion of its theoretical implications for both online and offline therapeutic technique. Psychoanalytic Psychology, 30(2), 281-299.
Special populations	• Discuss the absolute contraindications to online therapy. Use case examples to illustrate specific challenges that may arise with specific patients while receiving online services. • Have residents consider providing online therapy for special populations of patients such patients with psychotic symptoms or patients with personality disorder diagnosis.	• Kocsis BJ, Yellowlees P. Telepsychotherapy and the therapeutic relationship: Principles, advantages, and case examples. Telemedicine and e-Health 2018;24(5):329.