F on ie s in Psychology | www. on ie sin.o g 1 Feb ua y 2021 | Volume 12 | A icle 589536
PERSPECTIVE
published: 19 Feb ua y 2021
doi: 10.3389/ psyg.2021.589536
Edi ed by:
Moshe Bensimon,
Ba -Ilan Uni e si y, Is ael
Re iewed by:
Ke en Gue a,
Ba -Ilan Uni e si y, Is ael
Mey an Boniel-Nissim,
Kinne e College, Is ael
*Co espondence:
Ja ie Fe nández-Ál a ez
[email p o ec ed]
Special y sec ion:
This a icle was submi ed o
Psychology o Clinical Se ings,
a sec ion o he jou nal
F on ie s in Psychology
Recei ed: 30 July 2020
Accep ed: 12 Janua y 2021
Published: 19 Feb ua y 2021
Ci a ion:
Fe nández-Ál a ez J and
Fe nández-Ál a ez H (2021)
Videocon e encing Psycho he apy
Du ing he Pandemic: Excep ional
Times Wi h Endu ing E ec s?
F on . Psychol. 12:589536.
doi: 10.3389/ psyg.2021.589536
Videocon e encing Psycho he apy
Du ing he Pandemic: Excep ional
Times Wi h Endu ing E ec s?
Ja ie Fe nández-Ál a ez
1,2* and Héc o Fe nández-Ál a ez
3
1 Depa men o Basic Psychology, Clinical and Psychobiology, Jaume I Uni e si y, Cas ellón de la Plana, Spain, 2 Asociación
Aiglé, Valencia, Spain, 3 Fundación Aiglé, Buenos Ai es, A gen ina
Wi h he ad en o COVID-19, a sudden, unexpec ed, and o ced shi has been p oduced
in he ield o psycho he apy. Wo ldwide, many he apis s closed hei o ices and s a ed
o deli e psycho he apy online h ough a sc een. Al hough di e en media s a ed o
beinco po a ed, ideocon e encing is undoub edly he mos common way in which
he apis s a e doing he apy hese days. This is ca alyzing a apid change in he p ac ice
o psycho he apy wi h p obable las ing e ec s and dese es o beca e ully e lec ed upon.
The e o e, in his pape ou aim is o ou line he main challenges o a medium ha may
ha e a i ed o s ay. In ha sense, we e iew he li e a u e o desc ibe he s a e-o - he-a
ega ding he main aspec s o ideocon e encing psycho he apy as well as o sugges
possible a enues o u u e esea ch and p ac ice.
Keywo ds: COVID-19, psycho he apy, psycho he apis s, eleheal h, ideocon e encing psycho he apy, elemen al
heal h, e-men al heal h
INTRODUCTION
Al hough no consensus exis s among expe s ega ding wha comp ises In e ne -deli e ed
in e en ions (Smok unowicz e  al., 2020), he e is no doub ha hey ha e gained a cen al
ole in he clinical psychology ealm. A la ge body o e idence suppo s he inco po a ion o
di e en echnologies, wi h di e en media and deg ees o human suppo (Ande sson e  al.,
2019). E en psycho he apy, which has his o ically in ol ed an in-pe son sha ed space, has
slowly bu g adually inco po a ed mo e and mo e use o echnologies. Fundamen ally, he
applica ion o ideocon e ences in ou ine p ac ice has been p og essi e and is mainly explained
by p ac ical easons, such as geog aphical ba ie s, ea men -seeking s igma, o lexibili y in
scheduling sessions (Nickelson, 1998; Backhaus e  al., 2012). Resea ch on he emo e deli e y
o he apy has inc eased along wi h his inc easing use, and acco dingly, a la ge body o
e idence has been p oduced du ing he las wo decades showing he e icacy o deli e ing
psycho he apy h ough ideocon e ence, e en wi h compa able esul s o in-pe son he apy
(Va ke e  al., 2018; Ba as ini e  al., 2020). Howe e , i s applica ion in ou ine p ac ice has
no been widesp ead, wi h almos all he apis s ha ing no expe ience.
Wi h he ad en o he co ona i us disease (COVID-19), a sudden, unexpec ed, and o ced
shi has been p oduced. Wo ldwide, many he apis s closed hei o ices and s a ed o deli e
psycho he apy online. The use o echnology became he only way in many coun ies o p o ide
psycho he apy, and an o e nigh ansi ion om in-o ice o online p ac ice occu ed. Gi en ha
ideocon e encing cons i u es a simila way o deli e ing he apy o adi ional in-pe son
psycho he apy, i has been apidly inco po a ed (Sammons e  al., 2020; Wind e  al., 2020).
Fe nández-Ál a ez and Fe nández-Ál a ez Videocon e encing Psycho he apy in Times o COVID-19
F on ie s in Psychology | www. on ie sin.o g 2 Feb ua y 2021 | Volume 12 | A icle 589536
Al hough his massi e dissemina ion is posi i e since millions
o people could po en ially bene i om hese ea men s, a
se ies o ques ions emain unanswe ed. In his pape , we aim
o ou line he main challenges o a modali y ha may ha e
a i ed o s ay.
ISSUES IN WORKING WITH
VIDEOCONFERENCING
Gene al The apeu ic Ta ge s
The use o ideocon e encing psycho he apy (VCP) does no
change he needs o pa ien s and hus he gene al he apeu ic
goals. Pa ien s’ speci ic demands may ha e changed due o
he pandemic, bu hei su e ing will s ill be cen e ed a ound
hei di icul ies wi h he wo main componen s o dys unc ion:
sel -dys unc ion and in e pe sonal dys unc ion (Hopwood e al.,
2013). Besides, i is impo an o ocus he wo k on he wo
dimensions in which he psychophysiological unc ioning o
he o ganism is deployed: beha io and expe ience.
Demanding scena ios such as lockdown o unce ain y abou
he a e ma h o he pandemic cons i u e s esso s ha may
pa icula ly a ec people who al eady had maladap i e s a egies
o coping wi h eali y. In many cases, he con ex me i s
exace ba ed dys unc ional eac ions ega ding ou men al heal h.
Howe e , i is key o keep in mind ha al hough he con ex
ope a es as a undamen al a iable in peoples’ li es, he co e
aspec s ega ding he ways o o ganizing expe ience a e
pe sonali y and i s componen s, such as schemas, a achmen
s yles, egula o y capaci ies, and in e pe sonal unc ioning,
among o he s (Li esley, 2012).
I is necessa y o hink ou side he box and no jus conside
he dange s and nega i e aspec s o he pandemic. The cu en
con ex obliges us o li e unde cons an h ea , and he e o e,
he si ua ion eminds us ha we a e agile beings (Wong,
2020). Implemen ing VCP, in pa icula due o a o ced si ua ion
like COVID-19, may be an oppo uni y o wo k on issues
ha o he wise would no ha e been possible o add ess. The
p esence o a di icul si ua ion may acili a e he se ing o
new goals. Tha is, his con ex may also os e he p omo ion
o posi i e changes such as meaning in li e as an impo an
he apeu ic a ge (Hill e al., 2017). Meaning in li e has p o en
o be a e y powe ul way o egula ing emo ions as well as
p omo ing posi i e psychology p inciples ha , a om ocusing
on he posi i e as a supe luous hing, conside s exis en ial
so ow o be a way o ind eedom (Wong, 2011). The
unexpec ed consequences o he pandemic os e a discussion
ha is mo e impo an han e e : Wha should we pu sue in
li e? A e we li ing acco ding o ou alues?
The apeu ic Alliance
The e a e subs an ial di e ences be ween in-pe son psycho he apy
and VCP ha may ha e an impac on how he he apeu ic
alliance is de eloped. Fo ins ance, in VCP, bo h pa ien s and
he apis s ha e he possibili y o ha ing eedback om hei
own came as. Ce ain pa ien s and he apis s (e.g., na cissis ic
o socially anxious indi iduals) may pay oo much a en ion o
hei own beha io , and his may be de imen al o he apeu ic
communica ion (Payne e  al., 2020). Mo eo e , in-pe son
psycho he apy uses a physical sha ed space, en ailing he
immediacy o he senso y expe ience and hus an undoub edly
quali a i ely di e en exchange. The mos e iden di e ence
be ween in-pe son psycho he apy and VCP is he po en ial
echnical di icul ies ha may a ise du ing he la e . As explained
by Ma kowi z (2020), an uns able connec ion, a ozen sc een,
delayed audio o poo ligh ing a e some o he di icul ies ha
may impai engagemen in he apy. Addi ionally, as desc ibed
by Thompson-de Benoi and K ame (2020), di ec eye con ac ,
one o oice, he abili y o ha e an open pos u e, body mo emen s,
synch ony, and a unemen a e some o he communica i e
channels ha may behampe ed in VCP. Tha is, he pa alinguis ic,
non- e bal and p osodic aspec s o communica ion may
be a ec ed. P inciples ha g ound embodied cogni ion enable
one o g asp how physicali y is key o in o ma ion p ocessing,
in ol ing bodily aspec s ha may no be ans e able o emo e
modali ies (Ca amazza e al., 2014). A s ooped pos u e, a shaking
leg o a clenched is a e in isible in VCP. Tha ele an in o ma ion
is missed in VCP bo h o he apis s and pa ien s.
No aking in o accoun hese di e ences ha exis be ween
modali ies may a ec he de elopmen o he he apeu ic p ocess
and, consequen ly, esul in ea ly d opou s. O he up u es in
emo e psycho he apy may be exace ba ed due o he
a o emen ioned echnical p oblems o disappoin men wi h he
es ic ed possibili ies ha his modali y pe mi s. Iden i ying
bo h con on a ional and wi hd awal up u es and implemen ing
echniques o esol e hem is c ucial, and he e a e ini ial
sugges ions ega ding how o deal wi h his issue in VCP
(Dole -Ami e  al., 2020).
Beyond he concep ual deba e a ound he es ablishmen o
he apeu ic alliance in VCP, a g owing body o e idence shows
ha i can be es ablished, p esumably wi h compa able esul s
o in-pe son psycho he apy (Simpson and Reid, 2014; No wood
e  al., 2018; Lopez e  al., 2019). The esul s o hese s udies
con e ge on he conclusion ha a he apeu ic alliance can
be success ully o med in VCP. Indeed, Lopez e  al. (2019)
conclude ha VCP “…is a iable modali y wi h he po en ial o
imp o e access o ca e wi h a low impac on he apeu ic alliance.”
The au ho s sugges ha he he apeu ic alliance is no pa icula ly
a ec ed, and he e o e, i does no hinde any he apeu ic p og ess.
Al hough he apeu ic alliance can be well es ablished in VCP, i
is p ema u e o conclude ha i is equal o in-pe son psycho he apy.
Undoub edly, he he apeu ic alliance cons i u es a co e
elemen in all psychological ea men s (Flückige e al., 2018).
Indeed, he he apeu ic alliance may beconcei ed as a mode a o
o an ac i e mechanism o change (Zilcha-Mano, 2017; Baie
e al., 2020). The longs anding adi ion o he apeu ic alliance
esea ch in in-pe son psycho he apy has p oduced se e al lines
o esea ch ha ha e p o ided p o ound insigh in o how i
is deployed (No c oss and Lambe , 2019). Howe e , he e is
li le esea ch hus a on he ole o he he apeu ic alliance
in ea men in VCP esea ch compa ed o in-pe son
psycho he apy. One opic i would be ele an o conduc
esea ch on in VCP esea ch is he ecip ocal dependency
Fe nández-Ál a ez and Fe nández-Ál a ez Videocon e encing Psycho he apy in Times o COVID-19
F on ie s in Psychology | www. on ie sin.o g 3 Feb ua y 2021 | Volume 12 | A icle 589536
be ween he he apeu ic alliance and symp oma ology, as he e
is moun ing e idence in esea ch on in-pe son ea men , which
sugges s ha he o ma ion o a s ong he apeu ic alliance
p ecedes symp oma ic change (Zilcha-Mano e al., 2014; Zilcha-
Mano, 2017). Fo now, he e a e only a ew examples o VCP
esea ch on his issue, wi hou he same complexi y as esea ch
on in-pe son psycho he apy (Boucha d e  al., 2020).
F om a neu obiological poin o iew, he a achmen bond
is usually associa ed wi h he 9-amino-acid cyclic neu opep ide
oxy ocin (Schneide man e  al., 2014), which in u n is a
ma ke o he he apeu ic alliance and alliance up u es
(Zilcha-Mano e  al., 2018, 2020). Addi ionally, based on he
Poly agal Theo y (Po ges, 2007), he e is esea ch showing
ha highe in-session hea a e a iabili y (speci ically he
high- equency powe ) acili a es he es ablishmen o
he apeu ic alliance, and his p edic s symp oma ic imp o emen
(Blanck e  al., 2019). I will be impo an o demons a e
ha hese associa ions occu in emo e modali ies as well.
Should esea ch beconduc ed on hese mo e nuanced aspec s,
i would no be su p ising o ind ha di e ences be ween
in-pe son and emo e psycho he apy eme ge conce ning he
quali y o he he apeu ic ela ionship.
The e is a g ea di e ence ega ding he es ablishmen o
he he apeu ic alliance be ween ea men s ha begun wi h
an in-pe son modali y and ansi ioned o VCP and ea men s
ha we e deli e ed emo ely om he beginning. In ea men s
ha make a ansi ion o VCP, i is impo an o conside he
necessi y o making a new con ac (Inchaus i e  al., 2020).
Beyond he bond, he classical concep ualiza ion o he he apeu ic
alliance en ails objec i es and asks. E en hough he bond
may be e y s ong, he asks and speci ic goals p e iously
ag eed upon should beclosely examined o de e mine whe he
i is necessa y o in oduce changes gi en he new ci cums ances.
Conce ning speci ic objec i es, he e may be some nuances,
bu o e all, hey a e also ans e able om in-pe son o VCP.
The g ea es di e ence be ween in-pe son and VCP may lie
in he asks. Due o ei he he modali y o he con ex , he
usual asks canno be conduc ed. Commonly used echniques
in in-pe son psycho he apy may need a p ocess o adap a ion
o be implemen ed in VCP. An illus a i e example is he
deli e y o ele-chai wo k (Pugh e  al., 2020).
On a posi i e no e, i has been ound ha VCP can p omo e
mo e disinhibi ion and openness due o he possibili y o p oducing
a sense o sa e y and a mo e neu al powe balance. A he
beginning o ea men , his neu al disposi ion in he bond
can os e g ea e disclosu e among pa ien s who ha e ce ain
in e pe sonal pa e ns (e.g., submissi e pa ien s) and may bene i
om a less con on a ional ela ionship (Simpson e  al., 2020).
Adap ing he In e en ions o he Pa ien s’
P e e ences, Cha ac e is ics, and Clinical
P oblems
E idence-based p ac ice in psychology en ails he in eg a ion
o bes a ailable esea ch, clinical expe ise, and pa ien
p e e ences and alues (APA P esiden ial Task Fo ce, 2006).
Taking in o accoun he p e e ences and alues pe mi s o
adap he ea men o each indi idual. Cul u al sensi i i y
eme ges mo e han e e as an essen ial aspec o conside ,
gi en ha he e a e subs an ial di e ences depending on a
ange o ac o s o he p ac ice o VCP du ing c i ical imes
such as he cu en COVID-19 pandemic. The e o e, i is
ele an o ailo he ea men acco ding o he ollowing aspec s:
Clinical a iables such as psychopa hological
se e i y
I is s ill e y impo an o assess suicide isk, in pa icula in
he con ex o disas e s like COVID-19in which suicide a es a e
expec ed o inc ease (Gunnell e  al., 2020). I is c ucial o adop
eme gency measu es i suicidal hough s o a emp s a e de ec ed
(Gilmo e and Wa d-Ciesielski, 2019; Jobes e al., 2020). Fo se ious
men al illness as well as o pa icula clinical g oups ha may
be hinde ed om wo king p ope ly h ough ideocon e encing,
speci ic guidelines should be elabo a ed and ollowed.
The e a e ce ain clinical si ua ions ha may be mo e
challenging han o he s. Fo ins ance, dealing wi h a pe son
wi h a se e e ea ing diso de en ails ob aining session weigh s
o ha ing amily meals, which demands speci ic solu ions o
wo king emo ely (Ma heson e al., 2020). Likewise, he p ocedu e
o conduc ing exposu e he apy may be d as ically changed.
An exposu e ask o social anxie y diso de in emo e
psycho he apy can be adap ed by including unknown people
in a ideocon e ence call (OxCADAT, n.d.). Nume ous pape s
ha e been published o ea ing clinical condi ions ia emo e
he apy, including obsessi e compulsi e diso de (McKay e al.,
2020), bipola diso de s (De Siquei a e  al., 2020), suicide
(Mcginn e al., 2019), psychosis (DeLuca e al., 2020; Hasson-
Ohayon and Lysake , 2020), pos - auma ic s ess diso de
(Aa jes- an Doo n e al., 2020b; Fina e al., 2020), sleep diso de s
(A ned e  al., 2020), among o he s.
Sociodemog aphic a iables
The socioeconomic backg ound o digi al li e acy should
be pa icula ly aken in o conside a ion be o e s a ing a VCP
ea men (Nelson e  al., 2017; Ma kowi z e  al., 2020). Tha
means ha he he apis needs o design he speci ic goals
and asks in acco dance wi h he pa ien ’s cha ac e is ics, needs,
and p e e ences. This is pa icula ly ue gi en ha , wo ldwide,
people who su e he mos a e ulne able and unde se ed
popula ions (F ankham e  al., 2020). The p esen si ua ion
in ol ing he p esence o he COVID-19 pandemic is no
excep ional in his ega d. Socioeconomically excluded people
o people a high isk such as elde ly people a e logically
hose who po en ially would need mo e help unde hese
ci cums ances, bu pa adoxically also ha e less access o
psycho he apy, including o VCP.
Accep ance and a i udes owa d echnology
Al hough i was hough ha pa ien s we e esis an o VCP
in i s ea ly days, esea ch shows ha o e all pa ien s ha e a
posi i e a i ude owa d VCP (T ondsen e al., 2014; Bleyel e al.,
2020). Hence, i is essen ial o conside he expe ience o he
pa ien s wi h echnology as well as wi h p e ious psychological
Fe nández-Ál a ez and Fe nández-Ál a ez Videocon e encing Psycho he apy in Times o COVID-19
F on ie s in Psychology | www. on ie sin.o g 4 Feb ua y 2021 | Volume 12 | A icle 589536
ea men s and, acco dingly, o de e mine he ex en o which
he pa ien s conside ha such a ea men may be bene icial
o hem. Pa ien s’ esis ance may be explo ed and po en ially
coped wi h mo i a ional in e iewing s a egies (Walke e al., 2020).
Adap ing he In e en ions o Di e en
Modali ies and Se ings
VCP was i s deli e ed undamen ally in indi idual o ma s,
o adul s and in p i a e p ac ice. Recen ly, as a consequence
o he need o apidly adap ing p ac ice o emo e deli e y,
VCP has ex ended o all o ma s ( amily, couple, and g oup
he apy o ma s), popula ions (child en, adolescen s and elde
people) and se ings (e.g., hospi als, uni e si y counseling cen e s,
communi y clinics, p isons).
Family he apy is pa icula ly necessa y o ce ain clinical
si ua ions (Amo in-Woods e  al., 2020), such as hose ha
a ec ed younge people and adolescen s (Bu goyne and Cohn,
2020). An illus a i e example is he wo k wi h pa ien s ha ing
an ea ing diso de (Ma heson e  al., 2020) o cases in ol ing
child mal ea men (Racine e  al., 2020). Couple he apy has
been in inc easing demand ecen ly, due o he signi ican ise
o con lic s ha eme ge as a consequence o he ad e se
a e ma h o con inemen and he pandemic (Lebow, 2020;
Sahebi, 2020; S anley and Ma kman, 2020).
A a ie y o ci cums ances a ec he usual unc ioning o
g oup he apy, bu he p elimina y e idence sugges s ha e icacy
has been simila o ha obse ed p e iously (Ma ma osh e al.,
2020). The e is also e idence ha g oup VCP allows o he
de elopmen o cohesion o a simila ex en as in in-pe son
g oup psycho he apy (Gen y e  al., 2018; Lopez e  al., 2020).
Among he ba ie s, he pa icipa ion o se e al pa ien s in
VCP may educe he communica ion luency o he g oup
and hinde he usual dynamics (Weinbe g and Rolnick, 2019).
Wo king wi h g oups necessa ily inc eases he numbe o
in e ac ions and, acco dingly, he complexi y o any sys em
such as he apeu ic g oups (Au eli and Schino, 2019). I ,
no mally, g oup he apis s ha e o ha e a highe deg ee o
a en ional lexibili y and mo e di e se in e en ion p ocedu es
han indi idual he apis s in VCP, his is pa icula ly ele an .
The Pe son o he The apis
The e a e s ill a lo o unknown aspec s, bu i is an undoub ed
global phenomenon ha VCP became an essen ial ool ega dless
o he apis s’ he apeu ic o ien a ion, he clinical condi ions, and
e en he he apis s’ p e ious expe ience wi h echnology (Hume
e al., 2020b; Sammons e al., 2020). Besides, se e al s udies (e.g.,
Békés and Aa jes- an Doo n, 2020; Hume e  al., 2020a; Ju cik
e al., 2020) ha e demons a ed ha since he massi e inco po a ion
o ideocon e encing, he apis s’ a i udes owa d i ha e imp o ed.
Psycho he apis s would g ea ly bene i om de eloping a
sel - e lec i e a i ude du ing he whole p ocess o he apeu ic
alliance building in emo e psycho he apy as well as o he aspec s
ha may hampe (and po en ia e) he he apeu ic wo k. Unde
hese excep ional ci cums ances occu ing du ing he COVID-19
pandemic, people and he apis s all o e he wo ld a e no he
excep ion, had hei ou ines dis up ed and hei sense o
wellbeing challenged. Fo he i s ime, many he apis s may
beo e whelmed by he same complain s and p oblems as hei
pa ien s (Hasson-Ohayon and Lysake , 2020). Besides, in many
cases, he caseload o pa ien s has been educed, impac ing
hei income (Sammons e  al., 2020). Mo eo e , he apis s a e
no pa icula ly p epa ed o his kind o modali y, and he e o e,
ini ial e idence sugges s ha he apis s ind i mo e wea ying
o do VCP, p obably as a consequence o he a o emen ioned
educed channels o communica ion (Ho mann e  al., 2020).
Likewise, he apis s inexpe ienced wi h VCP ha e highe le els
o sel -doub and anxie y and eel less compe en and con iden
abou hei p o essional skills (Aa jes- an Doo n e al., 2020a).
I has been demons a ed ha he adop ion o VCP depends
a g ea deal on he a i udes o he p o ide s, including
psycho he apis s. In a sys ema ic e iew o 38 s udies, i has been
ound ha p e ious expe ience wi h VCP is highly ela ed o ha ing
posi i e a i udes owa d i . Besides, he apis s’ sa is ac ion le els
wi h VCP a e o e all high h oughou he s udies, al hough he
samples do no ep esen all psycho he apis s (Connolly e al., 2020).
All hese aspec s necessa ily en ail an unusual p o essional
and emo ional impac . Indeed, ample e idence has ecen ly
eme ged showing ha in COVID-19 imes, heal h p o essionals
a e p one o su e , no only due o he same s esses as
e e yone else bu also due o he necessi y o esponding o
he con ex ual demands o wo king in he heal h ca e sys em
in such an unusually s ess ul ime (B aquehais e  al., 2020).
Howe e , men al heal h p o essionals wo king emo ely may
also ha e a g ea bu den. Hence, sel -ca e p ac ices ha
psycho he apis s can adop a e essen ial (Ho man, 2020).
Supe ision and T aining
Fo una ely, in ecen yea s, online supe ision has become
p ac iced and s udied mo e o en, leading o a se o
ecommenda ions ega ding how o bes implemen i
(Rousmanie e e  al., 2014). Jus like he wo k wi h pa ien s,
ideocon e encing supe ision is mo e lexible in e ms o
scheduling mee ings, which can beespecially impo an in c i ical
si ua ions. The po en ial di icul ies ha may a ise in
ideocon e encing supe ision can becoun e ac ed wi h a clea
amewo k a he ime o de elopmen o he supe iso y alliance.
In ha sense, i is ele an o conside possible a ia ions in
he alliance, which is a ma e o impo ance jus as be ween
pa ien s and he apis s (Wa kins, 2014). The p inciples ha go e n
g oup he apy should also beapplied o g oup supe ision. Bo h
pee and adi ional supe ision could be aken as a i s s ep
owa d he aining p ocess o psycho he apis s doing VCP.
Acco ding o ainees ecei ing online supe ision, i is a
aluable componen o he aining p ocess (Be nha d and
Camins, 2020). Indeed, online supe ision may se e as a
i s s ep owa d he es ablishmen o s uc u ed aining
p og ams. Ac ually, gi en he massi e dissemina ion o VCP,
i is u gen ha psycho he apis s be ained o inco po a e
VCP e icien ly in o hei ou ine p ac ice. So a , he e a e
a ew exis ing s udies o VCP aining p og ams (Colbow,
2013; McCo d e  al., 2015; Dopp e  al., 2017; Pe le, 2020),
and despi e he undoub ed a en ion ha has been ecen ly
gi en o he opic due o he onse o he pandemic, he e
Fe nández-Ál a ez and Fe nández-Ál a ez Videocon e encing Psycho he apy in Times o COVID-19
F on ie s in Psychology | www. on ie sin.o g 5 Feb ua y 2021 | Volume 12 | A icle 589536
is s ill a dea h o sys ema ic knowledge ega ding VCP aining
(Hames e  al., 2020). Un il now, i seems a me e in ui i e
ansi ion om adi ional in-pe son aining.
T aining p og ams should be based on he e idence-based
p inciples ha ha e been shown o enhance he apeu ic e ec s,
such as delibe a e p ac ice (P ado-Ab il e  al., 2018). The
aluable p og ess ha has been made in in-pe son psycho he apy
should be applied o VCP. In his sense, i is impo an o
a oid dissemina ing manualized ea men s and ins ead ain
he apis s in gene al p inciples o change (Cas onguay and
Beu le , 2006; Cas onguay e al., 2019; Gold ied, 2019; Boswell
e al., 2020). I is impo an o a oid incu ing he in uc uous
dispu e be ween speci ic he apeu ic schools and ocus he
e o s on achie ing he apeu ic compe ence (Coope e  al.,
2019). The e we e al eady examples o VCP guidelines e en
be o e he ou b eak o he pandemic (Yellowlees e  al., 2010;
Tu ey e  al., 2013; McCo d e  al., 2020; Smi h e  al., 2020),
bu i is expec ed ha he moun ing e idence ha is being
p oduced and dissemina ed due o he pandemic will yield
aluable insigh s ega ding how bes o p ac ice VCP.
E hical Conside a ions
These days, e hical conside a ions a e usually educed o he
p i acy dimension. Tha includes in o med consen om pa ien s
doing VCP, he secu i y o he pla o ms, and he gua an ee
ha any s o ed da a will be ea ed acco ding o da a p o ec ion
egula ions, among o he aspec s. Howe e , e hical issues also
include accoun ing o he sa e y o he pa ien s, compe ence
o he he apis s, legal issues ega ding he egula ion o he
p ac ice, consul an s’ au onomy, and comme cial con ac s (in
pa icula o libe al and hi d pa ies’ p o essionals), among
o he issues (Lus ga en and Elhai, 2018; S oll e al., 2020a,b).
CONCLUDING REMARKS
Ce ainly, emo e human in e ac ion will inc ease in he coming
yea s. This has al eady been happening o a leas a decade.
Ye , he ou b eak o he pandemic has no ably accele a ed his
p ocess. Psycho he apy will de ini ely no be he excep ion o
he ule, and he e o e, i is c ucial o ou line how he ield will
be ans o med in he nea and long e m. Mos p obably, he
implemen a ion o VCP psycho he apy will inc ease in he nex
ew yea s (No c oss e al., 2013), and his will happen in a con ex
o he decline in he consump ion o psycho he apy (Gaudiano
and Mille , 2013). The e o e, we should gua an ee he highes
s anda ds o di e en ia e psycho he apy om pseudoscien i ic
disciplines and o demons a e he alue o inco po a ing
psycho he apy in o he e e -g owing pha macological ea men s.
While i may be ue ha p elimina y esea ch compa ing
in-pe son he apy o VCP yields compa able esul s in e ms
o e icacy, i would be inaccu a e o conclude ha bo h
app oaches ha e simila empi ical suppo . Despi e p esen ing
p omising esul s, VCP is only in i s beginning as a esea ch
ield. Thus, esea ch and aining a e key o he ad ancemen
o VCP, and his scena io should be aken as an oppo uni y
o os e also he ad ancemen o he ield o psycho he apy.
Real wo ld implemen a ion o e idence-based p inciples would
mean s eng hening he ac i e collabo a ion be ween esea che s
and p ac i ione s, edounding o he p oli e a ion o p ac ice
esea ch ne wo ks in which he p ac ice is e idence based and
he e idence is p ac ice based. Tha would mean a ecip ocal
en ichmen bo h o p ac i ione s and esea che s (Cas onguay
e  al., 2015). Howe e , his con ex undoub edly acili a es he
possibili y o imp o ing he a i udes o he apis s and consul an s
owa d VCP and by ex ension owa d o he echnological ools
(Wind e al., 2020). Acco dingly, a b igh e u u e can beexpec ed
i mo e collabo a i e esea ch in na u alis ic se ings occu s.
On a ela i e bu di e en no e, i is impo an o e lec
on he ole ha VCP will ha e in he u u e o psycho he apy.
Tha is, o many psycho he apis s, he use o emo e modali ies
cons i u es a subop imal esou ce ha is necessa y in o de
o con inue hei wo k. Howe e , many s akeholde s conside
his an e icien way o inc easing he p e alence o men al
heal h ea men . Al hough many he apis s may indeed p e e
his modali y, and o a ange o mild condi ions, i is p o ing
o be equally e icacious, he possibili ies o in-pe son he apy
seem o s ill be supe io .
Indeed, he e a e s akeholde s ha a e ad oca ing o he
inco po a ion o comple ely sel -applied online in e en ions
wi h minimal con ac . In ac , he e idence is conclusi e
ega ding he use ulness o low-in ensi y ea men s mainly
h ough In e ne in e en ions o imp o e access o ea men
o common men al diso de s (Ande sson e al., 2019). In ha
sense, i is imely o e iew he pape by Ba low (2004) in
which he di e en ia ed psychological ea men s om
psycho he apy. B ie ly pu , o public conce ns and o diminish
he massi e clinical mani es a ions ela ed o men al heal h,
all e idence-based psychological ea men s may be o
impo ance, including b ie p o ocolized p ocedu es. Howe e ,
psycho he apy is only one o he possible psychological ea men s
and mos o en di e s om o he psychological ea men s in
he sense ha he main objec i e is no only symp oma ic
educ ion bu also he eo ganiza ion o he pe sonal sys em
and he imp o emen o he quali y o li e. This si ua ion is
helping o dis inguish he espec i e alue o “psychological
ea men s” as an umb ella e m o many di e en psychosocial
in e en ions and “psycho he apy” as a mo e speci ic
non-manualized p ac ice o dealing wi h he complexi y o
expe ience and beha io . Ou s ance is ha bo h should coexis
and e en in blended ea men s could be simul aneously
ha nessed in he same si ua ion. Acco dingly, i is essen ial o
acknowledge ha he e a e nuances ha psycho he apy pe mi s,
and a leas o now, he op imal way o deli e ing psycho he apy
is in a sha ed physical space. Howe e , VCP will de ini ely
be expanded and hope ully in eg a ed as a modali y h ough
which complex psycho he apeu ic in e en ions can bedeli e ed.
AUTHOR CONTRIBUTIONS
JF-Á d a ed he manusc ip and HF-Á p o ided c i ical
e isions. Bo h au ho s e iewed and edi ed he inal e sion
o he manusc ip .

Fe nández-Ál a ez and Fe nández-Ál a ez Videocon e encing Psycho he apy in Times o COVID-19
F on ie s in Psychology | www. on ie sin.o g 6 Feb ua y 2021 | Volume 12 | A icle 589536
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Con lic o In e es : The au ho s decla e ha he esea ch was conduc ed in
he absence o any comme cial o inancial ela ionships ha could becons ued
as a po en ial con lic o in e es .
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