קו-תרפיה מרחוק: דרך לאינטגרציה בין גישה מבוססת יחסים לבין גישה מבוסס טכניקות

Dilemma

The possibility of using the internet for psychotherapy presents the therapeutic world with a fundamental dilemma. On one hand, it makes treatment accessible to populations that did not have access to psychological interventions beforehand, and to individuals with problems that prevent them seeking such interventions. On the other hand, it challenges the conviction that genuine human contact is imperative for successful psychotherapy.

Case Conceptualization

A hybrid therapy, in which the patient is in the room with a dynamic therapist, and a CBT therapist intervenes remotely (via the internet). The patient is a 30-year old, single woman who lives with her parents. She has several diagnoses (personality disorder, mixed anxiety and depression disorder) and she has been taking antidepressant medication. Treatment began with dynamic orientation. Although a good therapeutic relationship was developed and changes were made in several areas, there was no decrease in her level of anxiety and depression, or her ability to function on other levels. It was therefore decided to add an additional session ,which would be of behavioral cognitive nature. It would begin with psycho-guidance, and then proceed towards behavioral activation and exposure.

Outcome
Treatment is still underway. It is difficult to identify results at the symptomatic level, but the combined model was well-received by the patient. The patient previously resisted CBT treatment, but this arrangement makes it possible.

Review and Evaluation
The use of the internet for psychotherapy takes on different forms, ranging from psychodynamic videoconferencing, to CBT-based self-help applications. Recently, other combined interventions have been reported as well. The hybrid intervention reported in this paper presents an integrative approach that combines CBT with dynamic psychotherapy on the one hand, and face-to-face therapy with remote intervention on the other.