For many years, the world of psychotherapy has been divided into two different camps. The main difference between the two camps was their view of the curative factor in psychotherapy that might produce the desired change (Cf. Omer and London, 1988)
We will refer to one group as the Techniques Camp, and to the other as the Relationship Camp. Each of these camps view different components as central towards bringing about changes, and therefore their attitudes toward remote treatment will differ from one another, as explained in the introduction.
The Techniques Camp
The techniques camp emphasizes the importance of the treatment method and defines treatment protocols in which certain interventions are emphasized as the generators of change. This is easy to demonstrate in cognitive behavioral therapy (CBT), in which there is a clear and well-defined series of interventions that define the principles of the method.
There are different examples of such interventions that demonstrate the extent to which the transition to telemedicine affects the methods used by the techniques camp. For example, a cognitive therapist is expected to identify automated thoughts, and to use them to identify key beliefs or organizing schemes that manage the patient. In order to identify these thoughts and beliefs, the therapist will apply techniques such as the “ABC” model (A = Activating Event. B = Belief/thought. C = emotional and behavioral Consequence).
As its name suggests, this method also employs a series of behavioral interventions that are designed to improve the patient’s condition. Methods of soothing the body through muscle relaxation have been fundamental techniques in cognitive behavioral therapy for many years. Although today there is a tendency to undervalue the importance of these components, they are still basic tools that therapists use. Upon entering the third generation of CBT, less of an effort was made to use these techniques. However, the acceptance approach and mindfulness ultimately emphasize both breathing and body scan.
In any case, this quick overview of CBT emphasizes the essence of the techniques camp. This leads us to the question of whether it is possible to translate these techniques for remote therapy and if so, how.
It is important to keep in mind that the techniques camp encompasses many other approaches beyond classic CBT. It includes approaches such as Acceptance and Commitment Therapy (ACT), as well as behavioral approaches such as DBT.
The Relationship Camp
Advocates of the relationship approach regard the therapeutic relationship as the curative factor that is the central facilitator of change. This camp maintains a series of assumptions about the origin and development of mental problems, which focuses particularly on the importance of the initial characters in the patient’s life as designers of their worldview. It is assumed that an individual’s central experiences as a child are those that shape his adult life. This approach is often considered to be inspired by Freudian thinking and his hypotheses about the necessary processes that the newborn undergoes while developing a relationship with parental figures. Over the years, this camp has evolved and now places great emphasis on the attachment processes, i.e. the extent to which the child experiences a pattern of secure attachment to the parental figure.
Thus, the relationship camp assumes that past relationships are the source of psychological problems in the present. Therefore, reconstructing those relationships and remedying them through a relationship with the therapist is the central component of therapy. Therapeutic approaches that explore the characteristics of the relationship between the patient and therapist were developed based on this assumption. This helps explain the development of concepts such as transference, i.e. how a patient relates to his therapist based on experiences with significant figures from the patient’s past.
Dynamic therapists once placed a great deal of emphasis on interpreting relationships as “discovering the source of the patient’s problem,” however in recent years there has been an increasing tendency to perceive the patient’s relationship with the therapist as a therapeutic by itself.
Some of the central concepts that are often utilized by the relationship camp are “holding” and “containing”. Though these terms have different meanings, both imply the importance of the supportive and accepting relationship. The relationship camp will then question whether holding and containing can be conveyed through Internet communication and impersonal screens.