Search

Objective: The aim of this paper is to analyse the effect that the shift from face-to-face to distance relationship had on some procedural aspects of the clinical psychological setting and on the mental setting of psychologists and psychotherapists (in particular, those who used the online setting for the first time). In this perspective, the article illustrates and analyses the results of a pilot research conducted during the Italian national lockdown. Method: The research was carried out with a semi-structured questionnaire developed with Google Forms. The questionnaire (17 closed questions and 2 open questions) was divided into four sections: 1. Personal data; 2. Professional activity; 3. External/material setting; 4. Internal/mental setting. The questionnaire was available online from 6th to 27th April 2020. 160 questionnaires were collected: 45 (28.13%) psychologists and 115 (71.87%) psychotherapists. Results: 37.50% of the respondents did not perceive any significant change in their attitude following the changeover to the online mode (6.25% reported that they felt even better compared to face-to-face interviews). 27.50% of the respondents experience a greater "familiarity" with the patient; 24.38% are curious about the domestic environment framed by the webcam; 20.63%, on the other hand, experience embarrassment when entering the patient's home. The main problems reported by psychologists/psychotherapists are of a technical nature (limited quality of devices and connections) because they make it difficult to "tune in" to the patient. 43.75% of the respondents also reported difficulties in understanding the interlocutor's non-verbal communication. 25.63% of psychologists/psychotherapists also report being more active and 18.75% admit that in the online setting it is more difficult to remain silent. Conclusions: Technology-mediated communication has made it possible to overcome the constraints imposed by the pandemic and has enabled psychotherapists and patients not to interrupt counselling and therapy. However, the online setting has different characteristics from the offline setting, characteristics that tend to influence the behaviour and mental disposition of the psychologist/psychotherapist. Curiosity, embarrassment but also greater activity and difficulty in maintaining silence seem to be some of the possible outcomes of the online setting on the clinician. On the other hand, the prevalence of the visual channel can induce the psychologist/psychotherapist to superimpose what he sees with what he is. In essence, the online setting may induce the idea that no further meaning is needed or possible than what is shown on the screen. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present paper is to investigate aspects of the external setting characterizing remote clinical relationships. This is also accomplished through the presentation of data from a study conducted during the CoViD-19 lockdown. Method: Research was carried out with a semi-structured questionnaire developed with Google Forms. The questionnaire, consisting of 17 multiple-choices closed questions and 2 open questions, was divided into four sections: 1. Personal data; 2. Professional activity; 3. External/material setting; 4. Internal/mental setting. The questionnaire was available online from the 6th to 27th of April 2020. 45 psychologists (28.13%) and 115 psychotherapists (71.87%) participated in the research for a total of 160 participants. Results: The need to switch to the remote clinical relationship during the CoViD-19 lockdown led to some changes in the external setting. 53.13% of participants changed the day and time of their clinical encounters and 40% changed the number of weekly meetings. Compared to the characteristics of the external setting chosen by the patients, 30.43% of our study participants reported inappropriate environments (cars, balconies, parks, bathrooms, etc.) and a certain variability of the place used for the online clinical encounters. However, the majority of participants only occasionally investigated the reasons behind their patient's choice. 29.71% of participants reported that their patients engaged in other activities while in the meeting with them (looking after a child, drinking alcohol, petting pets, etc.) and 21.74% mentioned intrusions (parents, partners, animals, etc.) in the environment where the telehealth encounter was taking place for their patients. Finally, the research has shown that in the online setting 66.88% of responding participants had difficulty tuning in adequately with the patient; 25.63% tended to be more active; 37.50% more supportive; while 18.75% have greater difficulty remaining silent. Conclusions: After a brief analysis of the concept of setting, the authors state that in remote clinical relationships the clinician delegates the identification and management of a part of the external setting to his or her patient. This delegation affects the functionality of the clinical setting, particularly to what refers to its ability to isolate and shield the relationship from “external reality” and plays a role in the inhibition of enacted behaviors. The subdivision of the external setting into two locations and separate environments across the video screen increases the patients’ responsibility towards it but also the chances of acting out common emotional patterns. In fact here the actual structure of the clinical setting changes: the side managed by the therapist is more anchored on theoretical and on “theory of the technique” foundations and can therefore be considered “an actual traditional clinical setting”; while the side of the patient has the tendency to more likely express his or her internal world. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effects of COVID-19 lockdown on blood glucose control in individuals with type 1 diabetes (T1D) and to explore determinants of glucose variability.Methods: Fifty T1D patients undergoing continuous/flash glucose monitoring were recruited. The study's primary outcome was the change of time in range (TIR) from before to lockdown period. Three time-point comparisons of TIR, mean glucose levels (MG), estimated (e)HbA1c, time above (TAR) and below range (TBR), moderate/severe hypoglycemic events between pre-lockdown, lockdown and post-lockdown period were also performed. Information on lockdown-associated perceived stress, changes of work status and physical activity were recorded.Results: TIR significantly decreased (75(63-84)% vs.69(50-76)%,p < 0.001) whereas MG (154 ± 15 mg/dl vs.165 ± 25 mg/dl, p = 0.027) and eHbA1c (7.3(6.6-7.8)%vs.7.5(6.7-8.2)%,p = 0.031) increased from pre- to lockdown period; overall glucose control significantly improved when restriction ended. Lockdown-associated work loss/suspension independently predicted impaired TIR after adjustment for potential confounders (Standardizedβ: -0.29; 95%CΙ: -18.7 to -2.25;p = 0.01). Greater TAR, TBR and hypoglycemic events were also reported during the lockdown.Conclusion: In T1D Italian individuals, blood glucose control significantly worsened during the COVID-19 lockdown; work instability and related issues represented the main determinant of impaired glucose variability in this population. [ABSTRACT FROM AUTHOR]