RELAZIONI CLINICHE A DISTANZA E DOPPIO SETTING. UNA RICERCA PILOTA E ALCUNE RIFLESSIONI SUL SETTING ONLINE.

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]