Face-to-face clinical practice under COVID-19 pandemic: how psychotherapists describe their experiences

Driven by the theory-building around the role of the non-verbal components to
communication, we aimed to understand how therapists experience the therapeutic
process using a facial mask. The empirical evidence of the power of non-verbal
communication to engage therapists and clients in therapeutic work, develop a positive
and collaborative relationship between them, and display empathy is quite large.
A mixed-methods approach was adopted, drawing from the therapists’ participation
in an online survey. A sample of 137 psychotherapists with different therapy orientations
and years of clinical practice participated in the study. Therapists conducted faceto-
face therapy wearing face masks with existing and/or new clients. We performed
an exploratory analysis, using descriptive statistics, to explore the psychotherapists’
evaluations regarding perceived impact of face masks on different therapy quality
dimensions. In a complementary rationale, we analyzed the therapists’ perspectives
on their experience wearing face masks using the thematic analysis methodology.
Results show that among 137 psychotherapists, 114 were attending both existing
and new clients, whereas only 13 were seeing exclusively existing clients and 10 were
working exclusively with new clients. Despite no major differences were found between
conditions regarding the perceived impact of face masks on different therapy quality
dimensions and strategies adopted, the qualitative analysis allowed us to expand the
quantitative results and deepen understanding of psychotherapists’ experience. Based
on general and typical patterns, we propose two distinct models to describe the
therapist’s experiences narrative when working with existing or new clients wearing face
masks. Based on the results, we propose some recommendations to clinical practice in
similar conditions.
This study was conducted at the Psychology Research Centre (CIPsi/UM) School of Psychology, University of Minho, supported by the Foundation for Science and Technology (FCT)
through the Portuguese State Budget (UIDB/01662/2020).