EDITORIAL
The Role of Psychotherapy During the
COVID-19 Pandemic
Holly A. Swartz, M.D.
In the wake of the COVID-19 viral pandemic, the world will
likely experience a serious mental health crisis (1, 2). Even as
the first wave of infection passes, stressors associated with
COVID-19, including self-quarantine, social distancing, job
loss, and threat of illness, will persist. These factors can be
expected to have a significant impact on the human psyche
and contribute to a secondary mental health epidemic (1, 3).
Extrapolating from studies conducted in the aftermath of
other disasters, such as Hurricane Katrina (4), Hurricane
Sandy (5), and the terrorist attacks of September 11 (6), we
can expect as much as 10% of the population to meet criteria
for major depressive disorder (7) following a crisis and
perhaps even more to meet criteria for posttraumatic stress
disorder (2). Risk factors for persistence of psychiatric symp-
toms postdisaster include exposure to trauma, minority
status, low social support, and preexisting psychiatric illness
(2), suggesting that the most vulnerable among us may
grapple with the mental health consequences of the pan-
demic for years to come.
Psychotherapy is an essential part of the response to the
COVID-19 crisis. As psychotherapists, we are uniquely
qualified to explore with our patients the psychological
sequelae of social isolation, job loss, fears of contagion, and
grief. It is our privilege and obligation to support patients
going through major life changes related to the pandemic,
helping them to grapple with the upheaval that has been
thrust upon all of us. With us, they can be seen, heard, and
held in mind.
Strategies for supporting patients during the COVID-19
pandemic can be found in virtually all psychotherapeutic
disciplines; now may be a good time to draw broadly from our
rich psychotherapeutic armamentarium to help those in
need. Cognitive-behavioral therapy (CBT) can be used to
modify maladaptive automatic negative thoughts about the
pandemic, including excessive fears of contamination or
hopelessness about maintaining social connections during
periods of quarantine. Through behavioral activation and
scheduling of pleasurable activities, it can also help address
COVID-related inactivity and loss of regular daily routines.
Interpersonal psychotherapy (IPT) allows us to frame the
pandemic as a role transition, helping patients develop new
skills to adapt more successfully to the challenges before
them, including using technology to build social support
Am J Psychother 73:2, 2020
during social isolation and problem solving for relationships
negatively affected by the close quarters of home quarantine.
Psychodynamically informed approaches encourage us to
explore defenses such as rationalization and denial activated
by pandemic-related deaths and loss, helping the patient to
understand the impact of early childhood experiences on
reactions to current stressors. Regardless of the approach
used, therapists should adopt a supportive and humanistic
stance, given this time of shared suffering. Recognizing that
there are few among us who are unaffected by these ex-
traordinary events, we can communicate that working to-
gether will help all of us optimally manage this crisis.
Paradoxically, as we strive to establish even better con-
nections with our patients during these difficult times,
connecting with them has become even more complicated.
Use of video and telephone to deliver psychotherapy re-
motely, once the stuff of science fiction, has become the
mainstay of psychotherapy delivery during the pandemic.
The learning curve has been steep for some, especially
psychotherapists and patients who are less comfortable or
less experienced with technology. Fortunately, there is strong
empirical support for telemedicine in psychiatry (8, 9), al-
though evidence for remote delivery of psychotherapy is still
limited. Reassuringly, a network meta-analysis of different
methods of delivering CBT for depression found little dif-
ference in psychotherapy delivered remotely versus face to
face (10). Similarly, IPT has been delivered remotely with
evidence of efficacy (11). Thus, early reports are promising,
and more studies are likely to emerge as remote delivery of
psychotherapy becomes an established part of routine
practice.
Psychotherapy clearly plays an important role in helping
individuals address the psychological and behavioral health
sequelae of the COVID-19 pandemic. More information is
needed about which psychotherapeutic approaches, delivery
systems, supervision strategies, and dosing will optimally
serve the needs of our patients and communities. The
American Journal of Psychotherapy will continue to play its
part by reviewing, accepting, and publishing high-quality
articles on these topics. These publications will help to in-
form the field about psychotherapy best practices as we
support our patients and each other during this difficult time.
I wish safety and good health to all.
psychotherapy.psychiatryonline.org 41
EDITORIAL
AUTHOR AND ARTICLE INFORMATION
Department of Psychiatry, University of Pittsburgh School of Medicine,
Pittsburgh.
Send correspondence to Dr. Swartz (swartzha@upmc.edu).
Am J Psychother 2020; 73:41–42; doi: 10.1176/appi.psychotherapy.
20200015
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