Psychologists consulted by Clarín tell of their experiences with returning to the doctor’s offices and what is recovered with face-to-face contact.
Since the coronavirus arrived in Argentina, the vast majority of mental health specialists had to get used to attending to their patients through video calls. At first, this form of communication was difficult for both parties since, among other things, that face to face bond so important for a therapy. However, the weeks went by and this new remote methodology was imposed in the psychological consultations. In addition, many people who had finished their therapy before quarantine decided to “return” to the appearance of certain specific issues generated by the pandemic: uncertainty, panic attacks, sadness, anxiety, anguish, fear, among others.
The difficult thing for the patients was finding the right time and place to be able to maintain that special intimacy that was generated in the contact in the office. Some connected from the bathroom, others from the terraces of their buildings, there were those who did so from the car or those who chatted while walking down the street. Beyond that, the treatments generally ran their course.
However, from both sides of the desk or the couch, in some cases the need to return to presence began to appear, beyond the logical fears that these encounters could provoke. Some psychologists, psychoanalysts, psychiatrists and other mental health professionals decided to return, protocols through, to attend in their offices when each province, city or municipality gave them free rein to do so.
Amorina Diaz, clinical psychologist, specialist in contemporary cognitive therapies, said to herself during her quarantine: “as soon as I can return, I’ll be back”. And it resumed in August, a few weeks after it was authorized by the government of the City of Buenos Aires.
“In those weeks I organized agendas with the patients and we both saw the benefit of going in person or who could continue online. I talked about it with my family but as a ‘I’m going to take the necessary precautions to take care of all of us’ and right away I obtained full support. They know that I work in the health sector and that it is a risk that is assumed. I remember that I thought and I reviewed each part of the protocol. Leaving the house was strange because attending had turned into finishing preparing the mate in the kitchen and going to the room where I have the computer to continue with the mate with the patient online. I was very motivated by seeing them personally. The first day I attended to three patients in person to see how I organized myself and the pilot test of the time it took me to sanitize and disinfect the place between patient and patient. I organized myself so that there are few, but in terms of trying this new modality I lived it with enthusiasm and wanting to resume face-to-face, “Diaz comments to Clarion.
At the beginning of October, the psychologist Gustavo Quezada, returned to attend his patients in person. “I made the decision calmly and with great security because of my way of being and seeing the pandemic situation. While I respect and take corresponding care precautions, it is not a fact that causes me fear or insecurity. I try to give the same confidence to the patients with the corresponding protocols and the appropriate distance. My feeling when I returned to the office was one of joy. To see them again and be present in situ I lived it as a reunion in space that gave me satisfaction. The feeling of the patients was very confident and they were willing to come long before opening the office. Others chose to stick with the online mode for now, or maybe forever, yet that remains to be seen, “says Quezada.
Natalia Allegretto returned to her office the first week of November. For the moment, he says, the patients who attend are between 20 and 30 years old. “Many patients who would like to attend were left out, but the distances and the means of transport is generating fear. Despite the desire, they choose not to expose themselves to large concentrations of people and prefer to continue online for a while longer, “says the psychologist, who strictly complies with the protocol.
This is how he details it: “Patients enter the office once it is unoccupied by the previous patient. Between patient and patient there is an interval of at least 15 minutes which allows me sanitize the area, ventilate the environment, clean objects and surfaces of common use. Both my patients and I use mask during the whole session and shifts are spaced so as not to gather patients in the waiting room. The basic elements of hygiene such as alcohol gel, foot sanitizer for admission are provided and the responsibility of attending free of symptoms and without any direct contact, in the last 14 days, with an infected person is confirmed. with the virus. Hand hygiene is essential. “
Natalia Cociña has a degree in Psychology and an expert psychologist. “It was not difficult for me to make the decision to return to face-to-face care since I was waiting for it -he says-. My office is separated from my home, so I did not expose my family and the necessary measures were taken that were implemented in the care protocol in the context of the pandemic I evaluated the pros and cons and finally the decision emerged. I did not experience fear, the predominant feeling was to give response and containment to my patients, I knew that they need me, that it would be healthy for them to recover their space and that a decrease in their anxieties, their fears, their own emotional instabilities would be generated that generates the confinement, the distancing and the pandemic in general beyond their specific problems for which they attended before the doctor’s office, “he tells this newspaper.
On the day of the return, Cociña recalls: “He was nervous due to the changes to which he had to adapt, such as avoiding physical contact (greeting), disinfection, getting used to the mask or chinstrap. Every change generates a certain feeling of Strangeness. In my case, that first day I attended only four patients with the prudent time distance for disinfection, to avoid crossing patients and to ventilate the place. Each patient was informed that at the slightest symptom that could be compatible with positive covid, the call was communicated and the shift was suspended. In my case, care has been suspended for a few days for headaches or throat pain advising patients not to attend until they see the evolution of the symptom so as not to expose anyone. Today I find myself attending in person a maximum of eight patients throughout the day. “
Face-to-face therapy favors the development of the intimate context so that the patient can speak with greater confidence than if he were at home, since many times the spaces are small and in isolation several people were living together. The return to the office allows them, in addition to recovering a higher level of privacy, a respite from the mandatory isolation period.
For therapists the main benefit is being able have information from non-verbal language of the patient who in virtual modality has a certain cut when having the camera focusing on his face and part of the shoulders.
“The first day I had a pleasant feeling, I have a warm relationship with the patients and it is nice to see each other again. After the warmth of the meeting, the therapy continued. One of the most important things was see body posturesAlthough the mask does not help, being able to interrupt without the video call getting stuck, doing certain exercises, such as visualization, is easier in person, one has greater control of the process “, he describes Clarion David Mibashan, Doctor of Clinical Psychology.
“Resuming face-to-face therapy is part of resuming routines little by little and this can partly collaborate in a good evolution of psychological disorder or the condition that the patient brings to the consultation. It also favors fluid communication, in cases where the internet connection failed and this could interfere with sessions. I had to postpone sessions or reorganize shifts because the internet connection was failing for a patient or me, “says Diaz.
“What is recovered with the presence in the office is the closeness of the gaze, that intensity of energies that move in space, details in bodily gestures that can sometimes be read as hints of something. The gestures of the hands themselves, the tones of the voice and the implication of certain forms of enunciation. There are several elements that in the online mode are not always seen or revealed in the same way. But they are differences of nuances, it does not mean that it is not possible to work online, on the contrary. If something makes this situation clear, it is that it is possible and even as effective in most cases as the face-to-face mode. But that is not why one should fail to recognize that different things are at stake in each space “, says Quezada.
“Mainly, the trust and security that patients show when talking. They speak more fluently, they develop more spontaneity. And one, as a professional, reads and interprets much more. From silence, to a change in the tone of voice, a gesture, a body language that is almost impossible to perceive through the video call. In the face to face, the atmosphere and the listening tune that we all need so much is recovered. In a doctor’s office he is accompanied to go through moments of anguish, illusion, catharsis, suffering, joys. And it is accompanied from all the senses. With the ear sharpened, the voice, the word and also the body “, concludes Allegretto.