Telehealth Psychotherapy for Severe Personality Disorder during COVID-19: Experience of Australian Clinicians

OBJECTIVE: Restrictions on social interaction during the COVID-19 pandemic necessitated a rapid transition to telehealth to continue providing psychotherapy to people diagnosed with personality disorder. This naturalistic cross-sectional study evaluated the experiences of clinicians using telehealth for the first time to treat clients diagnosed with a severe personality disorder (complex and/or high risk presentation).

METHODS: Thirty clinicians working at a specialist clinic for personality disorders completed an online survey during May-June 2020 in Melbourne, Australia.

RESULTS: Despite having some initial technical issues, most participants rapidly and successfully connected with clients via phone and/or video-conference, recommencing individual and group evidence-based psychotherapies. Appointments were kept more reliably than when in-person treatment was offered. Issues around privacy, confidentiality, risk, quality of interaction, and treatment boundaries were raised, highlighting the need for specific guidelines and formal processes. However, clinicians’ awareness of some of the benefits of telehealth was evident, with most looking forward to using telehealth for some aspects of their work with clients and more generally into the future.

CONCLUSIONS: This experience with delivering psychotherapy using telehealth during COVID restrictions suggests that it is an acceptable platform that can be managed safely for treating patients with severe mental illness in the short term at least. This outcome encourages the pursuit of efficacy studies to evaluate telehealth as a more equitable and accessible treatment modality.