3.2.2. Drawbacks

*N* = 106 respondents (48.8%) reported the drawbacks of remote psychotherapy. Subcategories are displayed in Figure 3.

*N* = 31 (14.3%) respondents reported technical problems: connection problems, delays or interruptions in the transmission of sound and images and poor sound and image quality. These interfered with therapy processes and made it difficult for therapists to tune in to their patients. Therapists were also required to ensure the functionality of the technology and to comply with data protection regulations, which was an additional challenge for some.

Other (*n* = 64 (29.5%)) respondents noted that remote psychotherapy made them feel more exhausted. They reported fatigue from longer screen time and distractions at home. They also described that it required more concentration (1) to compensate for the lack of perceptions and capture patients' emotions (passive) and (2) to convey empathy through verbal communication only, in case of sessions on the phone (active). Respondent 170 mentioned how *"it was more exhausting to find the "right words" because all other sensory channels were eliminated".* Additionally, respondent 172 commented that *"Over the phone, it was difficult and required a lot of concentration to capture emotions only through the spoken word"*.

**Figure 8.** Percentage of respondents who commented on their perceptions regarding the intensity of psychotherapeutic work. The number in parentheses after the subcategory name indicates the number of coded text passages.


**Table 1.** Main categories of the qualitative content analysis by gender.

In this context, *n* = 26 (12%) respondents observed that they or their patients were more distracted in the remote setting. Other people in the household and pets were described as distractions for both therapists and patients. Therapists perceived patients as distracted if they ate or drank during psychotherapy sessions. They experienced themselves as distracted by glimpses into the patients' private spaces, by the environment at home or by seeing their own faces on the screen during videoconferencing sessions. *N* = 27 (12.4%) respondents, who worked from home, reported that it was challenging to maintain a separation between their personal and professional life. It was more difficult for them to distance themselves from work, pay attention to a healthy work-life balance, and maintain clear work schedules. It was also harder to adopt a therapeutic stance.

No differences between female and male psychotherapists in the frequencies of mentioned drawbacks were observed (*p* ≥ 0.372).
