3.2.7. Intensity of Psychotherapeutic Work

A final major category mentioned by *n* = 168 (77.4%) respondents subsumes statements about the intensity of psychotherapeutic work and comprises four subcategories, which are displayed in Figure 8.

*N* = 70 (32.3%) respondents experienced high or even higher intensity in remote psychotherapy. This was explained by the fact that emotions can be expressed more openly in the remote setting, and difficult or shameful topics can be raised more easily, as respondent 73 described: "*The distance allowed some patients to be more open because there was less closeness and less shame*". Respondent 193 put it this way: "*also an increased possibility to approach previously avoided contents from a distance*". Patients were described as more disinhibited and open when they participated in sessions from the safety of their home environment. Respondent 79 observed, "*Some appreciated their familiar surroundings and were able to talk about more intimate topics*". Themes activated by the pandemic also came into therapy and could be elaborated, which sometimes deepened the process, as respondent 62 reported: "*Patients perceive the switch* (to remote psychotherapy sessions) *as a form of caring (being concerned about them, making an effort, etc.), which sometimes also evokes memories, longings, deprivations,* etc. *regarding childhood".* A greater density and thus intensity of the conversations was also described, here by respondent 196: "*With many patients, an increase in intensity was noticeable, the conversations were denser and more often led to a mutually satisfactory result*".

In this context, *n* = 17 (7.8%) respondents also mentioned that the therapeutic work was more focused on topics or therapy goals. For example, respondent 177 commented, "*Condensed, rapid delving into all relevant topics of concern".* Respondent 135 observed, "*For many patients, the work was even more to-the-point and focused on change".* Respondents explained this as a result of increased concentration in remote contact and of the need for both parties to verbalize emotions more, as well as to focus attention on the available channels of perception and, in particular, on the spoken word.

However, respondents also made contrary observations. *N* = 128 (59%) respondents described that the intensity of therapeutic sessions decreased in remote psychotherapy, for example, because processes were disrupted by technical difficulties or because it was not possible to use the full range of interventions, or because patients did not engage emotionally and presented only everyday topics. More in-depth or biographical work was avoided, which was experienced by respondents as a flattening of the content. Respondent 6 summed this up with her statement, "*In some conversations, a kind of coffeehouse gossip atmosphere arose for a short time since otherwise you only talk on the phone with friends for such a long time".* Respondent 124 also commented pointedly that patients remained in their "*comfort zone*". Conversations were described as more rational and less emotional.

COVID-19 as a topic and the issues the pandemic raised (coping with everyday life, fears, dealing with COVID-19 preventive measures, job loss, etc.) were the focus of remote psychotherapies. Respondent 94 commented, "*Conversations became more superficial. It became almost impossible to explore topics in depth. The topics were limited to current events and Covid measures, and the original goal of the therapy was neglected. The intensity of the conversations decreased a lot".* Respondent 32 also noted that "*ongoing processes and reflections were interrupted".* At the same time, it was emphasized several times that the engagement with daily events was not necessarily due to the switch to remote psychotherapy but was due to the crisis. "*It wasn't the switch that changed the issues, it was the crisis that changed the issues"* (respondent 137).

In this context, *n* = 76 (35%) respondents stated that for them, the supportive function of therapy was the primary focus of remote contacts during the pandemic. This involved crisis intervention and counseling in the "*here & now*" (respondent 52) to relieve stress. Respondents described how they worked in a more supportive, resource-oriented and structuring way and were more directive and "*less exploratory*" (respondent 11).

No gender differences became evident in the frequencies of all reports related to the subcategories relating to the intensity of therapeutic work (*p* ≥ 0.064).
