*2.1. Study Design and Procedure*

The primary objective of the current study was to collect data on the changes experienced by Austrian therapists when switching from face-to-face to remote psychotherapy and/or from remote to face-to-face psychotherapy during the first year of the COVID-19 pandemic. Specifically, we wanted to find whether psychotherapists experienced changes in the therapeutic relationship (research question 1), whether they experienced changes in the content of the sessions (research question 2), whether they noticed changes in the intensity of the sessions (research question 3), whether the structure of the sessions changed in their practice (research question 4), and how they experienced the digital setting and the lack of physical presence (research question 5). A further aim was to investigate potential differences in these experiences with respect to the sociodemographic and professional characteristics of psychotherapists.

Following an exploratory research approach, we conducted a cross-sectional online survey among Austrian psychotherapists authorized to provide psychotherapeutic treatment to patients. This includes psychotherapists in training in recognized training institutions, who are already working under supervision after the fourth year of training and psychotherapists registered at the Austrian Federal Ministry of Social Affairs, Health, Care, and Consumer Protection. Registered psychotherapists have completed their training as

psychotherapists and are officially licensed to treat patients. Health insurance companies only refund psychotherapy sessions provided by registered therapists. The survey was set up with REDCap (Research Electronic Data Capture) [27,28] and was open from 26 June 2020 until 3 September 2020. By this time, the COVID-19 measures imposed by the government had been largely relaxed. A previous initial lockdown in Austria from March 16 to 30 April 2020, mandated that Austrians were only allowed to leave their homes for certain activities, such as covering important basic needs, caring for others in need or going to work. During this time, many therapists switched from face-to-face psychotherapy to remote sessions [4].

The survey included a total of 128 questions covering basic sociodemographic variables; the number of patients who were switched from face-to-face to remote psychotherapy or from remote to face-to-face psychotherapy; therapists' experiences with digital media; the type of media used; an assessment of the various therapeutic interventions used in the different settings; as well as several open-ended questions about the therapeutic relationship, content, intensity, and structure of remote as compared to face-to-face sessions and therapists' experience of the lack of physical presence and the spatial distance between themselves and the patient. Open-ended questions were formulated to elicit as wide a range of perceptions as possible. We estimated that it would take psychotherapists 15–20 min to complete the questionnaire in its entirety. In the present study, only the open-ended questions from the survey were analyzed. Quantitative findings are published elsewhere [26].

The study received approval from the ethics committee and the data protection officer of the University for Continuing Education Krems (EK GZ 27/2018-202). We follow the APA Journal Article Reporting Standards for Qualitative Research in Psychology [29] in the presentation of our research.
