Wednesday, April 22, 2020

Ethics Expert Offers Guidance on Adapting to New Boundaries in Psychiatric Care

As COVID-19 continues to upend many aspects of “normal” life, psychiatrists in all settings are forced to adapt to new and evolving boundaries in research, administration, and patient care. In an article in Psychiatric News, Claire Zilber, M.D., explores how psychiatrists can continue to establish a therapeutic connection in this new normal. Zilber is a psychiatrist in private practice in Denver, chair of the Colorado Psychiatric Society’s Ethics Committee, and a senior faculty member of the PROBE (Professional Problem Based Ethics) Program.

As many psychiatrists have shifted from seeing patients in the office to seeing them over the computer or phone, Zilber recommended psychiatrists consider integrating familiar elements from the office into the video background to help “foster a sense of continuity” for patients.

Other patients may prefer audio-only communications. “Perhaps to see me in a new environment would feel disruptive, and they prefer to imagine my voice coming from my office, although there are many other possible reasons to avoid videoconference, including fear of technology or weariness from too many video meetings in their own workdays,” she wrote.

COVID-19 didn’t just change the workspace, Zilber noted. The therapeutic process is also shifting, as patients express more requests for grounding and reassurance and ask questions about how she’s coping with the pandemic.

“In the old way of the world, I would have moved asymptotically around questions that shifted the focus onto me. In a mere couple of weeks, the frame has bent; delicately avoiding these questions would feel unkind, almost inhumane,” Zilber continued. “We are two human beings doing our best to manage a crisis together. I strive to be a role model for coping and resilience, and that includes being honest and authentic in new ways.”

Zilber noted that as the COVID-19 pandemic continues to evolve, further shifts are likely. And when the pandemic recedes, there will likely be questions on how or even whether psychiatrists can restore their former routines. “Will interpersonal boundaries fall back into their old places, or will they be fundamentally altered by this shared experience?”

To read the full article, see the Psychiatric News article “Surreal Boundary Shifts During a Pandemic.”

(Image: iStock/TommL)

Join Us for APA’s Spring Highlights Meeting This Weekend

APA’s free, live virtual Spring Highlights Meeting is just days away. Join psychiatry’s foremost experts and leaders this Saturday and Sunday, April 25 and 26, for discussions about physician leadership in a time of crisis, challenges and opportunities in research, and more. Participants in the free Spring Highlights Meeting can claim up to 10 AMA PRA Category 1 Credits and 8 hours of MOC Part 2 Credit but must register to claim credit.


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