The COVID-19 pandemic and ensuing social distancing requirements resulted in an abrupt transition in the provision of most mental healthcare to telehealth; yet it was, at first, unclear whether patients' emotional expressions - of great import to the success of many psychodynamic therapies - could be facilitated using teletherapy. This article first presents a targeted literature review focused on emotional expressions in psychotherapy and implementing psychodynamic therapy over telehealth and then describes our clinical experience transitioning a psychodynamically-informed, evidence-based, and experiential group treatment for chronic pain, emotional awareness and expression therapy (EAET), to video telehealth at VA Greater Los Angeles Healthcare System. We discuss barriers we encountered in our implementation of EAET over video telehealth but also illustrate the ultimate success of the approach using verbatim excerpts from our therapeutic work, which aim to demonstrate the potential to facilitate powerful emotional expressions over video telehealth when conducting a psychodynamically-informed treatment. We examine the possible applications for video telehealth to maintain emotionally focused, psychodynamic psychotherapy administration and enhance its teaching and training. Although we describe limitations of our specific approach, ultimately, our experience supports the potential efficacy of experiential, emotion-focused psychodynamic therapies in a telehealth setting.

The complexity of a mental disorder such as depression is such that a way of interlinking the neural, mental and interpersonal levels is needed. This paper proposes that a theoretical framework which distinguishes, and relates, macro-theory and micro-theory at these levels can serve this purpose. The 'Interacting Cognitive Subsystems' approach to mental architecture is used to show how, via the detailed specification of mental processes and representations, a macro-theory of mental architecture contributes to our understanding of depressed states. In the account advanced by Teasdale and Barnard depressed states are seen as being maintained by an abnormal version of a dynamic dialogue between two qualitatively distinct types of meaning: one is referentially specific, propositional meaning, the other consists of holistic schemata rich in latent content and is called implicational meaning. In depressed states with ruminative and avoidant thought patterns, the mental function of attention is seen as being directed preferentially at propositional meanings. There is a corresponding neglect of attention to implicational meanings. The paper concludes with a brief discussion of how this approach can address transdiagnostic issues and how it may suggest new strategies for therapeutic interventions.

Better understanding of the connection between therapeutic processes and outcomes in minority groups can help design and use culturally-adapted treatments.