International Journal of Environmental Research and Public Health Article Barriers and Facilitators to Resuming In-Person Psychotherapy with Perinatal Patients amid the COVID-19 Pandemic: A Multistakeholder Perspective Nicole Andrejek 1 , Sabrina Hossain 1,† , Nour Schoueri-Mychasiw 1,† , Gul Saeed 2 , Maral Zibaman 1 , Angie K. Puerto Niño 1 , Samantha Meltzer-Brody 3 , Richard K. Silver 4 , Simone N. Vigod 5,6 and Daisy R. Singla 1,6,7, *   Citation: Andrejek, N.; Hossain, S.; Schoueri-Mychasiw, N.; Saeed, G.; Zibaman, M.; Puerto Niño, A.K.; Meltzer-Brody, S.; Silver, R.K.; Vigod, S.N.; Singla, D.R. Barriers and Facilitators to Resuming In-Person Psychotherapy with Perinatal Patients amid the COVID-19 Pandemic: A Multistakeholder Perspective. Int. J. Environ. Res. Public Health 2021, 18, 12234. https:// doi.org/10.3390/ijerph182212234 Academic Editors: Nicole L. Letourneau and Panagiota Tryphonopoulos Received: 21 October 2021 Accepted: 18 November 2021 Published: 22 November 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, ON M5G 1X5, Canada; nicole.andrejek@sinaihealth.ca (N.A.); Sabrina.Hossain@sinaihealth.ca (S.H.); Nour.Schoueri-Mychasiw@sinaihealth.ca (N.S.-M.); Maral.Zibaman@sinaihealth.ca (M.Z.); Angie.PuertoNino@sinaihealth.ca (A.K.P.N.) 2 Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; gul.saeed@mail.utoronto.ca 3 Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC 27514, USA; samantha_meltzer-brody@med.unc.edu 4 Department of Obstetrics & Gynecology, NorthShore University Health System, Evanston, IL 60201, USA; RSilver@northshore.org 5 Department of Psychiatry, Women’s College Hospital, Toronto, ON M5S 1B2, Canada; simone.vigod@wchospital.ca 6 Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada 7 Campbell Family Mental Health Research Institute, Center of Addiction and Mental Health, Toronto, ON M6J 1H4, Canada * Correspondence: daisy.singla@utoronto.ca † These authors contributed equally to this work. Abstract: During the COVID-19 pandemic, outpatient psychotherapy transitioned to telemedicine. This study aimed to examine barriers and facilitators to resuming in-person psychotherapy with perinatal patients as the pandemic abates. We conducted focus group and individual interviews with a sample of perinatal participants (n = 23), psychotherapy providers (n = 28), and stakeholders (n = 18) from Canada and the U.S. involved in the SUMMIT trial, which is aimed at improving access to mental healthcare for perinatal patients with depression and anxiety. Content analysis was used to examine perceived barriers and facilitators. Reported barriers included concerns about virus exposure in a hospital setting (77.8% stakeholders, 73.9% perinatal participants, 71.4% providers) or on public transportation (50.0% stakeholders, 26.1% perinatal participants, 25.0% providers), wearing a mask during sessions (50.0% stakeholders, 25.0% providers, 13.0% participants), lack of childcare (66.7% stakeholders, 46.4% providers, 43.5% perinatal participants), general transportation barriers (50.0% stakeholders, 47.8% perinatal participants, 25.0% providers), and the burden of planning and making time for in-person sessions (35.7% providers, 34.8% perinatal participants, 27.8% stakeholders). Reported facilitators included implementing and communicating safety protocols (72.2% stakeholders, 47.8% perinatal participants, 39.3% providers), conducting sessions at alternative or larger locations (44.4% stakeholders, 32.1% providers, 17.4% perinatal participants), providing incentives (34.8% perinatal participants, 21.4% providers, 11.1% stakeholders), and childcare and flexible scheduling options (31.1% perinatal participants, 16.7% stakeholders). This study identified a number of potential barriers and illustrated that COVID-19 has fostered and amplified barriers. Future interventions to facilitate resuming in-person sessions should focus on patient-centered strategies based on empathy regarding ongoing risk-aversion among perinatal patients despite existing safety protocols, and holistic thinking to make access to in-person psychotherapy easier and more accessible for perinatal patients. Keywords: perinatal depression and anxiety; psychotherapy; barriers; facilitators; COVID-19 Int. J. Environ. Res. Public Health 2021, 18, 12234. https://doi.org/10.3390/ijerph182212234 https://www.mdpi.com/journal/ijerph