Therapy on-the-Go: Surprising New Evidence on Over-the-Phone Support

Last Monday, I investigated the potential effects of Evidence-Based Practice on the therapeutic relationship. This week I chose to explore the blogosphere in search of practices that, while not necessarily approved by Division 12 as "Empirically-Based," utilize innovative approaches to connecting with clients. As a counselor on a local crisis hotline, I was thrilled to discover the publication of a new study offering compelling evidence that phone therapy is just as effective at improving mood as traditional, sit down, face-to-face therapy. In my search for reactions to this recent publication, I realized that this publication has sent waves through the mental health field and many bloggers have already formed strong opinions around phone therapy. The first post I came across was written by Dave Turo-Shields, a Licensed Clinical Social Worker and current provider of telephone therapy. His post was published in the blog of Dr. Kathy Sifert entitled Preventing Violence Among Children and Families. Dr Sifert is the CEO of Eastern Shore Psychological Services, a private practice specializing in the assessment and treatment of at-risk youth and their families. Her blog is an interesting amalgamation of posts by various specialists within the field of Mental Health. Mr. Turo-Shields' post within Dr. Sifert's blog presents a Question-and-Answer style analysis of his extremely positive experiences providing phone therapy. The second post I came across was in the Blogging Therapy section of GoodTherapy.org. This post entitled Research Compares Telephone Therapy with Face to Face Therapy: More Surprising Results, was written by Licensed Clinical Social Worker, David Brezenoff. Mr. Brezenoff's post takes a more critical eye to the phone therapy craze, pointing out that while the phone therapy study does have some powerfully compelling attributes, the results must be viewed through a slightly skeptical lens. I offer my comments to Mr. Turo-Shields' and Mr. Brezenoff's analyses below as well as on each author's post.

"Phone Counseling - It's What's for Dinner!"
My Response:

I would like to thank you for your organized analysis of the phone counseling craze. The recent meta-analysis of twelve phone therapy-focused studies published in Clinical Psychology: Science and Practice has triggered my interest in this alternative to face-to-face treatment. I was excited to read an entry written by a clinician who actually employs this practice. Efficiency seems to be a common theme in 21st century life: order your groceries (and have them delivered right to your doorstep), conduct a meeting, buy or sell stock, and now receive therapy - all over the phone. While I admit that with the attrition rate for traditional psychotherapy nearing 50%, the convenience offered by phone therapy does appear promising, I think that there is a careful balance to be struck between convenience and enabling. Under your "Phone Therapy Fits Busy Schedules" section, you briefly touch on how phone therapy can benefit clients with logistical barriers to receiving face-to face therapy such as a hectic work schedule. I agree that phone therapy brings new meaning to the term "client-centered." Half the battle of keeping clients in therapy can center on scheduling a convenient time for both client and therapist. However, the clients who are simply too busy to sit in a therapy office for 50 minutes a week seem like the clients who may most need that 50 minutes of relaxation in the neutral environment that can be achieved in the therapist's office (see above left). An important part of time management is making some time during the week for self-care. It seems as though phone therapy might maintain poor time management skills by allowing the ultra-busy client to brush aside self-care in favor of attempting to juggle the world news report, therapy, and dropping the kids off at school, all in the span of their morning commute. Perhaps some loose ground rules for when and where a phone session should take place are in order. Ultimately, I really enjoyed reading your take as a clinician on phone therapy. While I maintain many reservations about hailing it to the extent that you did in your post, I do believe you offered some crucial advantages of phone therapy and have inspired me to continue to explore this increasingly popular form of treatment.

"Research Compares Telephone Therapy with Face to Face Therapy: More Surprising Results"
My Response:

Thank you for your informative synopsis of the recent publication in "Clinical Psychology: Science and Practice." In the face of an ever-increasing need for mental health services to be available and accessible to the community at large, I was excited to learn of a form of therapy that can potentially transcend some of the traditional logistical and emotional barriers to seeking treatment . I find it truly amazing and very much promising that this form of treatment can boast an impressive 7.6% attrition rate. I do agree with you in your opinion that even though the results of this study are promising, they do need to be viewed with a certain degree of skepticism. As you point out, phone therapy could be an easy out for clients who are too anxious or too depressed to meet their therapist face-to-face. Often, one of the first steps in treating depression is to get the client up off the couch or out of the house. Phone therapy seems like it might skip this important step. However, I do believe phone therapy might show some promise as a tool in the treatment of severe anxiety. For example, anxiety often inhibits the individual's ability to properly describe their feelings to another person, especially in the initial stages of therapy. The client might be embarrassed or feel as though they are being judged. Is it possible that phone therapy could be successfully used for the first couple of sessions to make the client feel more secure through the added element of perceived anonymity? I liken phone therapy to hotline counseling. Millions of people each year call local hotlines during a time of crisis, depression, or confusion (see right). The hotline often serves as a way of "testing the waters." That is, realizing the problem by speaking it and having the counselor validate while still having this element of anonymity that allows for a quick hang-up should the need arise. I do however recognize that one of the best predictors of positive outcome in longer-term (as in more than one call to a hotline) therapy is the rapport between client and therapist. It might be difficult for many client-therapist pairs to build a secure and trusting relationship over the phone. Clearly this is an area of therapy that needs more research. Thank you again for carefully pointing out the controversies surrounding the recent publication of the findings related to phone psychotherapy.