Phone-based therapy can be less hassle for patients. (Peter DaSilva for the New York Times)Most therapists schedule face-to-face meetings with their patients. But new data suggest that therapy by phone may be a better option for some patients.
It has long been a concern among therapists that nearly half of their patients quit after only a few sessions. As a result, a number of health care providers and employee-assistance programs now offer therapy services by phone.
A new analysis of phone therapy research by Northwestern University shows that when patients receive psychotherapy for depression over the phone, more than 90 percent continue with it. The review of a dozen studies of phone therapy showed that the average attrition rate in the telephone therapy was only 7.6 percent, compared to nearly 50 percent in face-to-face therapy. The researchers also found that telephone therapy appeared to be just as effective at reducing depressive symptoms as face-to-face treatment.
“The problem with face-to-face treatment has always been very few people who can benefit from it actually receive it because of emotional and structural barriers,” said David Mohr, professor of preventive medicine at the Feinberg School of Medicine and lead author of the study, published in the September issue of Clinical Psychology: Science and Practice. “The telephone is a tool that allows the therapists to reach out to patients, rather than requiring that patients reach out to therapists.”
Among patients who say they want psychotherapy, only 20 percent actually show up for a referral, and half later drop out of treatment.
Dr. Mohr said he began using phone therapy because he was working with patients who had multiple sclerosis who could not get to a therapist’s office. Some patients don’t have regular transportation to a therapist’s office or can’t take time off work or away from their families. In addition, a patient with depression may simply not be capable of getting themselves to the therapist’s office on a regular basis.
“One of the symptoms of depression is people lose motivation,” Dr. Mohr said, in a press release. “It’s hard for them to do the things they are supposed to do. Showing up for appointments is one of those things.”
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When I moved away from my therapist, who I’d developed a trusting relationship with, we attempted to continue our work via telephone. I didn’t like it–it was much less intimate, and more difficult for each of us to relate. I was considering finding another therapist closer to home. Instead, we decided to give videoconferencing a shot, and I love it. Two years later and still going strong. My therapist is now working with several other patients in the same way, most of whom are surprised at how effective it can be.
FROM TPP — Great story. thanks for sharing.
— Lovely BunnyContact between sessions is also useful. This is usually done by phone. I have dealt with two types of therapists: one who minded my calling in between sessions and one who has not. Guess which one I’ve had more success with in terms of progress?
Sometimes just hearing the therapist’s voice on the other end of the line, even if it’s a recorded message, is helpful. I know that this can be stressful to the therapist but sometimes patients really need that between session contact.
— hen3ryI wonder if this has something to do with 2 factors:
1. The fact that phone therapy doesn’t require the patient to travel to the therapist’s office and be challenged by traffic or lack of convenient parking space (especially in big cities), By phone, the patient simply dials the therapist’s number and it doesn’t matter if he is at home, the office, an airport or the beach, the patient will always be able to make it to his phone appointment.
2. By phone, the therapist and and the patient remain somewhat anonymous to each other, since they probably will never meet face to face and, someimes, it is easier to talk to a total stranger, who will not judge you, than to someone more familiar.
However, if I ever feel the need to use the services of a therapist, I guess I’d prefer the traditional face to face model.
— SamWhat about the charge for this type of session? Not fair if it is the same as a face to face
FROM TPP — Interesting…Why wouldn’t it be fair? A doctor’s time is a doctor’s time. The difference here, is that you, the patient will actually save on commuting time or time off work. I’m not sure a different pay structure is warranted.
— Tess WagnerOn the other side of the couch, as a therapist who does cognitive-behavioral therapy I would be concerned about what would get missed in a phone session. So much of human communication is nonverbal, such as eye contact, facial expressions (or lack thereof), a slumped posture, fidgeting or tapping, where the person’s attention goes in a room, etc…I think the teleconferencing idea is a good one because it would help get that information, but over the phone, I think that more than 1/2 of the communication would not get through. I’ve known a lot of clients whose voice gives off one emotional impression while their facial expression betrays another, often more accurate picture of their emotional state, and I’d be concerned that I’d be working with one hand tied behind my back.
— NigelI agree with Henry #3, the sound of my psychmd’s voice is often enough to remind me I am not in “this” alone.
I live 90 miles away but continue in person office visits, I have asked about phone and video and both are options.
Fees should be the same.
— AS - CaliforniaJust please, please do not hold these calls while you’re driving. That depresses ME!
As far as the service, if I needed counseling again, this might be of benefit. I would like to meet the person face-to-face the first time. But after that, saving the stress of driving, parking and the waiting room most of all would be great.
I’m not sure how relevant this is to therapeutic settings, but I seem to recall news reports from a few years ago about studies showing that people can better gauge truthfulness over the radio than they can from TV or in person. In other words, when we aren’t distracted by looks or other visual cues, we really listen.
— Janet VThere’s no reason at all why fees should be different for therapy provided face to face or by phone. As TPP noted, time is time - however it is spent. Do lawyers bill differently for their time depending on whether they meet with the client by phone or in person? I think not.
Besides, working by phone doesn’t make the work easier for the therapist, only for the client.
— A therapist and therapy clientA therapist I know encouraged her clients to use her voicemail when they needed to talk about something that had come up between sessions. She maintained her boundaries around the relationship and yet the client was able to get something off her chext, which was sometimes included in the next session, and sometimes not. Often we just need to feel heard.
I can see guided imagery and lots of other modalities working just fine over the phone. Too bad not bodywork!
— AliceFor patients that have difficulties traveling to the doctor, this sounds like a great idea.
And all you need is a computer, internet access and an internet camera to be face to face with your therapist.
— DRQuite interesting idea! Before ‘phone therapy’ is used on a widespread basis, a scurpulous scientific study using a methodology which would lessen the influence of extraneous varibles.
Then, replicate. In each separate study using sufficient sample sizes choosing at random from the same ‘defined’ population which has a given disorder. E.g., moderate depression, phobias, other specific anxiety disorders, bipolar disorder, PTSD…
An independent person should evaluate the efficacy of the
‘phone’ vs. ‘face to face’ groups.
Perhaps the result might be that for some persons one of
the modalities might work better; others might respond better to the other venue. Those potential characteristicss should be carefully investigated for and noted.
After say, “X” weeks, months… participants should be measured for compliance (continuing the therapy) and whether it works.
One more comment: ‘therapy’ comes in many varieties — so, the same kind should be used in each study: cognitive, behavioral, psychodynamic, and etc.
It can be noted that in reality, all therpists practice in an eclectic fashion, no matter they say is their stated orientation.
— David Chowes, New York CityWhen I finally started talking to a therapist, it was after getting over several hurdles that talking over the phone would have solved. I was uncomfortable meeting someone in person on the off chance that I was going to recognize him or her. I also thought it would feel uncomfortable to be “locked” in a room with someone, made worse because it would be an unfamiliar place inhabited by the ghosts and the karma of other patients. I didn’t even want to go into the building, since people would see me coming in and I might have to talk to other people in the waiting room, which did happen. I had to be ready to have people know I was talking to someone. None of these matter if it’s a phone call. On the other hand, and I don’t know how much this matters if the outcome is the same, talking to someone over the phone makes it harder to know if that person is paying attention unless there are verbal cues periodically, potentially more often than would be necessary in person. That could change the flow. It is probably harder for the psychiatrist to pay attention for that long on the phone, especially without playing minesweeper or something in the background.
— JesseCurrently, I am obtainging some phone phychotherapy sessions via the telephone. Actually, I like hearing my therapist voice via the phone when I can not make it to his office. However, actually going to his office produces more of an intimate therapist-client relationship!
— DerrickAll above are good points. I was well experienced with therapy and therapists and was referred to one who was my last ditch effort at therapy. He is brilliant. I relocated from NY to LA and, until recently, continued my therapy by phone for years. I tried other therapists here, thinking direct face to face contact important, but no one could measure up to this man’s genius. I went back to him each time. This man and phone therapy have been invaluable through enormously stressful situations. Did I mention he’s a cognitive therapist. He’s changed my life: perceptions, thinking patterns, reactions. I am indebted to this man and will resume our phone sessions when I feel the need. And, yes, he charges his regular fee. I have never questioned his fee or increases in fee. I cannot put a price tag on this man’s influence.
— RLJThis is a bit stupid. One of the main aims in treating depression is to get the patient to move, to go out. Treating depression by phone is like saying “It’s so bad that you need to stay home” or “you won’t be able to go out”. Another aim is to get the patient to be responsible for themselves and that involves making efforts…..this is nonsense. These phone meetings over the phone sound more like counselling not therapy. I agree with Nigel, what about the non verbal communication? it’s like treating patients like babies not being able to make any effort. That’s not therapy. This comment is not for people that due to medical-physical reasons can’t leave home.
— Miguel RodriguezI agree that fees should be the same. Seems pretty obvious to me.
I also understand why therapists don’t like doing phone only meetings, especially if they haven’t already developed a relationship with the client. But once they have, I see no reason why phone calls can’t work once in a while, in place of face-to-face. I agree with others though that phone sessions shouldn’t be the only type of sessions you have with a therapist. They should always be interspersed with f-to-f sessions, again, because of all the other benefits that come from seeing someone’s body language, etc.
— yippee1999Like the first commenter, I also did phone therapy with my therapist after moving to a new city. I had tried to find a new therapist, but this is actually pretty tough. Unlike the first commenter, though, I have had great success with phone sessions. By the time we started phone sessions, though, I had seen her in person enough that we had a good professional relationship, and I was comfortable with her. I also wasn’t having regular sessions, just periodically when I was struggling with something (like a friend’s death) and needed some help. I am not sure that this would have worked so well with a brand new therapist, though.
— QDavid Chowes ought to know that psychology is hardly a science’ it’s highly idiosynchratic, with too many variables to measure. Were we to depend on the scientific method to prove its merits, there would be no psychotherapy.
— RLJTry getting yourself to a therapist when you have some degree of agorophobia, no way. Therapy by phone would make help available much sooner.
— ethelMy perspective is one who has worked with a psychologist for myself and my brain-injured son for 13 years. Phone conversations were highly effective for me and my son. Many reasons:
== Clarification between sessions when processing after a session. Makes the next session more effective.
== Comfort and assurance from a trusted and knowledgable professional. Feels like he knows me more than just when in his office.
== Immediate contact when under extreme and unexpected stress. Not often, but crucial when it occurs.
== We’re more likely to reach out knowing he cares and is willing to talk to us. Also more willing to reveal the inner feelings.
Billing at office rates seems fair to me. Possibly more than fair since the calls are often at my convience and he interrupts what he’s doing to take care of me.
— Mike SuflitaI agree with the point that “in person” cues can matter, though I’m not sure that is a reason not to make use of this (maybe a mixture of in-person and phone?)?.
I also agree somewhat with #3’s comment, though not for the same reasons. Yes, a doctor’s time is a doctor’s time, but at the same time if part of their fee is for upkeep of an office, and as a patient I am not making use of the office, should I be funding it?
— PSCI have had good experiences with therapy over the phone, and this was after a decade of face to face visits with my therapist.
One thing to keep in mind, a lot of so-called nonverbal communication still gets communicated via voice, all the pauses, changes in things like tone, volume and tempo. Since I’ve also been in coaching roles, and have used the phone, I can assure you that when you learn to adapt to using this one channel, you can get a tremendous amount of information.
— John SI’m a therapist with a private practice, and I discovered Skype, and iChat, and have been seeing patients that way for a couple of years now. I particularly like that there’s no long-distance charge, so I can keep in touch with patients who have moved to different parts of the world. I see someone who lives in the Philippines via Skype every two weeks, and I have other patients in England, Taiwan as well as California, Florida and Connecticut. The odd thing is that with the video feature, it doesn’t feel much different from an in-person session - some of the fluidity or regression that comes from working on the phone is lost. It can be nice once in a while to turn off the video and just use the voice connection - it has a very different feel, and can loosen up some patients who are more resistant.
— Will MeyerhoferJust a note, there are some licensing issues that therapists need to be aware of if they are providing services to patients who are in states/jurisdictions where the therapist does not hold a license. Probably most consumers are not aware that therapists are licensed by state. If a therapist is providing treatment to a patient who is in a state that the therapist is not licensed in, then it can lead to problems with the state licensing board. Also, it’s not clear how insurance companies feel about reimbursing patients or therapists for services provided via phone. These are all issues that will have to get resolved as technology improves.
— AnneI cannot imagine doing therapy over the phone, it’s a scary and alienating process enough already, and sometimes the only thing that brings me back is the chance to have a human connection, in person, with the therapist.
In this vein, I’d be curious to know what people think about therapy and email. There is a small but (I think) growing movement toward cybertherapy and conducting the whole relationship this way, but I think email can also be an effective way to communicate between sessions when something feels pressing. It can also help people who are better writers than talkers. I know therapists who are wide open to this idea, and others who feel it detracts from the relationship (or are not comfortable enough with the technology to use it well).
Perhaps another column idea, TPP?
FROM TPP — The whole notion of using information technology (email/video conferencing) for therapy is interesting, but as you might expect, there are not a lot of data on it.
— Carolyn