Technology in Counselling: Telephone Therapy

Technology in Counselling and Psychotherapy

• A practitioner's guide, written by Stephen Goss and Kate Anthony.
• The book is published by Palgrave Macmillan.

Part II: Telephone and video links

• Page 91

Telephone counselling and psychotherapy in practice

• Maxine Rosenfield is the author.

• Page 93

• History of telephone therapy, including practitioners initially considering telephone therapy not 'real' therapy as recently as 1997.

• Telephone therapy has been used for crisis support for over 40 years.

• Practitioners have considered issues like: client receiving help, building relationships, privacy, and payment.

• Telephone therapy as ongoing, contracted relationship between practitioner and client.

• All sessions occur by phone without face-to-face contact.

• Many people have access to telephones and value the safety and confidentiality.

• Counselling services using telephone received an average of one call every two seconds, every minute of every day for a 12-month period.

• Reasons a client might choose telephone therapy:

• Vulnerability/feeling vulnerable (e.g., rape victim)

• Mobility issues

• Need for specific type of client/practitioner

• Rural location

• Avoiding face-to-face meetings.

• Suitable therapy styles include cognitive-behaviorist, and person-centered.

• Techniques like Gestalt therapy are not suitable for telephone therapy.

• Considerations for practitioners during telephone therapy:

• Vocal communication.

• Nonverbal cues in voice tone, speech patterns and pauses.

• Verbal pauses and silences

• Client's experience of phone therapy.

• Use of accents

Assessment Session

• During an assessment session, participants agree on session frequency and lengths.
• Payment terms must be negotiated.
• Confidentiality must be agreed upon.
• The need to provide client comfort is acknowledged.
• Consideration of working with time zones.

Frequency and duration of sessions

• The frequency and duration should be planned in the assessment stage, ideally a minimum of six sessions over a set period.
• Set clear boundaries like session length and frequency to ensure both parties have clear expectations.

Trust

• Building trust is essential in telephone counselling.
• Encouraging client's comfort level about the telephone, especially with potentially sensitive issues.
• Ensuring clear telephone etiquette for calling and response procedures.

Control and empowerment

• Clients can end a session with no negative repercussions to their therapy experience.
• Important to discuss expectations for both therapist and client for continuity and reassurance.

Group Work

• Suitable for short-term process work.
• Effective for clients who find in-person group work challenging.
• Suitable for clients geographically isolated, disabled, etc.
• Ensure that clients are able to join and participate from their location.

When therapy by telephone is not suitable

• Considerations for circumstances that make telephone therapy unsuitable for clients and practitioners: lack of articulateness via telephone, or strong accents, or hearing impairment or inability to use video/audio, etc.
• Clients and therapists may prefer face-to-face sessions, for example, if they feel uncomfortable in the telephone based setting.

Case Study One (Narelle)

• Narelle is an actor with relationship issues.
• She initially perceived telephone therapy as an 'ideal' lifestyle option.
• Issues she discusses in therapy were related to her partner and difficulties with social interactions.

Case Study Two (Dorothea)

• Dorothea is a 40-year-old mother with significant learning disability child and chronic pain related to her husband.
• She found it difficult to communicate clearly on telephone therapy.
• Issues in therapy centered on her relationship with her husband, loss of independence, and difficulty with everyday tasks.

Video counselling and psychotherapy in practice

• Susan Simpson is the author.

The development of videoconferencing in telehealth and Psychotherapy

• Videoconferencing has been used commercially and in medicine for 40 years.
• Videoconferencing is used for telemedicine, commercial uses, educational settings and is becoming more accessible to individuals and developing countries.
• Videoconferencing is gaining traction for therapy.

Client satisfaction

• Video therapy is preferred or considered equivalent to face-to-face sessions by clients.
• Client satisfaction regarding videoconferencing has been positive.
• Clients value the anonymity and privacy of video therapy.
• Video therapy is a solution with equal value for clients with complex needs as well as simplifying issues for less confident or socially anxious individuals.

Therapist Satisfaction

• Therapists find video therapy to be as effective as traditional methods.
• Adjustments are needed in communication.
• Comfort levels are reported to be maintained through adjustments to the sessions.
• Therapists may be relieved to find that they can still utilize their standard techniques and need to learn more adjustments.

Videoconferencing versus telephone, therapy

• No single approach is necessarily better than another.
• Considerations for client traits and preferences.
• Therapist preference for therapy techniques.

Clinical efficacy

• Video therapy has been shown to be as effective as face-to-face sessions.
• More research and trials are required to determine efficacy in comparison and/or contrast with face-to-face.

Therapeutic process issues

• Video therapy processes and rapport building are similar to traditional face-to-face sessions,
• Important to consider and assess client and therapist comfort levels in this new setting.
• Therapy boundaries need to be made clear.
• It is beneficial for therapists to be familiar and comfortable with the equipment in use and the technological aspects of telehealth and psychotherapy.
• Consult local/national health professionals

Recommendations

• Therapists to maintain close contact between sessions and to have support available in case of issues.
• Pre-therapy information sheets should provide essential context about how video therapy works.
• Practitioners should be familiar with communication etiquette to maintain flow of conversation.
• Technical adjustments may need to be considered for efficient and safe practice and implementation.