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Posted June 9, 2003 

Use of the Telephone in Psychotherapy

Edited by Joyce K. Aronson. Northvale, N.J.: Jason Aronson International, 2000

Reviewed by Roy Phillips, Ph.D.

The focus of this book is to provide therapists with suggestions about how to effectively use the telephone in their practice. Each section of the book includes a discussion, practical suggestions, and case illustrations about: the use of the telephone as it pertains to general issues in individual therapy; specific issues regarding individual therapy with parents, children and adolescents; and various therapeutic modalities and diagnostic disorders.

The first section describes how the telephone has effectively been used for crisis intervention, for the initial interview or call of inquiry, for couple and/or group therapy, family work, impasse resolution between adolescents and parents, and for persons with medical illness. For example, the telephone can be used as a tool for therapy when formal office visits are not available or are anxiety provoking. The disadvantage of using the telephone is that it can cause transference and counter transference with the therapist and patient. Also, the telephone does not allow for visual cues, and it is suggested that fees not be discussed on the telephone; it is preferable to discuss this face-to-face.

The second section discusses the benefit of using the telephone in transitional times, for example, when the patient or therapist relocates, or when a patient needs to work out of town and therapy is at a crisis point and needs to be continued. Also, the telephone is an effective way to open up more intense areas of therapy that the patient has not been able to discuss in person, perhaps because the patient may feel safer with distance from the therapist.

The book’s third section describes how the telephone can be a vital link for allowing the parent and therapist to keep in close touch. One suggestion was for the therapist to call the parent to learn of the child’s reaction to his or her initial session, thus also confirming the interdependence between the parent and the therapist. My personal experience is that therapy is more effective if the therapist knows what is going on at school and at home prior to the session.

Later sections in the book discuss how the telephone is used to meet developmental needs in various stages of adolescence. It also discusses how telephone therapy has been used for years for suicide prevention and interaction, to follow up psychiatric hospitalization, as well as for alcohol rehabilitation, group therapy, reducing reactions caused by a transition to a new therapist, and to treat separation anxiety. The telephone has also been shown to be helpful for communicating with a helper, identifying and solving problems, working on language difficulties, for increasing self-observation, for freedom of expression, and to overcome family resistance to therapy with hospital patients.

Telephone therapy is suggested as an effective treatment for learned helplessness, for traumatized or suicidal or alienated patients and for crisis intervention. Also, separation anxiety appears to be positively affected by telephone therapy. It is also an effective tool for a consultant to use to help resolve an impasse between a therapist and patient. The weakness of the telephone is that it omits information that can be obtained by observing body language and visual cues, and can be challenging to use with people who have difficulties focusing their attention and maintaining concentration.

A discussion of the state laws that govern the use of Internet, telephone conferencing and telephone therapy was also included in the book. Other suggestions included having the therapist do a mental status examination in the office before scheduling telephone therapy, which is suggested as an adjunct to, rather than a replacement for, office therapy. Written and informed consent should be obtained from the patient and therapists need to consult with their clients about the use of telephone therapy, with the therapist maintaining records of telephone sessions. The authors also suggest reviewing the American Psychological Association (APA) rules for telephone use and warn that state laws regarding telephone use may be revised yearly. Finally, the author suggests consulting with an attorney to answer possible legal, confidential and ethical issues.

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