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Phone Therapy Goes Awry

Posted Oct 23 2008 11:26am

When clients fall ill, have scheduling conflicts or bad weather strikes, a full-length session over the telephone can be a viable way to provide treatment in lieu of a client coming to the office. In fact some experts in specific areas of Psychology have entire practices based on phone therapy so that they may work with people all over the world. My understanding is that there isn't intensive research conducted on the efficacy of telephone therapy but that most practitioners believe it can be a useful alternative to a face-to-face session.

Like all forms of therapy such a system is far from perfect. Insurance companies do not pay for telephone sessions. A crackling cell phone can interfere with communication and something is missed when I can't see my clients non-verbal cues. If there is a long pause during a face-to-face session a client is usually either thinking about the conversation or has nothing to say at that moment. Over the phone however it's difficult to tell: is he jotting down a note about something we're discussing? Thinking about the unbelievably potent insight I've just delivered? Could he be reading his email or eating a sandwich? Did I just piss him off and he's giving me the finger?

Recently I got a call from a client, I'll call him Charlie, who stated that he had had an argument with his spouse. Again. He was hoping to come in for a session to talk it through, "because it was my fault as usual." I accommodate clients as best as possible but I simply didn't have any available space that day. Rather than waiting for the first available appointment the following morning he asked if I could do a telephone session at the end of the evening. I told him that I would be driving home from the office at that time but as long as he didn't mind some outside traffic noise it should be fine.

I have a fairly ancient cell phone with a horrible speaker. I've always found headsets and those Blue Tooth things to be cumbersome and, quite frankly, they look ridiculous. It's like a gigantic mosquito has settled onto a person's ear. I also hate the idea of not speaking into a phone. I feel bizarre just throwing words out into the air. So like every other person who doesn't think things through I drive with the phone to my ear, violating New York State law. You would think after seven tickets over the past few years I would have learned something. It takes me a long time to learn things.

Ten minutes into the phone conversation with Charlie I had learned that he was very anxious at having yelled at his wife (again) for burning toast that morning. Charlie has what is known in some circles as Low Frustration Tolerance (LFT). It can sometimes be helpful for clients to put a label to a specific concept that they are trying to work with. As I started to remind Charlie about LFT and its relevance to his immediate problem the flashing red and white lights popped up in my rearview mirror.

"Charlie I'm going to have to call you back in a few minutes," I said.

"Wait! You're not going to charge me for the time off the phone are you?"

"No Charlie I won't do that. I'll make sure you get your full time. I have to hang up now," I said and snapped the phone shut. I considered throwing it out the window and pleading innocent ("Cell phone? What cell phone?") but then remembered that paying a fine costs less than paying a fine and buying a new phone.

I know I am not above the law but I am also not above attempting to get out of tickets. I once feigned a southern accent in an attempt to convince the officer that I was from out of town and my crime was simply an act of ignorance. The attempt was laughable and didn't fool him. This time I decided to put my doctorate to use.

"License and registration please."

"Officer, you have to understand that I'm a doctor and that phone call was a clinical emergency."

"Is that so?" he said suspiciously, eyeing my clothes from the Gap. "You look a little young."

"I'll have you know I'm 36 years old and a private practitioner with a full case load of individuals who need my assistance."

"What type of doctor are you?"

"Um...I'm in mental health."

"A Psychiatrist?"

"In a way."

"What kind of way?"

The untrue way."I'm a Psychologist."

"I see. And what was the 'clinical emergency?'"

"A client, no a patient of mine is having significant interpersonal skills difficulties with his significant other leading to cognitive distortions that are impacting his mood negatively and significantly I should add. I was restructuring those thinking errors to buoy his mood and reduce any associated anxiety."

"Sir I have no idea what that means nor do I care. Was the man suicidal or homicidal?"

Unfortunately no."I haven't done a complete risk assessment as of yet."

"Why don't you just tell me what you were doing on the telephone without a headset?"

I hung my head, defeated. I decided to resort to honesty as a final hope for redemption (i.e., no $85 citation). "I was doing a phone session with a client on my way home from the office because he got in a huge fight with his wife and started to feel anxious. I was getting ready to talk him down from the anxiety by going through some simple breathing instructions and by reminding him that he is constantly blowing a gasket over the simplest mishaps on his wife's part which is making both him and her miserable." Are you happy now?? I'm not a real doctor. There was no real emergency. I just try to help people through talk...which is laughable. I suck at life. It's no wonder my friends never call me.

"Did it help?" the officer said.

"Did what help?"

"Talking with him."

"Not yet. We got derailed from our conversation when you pulled me over."

"Well that was nice of you to try to help your guy out on your way home from work." He scribbled something on his pad and handed it to me. It was a warning, not a ticket. "Get yourself a Blue Tooth, Doc" he said and walked away.

But I'll look like such a douchebag."Thank you officer" I yelled as he closed his door.

The lesson here is that honesty is the best policy. And don't break the laws of the road. And buy a Blue Tooth. And if your name is Charlie stop yelling at your wife over burnt bread. There is probably more to be learned but I've had enough of morality for one day.
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