While the use of telephone counseling has long been used for crisis intervention services, hot lines, suicide prevention, and as an adjunct to face-to-face counseling, the use of the phone as the primary means for delivering psychotherapeutic services is still somewhat of a new phenomenon. In fact there are few outcome studies that directly compare the efficacy of phone vs. face-to-face therapy. However there are several published articles that detail the advantages and the possible challenges of phone therapy.

Grumet (1979) pointed out that the auditory intimacy and visual privacy afforded by the phone make it uniquely useful for the patient who is ambivalent. The telephone allows the reluctant patient to achieve closeness at a safe distance. Similarly, those who feel shame or embarrassment in discussing a subject in person are able to approach it when the therapist's visual presence is screened out. Another important component to the process of phone therapy is that the patient is able to retain a sense of control over the process of therapy itself. A prospective patient is able to test the waters and can dispel some of the mystique of therapy at a safe distance. He also pointed out that a patient at ease in their own home is likely to be less inhibited and guarded, and phone therapy in which both participants are at home is one of the few therapeutic mediums in which dress and appearance are of absolutely no consequence. Grumet concluded that the telephone offers a strategic combination of intimacy and safety and is a useful treatment option.

More recently, Swingson, Cox, and Wickwire (1995) found that telephone behavior therapy was a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services weren't available. The treatment phase of the study consisted of eight therapy sessions conducted by phone over a ten week period. They found that the positive effects of phone-delivered therapy were as effective as those obtained in face-to-face therapy and were present at the end of a six-month follow-up.

Haas, Benedict, and Kobos (1996) explored the risks, benefits, and the ethical implications of phone psychotherapy. They point out that there is a time savings in eliminating the need for traveling to a therapist's office, which is not a trivial consideration for prospective clients who have limited time off from work. However it is much easier to identify the therapist's credentials when visiting the office and seeing visible diplomas, licenses, etc. In regard to ethical issues, they state that the use of the telephone does not change the therapist's obligations to provide sound, competent services, the obligation to avoid harm to consumers, the obligation to make explicit financial arrangements, the obligation to protect confidentiality, the obligation to avoid deceit in public statements, and the obligation to obtain informed consent from consumers. They also point out the difficulty of ensuring the client's immediate safety should the client need hospitalization. They conclude that the therapist has a responsibility to continually assess both the process and outcomes of telephone treatment.

Perhaps one of the larger difficulties for the therapist in performing phone therapy, is the absence of visual cues; for example the patient suddenly starting to fidget at an important emotional point. However it has been postulated that the deprivation of visual input intensifies the need to listen and the ability to listen. This is consistent with research on information processing that has found that the nervous system acts like a single communication channel wherein the inputs to one sense dominate those being received through other senses (Broadbent, 1958). Lester (1995) points out that restricting the cues available to the client and the therapist is not new. Traditional psychoanalysis has the analyst out of sight behind the client, restricting the visual cues for both. And of course the traditional Roman Catholic confessional also restricted visual cues.

Lester (1995) detailed the advantages and problems of phone counseling. He pointed out that it is advantageous for physically disabled clients who may not be able to travel easily . For many clients, the anonymity of phone counseling encourages greater self-revelation and openness of thoughts and feelings. The client has a greater sense of control while on the phone as compared to sitting in the therapist's office. There is still a stigma attached to seeing a therapist and phone therapy may feel less shameful. On the other hand, since the phone is usually used for conversation, the therapist must guard against the treatment becoming conversational rather than therapeutic. Lester also pointed out the problems of dealing with individuals who make obscene calls. In follow up studies of phone counseling in which callers were contacted and asked to evaluate the service, the majority of callers were satisfied and listed the helpful behaviors in their counselors as listening and feedback, understanding and caring, nonjudgmental support and directiveness.

In conclusion, the research quite correctly points out some possible pitfalls and issues that the therapist must keep in mind in order to insure that therapy goes successfully. The research also clearly states that telephone therapy offers a strategic combination of intimacy, safety, and convenience, and is a viable treatment option for many individuals.

Broadbent, D. (1958). Perception and Communication. Pergamon Press, London.

Grumet, G. (1979). Telephone Therapy: A Review and Case Report. American Journal of Orthopsychiatry, 49, 574-84.

Haas, L.J.,Benedict, J.G., & Kobos, J.C. (1996). Psychotherapy by Telephone: Risks and Benefits for Psychologists and Consumers. Professional Psychology: Research and Practice, 27, 154-160.

Lester, D. (1995). Counseling by Telephone: Advantages and Problems. Crisis Intervention, 2, 57-69.

Swinson, R.P., Fergus, K.D., Cox, B.J. & Wickwire, K. (1995). Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia. Behaviour Research and Therapy, 33, 465-469.