Phone-based counselling has a long history (Reese et al., 2006). Originally reserved for crisis hotlines, it has for decades already been used both as an adjunct for face-to-face therapy and as a sole intervention, in particular for clients who might struggle to attend face-to-face counselling – perhaps because of a physical health condition or disability (Proctor et al., 2018). According to Irvine et al. (2020, p. 121) ‘one-fifth of publicly-funded adult primary care mental health provision is delivered via this mode’ currently in the UK.
Do you like to have long conversations on the phone? If yes, why? Or if not, why not? Have you ever used the phone to do more than, say, organise appointments with any of your clients? If you have, what was that like?
It is worth thinking about your own history of using a phone to talk rather than sending text messages because – as you considered in Section 1 of this course – this is likely to affect how you engage with audio-only/phone-based counselling.
Phone-based therapy has been shown to be effective (Leach and Christensen, 2006), and client satisfaction and acceptance of telephone psychotherapy has also found to be high (Reese et al., 2006; Bee et al., 2008). Of course, this does not necessarily mean that conducting counselling through the phone is the same as a face-to-face session.
Counsellors and psychotherapists have long expressed concern about engaging in phone/audio-only counselling: the criticisms focus on the negative potential impact of the absence of visual cues on both their understanding of what is going on (and the ability to judge risk), as well as the therapeutic relationship.
However, Irvine et al.’s (2020) review of research on interactional aspects of phone-based counselling found little evidence of difference between phone/audio-only and face-to-face counselling in terms of therapeutic alliance, disclosure, empathy, attentiveness or participation. When considering this, remember that one-third of the studies in the researcher’s review were 30-plus years old, while others were based on small samples or were potentially of low quality.
In other words, it may be that there is not enough good or recent research to really know whether there might be differences. Alternatively, there really may not be differences in, for example, measured empathy – but counsellors and psychotherapists may still be expressing empathy in different ways on the phone versus face-to-face.
So how might working on the phone be different? Engage in the next activity to find out more.
Listen to the following audio and answer the question below.
What potential benefits and difficulties of phone-based counselling were mentioned?
Potential advantages include:
Potential disadvantages (for both clients and counsellors) include how to understand silence.
You should now move on to Topic 6: Text-based counselling.