What does the research say about the differences of phone-based counselling?

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.

Activity 15: Clinical considerations for working on the phone

Timing: Allow approximately 10 minutes

Listen to the following audio and answer the question below.

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It’s something that I’ve also experienced working with clients – not so much online, but I found that something happens when you just work on telephone, and sometimes I do that. But we’ve never met, and we’ve never seen each other, but we’ve worked [together] over the telephone. And it seems as though we get to the nitty-gritty, shall we say, very quickly that way.
And whether there is that sense of, OK, we’ve got anonymity, as you said – if I can say that word – and also that just, ‘I’m never going to meet you in the streets, you don’t know anyone I know.’ I typically work with clients who don’t live in my area. So it can get to some quite important work quite quickly. And I guess what you’re saying is that that’s good, but it also needs to be carefully managed –
– by the therapist, and the therapist has to make sure that they’re OK with that, and they can manage what’s coming out in a quick way.
Absolutely. I think that’s beautifully summed up. And another point to what you were saying there as well, is I think a big part of that is not seeing the therapist’s face means I’m not wondering, ‘Well, what are you thinking? What’s behind that expression? There was a certain twitch in your expression – what does that mean?’
So all that’s taken away and removed, and they’re able to actually focus more on themselves and what’s going on and, as you said, almost put it out there. Because if they do pass me in the street if we live in the same area, they’re never going to know that I was the person they spoke to. So absolutely, as you said, it can be hugely beneficial while you need to feel confident in how to respond to it ethically and appropriately.
Well, as you say, the not being able to see someone’s face – and we’re talking specifically here I think about working on telephone rather than –
Or instant messaging, or email.
Or email. The downside is silence, isn’t it? Because obviously, we can work with silence when we’re face-to-face, and probably to a certain extent work with it when we’re doing videoconferencing. Allowing, knowing, being able to read the client’s body language and know when they just need time to sit with an idea or sit with something they just said or are feeling – not jumping in and filling that space and allowing that silence to be there, that is much harder to do, I think, on the phone. Just to let be.
Absolutely. And again, with instant messaging, you – and again, this is why the training’s so important to understand, yes, the differences, what you do, how to respond to that, how to let the client know that you are still there.
End transcript
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What potential benefits and difficulties of phone-based counselling were mentioned?

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Potential advantages include:

  • the anonymity afforded to clients
  • phone/audio-only counselling may allow clients to ‘get to the nitty-gritty’ more quickly
  • it may allow a greater focus on the self, because the counsellor is not visible.

Potential disadvantages (for both clients and counsellors) include how to understand silence.

You should now move on to Topic 6: Text-based counselling [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .

5 Audio-only and phone-based counselling