Wednesday, June 6, 2012

Phone It In Psychotherapy?

I'll be the first to admit that going for psychotherapy is not easy. There are some steps that you need to go through before therapy even becomes a viable option, let alone successful. That is why when I read a press release yesterday about phone-it-in therapy, I had my doubts. Very strong doubts.

According to the press release, researchers from Northwestern University studied 325 patients who were very depressed and who received psychotherapy either by phone or in-person. It doesn't say how many patients were in each group, but the researchers did say that only 20.9 percent of the patients who had cognitive behaviour therapy by phone dropped out of the program compared with 32.7 percent of people who had gone to traditional face-to-face sessions.

This difference doesn't surprise me. It's much easier to make a phone call from your home than to get up out of bed, get dressed. and go to your therapist's office. There are many times that I sure didn't want to make that effort.

The release goes on to say, "Patients in both therapies showed equally good improvement in their depression when treatment ended. Six months after treatment ended, all patients remained much improved." Interestingly, the release goes on to say that those who completed the telephone therapy also scored three points higher on the depression scale than did those who went to in-person sessions.

The researchers downplayed the three-point difference, saying that it might not be significant, but lead researcher, David Mohr, suggests that the face-to-face treatment is better for some people.

This is where my "gee, you think?" reaction kicks in. Mohr says, "The physical presence of the therapist may be therapeutic in a way that helps some patients maintain their improvement in mood. There may be a unique quality about the human contact that increases resilience and maintains the skills learned to manage depression after treatment has ended." Again, you think?

In my opinion, telephone calls have a definite place in therapy. There are times between sessions when you just need to speak to your therapist. You need to calm down, you need reassurance, you need to talk something out with someone who won't judge you - these are all good reasons for a phone call. But primary therapy? I have my strong doubts.

Getting professional help for depression, anxiety, or any other mental illness takes several steps for it to become reality and to be successful. Here are just three:

1- You have to be willing to do it. 
     Having people tell you that you should consult a psychologist and/or knowing theoretically that you would be better off doing so are not the same thing as accepting and knowing in your heart that seeking help would be a good thing to do. 
    I knew I had problems that needed to be resolved. I had pain that was coming out in all the wrong ways and I knew I was having trouble coping with certain situations. But would I admit that help from a psychologist would be good? That was a totally different thing. That took a long time, despite encouragement from my doctor, and my friends and family.

2- You have to find the right person.
    Saying that you will go for psychotherapy is difficult enough, finding the right person who will help you may be more so. Some people are fortunate and will luck into finding the right therapist fit straight away. Others have to do some shopping around before that becomes a reality. 
    It's so important to understand that if you don't click with one therapist that it is OK, really OK, to go find another. It may take many tries and that is where people may give up. After all, if you've given your all with one or two therapists, where can you get the energy and will power to try again with another?
    The problem is not unlike dating. You can't always hit it off when you date someone. You may dislike that person the first time you go out or you may date him or her for a few months before you realize that it's just not going to work out. With therapy, just like dating, you have to make the decision to move on if it isn't working out. You owe that to yourself.
    It took me three tries before I found the one psychologist I trusted. I don't know why that trust was there because I didn't trust many people - but it was. Not only was I lucky enough to find him, I was lucky enough that he had the time and wherewithal to help me. I know I wasn't an easy one. ;-)

3 - You have to be committed.
    Once you've decided that you do want to go through therapy and you've found the right person for you, you have to be committed to making this work. Therapy is not easy. There are many times that you may want to throw in the towel, tell your psychologist to take a flying leap off a tall building. 
    You may decide that you don't ever want to go back, that you don't want to subject yourself to the painful feelings that may come up during the therapy. But you have to. You have to trust that individual enough that he or she will help you through those painful feelings and help you come out on the other side.

I don't know if you can attain these three points by telephone.

In my mind, you need to physically be with a person to develop the level of trust it takes. Not only does the therapist need to see you - how you physically react to certain things - you need to see your therapist. You need to make that connection.

Some people may argue that Skype would be a good way to communicate with a therapist without physically being in his or her office. While this may be better (in my opinion) than telephone, Skype only allows you to see what the person on the other end allows you to see; in most cases, this is the face only. And faces only tell so much about a person.

Do you think that telephone therapy is a viable option? Perhaps it is a good idea if there is no other way. What do you think?

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