Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=99461
Story Retrieval Date: 5/19/2013 1:57:34 AM CST
Much like the trade-off between face-to-face therapy and phone therapy, the Vatican II trend in the Roman Catholic Church from veiled, boxed confessions to a more conversational, in-person style has raised questions about effectiveness.
In-person confessions tend to run longer than those behind the veil, resulting in deeper content and thus producing better results, said the Rev. Ian Gibbons, a teaching Jesuit.
But people are starting to migrate back to the box, Gibbons has found, and they can be “quite emotional” there.
Confessions via the Web or hotlines may be psychologically beneficial, h said, but they are not redemptive in the eyes of the Church.
“The human element has got to be there,” Gibbons explained.
People turn to their phones for nearly everything, even psychological counseling. The practice may sound inherently problematic, but a new study has opened up the lines of communication about the effectiveness of phone therapy.
The meta-analysis, a combined study of studies, was published in the September issue of “Clinical Psychology: Science and Practice.”
The lead researcher, David Mohr, is a clinical psychologist and professor of preventive medicine at Northwestern’s Feinberg School of Medicine. It was during his work with multiple sclerosis patients who wanted to manage depression that Mohr began to wonder if perhaps face-to-face therapy wasn't the best way to accommodate those with limited mobility.
What he discovered was that phone therapy was not only effective for these patients, but it also resulted in lower drop-out rates across the board.
“Over all the studies, drop-out rates were around 7.5 percent [for phone therapy] versus 25 to 50 percent for treatment for depression face-to-face,” he said.
Mohr has launched another study in Chicago that will more directly analyze the effects of the two different modes of therapy.
The research will not be complete for another couple of years, but Mohr suspects they will find that phone therapy is better suited for certain types of problems.
“People who are very socially anxious, who might be more hesitant to reveal information, they may feel more comfortable over the phone,” he explained. “On the other hand, somebody who tends to have more paranoid features and be suspicious and worried about the motivations of others, the phone may just aggravate that because they can’t see the therapist.”
Having the therapist out of view hearkens to the classic model of psychoanalysis, fathered by Sigmund Freud and his trademark sofa.
Freud believed the analytic couch allowed the unconscious to flow more freely by removing interferences, especially those of the therapist’s facial expressions and reactions. He also wrote that he could not "put up with being stared at by other people for eight hours a day.”
Annoyances aside, the concern of modern therapists is not that the patient can’t see them but that they can’t see the patient, Mohr explained. Important information is expressed through facial impressions and body language.
This is exactly the hang-up for Monique Cleminson, a clinical psychologist with offices in Skokie and Chicago. She begins therapeutic relationships in person and offers phone therapy only for patients who are in crisis or who move away. But long-distance clients whose problems become more severe are referred to another psychologist who can meet in person.
Face-to-face meetings are more in-depth and speed up the therapeutic relationship, a key component for change, according to Cleminson. And she doesn’t want phone therapy to become a crutch for her patients with social phobias.
“I find it helpful for the person to get out of the house and face the challenges,” Cleminson added.
For Mohr, however, as long as the patient is talking, the therapist can get a lot of information over the phone.
“The leakiest channel for emotions is the voice quality,” he said. “It’s easier for people to control their facial tics related to emotion than it is to control their voice, so when people are anxious or they’re sad, usually the therapist can hear that.”
The same is true for dance therapist Gina Demos. When she does phone sessions (she is aware of the essential irony), Demos puts herself in a deeply relaxed state in order to fully pick up the nuances in the patient’s voice. The reduced stimulation can greatly contribute to understanding where a person is emotionally, she said.
A diplomat and fellow in the American Psychotherapy Association, Demos has worked as a dance therapist for 35 years, using the body as “home base” to do psychotherapy.
She has found that some patients are simply more comfortable moving their bodies over the phone than in person.
Demos recalled one patient who puts the phone down and then “moves what she is experiencing. And then she comes back [to the phone]. …I don’t think she’d be as free here [in person].”
Beyond lack of inhibition, geography is often the strongest variable in a patient’s choice of phone therapy.
Experimental psychologist Timothy Heckman contributed to Mohr’s findings. Growing up in a small town in central Pennsylvania sensitized him to the experience of rural people for whom phone therapy creates more choice of care and eliminates travel.
Heckman reached out even further to people in rural areas who are living with HIV/AIDS. With the help of two facilitators, he conducts “tele-health conference calls” with six to eight HIV-infected people.
“I eventually concluded that telephone interventions might be a good way to reach geographically and psychologically distant persons living with HIV/AIDS,” he explained.
Heckman added that many participants are thrilled to finally have the chance to be connected with others who are going through similar circumstances. An added benefit of this kind of phone therapy is that HIV-infected patients can get to work right away on issues and preserve their anonymity, Heckman said.
Another contributor to Mohr’s study, Gregory Simon, works as a researcher, professor and psychiatrist. He finds that the biggest challenge to phone therapy is quite simple.
“It’s not covered by most insurance plans,” Simon explained. “Until that happens, it won’t be widely available or widely used.”
Regardless, “phone therapy probably has the greatest advantages for people who are just not able to stick with in-person treatment,” he added. “For whatever reason.”