An Investigation into Telephone Therapeutic Support For Growth and Change
An Investigation into Telephone Therapeutic Support For Growth and Change.
In this post, I intend to explore how effective Telephone/Skype is as a medium to support personal growth and change.
As a Health and Care Professions Council Registered Dramatherapist, and an Advanced Certified Integral Professional, I have always felt the importance of face-to-face embodied therapeutic work.
Of the 80+ training and institutions linked to UKCP only a very few are dedicated to working with the body. Seeing the body not as an additional tool for emotional change, but as a way of exploring psychological adjustment, and being trained as an actor and having spent my early career as a physical theatre performer, for me the body is always the starting place when beginning to integrate the dis-integrated self.
And we also have the much used Mehrabian communication map, you know, the one that says 38% of communication is non-verbal, and here I am using the map for its original intent – the communication of affect and emotions.
The importance I place on working with the body leads me to run workshop and retreats through the year, if you would like to read a recent review of my last retreat you can find a very revealing review here.
Yet, I have seen my partner working as a Life Coach successfully helping her clients navigate the sense of dis-integration and move towards a more integrated self. And all of this is conducted over the phone.
It was my partners success in supporting her clients to achieve their goals, whilst using Phone and Skype that I began to wonder if it was possible to providing therapeutic coaching over the phone or online.
Internet Therapeutic Support
With the rise of fast internet connection it has now become possible for therapist not only to hold voice to voice Phone/Skype session but also to hold video to video sessions. There is still little evidence based research on the effectiveness of Internet Therapy, but a reading of what literature is available shows that Internet therapy has some positive benefits:
- For many people, having to travel to a practitioner’s office, spend an hour or so there and travel back makes face-to-face work prohibitive in terms of time and possibly money.
- Clients that might have a specific needs, seeking to work with someone from a similar cultural background or wish to work with a specific practitioner who might not live nearby or even in the same country.
- The immediacy afforded by an internet based session enables contact to be made without time delays and at the convenience of both parties.
- An internet based session also provides clients with a degree of safety and control they do not normally have.
Reading through the above all the point dealt with organisation and structure, what I was not reading within the literature was any expression of interiority and then I came across this…
- …The telephone provides an intimacy as the counsellor and client speak directly into each other’s ears. It is possible to feel cocooned by holding the telephone to one’s ear, which enhances a sense of safety and trust.
The Inter-Personal Evidence
Within any therapeutic encounter there is a need for inter-personal intimacy, research evidence suggests that the using Telephone/Skype as the medium of interaction enable a quickening of inter-personal intimacy than found in a face to face session. This may be due to the coachee being in a space in which they feel safe (such as their own home), and the removal of the added pressure of interrupting the therapist non verbal regard as judgemental.
A trusting relationship can develop very quickly with telephone counselling clients and, anecdotally, it seems that fewer sessions are needed than in comparable face-to-face work. It would appear that the relative anonymity afforded by the medium enables clients to take risks and talk more freely sooner than they might in other settings. This also enables the practitioner to take risks and use all intuitive streaks before he or she might have done if working in the same room as the client. I have found that the disclosure of very painful events or experiences often happens within the first two or three sessions by telephone, whereas I found it took several more before a similar level of disclosure was reached face to face. (Rosenfield M)
It is also worth mentioning that due to there being no direct face to face encounter within the session the coachee can also fall into benign disinhibition, this is a state which indicates
…an attempt to better understand and develop oneself, to resolve interpersonal and intrapsychic problems or explore new emotional and experiential dimensions to one’s identity. We could even consider it a process of “working through” as conceptualized in psychodynamic theory, or “self-actualization” as proposed in humanistic perspectives. (Suler J)
The evidence appears to suggest that telephone work can also amplify the positive dishibition in a similar way to traditional therapy where the therapist sits behind the analysand reducing the amount of inhibition the analysand may experience
There is also an interesting point which might be that without physical direct contact it may be felt within a therapeutic coaching session as if there is a melding of minds, that as there is a deepening of the inter-personal connection being made, this is also experienced by the coachee as a dialogue that is taking place intra-psychically, which might increase the intensity of transference.
Such approaches as Inter-subjective systems theory (Stolorow R) have shown how important it is for the coachee to feel heard and understood within their anxiety or pain. A person can feel completely isolated with their pain, feeling and thinking that not only can people not understanding how there are feeling but no one can see the world as they do. The reliance on voice and listening within an internet based therapeutic coaching session, might increase the feeling of being heard.
When Skype therapy brings an inter-subjective awareness into the therapeutic encounter this deepens not just the connection but the intimacy of the conversation. This moves the work from just one of talking into one of enfolding into a deeper space of contemplation enactment.
A meta-analysis of Skype administered psychotherapy addressing the symptoms of depression showed that there is a significant reduction in depressive symptoms (Mohr et.al)
The Application
There are systemic considerations when setting up telephone therapy, the therapist is now able to use landline, VoIP, and mobile each have strengths and weakness.
I have found VoIP (Skype) to be the best medium to use for session, this allows me to offer session for clients from within and outside the UK. Skype works well for conversation within the UK. Due to the lack of physical presence within the conversation there is a heighten awareness of listening and understanding. I have found that the need to ensure I fully understand a coachee helps them to reorganise their thinking, this can be a little like the experience of giving direction to someone who is new to your neighbourhood, you have very abstract directional cognitive map fully of symbols and short cuts, but to ensure that you give the right direction you need to reorganise the map, to ensure that you avoid any signifiers that the person will not understand. I am still surprised how little I know of the street names in my neighbourhood and yet I never find my self lost.
This reorganising of the cognitive map of past experience allows the coachee to rethink and reevaluate how past experience might be holding resonance or occlusions for present feelings.
This reorganising and the reconnection to feelings that might have been long repressed help a coachee to bring life to deeper feelings and affects.
I have been constantly surprised at how seemingly random life experience suddenly link and bring forth a personal illumination within the coachee, my feeling is that the coachee is deducting ways they feel like based on past feelings and the therapist is inducting ideas and links that the coachee may not have been previously aware of.
And as I have noted it is the scaffolding inter-personal conversation, begin able and willing to, on the part of the therapist, to understand the lifeworld horizon that the coachee’s being-in-the-world is manifesting within. This leads to a shared horizon of meaning making, I do not just understand you, I feel the interior of your lifeworld because we are members of the same lifeworld.
The Evidence
The evidence then shows that using the Telephone/Skype as a medium for therapeutic change works. What I would like to finally offer are a number of 1st person expression of working with me.
These quotes from people I have worked with demonstrate the effectiveness of internet therapeutic coaching:
“When you (Gary) first suggested working by phone I was quite sceptical, feeling I would prefer working face to face. After one trial session by phone I decided to proceed by phone. Two of the practical advantages of the sessions by phone are: The convenience of being at home and literally lying back “on the couch”. I have found your approach very beneficial and rewarding in assisting me to gain some deeper understanding and insight into anxieties that I have and where they may originate from, and hopefully with that understanding being better able to “deal” with them; both within my-self and how I perceive my place in the world. I have also found the integrated wide-ranging approach very useful, particularly in making sense and connections between the internal and external, personal and social, individual and collective. I find I can utilise it in various aspects of life…. almost like fitting pieces of a jig-saw together – making sense of the bigger picture that I/we are part of.” D Marzella
“I have been working one to one with Gary, via Skype, once a month for about 2 years. Gary has skilfully, and compassionately helped me uncover patterns in my behaviour that lurk, hidden in the shadow. one in particular stands out, and that is my tendency to use intellect and grand spiritual narratives, to escape the discomforts of body, heart, mind and spirit. Gary patiently, and kindly, guides me back to the immediacy of the present moment, yet using a bit of ‘stick’ when appropriate. this has helped me discover the deeper truth of the Self that is at one with ‘what is’.” R Cree
It is possible to read in the above 1st person reflections that using the Telephone/Skype in no way limits the personal and social transformations taking place for the people I work with. Within the session it is still possible to focus on the ontological question of who am I, in what appears to be a very free and rewarding way.
This freedom of exploration can lead into a deeper realisation of self, thus bringing a greater awareness to the what kind of things need to change and ways to make the change happen.