I have this friend at work that always seems to be fielding phone calls. Compared to other vocations, it seems to me that therapists don't really need to use phones a whole tremendous lot. Sure, we need to schedule appointments, co-ordinate with psychiatrists and primary care doctors, and even sometimes talk to dreaded insurance companies. At our hospital, most of us don't even get direct incoming phone lines. Call my number and you're going straight to voicemail. We have
pagers, a.k.a. electronic leashes, but mine feels more like a status symbol (that's right, I find it cool to have a pager and look important, what of it?) than a necessary electronic device. But there goes my friend, off on some other phone call mostly having to calm down or reason with some ramped up
parent of a child patient. I tell her she should develop some niche practice in telephone
psychotherapy. Well, this week brings evidence that when I dole out
career advice, you best listen up!
This Wednesday, Professor Yukata Ohno of Keio University launched a Japanese psychotherapy service that can be accessed from the comforts of...a mobile phone. No couch required.
This web-based phone-in program offers assessment of common
depression symptoms like
appetite changes, loss of interest, sadness, and
sleep disturbance. From there, it offers guidance through
cognitive-behavioral therapy influenced techniques like relaxation strategies, reframing negative thoughts, communication tips, and problem solving strategies. The service is hoped to be attractive to Japanese consumers as access to treatment for depression is limited by insurance constraints, a dearth of practicing psychotherapists, and a strong
cultural bias against mental illness.
Mental health support communities and providers are taking advantage of the rapid development in communications technologies. But do these approaches work? A recent meta-analysis conducted by David Mohr and colleagues was published examining the effectiveness of telephone therapy interventions for depression symptoms. A meta-analysis is like the beef stew of research, it collects data from as many individually published studies on a topic as possible and uses a statistical procedure to combine those findings into one big summary study.
Phone treatments studied lasted between 4-16 sessions (most studies used about 8 weekly sessions) and included cognitive behavioral, interpersonal, and emotion-focused methods. Most of the patients sampled in the studies also had co-existing major medical illnesses such as HIV, cancer, and multiple sclerosis. The authors obtained a number of interesting findings. For one, they found that the telephone treatments were effective in creating large and significant reductions in depressive symptoms. Next, phone therapy was more effective when delivered by trained mental health specialists; it's a finding that echoes results from a prior major survey of psychotherapy effectiveness. Finally, only a small number of people dropped out of phone treatment (7.6% overall; people receiving cognitive-behavioral phone therapies were significantly more likely to drop-out than those receiving interpersonal/emotion- focused treatments). It's an eye-raising finding when compared to a nearly 50% drop-out rate one meta-analysis found for face-to-face therapies. While not definitive, these results suggest that phone therapy could be effective for reducing depressive symptoms, and may make it easier for patients to complete a brief treatment.
Still, ethical dilemmas with the practice of telecom therapy exist and need to be managed. Also, patients often seek treatment with goals of achieving even more beyond acute symptom reduction with targets for improving social/occupational functioning, strengthening tolerance for difficult emotions, and increasing psychological health and well-being. The regularity and time spent in a face-to-face therapy relationship with another human being can facilitate an open, genuine, and meaningful relatedness that probably doesn't translate through the transmission of electronic signals.
Regarding the use of his new mobile phone service, Ohno, who is also known for advising Japan's Crown Princess Masako, told AFP news services: "I think this can be helpful for people in times of need or when they feel a little blue, as a form of daily prevention against depression". So let's say you're out and about, and your partner breaks up with you Britney Spears style - by text message, help might be just a phone call away. Personally, I'd rather use that call to set up coffee with a friend or an appointment on the shrink's couch any day. Now, if I could just get them to hang up the phone...
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Jared DeFife, Ph.D.
www.psychsystems.net
