Imagine a treatment that was so powerful and useful, it could even be delivered by the telephone.
That treatment? Good old psychotherapy.
We’ve previously discussed the benefits of using web-based self-help programs for depression based upon proven cognitive-behavioral therapy techniques. And we’ve noted previous studies that showed the benefits of telephone therapy for depression. But this new 600-person study is the largest to date of psychotherapy by phone — and one of the largest studies of psychotherapy ever.
Subjects in the study were randomly assigned to one of three groups — treatment as usual, telephone care management, and telephone care management + psychotherapy.
People in the treatment as usual group continued to receive any treatments normally available, such as follow-up visits with their primary care doctor, and referrals to mental health professionals (but not psychotherapy). The telephone care management group received up to 5 brief telephone calls or personalized mailings intended to monitor and improve antidepressant adherence and to support follow-up in primary care. People in the care management plus psychotherapy group received up to 12 calls, including both care management and a structured cognitive behavioral psychotherapy program delivered by telephone.
How Can Virtual Psychotherapy Help?
Yes, psychotherapy conducted by telephone can be helpful. In fact, it can offer many benefits, including:
- Accessibility: Telephone therapy eliminates barriers related to physical accessibility, such as geographical distance, mobility difficulties, or scheduling conflicts.
- Convenience: Telephone therapy can be done from the comfort of one’s own home or office, eliminating the need to travel to appointments.
- Flexibility: Telephone therapy sessions can often be scheduled outside of traditional office hours, making it easier for people to attend therapy at a time that suits them.
- Anonymity: For some people, the anonymity of telephone therapy can help them feel more comfortable discussing sensitive or personal issues.
- Ease of use: Telephone therapy is relatively straightforward and does not require any special equipment or technical expertise.
However, it’s important to note that telephone therapy may not be appropriate for everyone and certain types of issues may be better suited to in-person therapy. It’s important to consider one’s individual needs and preferences when deciding whether telephone therapy is a good fit.
Current Findings on Teletherapy
The best part about the study’s findings if that it was inexpensive to administer and resulted in far more depression-free days than the other treatment methods:
Over two years, phone psychotherapy plus care management led to a gain of 46 depression-free days, with only a $397 increase in outpatient health care costs. The incremental net benefit of phone psychotherapy plus care management was positive, even if a day free of depression was valued as low as $9.
One of the benefits of this study is that it also directly measures and discusses costs associated with the various treatment groups, so those who are focused on such measures (hello insurance companies) can see the benefits of ensuring people have access to this kind of treatment. The telephone psychotherapy group resulted in the most effective treatment method out of the three, at the lowest possible cost (since nobody’s actual work day is measured as low as $9). People free of depression are more focused, can concentrate better, and are generally more productive than those who feel depressed.
According to the researchers, few of the patients who received phone-based therapy sought in-person therapy. They went on to suggest that phone-based therapy is more convenient and acceptable to patients than in-person psychotherapy. The same could be said of web-based interventions as well.
Telephone-based psychotherapy also has a much smaller drop-out rate compared with face-to-face psychotherapy. A study last year found an attrition rate of only 7.6 percent for those in telephone therapy, versus nearly 50 percent for those in face-to-face therapy. It’s cheaper to provide, is more convenient and acceptable for the client, and has a significantly smaller attrition rate.
Will this finally be the study that convinces people, providers, and insurance companies that telephone therapy is a legitimate and useful alternative to face-to-face psychotherapy? I hope so, as it’s pretty clear that at least for depression — one of the most common mental health concerns — it’s of great benefit.
The study appears in the current issue of the Journal of the American Medical Association (JAMA).
12 comments
This phone psychotherapy stuff is an great idea! It will be interesting to see how it is utilized in the coming years.
Great article, John. I’ve used phone psychotherapy in my practice for over 20 years as a supplemental therapy. I have found it to be particularly helpful when a client suffers from depression and feeling cut off from the world and themselves, particularly when they are grieving.
Sometimes phone psychotherapy is just plain helpful for some down to earth support of a client or patient’s journey whatever their personal struggle might be.
Kind regards,
Mary Jane Hurley Brant, M.S., CGP
Oh yeah, this is a great article about a great concept. Maybe all clinical care mental health care providers should just close their offices and carry around their cell phones and lap tops so they can literally be on call all day for patients to just phone in their issues.
Bunk! Another quick fix idea that insurers will jump on to dumb down interventions further. It just amazes me that people who allegedly practice mental health care are so quick to support alleged interventions that supposedly make a sizeable difference in people’s lives; Only to realize later that the realistic application will be overused and replace more responsible interventions. Hey, don’t believe me, just read these affirmations above and grin blissfully as you go off the cliff!!!
Mark my words: as things regress further as they have these past 7-10 years, psychotherapy as we responsible clinicians know it to appropriately be provided will be an extinct craft by 2015. Not only is the road to hell paved with good intentions, good providers are being tied up and dumped on it to be run over by reckless and clueless drivers!!!
Phone contact is an adjunct, and should be used cautiously, that should be the disclaimer at the end.
Skillsnotpills…do you have anything positive to say about anything? Who gave you the power to say something is effective or not? Just because it’s something that you may not find conventional doesn’t make it wrong or a bad idea.
Since I have a minute before seeing my 15 patients in 3 & 1/2 hours this PM, let me just say this to the Carries’ who comment at this page: if the field of mental health was allowed to practice as most of us were trained, there would not be much to be negative about because we would be helping people help themselves and see a lot more positive results. But, that is not the case, is it, to those of you who are practicing clinical mental health care these days, eh? And, I don’t see my commenting as power, but one opinion. If those of you so insulted or outraged by my opinions, then I suggest you go elsewhere for your lovefest. I comment because I care, I do not agree with some of Dr Grohol’s postings, others seem to echo my comments, and I have to wonder why people try to take me to task when I have the right to comment, just as you do. It is like Furious Seasons all over again, different names, but same agenda!
I can’t wait to read if Dr Grohol is going to weigh in about the health care reform effort. I guarantee that those of you supporting the existing legislation as is, half of you will be significantly screwed within two years of it implemented. That should be the main issue at hand at sites like this. You think those 150 doctors in that photo opp represent the majority of physician opinion in this country? Talk to your doctors, I think you’ll hear otherwise.
Postings like this are ammunition for insurers to further limit mental health care interventions. So, to Carrie, I’m sure if you are in therapy, you are so eager to have the option of calling your therapist instead of seeing him/her. Because in the end, it is about convenience, not about needs.
I see this attitude pretty much every frickin’ day, ma’am, so that is why I have my opinion.
Actually I have tried therapy three times for my severe anxiety and panic and honestly it did nothing but waste a lot of my money and time. Honestly I really did try, I attended every session on time with an open mind wanting desperately to get rid of the awful anxiety that left my incapacitated. In the end medication was the only thing that helped me. So yes it is more convenient to just call up my doctor for a refill and it’s much cheaper as well. If that’s what works for me and many others then so be it. If telephone therapy works for some people then good for them, just let it be instead of shooting it down.
I believe that telephone psychotherapy is not just about convenience for many, but access. I am disabled with an immune-system disorder that makes me extremely hypersensitive to heat and light exposure, as well as a number of other chemical and environmental substances, including most medications of any kind. I take MASSIVE doses of antihistamines (in place of Prednisone) daily to suppress my immune system, so, driving myself is not really safe; I am not eligible to use Handitran or other such transportation services since my disability does not specifically prohibit me from driving, and having to pay cab fare in addition to insurance co-pays is hard to manage on my limited income, especially since I receive “too much” money from disability to qualify for any other financial assistance at all, such as food stamps, housing, utilities, etc. I also have Major Depressive Disorder, PTSD, and Chronic Pain Disorder, but cannot take any medications to help me cope due to the immune-system disorder. The point being that psychotherapy is a very important support tool and coping resource for me, but my access to it is essentially non-existent due to my physical conditions. I have tried to find therapists in my area who would be willing to provide telephone therapy, but have had no luck – most say that the insurance companies will only pay if the patient is treated in person at the therapist’s office – which essentially deprives me of access to this important resource, especially since the online therapy fees are not covered by insurance and I cannot afford the out-of-pocket expense. There are pros and cons to every method of providing treatment of any kind to those who need it – but at least having some access is better than none.
To Lynn 09:
It has been proven that online and telephone therapy is ideal for disabled folks. You are right too about access-some therapists offices are not physically accessible. Do they change it and make it accessible? Hell, no!!! I am a therapist-disabled, Ivy League Masters Degree in Social work and have been pondering having an online, telephonic practice to help my fellow disabled “warriors”. Why “warriors”? Because we have to fight and be in a war every day, with the insensitive, exclusionary society who only promotes that we hide-whether behind a computer as we are writing these words or a telephone where yet, again, we are faceless or grotesteque to hide behind a telephone or computer. We have feelings, problems, diagnoses, etc. I’m on your side, Lynn 09. Perhaps you are interested in my services? Would you have a disabled therapist or care whether or not they were disabled? Yes, you are ENTITLED to treatment. Because you want and NEED it!!! Send me an email.
a closed off
The only thing that made me hesitate immigrating to a different country was the loss of my therapist. Fortuantely she was open to phone counseling. In ten years she has been a real source of help for me. Phone counseling is great for many different reasons including distance and also agoraphobia.
I live in Greece now and was able to walk into a neurologists office and get an appointment almost immediately. Within 5 minutes he had diagnosed my problems as depression. He did the necessary testing to be sure of no complications (catscan and neurological stuff) but knew which medicine to prescribe immediately. All he asks is that I check in with him every 10days and come in for an appointment once a month. Talk about caring.
With both psychotherapy on the phone and my medication I have been living a much more productive, happy life. I couldn’t do without either.
I had a great therapist that I had to leave behind when I moved to a city 9 hours away. I have done some phone therapy with her since then, and while I was glad to still have access I think face to face therapy is much more powerful. For one thing, it’s easier for me to become distracted when I’m on the phone, and it makes avoidance much easier.
Although this article is old, I wanted to comment as I wanted to add my name to those who could desperately use telephone therapy. I too am disabled, and the nature of my disability makes it virtually impossible to schedule anything that takes me outside of my home. I cannot schedule regular doctor’s appointments because 9.95 times out of 10 I won’t be able to make the appointment. I too cannot take pain medication and am very isolated. I am sitting here on a Saturday night, very alone, with nobody to talk to who understands. I need a therapist, somebody to talk to, to help me, so that I don’t end up in crisis situations like I am in now. The only way that will be possible for me is having sessions by telephone, or Skype. So I hope that this will someday be possibe.
Probably good for disabled folks, patients with severe anxiety disorders, patients living in rural areas with limited access to CBT, and as an adjunct to therapy. However, I doubt it’s more cost-effective because therapists typically charge just a much for a phone session as an inperson session and in an inperson session the therapist can make a more personal connection and tell more about the patient. It’s easily to lie on the phone, but harder in person and both parties can pick up on emotions better.
But yes, better than nothing.
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