Yes, the latest manifestation of our mobile, rootless, but very anxious society is phone therapy. It’s an answer for people who are working through psychological transference when they actually get transferred to another city. Because of tight schedules and time-zone differences, these patients often find themselves having therapy from pay phones, hotel rooms or their offices. Therapists say continuing a relationship by phone can help patients move away without feeling disconnected. “I think telephone therapy is one of the major therapies of the future,” says Dr. Ellen McGrath, a psychologist in private practice in New York City. But both doctors and patients acknowledge that therapy changes when it becomes a long-distance relationship.
It was McGrath’s own move from Los Angeles seven years ago that prompted her to begin counseling from another area code. The California women’s group she led missed her so much that they bought a speakerphone so she could continue to conduct the sessions from the East Coast. But even clients who live in the same city have trouble seeing her face to face. “A lack of time is one of the biggest problems and sources of stress all of us have,” says McGrath. Many of her New York patients are so busy that they can’t get across town to see her. So they phone her from the office–or from the lobby of nearby hotels.
But reaching out does not always mean touching. Therapists say they miss the nuances of their patients’ body language and facial expression, and vice versa. And participants say phone therapy lends itself more to quick fixes than free association. Dr. Thomas Nagy, a psychologist at the Stanford University School of Medicine in Palo Alto, Calif., moved from Chicago four years ago and found himself on the phone with a group of patients who were not ready to face a new therapist. He thought that the sessions became more like “supportive discussions” than rigorous therapy. “There’s nothing wrong with that,” he says, “but they were less interesting and exploratory. They didn’t have the same forward movement.”
Therapists’ professional organizations do not have formal positions on the subject, but spokesmen say the groups have no ethical objection to properly handled phone therapy. Still, some professionals have qualms. Classical analysis would be inappropriate over the phone, says Richard Weiss, a psychiatrist and member of the New York Psychoanalytic Society. “When you’re doing analysis you are focusing on what the patient is experiencing moment to moment,” he says. “To do that on the phone is such a distortion of the interpersonal atmosphere.” Dr. Weiss adds that the phone may exacerbate certain psychological problems. “Often therapy is dealing with how a patient does or doesn’t feel close to people. Doing it over the phone gives the patient a place to hide.”
Says Dr. Nagy, who has researched the subject for the American Psychological Association: “The question for the therapist is: are you depriving a patient of a better quality of care in a face-to-face setting with someone in the same city?” He confronted the limitations of his phone work when he discovered he couldn’t tell a patient had broken down in sobs. “This patient had a multiple-personality disorder. I had no idea he was crying until an alternate [personality] came on the phone and said, ‘Doctor, don’t you know tears are streaming down his face?”’
Yet despite the drawbacks of hardware and distance, it is soothing to know there’s someone who cares at the other end of the line. One bicoastal advertising executive, who conducts much of her business over the phone, has found her four years of phone therapy in some ways preferable to being there. When she calls her New York therapist from her Los Angeles bedroom early in the morning, “I’m in my robe, in a very comfortable therapeutic space having an intimate conversation in an intimate setting. I’ve always thought there was a certain artificiality to a therapist and patient sitting in two chairs facing each other.” Austin, Texas, psychologist Mary Teague has had so many patients move and stay in contact over the phone that she jokes, “Sometimes I think I could just talk on the phone and have a practice.”
There is one immutable phone therapy law: what doesn’t get shrunk are the patients’ phone bills. No matter who moves, the patient picks up the tab. Comedian Paula Poundstone, who travels heavily, talks almost exclusively by phone with her Los Angeles therapist. “No one has profited more from my therapy than the phone company,” she says.
