Psychotherapy on the Go

Since 1998 all my therapy sessions have been on the telephone. Everyone told me it couldn’t be done. They insisted, that to be effective, therapy had to be done face to face in the office. I too, once believed that “conventional wisdom,” but today I know it isn’t true. I know that the work I do with people over the phone is not only as effective as the face to face consolations I did for years, it is often more effective. Here’s how it happened.

In 1994, I moved from Los Angeles to Florida and, believing that therapy had to be done face to face, I referred all my clients to local therapists. Shortly after I moved I got a phone call from an advertising executive who was dealing with a mid-life crisis. After talking to him for a while I offered to refer him to therapists in Los Angeles. He asked me to treat him on the phone. I declined. He said that he’d gotten so much from our brief conversation and his travel schedule made it impossible for him to visit any of these therapists. I agreed to four trial sessions, but said that if I didn’t think it was being effective I wouldn’t continue. It quickly became evident that he was not only struggling with mid-life crisis issues, but with a terror of intimacy which made it impossible for him to say what he needed to say when facing another person. He needed the anonymity of the phone to benefit from therapy.

Intrigued by this result. I wrote to my Los Angeles clients telling them I’d be available for phone sessions. An artist, who’d been a previous client called. He remarked that talking on the phone was “better than in person.” He said that, as a visual person, he was distracted by everything he saw, including “the way your earrings moved.” On the phone however, it was as though we were connecting “mind to mind.” I assumed I’d only hear from previous clients, and then, only for emergencies or an occasional “tune-up.” I was surprised when I began to get referrals from people I’d never seen, and might never see. I was further surprised to discover unexpected benefits from working on the phone. In the office, although not necessarily intending to, clients were on good behaviour. When talking from home they behaved more naturally, offering me additional valuable information. Many people, like the advertising executive and the artist, are simply more comfortable on the phone, and others can’t, or don’t want to, go to an office. That is no longer an obstacle.

Working on the phone opens offers many other advantages not present in an office-based practice. Obviously scheduling is much easier. No one has to get dressed or go anywhere; I’ve done sessions when the clients, and I, were in hotel rooms, friends’ homes, moving trains, and airport lounges. I’ve treated couples when each was in a different room, home, or country. One client interrupted a session to go through security at an airport, calling me back when he’d collected his bag and put on his shoes.

I can, of course, only speak from my own experience. I’m an auditory learner, receiving most of my information from what I hear. Subtle changes in the pitch, tone and the volume of the voice, breathing, hesitations and use of language, all have meaning for me, and make working on the phone perfect for me. I don’t depend on, and am therefore not as hampered by, the loss of visual cues as a visual learner, to whom facial expressions, and body language are essential. The pandemic has forced many therapists to leave their comfort zone, and for visual learners Face time and Zoom can free them from the office and offer the visual cues they need.

Written By: Lynne Bernfield MA, LMFT

Lynne Bernfield MA., MFTC has been in private practice for over 40 years. She is the author of When You Can You Will, why you can’t always do what you want to do and what to do about it. She has recently made available the When You Can You Will audio book and Workbook.

She can be reached at the whenyoucanyouwill.com website.