Safe Medical Home Phone Service For Psychotherapy.

What are the differences between home phone service and face-to-face psychological therapy?

Many of us have been self isolated due to the 2020 Pandemic. This has impact the use of medical practitioners changing the way they operated. They have turned to online consultations rather than face to face contact and possible infection. Its important to know whether the standard is monitored and are there implications for the patient when seeking out psychological therapies. If you are uncomfortable with the change please discuss it with your practitioner so that as soon as social isolating rules are lifted you can return to face to face contact.

Based on the findings of this study, there is no empirical evidence to support assumptions that home phone service, specifically its lack of visual and physical co-presence, is counterproductive to alliance creation.

The clear result is that partnership is similarly valued across types by clinicians, patients, or third-party raters. Similarly, the analysis found no evidence that empathy, attentiveness, or engagement suffered from home phone service or contact.

Patient-rated analyses of different factors in the development of a therapeutic partnership show that while eye contact is considered one of the most important individual factors, non-verbal movements and body language as a whole are considered substantially less important than therapist confirmation of patient experience (Bedi, 2006; Bedi and Duff, 2014).

Standards for Home Phone Service

home phone service
Home Phone Service

Validation requires therapeutic acts such as normalising the patient’s experience, presenting it as rational or understandable, recognising and expressing backward emotions, paraphrasing, agreeing, and making positive remarks; importantly, none of these depend on visual co-presence.

Other studies suggest that the ‘mission’ aspect of the marital relationship can be magnified in telephone therapy and can compensate for any decrease in (traditionally conceptualized) ‘bond.’ In addition, Lingley-Pottie and McGrath (2007) propose to develop a framework on the telephone with visual anonymity as an alternative, special and beneficial aspect of therapeutic partnership.

We only found evidence of a mode-related variation in the length of sessions, with telephone sessions reliably and substantially shorter than those held face-to-face. “If clients make an effort to see the counsellor in person, both the client and the counsellor and stick to the traditional, hour-long counselling session. However, since the home phone services have never been correlated with standard length of time, counsellor and client the end the session at what they feel is their normal ending “(Stephenson et al., 2003, p.31).

Nevertheless, it remains an untested issue whether this frequently observed shorter period is a beneficial or efficient consequence of more concise telephone contact and timekeeping, or rather results from some kind of interactional difficulty that leads to foreshortened encounters.

Impact On The Consultant in Home Phone Service

home phone service
Home Phone Service

According to the current evidence base, the telephone mode does not apparently make a difference to anything except the duration of patient contacts. However, effecting a change in practice requires more than simply informing practitioners of this evidence base. Indeed, in our consultation with the Lived Experience Advisory Panel, it was highlighted that perceptions can be extremely influential and persist even in the absence of evidence. We know that more nuanced forms of intervention are required to effect change in practitioner attitudes and behaviours, and that barriers to change lie not only at the individual or interpersonal level, but also at the systems level (Bee et al., 2016).

As emphasised in consultation with the EQUITy Lived Experience panel, patient choice and preference must remain at the heart of service provision.

Studies Covered

Home Phone service
Home Phone Service

Finally, we note that the 15 included studies used a range of different therapeutic modalities (e.g. CBT, counselling, Solution-Focused Therapy) and varied in the of type and severity of mental health problem. It is possible that the effect of the telephone is different in each of these therapy contexts, depending on, for example, the extent to which treatment follows a guided self-help vs. interpersonal model, and the nature of mental health symptomatology being addressed. Amongst the existing body of comparative literature identified here, we note the predominance of depression and broadly specified (subthreshold) psychological difficulties.  Lastly, effects may be influenced by therapist allegiance with modality, therapist expertise and patient preference. These factors will all be important to explore in future research.

Limitations

This review was based on only a small number of heterogeneous studies, a number of which used non-randomised, opportunity samples and did not use validated measures to assess the constructs under investigation. Some studies developed their own ratings scales, and there was inconsistency in the conceptualisation of some of the constructs of interest. Moreover, a range of different therapeutic modalities were used across the included studies, and samples included both clinically diagnosed and non-clinical populations.

Due to our specific focus on situated comparative studies, we excluded several non-comparative qualitative and interactional studies that make an important contribution to this area of understanding. Hence, whilst the present paper offers a unique analysis of directly compared interactional features, we recognize that this approach provides only one part of the knowledge that is required in order to address resistance and barriers to uptake of telephone psychological therapy. We also acknowledge that this paper has not addressed online modes of therapy, which are growing exponentially alongside the continued use of the telephone. Yet, the telephone is frequently used as an adjunct to support online therapies and so arguably has significance to the spectrum of distance therapeutic modes.

Conclusion

At a time when demand for mental health services is high, we need more efficient service models and systems that overcome the barriers posed by patient illness and competing responsibilities. The home phone service is a convenient, reliable and virtually universal communication channel. Yet despite evidence of comparable clinical outcomes, adoption amongst services is challenged by practitioner ambivalence, embedded views and systems that favour face-to-face (Bee et al., 2016).

Reviews identified only a small and heterogeneous group of studies on interactional difference in telephone and face-to-face therapies, limiting the strength of any conclusions that can be drawn at this stage. However, the available evidence does suggest a lack of support for arguments that the telephone has a detrimental effect on interactional aspects of psychological therapy.

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