Monthly Archives: June 2012

CBT by phone: Shorter-lasting effects for more.

There’s one kind of client no therapist can help – the one that doesn’t come in.  David C. Mohr, Ph.D, of the of the Northwestern University Feinberg School of Medicine, Chicago, IL,  has a new study that suggests they may not have to.

Alexander Graham Bell, inventor of the telephone.

In 2008, Mohr found clients will stick with therapy conducted over the phone longer than with therapy provided face-to-face. His latest study found that cognitive-behavioral therapy (CBT) for depression delivered over the phone was just as effective as the same therapy delivered face to face. Six months after treatment,  all the clients were still improved.

There was one catch:  the clients who met their therapists face-to-face were doing better at the follow-up than those who telephoned. 32% of those who came to their therapist’s office were depression-free compared to 19% of those who  phoned. Click the mp3 link on this page, and around the four-minute mark, you’ll hear Dr. Mohr describe the face-to-face clients as, “slightly better off.” This is an unnecessary understatement, considering the increased numbers who finished therapy.  Estimates of the drop-out rate in face-to-face therapy have ranged as high at 60%. Researchers have developed simplified feedback forms, helping some therapists reduce their attrition to around 18%. Mohr’s 2008 meta-analysis found the mean attrition rate for telephone psychotherapy was just 7.6%.

Sigmund Freud, father of modern psychology

Could coming to a therapist’s office for treatment increase the risk that a client will drop out?  Consider another industry whose consumers keep their customer status private: pornography. Reliable stats are rare, but it’s believed porn consumption exploded in the early 1980s, and did so again in the 2000s.  Changes in technology led the way. With the rise of the VCR, consumers could get their obscenity without visiting the seedy part of town. Once internet access spread, they didn’t even have to leave their home. There’s little reason to doubt most folks feel shame about going to a mental health center, just as they would about a grimy peepshow or massage parlor. Providing therapy by telephone would not only simplify clients’s busy lives, it would also remove low-level fears about being recognized at a therapist’s office.

Larry Flynt, pornographer. (Photo by David Livingston/Getty Images for COPE Health Solutions)

One can’t blame Mohr and Co. for trumpeting the effectiveness findings. Counseling someone you can’t see?  There have been long silences where I was grateful I could see my client quietly weeping or mulling things over. But  Mohr’s findings, and the number of successful blind therapists suggest visual contact’s importance may be overrated. Alexander Graham Bell invented the telephone in 1874. Sigmund Freud coined the term ‘psychoanalysis’ in 1894. In 2012, mental health therapy is still mostly conducted face-to-face in therapist’s office.  If combining Freud and Bell’s inventions would help more people, with only some decrease in the length of therapy’s effect, one is forced to ask, “Why not?”


@ 2012 Jonathan Miller All Rights Reserved


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Making therapy offices therapeutic

An interesting photo gallery here, where therapists muse on their offices. More than just decorating tips, they explore the thought process that went into creating a therapeutic space.  Author Jose Ribas MD explains:

An examination room in a North Carolina hospital or clinic probably appears quite similar to an examination room in a hospital or clinic in New York, South Dakota or Texas. Where this model departs is in Psychiatry, where the room itself plays an important role, as it becomes the physical “holding environment” where the therapist conveys to the patient that he or she is safe to explore those areas within him/herself that are threatening or causing distress.

My Tuesday-Friday office. The architects added on to the building some years ago, giving my clients and I a view of the billing area. (photo credit: Mrs. ‘Sphere)

Designing my own space, the aim was to balance professionalism and homeyness; to be colorful but not gaudy and warm without being oppressive. I realize now that all three posters show scenes from Europe. We Americans associate the continent with intelligentsia – perhaps it’s saying, “I’m smart enough to help you solve your problem.”


@ 2012 Jonathan Miller All Rights Reserved


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