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.
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%.
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.
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
2 responses to “CBT by phone: Shorter-lasting effects for more.”
I used to believe that face-to-face therapy was ALWAYS better than therapy conducted over the phone. After reading this and other articles about the same topic I’m starting to change my mind. However, I still have some questions about the type of disorders /problems being treated over the phone. It would be fantastic to see if CBT by phone is equally effective for non mood-related disorders; this article only mentions depression, but I would like to know more about the outcome for other disorders…
Thanks for commenting, Darley! If the evidence shows that phone therapy is equally effective for other disorders,I look forward to discussing the ethics of providing services while working on one’s tan.