1st Edition
Phone Therapy A Guide for Practitioners Working with Voice Alone
Phone therapy is as relevant as it was 50 years ago. The increased use of this medium during the COVID-19 pandemic, and the revision of professional therapy body guidance, has endorsed the validity and effectiveness of phone therapy.
The book updates, revises and reinvigorates the medium for individual therapists, counselling services and training organisations in a post-lockdown world, where blended therapy is the norm. It includes practical considerations, phone-related theory, personal experience and self-reflection exercises. Contributing counsellor vignettes cover topics such as adapting theoretical modalities and EDI considerations without visual cues. From assessments, contracting and core skills to assumptions, disinhibition and privacy issues, it supports therapists and counselling organisations to embrace the accessibility, flexibility and creativity that therapy by phone provides.
Relevant for experienced and trainee therapists alike, this book provides practitioners with the support and knowledge to confidently use phone therapy in their practice.
Preface
Acknowledgements
Chapter 1 - You can trust what you hear
Hearing is our fastest sense, neuroscience and cognitive science
What is hearing exactly?
So how do we hear?
The pathway of sound
Frequency, amplitude and the soundtrack to Jaws
Sudden noise and Misophonia
Silence and heightened arousal
Hearing is always switched on
Theories of Selective Attention
The Cocktail Party Effect
‘Halfalogues’
Hebbrian plasticity
How we manage degraded sound
Human sound, emotion and the therapeutic relationship
Chapter 2 - Phone therapy uncovered
The phone therapy setting
How help lines differ from phone therapy
Limitations and benefits of phone therapy
Phone therapy’s greatest attributes
Accessibility and inhibition
Attentiveness, focus, closeness and safety
Anonymity, equality and client participation
Phone therapy’s benefits to therapists
Main differences between phone and face to face therapy
Chapter 3 - Communication and core phone therapy skills
Non verbal communication and paralanguage
Vocal characteristics – pitch, tone and intonation
Uptalk
Vocal fry or creaking voice
The therapist’s voice
The effective therapeutic phone alliance
Demonstrating empathy without body language and physical presence
Verbal nods
Maintaining contact – fast talkers
Making and maintaining contact with less communicative clients
Personality type
Recognising emotions through the client’s paralanguage
Crying
Silences
Anger
Psychological processes and disinhibition
Therapist disinhibition
Assumptions and unconscious bias
Chapter 4 – Theoretical modalities used in phone therapy
Person centred - Joanna Farmer
Psychodynamic - Donna Stratton
Integrative Transpersonal - Linda Gaskell
Pluralistic - Michelle Nicholson
Cognitive Behavioural Therapy – phone delivered IAPT findings
Chapter 5 - The contract - working legally, professionally and ethically on the phone
Security and confidentiality relating to phones
Smartphones, mobile phones and landlines
When is online security relevant for phone therapy?
Therapist’s digital footprint
The main security issues in the provision of phone therapy
Higher levels of risk
When and how to contract
Informed consent
The first contact with clients
Phone therapy contract with clients
Arrangements for telephone sessions
The first session
Who will initiate the call?
When the client calls the therapist
When the counsellor calls the client
Verbal contracting and boundary setting
Technical issues boundary setting
Some thoughts about privacy
When a privacy breach isn’t obvious
Regarding therapist privacy
Contracting privacy
Ending the first and subsequent sessions
Chapter 6 - Assessment, psychological suitability and risk
The phone therapy assessment
Client identity and contact details
Adapting your face to face assessment process for phone therapy
Assessing risk
Positive risk taking
Assessment of psychological suitability for phone therapy
Managing risk in times of crisis
Suicidal ideation and self harm
Managing other types of risk and safeguarding
Immediate Risk Management Plan
Working with eating disorders and substance abuse on the phone
Referral and signposting pathways
Blended therapy and the blended assessment
Chapter 7 - Equality, diversity and inclusion within phone therapy
Disability - Mel Halacre
Hearing loss - Judith Sweetman
Race and culture - Anthea Benjamin and Jessie Emilion
Gender, Sexual, and Relationship Diversity (GSRD) - Karen Pollock
Older people - Siwan Leach
Children and young people:
Contracting
Boundaries and the therapeutic space
Assessment
Safeguarding, assessing and managing risk
The therapeutic relationship and communicating with CYP in phone therapy
Disclosure of difficult material
Communication and core skills
Chapter 8 - Creative interventions for phone therapy
Creative interventions on the phone - Tanja Sharpe
Suggestions for safe creative working
Expressive writing therapy - Michelle Nicholson
Visualisation
EMDR stabilisation techniques - Andrea Howmans
Grounding the client during phone therapy
Chapter 9 - Considerations for supervision by phone
Models of online supervision
Adapting face to face supervision for the phone
Contracting and practicalities for supervision by phone
Working legally, professionally and ethically
Helping the supervisee develop communication skills for phone therapy
Equality, diversity and inclusion (EDI) as part of phone supervision
Psychological suitability and managing risk during supervision
Understanding the context and legal implications of the supervisee’s work
Choosing a phone therapy supervisor
Index
Biography
Sarah Hart is a BACP-accredited therapist and supervisor, providing phone therapy supervision to therapists working for phone-delivered therapy services. She works in private practice for a charity and provides group supervision in a face-to-face setting. She has provided phone therapy for 14 years and phone therapy training for 11 years.
"This is an excellent resource, providing counselling and psychotherapy practitioners with a comprehensive guide to working safely, ethically, effectively and creatively with clients over the phone. I can’t recommend this resource highly enough to existing phone therapists, and to those who are considering working in this way" — Caroline Jesper, BACP Head of Professional Standards.
"Sarah’s book is an accessible and detailed read, suitable for both experienced therapists and trainees. I particularly like the way she interviewed therapists from different theoretical orientations. As hybrid ways of working are now a part of many therapists working life, this book feels like an essential read for all." — Rachel Golding, MBACP Snr. Accred. Programme Tutor at The Counselling Foundation.
