I’ve written about phone counselling before and it’s actually a significant part of my counselling practice, even chosen by people living here in Vancouver.  Its popularity surprises me in an era where it seems like no one talks on the phone anymore. Maybe this is part of its appeal.

There are many practical reasons for why phone counselling can be a good thing, but I’d like to focus more specifically on some of its psychological benefits, and float the idea that phone counselling may have the power to break down the emotional barriers that keep some of us out of counselling offices. And I want to be clear: phone counselling is not for everyone. For many people, nothing beats an in-person counselling experience.

I occasionally get asked why I don’t do Skype counselling and while I’m naturally suspicious about the security of the Internet and the implications for confidentiality—so critical in counselling—there are psychological reasons which have kept me away from that option. But more on that later.

Let’s look at some common clinical counselling concerns and how phone counselling could help.

Counselling Concern #1: Counselling is Too Intense

You betcha, counselling can be intense, especially if you have never done it before. When you think about it logically, there are a number of factors to absorb at once: meeting someone new, understanding how counselling works, discussing personal subject matter, finding the location and adjusting to being in a new space.

A repeat comment I hear about phone counselling is that it helps people feel less self conscious and more free to talk—phone counselling may represent a gentle forcefield of sorts which can soften the experience of counselling or serve as an introduction for folks that are reticent to try therapy.

Counselling Concern #2: I Can’t Focus For That Long

While sitting on a counselling couch for an hour may feel like an exquisite luxury to some, others worry that they would become antsy, unable to keep still and distractible.

Some choose phone counselling because, in the freedom of their own home, they can get up, move around, pour a glass of water if need be, all of which can help continue a conversation. Also, without the requirement of eye contact, some folks people that they can talk more easily, even closing their eyes to help with concentration.

The possibility for distractibility is one of the things that has deterred me from using Skype, with its potential for delays, shaky or blocky video, poor quality audio, dropped calls, silences or unusual background noises. An old school telephone call keeps the focus on the counselling conversation.

Counselling Concern #3: I Am Too Anxious To Go To Counselling

For some people, knowing that they do not have to “see and be seen” in counselling can make a significant difference, particularly in situations where social anxiety or agoraphobia (intense fear of public spaces where escape is limited or impossible) are factors. For those prone to panic attacks, one fear may be having the panic attack noticed by others. While seldom detectable, sometimes the privacy of the phone—knowing that the therapist cannot see—gives enough reassurance to proceed with the session. Again, another reason why I do not choose to use Skype.

Counselling Concern #4: I Could Never Open Up in Counselling

This may be related to a fear around not knowing what to say, expect, anxiety or a self-belief that “I don’t do that kind of thing.” While these concerns may still be present in a phone counselling situation, I sometimes hear that if the counsellor has more of an anonymous presence, it can make it easier to open up, or that the very structure of phone counselling feels more emotionally intimate and facilitates the act of opening up. In fact, when the option to come in to my office has been arranged, some people still say that they prefer phone counselling!

Counselling Concern #5: I Have Had a Poor Sleep – I Can’t Attend My Counselling Appointment

Unfortunately, sometimes it’s the anticipation of the counselling appointment the next morning which triggers the sleep disruption. Knowing that a phone counselling option exists can reduce the pressure around falling asleep, even making an in-person session more likely to happen.

Counselling Concern #6: Oh Crap! My Reminder Just Went Off and My Counselling Appointment Is Starting Now!

Talk about anxiety city!  This can happen and it can be a relief to know that counselling can happen by phone, providing your counsellor offers this option. The time is not wasted.

Suitability

Of course, phone counselling is not suitable for everyone. If you are experiencing suicidal thoughts, psychosis, mania, are actively self-harming or are engaging in other behaviour that compromises your safety, phone counselling is not a safe or ethical option. However, phone counselling should not be confused with suicide hotlines which ARE an appropriate resource. In British Columbia, contact 1-800-SUICIDE, available 24/7.

Availability

If you think that phone counselling might work better for you, talk to your counselling provider or interview potential counsellors to see whether they do phone counselling or whether they would be open to it.  Some counsellors don’t practice phone counselling routinely, but are willing to provide the service if you ask. Others never do phone counselling and will be very clear about it. If the counsellor provides it, ask about their policies and how they differ from an in-person counselling session. Whether you choose phone counselling for all your counselling sessions or use it sporadically, it may help counselling proceed when it doesn’t otherwise feel possible.