Dial-a-therapist: when help can be a phone call away

November 30, 1992|By Los Angeles Times

LOS ANGELES — David was depressed. His girlfriend had just broken up with him, and he felt lonely and helpless.

Spotting a newspaper ad offering telephone counseling any time of the day, the 35-year-old New Yorker dialed the 900 number. For the next 20 minutes, at $3.99 a minute, David hashed over his feelings with a licensed, certified therapist ensconced in a Los Angeles office building.

By the time he hung up, David said, he felt confident that he could come to grips with the end of the relationship, and he thanked the therapist.

End of session.

If therapy in the 1970s and 1980s enjoyed the indulgence of long-term counseling, the '90s may jolt couch potatoes and their therapists to their feet. Capitalizing on a trend in single-session or very short-term therapy, a growing number of mental health professionals are offering counseling by telephone or computer.

Therapists like Tom McWhirter, the Los Angeles-based founder of Psych-Line, a 900-number service, says that electronic counseling is quick, convenient, cost-effective and to the point.

"You can give them some [suggestions] on the phone, some insight into what's happening and a little bit of support. You'd be surprised about how much that helps people," says Mr. McWhirter, a clinical social worker and founder of the Los Angeles-based California Counseling Center.

Most therapists, however, are not so sure. Their reaction to the newfangled approaches in the tradition-steeped fields of therapy psychiatry, psychology and clinical social work -- is a blend of intrigue, skepticism and dismay.

And in a 1986 American Psychological Association position paper on electronic counseling, Palo Alto, Calif., psychologist Thomas F. Nagy suggested it might not be ethical.

"They are popular because they are convenient," says Mr. Nagy. "But the worst-case scenario is blatant misdiagnosis."

Electronic counseling appears powered by several trends that, together, are dramatically reframing how psychological services are delivered nationally:

* Health insurers have placed tight spending caps on mental health services.

* Consumers are demanding quickness, convenience and anonymity.

* There is increasing recognition by mental health professionals that therapy sometimes becomes less effective over a long period and thatshort-term counseling can succeed.

* More Americans say they could use therapy, but few obtain it.

"Twenty percent of the population has suffering and symptoms that require therapy," says Los Angeles psychoanalyst Roger Gould. "At most, 5 percent get in therapy."

Mr. Gould is the founder of a chain of centers that provides computer-assisted counseling interspersed with face-to-face therapy. It is a less radical concept than telephone counseling and has attracted favorable attention. He says he may soon explore home-based, computer-only counseling and argues that electronics is the wave of the future.

Leading proponents of telephone counseling say their services are ethical. Consumers can call an 800 number first to get information on how the phone line works, Mr. McWhirter says. And strict guidelines bind the counselors -- licensed, certified therapists -- about what cases to accept and how to deal with clients.

The service is meant for people with short-term, specific problems like relationships, employment, anxiety or depression, avoidance or denial. Mr. McWhirter calls them "I'm just having trouble dealing with my boss" kinds of problems. He says research shows short-term anxiety or depression make up more than 90 percent of the emotional problems taken to therapy.

It is not intended for people seeking long-term analysis or long-term psychotherapy or for those with personality disorders or addictions or who are suicidal.

"Any problem not appropriate to deal with on the phone, we'll make a referral," he says.

Mr. McWhirter estimates that most sessions will take fewer than 30 minutes and that callers will use the service infrequently.

"If we let someone go on and on and we don't help them, they're going to be an unhappy customer," he says. "We need to stay focused with them and what problem they have."

Mr. Gould says his clients have no trouble spilling their guts to a computer. Indeed, electronic counseling appears to be no big deal to Americans who have long called radio or television therapists like Joyce Brothers, David Viscott or Dr. Ruth Westheimer.

Electronic therapists argue their method forces the client into a moreassertive role while discouraging dependence on the therapist. The relationship between therapist and client is less intimate, more businesslike.

The lack of a therapist-client relationship, however, troubles others.

Many therapists say they learn much about a client from visual cues: slumped shoulders, excessive thinness or obesity, red eyes, trembling, even needle tracks. Judi Striano, a Santa Barbara, Calif., therapist and author of "How to Find a Good Psychotherapist," says not seeing the patient can lead to misdiagnosis.

She says one client complained over the phone of anxiety, and Ms. Striano urged her to come into the office. Once there, she noticed the woman's bulging eyes and suspected a thyroid disorder. Tests confirmed that the physical disorder had caused the anxiety.

But Mr. McWhirter says his telephone counseling service is designed for callers with specific problems, such as someone being anxious about delivering a speech to colleagues next week.

"We're not dealing with a lot of subtleties here," he says. Moreover, the telephone can help timid individuals who otherwise might never seek help.

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