Investigating Telephone Therapeutic Support

An Investigation into Telephone Therapeutic Support For Growth and Change.

In this post, I intend to explore how effective Telephone/Skype is as a medium to support personal growth and change.

As a Health and Care Professions Council Registered Dramatherapist, and an Advanced Certified Integral Professional, I have always felt the importance of face-to-face embodied therapeutic work.

Of the 78 training and institutions linked to UKCP only three are dedicated to working with the body. Seeing the body not as an additional tool for emotional change, but as a way of exploring psychological adjustment, and being trained as an actor and having spent my early career as a physical theatre performer, for me the body is always the starting place when beginning to integrate the dis-integrated self.

And we also have the much used Mehrabian communication map, you know, the one that says 38% of communication is non-verbal, and here I am using the map for its original intent – the communication of affect and emotions.

The importance I place on working with the body leads me to run workshop and retreats through the year, if you would like to read a recent review of my last retreat you can find a very revealing review here.

Yet, I have seen my partner working as a Life Coach successfully helping her clients navigate the sense of dis-integration and move towards a more integrated self. And all of this is conducted over the phone.

Anne has developed a successful way of working with her clients and I would highly recommend working with her, she can be contacted at confluentliving@gmail.com.

It was Anne’s success in supporting her clients to achieve their goals, whilst using Phone and Skype that I began to wonder if it was possible to providing therapeutic coaching over the phone or online.

The Client

Within Alethic Coaching  the client is seen as an animateur: someone who breathes life into something as they present and lead an exploration.

In someway I prefer the term animateur to client (although I tend you use the two terms interchangeable) as it empowers the person I am working with to recognise that within the holonic construction of self they have the capacity to breath new life into their alethic truth.

Within Alethic Coaching, the animateur with adequate scaffolding from the coach brings life and meaning to their transform faults, thus releasing the energy trapped within the fault to drive towards first reorganising and revealing of being, and then to a transformation of self to a more expansive level of truth.

Alethic Ecology of Self

Let’s suggest that the Alethic Ecology of Self has three levels.

  • Surface Level Structure
  • Deep Level Structure
  • Core Level Structure

At each level there are transform faults that are created as tension arises within the psychic, the transform fault acts as a release valve as psychic seismic shifts take place. Just like a geological transform fault a depression in the structure of the self is created.

Within the self structure a depression is a symptom of the seismic disturbance, depending at which core level depends in some way as to how severe the depressed state can be, and one effect of the depressed state is anxiety.

As both the depressed and anxiety states are intra-psychic, it can be extremely difficult to feel understood.

Robert Stolorow describes this lack of shared meaning as feeling like everyone is outside of the lifeworld of the person in a depressed state. This makes sense from an Integral perceptive as the feeling of the depression/anxiety not being understood means that the sufferer is feeling that there is no one who they can share meaning with and thus no one can be a members of the same interpersonal space.

Alethic Coaching supports a transform fault at the surface and deep level structures, by empowering people to recognising and overcome blocks or occlusions that are keeping them from connecting with their ground-state.

Transform faults that occur at the core level structure led to psychic wounding, which can leave scars on the self. If however the transform fault does not ease the energy from a core level psychic seismic shift this may result in a psychosis self.

This break down in the boundary of self would need highly specialised support, to enable a re-binding of self. Although there is evidence that dramatherapy is able to provided an adequate intervention to support re-binding, Alethic Coaching would not be a suggested supportive intervention.

Transform fault that did maintain the psychic structure at the core level structure would still leave wounds and scars but the self would maintain the psychic self boundary, if this boundary is secure enough that it allows the animateur to maintain self reflection, then due to Alethic Coaching being built around a sound therapeutic framework, and that Alethic Coaching is offered by a partitioner registered by The Health Professions Council, core level faults, which would still manifest as forms of depression or anxiety, can be worked with.

It is my belief with the right inter-personal scaffolding telephone therapy built around the a metaintegral framework, such as developed through Alethic Coaching exposer to Integral Theory and Critical Realism, whilst recognising the need for the animateur to regain Alethic truth (real self truth) would and does help support the animateur to integrate the dis-integrated self.

Internet Therapeutic Support

With the rise of fast internet connection it has now become possible for therapist not only to hold voice to voice Phone/Skype session but also to hold video to video session, such as here and here. There is still little evidence based research on the effectiveness of Internet Therapy, but a reading of what literature is available shows that Internet therapy has some positive benefits:

  • For many people, having to travel to a practitioner’s office, spend an hour or so there and travel back makes face-to-face work prohibitive in terms of time and possibly money.
  • Clients that might have a specific needs, seeking to work with someone from a similar cultural background or wish to work with a specific practitioner who might not live nearby or even in the same country.
  • The immediacy afforded by an internet based session enables contact to be made without time delays and at the convenience of both parties.
  • An internet based session also provides clients with a degree of safety and control they do not normally have.

Reading through the above all the point dealt with organisation and structure, what I was not reading within the literature was any expression of interiority and then I came across this…

  • …The telephone provides an intimacy as the counsellor and client speak directly into each other’s ears. It is possible to feel cocooned by holding the telephone to one’s ear, which enhances a sense of safety and trust.

The Inter-Personal Evidence

Follow up on the inter-personal intimacy, evidence suggests that the animateur is able to disclose transform faults much quicker than in a face to face session, this may be due to the animateur being in a space in which they feel safe (such as their own home). There is also not the added pressure of interrupting the therapist non verbal regard as judgemental.

A trusting relationship can develop very quickly with telephone counselling clients and, anecdotally, it seems that fewer sessions are needed than in comparable face-to-face work. It would appear that the relative anonymity afforded by the medium enables clients to take risks and talk more freely sooner than they might in other settings. This also enables the practitioner to take risks and use all intuitive streaks before he or she might have done if working in the same room as the client. I have found that the disclosure of very painful events or experiences often happens within the first two or three sessions by telephone, whereas I found it took several more before a similar level of disclosure was reached face to face. (Rosenfield M)

It is also worth mentioning that due to there being no direct face to face encounter within the session the animateur can also fall into benign disinhibition, this is a state which indicates

…an attempt to better understand and develop oneself, to resolve interpersonal and intrapsychic problems or explore new emotional and experiential dimensions to one’s identity. We could even consider it a process of “working through” as conceptualized in psychodynamic theory, or “self-actualization” as proposed in humanistic perspectives. (Suler J)

The evidence appears to suggest that telephone work can also amplify the positive dishibition in a similar way to traditional therapy where the therapist sits behind the analysand reducing the amount of inhibition the analysand may experience

There is also an interesting point which might be that without physical direct contact it may be felt by both the therapist and animateur as if there is a melding of minds, that as there is a deepening of the inter-personal connection being made, this is also experienced by the animateur as a dialogue that is taking place intra-psychically, which might increase the intensity of transference.

I have found that during Skype session I have been able to hold and response in a much more authentic and personal way to the transference picked up from the animateur and reflecting this back has help the animateur bring a greater degree of ownership to their psychic self inquiry.

Such approaches as Inter-subjective systems theory (Stolorow R) have shown how important it is for the animateur to feel heard and understood within their anxiety or pain. An person can feel completely isolated with their pain, feeling and thinking that not only can people not understanding how there are feeling but no one can see the world as they do.

When Skype therapy brings an inter-subjective awareness into the therapeutic encounter this deepens not just the connection but the intimacy of the conversation. This moves the work from just one of talking into one of enfolding both the therapist and animateur into a deeper space of contemplation enactment.

A meta-analysis of Skype administered psychotherapy addressing the symptoms of depression showed that there is a significant reduction in depressive symptoms (Mohr et.al)

Applying the metaIntegral Map leading to Alethic Truth

circled 3There are systemic considerations when setting up telephone therapy, the therapist is now able to use landline, VoIP, and mobile each have strengths and weakness.

I have found VoIP (Skype) to be the best medium to use when I am working with an animateur from outside the UK and for easy of use and cost Skype works well for conversation within the UK. The only draw back can be Internet connection, I have had experience of the line dropping and this can be a source of external frustration for both participants within the conversation.

Due to the lack of physical presence within the conversation there is a heighten awareness of listening and understanding. I have found that the need to ensure I fully understand an animateur helps them to reorganise their thinking, this can be a little like the experience of giving direction to someone who is new to your neighbourhood, you have very abstract directional cognitive map fully of symbols and short cuts, but to ensure that you give the right direction you need to reorganise the map, to ensure that you avoid any signifiers that the person will not understand. I am still surprised how little I know of the street names in my neighbourhood and yet I never find my self lost.

This reorganising of the cognitive map of past experience allows the animateur to rethink and reevaluate how past experience might be holding resonance or occlusions for present feelings.

This reorganising and the reconnection to feelings that might have been long repressed help an animateur to bring life to deeper feelings and affects.

I have been constantly surprised at how seemingly random life experience suddenly link and bring forth a personal illumination within the animateur, my feeling is that the animateur is deducting way they feel like based on past feelings and the therapist is inducting ideas and links that the animateur may not have been previously aware of.

And as I have noted it is the scaffolding inter-personal conversation, begin able and willing to, on the part of the therapist, to understand the lifeworld horizon that the animateur’s being-in-the-world is manifesting within. This leads to a shared horizon of meaning making, I do not just understand you, I feel the interior of your lifeworld because we are members of the same lifeworld.

The Evidence

The evidence then shows that using the Telephone/Skype as a medium for therapeutic change works. What I would like to finally offer are a number of 1st person expression of working with me through Alethic Coaching:

The two links below demonstrate ways in which I work therapeutical with clients over Skype/Internet.

In this video I take a client through a releasing process, this session is a follow up session after the client and I work with the MAPS protocol over a five hour face to face session.

In this interview, I am invited to take the client through a short process that leads to a revealing of personal efficacy.

These quotes from people I have worked with demonstrate the effectiveness of Internet therapy.

When you (Gary) first suggested working by phone I was quite sceptical, feeling I would prefer working face to face. After one trial session by phone I decided to proceed by phone. Two of the practical advantages of the sessions by phone are:

The convenience of being at home and literally lying back “on the couch”.

One disadvantage is I can occasionally lose concentration/focus sometimes.

In general I have found the alethic integral approach very beneficial and rewarding in assisting me to gain some deeper understanding and insight into anxieties that I have and where they may originate from, and hopefully with that understanding being better able to “deal” with them; both within my-self and how I perceive my place in the world.

I have also found the integrated wide-ranging approach very useful, particularly in making sense and connections between the internal and external, personal and social, individual and collective. I find I can utilise it in various aspects of life…. almost like fitting pieces of a jig-saw together – making sense of the bigger picture that I/we are part of. (Alethic Coaching Animateur)

I have been working one to one with gary, via skype, once a month for about 2 years. Gary has skilfully, and compassionately helped me uncover patterns in my behaviour that lurk, hidden in the shadow. one in particular stands out, and that is my tendency to use intellect and grand spiritual narratives, to escape the discomforts of body, heart, mind and spirit. Gary patiently, and kindly, guides me back to the immediacy of the present moment, yet using a bit of ‘stick’ when appropriate. this has helped me discover the deeper truth of the Self that is at one with ‘what is’. (Alethic Coaching Animateur).

It is possible to read in the above 1st person reflections that using the Telephone/Skype in no way  limits the personal and social transformations taking place for the animateur. The animateur is able to focus on the ontological question of who am I, in what appears to be a very free and rewarding way.

This freedom of exploration leads the animateur into a deeper realisation of self, thus bringing a greater awareness to the “Alethic Truth of Self”.

REFERENCES
Mohr D et al (2008) The Effect of Telephone-Administered Psychotherapy on Symptoms of Depression and Attrition: A Meta-Analysis, Retrieved 13/2/2012, http://northwestern.academia.edu/DavidMohr/Papers/101301/The_effect_of_telephone-administered_psychotherapy_on_symptoms_of_depression_and_attrition_A_meta-analysis
Rosenfield M (2003) Telephone counselling and psychotherapy in Practice, in Gross & Anthony Ed (2003) Technology in Counselling and Psychotherapy, A Practitioner’s Guide, PALGRAVE MACMILLAN New York,
Stolorow R (2007), Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections: 23 (Psychoanalytic Inquiry Book Series) Routledge London
Suler J, (2004) The Online Disinhibition Effect, CYBERPSYCHOLOGY & BEHAVIOR Volume 7, Number 3, 2004 © Mary Ann Liebert, Inc.