Phone Therapy Goes Awry

When clients fall ill, have scheduling conflicts or bad weather strikes, a full-length session over the telephone can be a viable way to provide treatment in lieu of a client coming to the office. In fact some experts in specific areas of Psychology have entire practices based on phone therapy so that they may work with people all over the world. My understanding is that there isn’t intensive research conducted on the efficacy of telephone therapy but that most practitioners believe it can be a useful alternative to a face-to-face session.

Like all forms of therapy such a system is far from perfect. Insurance companies do not pay for telephone sessions. A crackling cell phone can interfere with communication and something is missed when I can’t see my clients non-verbal cues. If there is a long pause during a face-to-face session a client is usually either thinking about the conversation or has nothing to say at that moment. Over the phone however it’s difficult to tell: is he jotting down a note about something we’re discussing? Thinking about the unbelievably potent insight I’ve just delivered? Could he be reading his email or eating a sandwich? Did I just piss him off
and he’s giving me the finger?

Recently I got a call from a client, I’ll call him Charlie, who stated that he had had an argument with his spouse. Again. He was hoping to come in for a session to talk it through, “because it was my fault as usual.” I accommodate clients as best as possible but I simply didn’t have any available space that day. Rather than waiting for the first available appointment the following morning he asked if I could do a telephone session at the end of the evening. I told him that I would be driving home from the office at that time but as long as he didn’t mind some outside traffic noise it should be fine.

I have a fairly ancient cell phone with a horrible speaker. I’ve always found headsets and those Blue Tooth things to be cumbersome and, quite frankly, they look ridiculous. It’s like a gigantic mosquito has settled onto a person’s ear. I also hate the idea of not speaking into a phone. I feel bizarre just throwing words out into the air. So like every other person who doesn’t think things through I drive with the phone to my ear, violating New York State law. You would think after seven tickets over the past few years I would have learned something. It takes me a long time to learn things.

Ten minutes into the phone conversation with Charlie I had learned that he was very anxious at having yelled at his wife (again) for burning toast that morning. Charlie has what is known in some circles as Low Frustration Tolerance (LFT). It can sometimes be helpful for clients to put a label to a specific concept that they are trying to work with. As I started to remind Charlie about LFT and its relevance to his immediate problem the flashing red and white lights popped up in my rearview mirror.


“Charlie I’m going to have to call you back in a few minutes,” I said.

“Wait! You’re not going to charge me for the time off the phone are you?”

“No Charlie I won’t do that. I’ll make sure you get your full time. I have to hang up now,” I said and snapped the phone shut. I considered throwing it out the window and pleading innocent (“Cell phone? What cell phone?”) but then remembered that paying a fine costs less than paying a fine and buying a new phone.

I know I am not above the law but I am also not above attempting to get out of tickets. I once feigned a southern accent in an attempt to convince the officer that I was from out of town and my crime was simply an act of ignorance. The attempt was laughable and didn’t fool him. This time I decided to put my doctorate to use.

“License and registration please.”

“Officer, you have to understand that I’m a doctor and that phone call was a clinical emergency.”

“Is that so?” he said suspiciously, eyeing my clothes from the Gap. “You look a little young.”

“I’ll have you know I’m 36 years old and a private practitioner with a full case load of individuals who need my assistance.”

“What type of doctor are you?”

“Um…I’m in mental health.”

“A Psychiatrist?”

“In a way.”

“What kind of way?”

The untrue way. “I’m a Psychologist.”

“I see. And what was the ‘clinical emergency?'”

“A client, no a patient of mine is having significant interpersonal skills difficulties with his significant other leading to cognitive distortions that are impacting his mood negatively and significantly I should add. I was restructuring those thinking errors to buoy his mood and reduce any associated anxiety.”

“Sir I have no idea what that means nor do I care. Was the man suicidal or homicidal?”

Unfortunately no. “I haven’t done a complete risk assessment as of yet.”

“Why don’t you just tell me what you were doing on the telephone without a headset?”

I hung my head, defeated. I decided to resort to honesty as a final hope for redemption (i.e., no $85 citation). “I was doing a phone session with a client on my way home from the office because he got in a huge fight with his wife and started to feel anxious. I was getting ready to talk him down from the anxiety by going through some simple breathing instructions and by reminding him that he is constantly blowing a gasket over the simplest mishaps on his wife’s part which is making both him and her miserable.” Are you happy now?? I’m not a real doctor. There was no real emergency. I just try to help people through talk…which is laughable. I suck at life. It’s no wonder my friends never call me.

“Did it help?” the officer said.

“Did what help?”

“Talking with him.”

“Not yet. We got derailed from our conversation when you pulled me over.”

“Well that was nice of you to try to help your guy out on your way home from work.”

He scribbled something on his pad and handed it to me. It was a warning, not a ticket. “Get yourself a Blue Tooth, Doc” he said and walked away.

But I’ll look like such a douchebag. “Thank you officer” I yelled as he closed his door.

The lesson here is that honesty is the best policy. And don’t break the laws of the road. And buy a Blue Tooth. And if your name is Charlie stop yelling at your wife over burnt bread. There is probably more to be learned but I’ve had enough of morality for one day.

(Visited 117 times, 1 visits today)

17 Responses to “Phone Therapy Goes Awry”

  1. Donika says:

    AW! You don’t suck at life. You’re good at it! (Sorta.)

  2. George says:

    I love your blog, it’s one of the best Rudius blogs. (Although the fact that you update more than once per millenia kinda automatically puts you in that category.)
    The problem is, I only ever read your site through my RSS reader; I never have any reason to visit the actual site (unless I want to post a comment, but then this is the first time I’ve done that). I guess that doesn’t help you bring in the ad dollars.

  3. Ilan Bouchard says:

    Rob, couldn’t you have made him yell at her over spilled milk?
    Pleasssee? I’m a sucker for cliches.

  4. Wayland says:

    I think Donika is a fan. What do you think? Can editors really be fans? You were totally ripping on yourself. Has someone been putting words into your mouth?

  5. scootah says:

    Maybe it’s the years of standing intoxicated in front of massive speakers for hours at a time – but I can’t hear a fucking word when I try and use a bluetooth kit. This is what my side of a conversation on bluetooth headset usually sounds like.
    “G’day mate, how’s things?”
    “What?”
    “What?”
    “What?”
    “What?”
    “Fuck this, I’ll call you back when I’ve stopped driving.”
    “What?”
    click.
    My phone now has a speaker phone, I just sit the fucking thing in my lap and yell.

  6. not a doktor says:

    do you know what kind of phone you have? I may be able to help.
    I have a music playing phone (nokia 5300) and I use a headset*-to-headphone adapter that goes to the tape deck, so I can hear the voice over my speakers, and then I just kinda hold the phone up to my mouth like a microphone. Sometimes I’ll get urges that it’s CB radio and yell out “breaker breaker one-4 niner, we gots ourselves a convoy”
    I found that’s the best way to get my mom to stop talking.
    *http://www.amazon.com/2-5mm-3-5mm-Stereo-Audio-Adapter/dp/B001078FV8/ref=pd_bbs_sr_2?ie=UTF8&s=electronics&qid=1210291820&sr=8-2
    http://www.amazon.com/Ipod-cd-to-Cassette-Adapter/dp/B000E4FZMK/ref=pd_sim_e_img_21

  7. Michelle says:

    “Like all forms of therapy such a system is far from perfect. Insurance companies do not pay for telephone sessions.”
    Does that vary by state? I had a “phone session” w/ my thera-bitch and she definietly charged my insurance company for no better reason than I didn’t feel like driving there. I’m not complaining; I’d much rather pay the co-pay–just wondering if she broke…the…law…

  8. I am frequently speeding to get to my sessions, and I’ve definitely thought of a few angles if I’m stopped. I always keep biz cards and my ID cards around….I figure I can always pull the “crisis” angle, but then with my luck he’d give me an escort, and then I’d be screwed. I’m not sure about honesty….I may just have to think of a better lie!

  9. jackmo says:

    haha nice one Rob, well done on escaping the fine.
    I’ve always been inherently distrustful of police – and I’m not even a crim! I really feel like there can be so much inconsistency and that officers will make decisions based on their emotions.
    Also it doesn’t help when you know sexy young blonde girls that have been caught drink-driving in a work 4×4, get pulled over but instead of being done the officer ‘escorts’ her home and parks in the driveway to ensure she ‘got home safely’.
    A body language book I read suggested admitting responsibility and using submissive body language in the hopes of inflating the officer with a feeling of power and hopefully eliciting pity towards you.

  10. Jen says:

    My boyfriend chews with his mouth open, I tell him “I’m going to smack your lips off”
    It derived from my mother.
    Hilarious story Dr. Rob, also, nice evasion of citation, it made me laugh :]

  11. Kakutogi says:

    I definitely have LFT and it fucking sucks. Even when i’m consciously not trying to be an asshole i just bottle it up and it hurts me as bad as I would have hurt someone else.
    I agree with Donika, just for posting so consistently your blog is one of the best on rm.
    oh yeah, and its a quality-fun time too.

  12. Amber says:

    You should get a blue tooth. Then I could call you RoboShrink. And it would make me smile.

  13. Dances With Routers says:

    Friendly advice from a fellow New Yorker: don’t fart around with the hands-free phone requirements in the 5 boroughs. Don’t screw around with not being buckled in either.

  14. Tippy says:

    Can you get the blue tooth in other colors and pretend it’s a hearing aid? Hearing aids are much more attractive, in my opinion.

    No one calls the deaf douches. Well, not out loud..

  15. […] an afternoon when I had about 5 patients lined up for treatment, I began the day with a telephone session. At the end of the session I heard a slight thud coming from the weighting room. I suspected it was […]

  16. best dentist says:

    best dentist…

    Phone Therapy Goes Awry « Shrink Talk…

  17. Jamika says:

    I am not sure where you’re getting your info, but good topic.
    I needs to spend some time learning much more or understanding more.

    Thanks for excellent information I was looking for this information for my mission.

Leave a Reply