Having worked in numerous roles across mental health, a challenging one has been phone based support. When engaging with people, I really enjoy every aspect of that human interaction, not just the content of the discussion, but being able to share time with another person, holding genuine eye contact and trying to understand their world view. When attempting to do this over the phone, it becomes a very diluted therapeutic encounter. I’m having to listen to background noise in an attempt to picture where the person is and what they may be doing, genuine empathy is harder to convey, and the ability to build trust with the person is even harder, as I’m no longer a stranger they’re meeting in person, I’m just a single voice on the phone with no body language to help sell myself. Unless I (pointlessly) describe my physical behaviours, there’s no pen and jotting paper or coffee mug to play with in my hands when trying to fill silences. There’s just nothing. So how can this situation be improved? My main focus is always to be authentic and genuine, so I like to start off by acknowledge how the phone can be problematic and ask if the person on the other end has any concerns or questions before moving on. My view is that this is a much more genuine way of warming the conversation, rather than the small talk that sometimes takes place when walking from a reception area to a meeting room, such as “how was your weekend?” or “did you watch the football last night?” all of which is forgotten once in the session and written-off as irrelevant small talk. However, it may turn out that the person prefers phone rather than direct contact as it may be less confronting and more anonymous, or maybe just convenient in order to ensure consistency in contact. In that case, the issues of phone working would be my personal issue and should be taken to my own supervision so that it does not detract from my role and takeover the needs of the client.
Apart from the impact that phone based work can have on therapy, there’s obviously greater risks. The person could be in a vulnerable state or environment when being contacted, and the phone call may have even created further risks for some situations such as domestic violence. All of these things need to be carefully thought through. For situations such as personal safety around others, a code word or question could be developed as a way of sounding the alarm without escalating the current risk on the other end of the phone. If taking this strategy though, there obviously needs to be a follow-up plan of what happens next, what’s my role and their role, what steps do I immediately need to take for this person. Along with this, being able to perform a good and thorough mental state examination is much more difficult. The person could portray a beautiful picture of their current circumstances, only to actually be the complete opposite. So, picking up on subtle background noises can help as well as tone of voice, inflections and how the conversation is flowing can make the difference between a deep or superficial conversation. Going back to filling silences, this is also an important aspect as not all persons (clinicians included) enjoy silence. It can make them feel uncomfortable or create an urge to wrap things up. But over the phone, it’s just as important (if not more) to hold those silences when they arrive.
A way to practice the art of phone based work is to find a friend or colleague and practice having a meaningful conversation over the phone and then for you to feedback what you pictured was taking place for them as well as receiving feedback on their experience. This could be taken even further by replaying the same scenario twice, once via phone and then in person, to really notice the difference between a physical interaction in comparison to just two voices connecting over the phone. Going further with this, maybe even sit on public transport or in a park with your eyes closed for a few minutes and try to picture what may be taking place around you. How many people are present, how much traffic is around you, what do you imagine all of these things to look like and so on.