‘Ring Ring: telephone work at the end of the world’ – The Challenges of Distance Therapy

Image designed by Anna Vanes (c)

Deprived of social interactions as a form of comfort and as treatment for their illness, individuals with social anxiety disorder symptoms will rely more than ever on therapy and counselling during the COVID-19 virus pandemic. Whilst the NHS in Britain has been providing talking therapies using a variety of delivery methods for some time now, the virus pandemic and government health measures have meant a sudden, greater shift towards electronic delivery, sometimes, without full training for staff.

The necessity of treatment at this time is outlined well in a recent article by a Canada-based psychologist: “Anxiety and trauma is cumulative. The thing that tips the jar of anxiety over causes a whole bunch of issues to spill out. It can bring up other things in a person’s past that they haven’t dealt with before like a sexual assault, a trauma, an affair, a divorce. It can bring out things that remained buried for a long time. So, people have to be aware of that.”

Both patients and therapists will benefit from reading the blog-post linked below in which an anonymous NHS ‘Low Intensity Therapist/Psychological Wellbeing Practitioner’ (LIT/PWP) writes about challenges and recommendations for electronic delivery for therapists/practitioners. Patients too can benefit from understanding some of the challenges faced.

The blogger writes mainly of Low Intensity Therapy, that is therapy which is, according to the British Psychological Society, “delivered in such a way as to reduce the need for extended one-on-one time with a qualified psychotherapist. It typically incorporates self-help books and internet exercises, usually completed under the guidance of a “well-being practitioner” or coach who is trained to follow a highly structured programme rather than having any formal psychotherapy training.”

Being based on skills training, rather than relationship building, and rigid principles and structure, the blogger suggests that Low Intensity Therapy is highly suitable for distance treatment: “I’ve suggested to trainee LITS/PWPs that working on the phone uses the same skills as working with someone who has a visual impairment; plenty of non verbal signals don’t rely on sight: pace, tone, choice of words, reflection, summary and verbal empathy, the use of silence.”

Therapists and other practitioners may experience their own anxiety or uncertainty using what may be a new delivery method: “I used to have quite severe anxiety symptoms when I got phone calls or had to make calls; that subsided after the first few weeks of doing regular telephone assessments! But seriously, if you’re anxious about phone calls generally then use supervision and be gentle on yourself, but don’t let the anxiety stop you.”

The blogger describes feedback from colleagues expressing a concern about emotional detachment: “What was difficult was a feeling that if we took our physical presence away the patient would lose something vital to their recovery. There’s also a sense that we, the PWPs (and I would imagine therapists in other modalities) would lose something about the work that helped and refreshed us too.” The blogger’s own view seems quite clear: “…we thought that we were the magic ingredient, and we wanted to keep that sense of connection for ourselves.”

There are other potential practical shortcomings, such as difficulty conveying visual formulations which are integral to, for example, Cognitive Behavioural Therapy (CBT) and the patient data collection required to measure progress. One suggestion is that this information is provided via digital format before a telephone session.

Face-to-face interaction is particularly suitable for therapies dependent on a therapist-patient relationship and for treatment of specific conditions, such as social anxiety disorder. It provides for more complete human interaction, including physical cues and expressions. However, alternate delivery formats can supplement this through greater focus on, for example, vocal (telephone) and facial communication (video). With more therapy being conducted through electronic means, therapist and patients must consider how to ensure effectiveness – as well, as considering the longer-term place for such formats.

Image designed by Anna Vanes.

To read the full blog-post by ‘Not A Guru,’ click the link below:

Not a Low Intensity Guru

First, you might want to play this song while you read. Thanks Patricia for the mood music!


Unfortunately I can’t do hyperlinks within a post in this version of WordPress so I’m sorry for difficulty navigating. There is unlimited room to add to this. If counsellors would like to include any specific learning from their experience please let me know – I can only get my hands on CBT folks at short notice! Roughly the post is organised into:

  • Introduction
  • Setting up an appointment
  • General skills during an appointment
  • PWP/IAPT specific notes
  • High Intensity CBT specific notes
  • Links to online resources
  • References


Welcome to the first NaG post written from the self isolation couch. I promise that the cough wont transmit through the keyboard. Please be kind and…

View original post 2,781 more words

Author: Workers' Archive

Covering sensitivity at work and beyond on my website: https://samuelaliblog.wordpress.com/

One thought on “‘Ring Ring: telephone work at the end of the world’ – The Challenges of Distance Therapy”

  1. Hi! Thanks for reading my blog, your post was a really helpful perspective. I’m keen to include feedback from people who have got to access therapy remotely all of a sudden. We need to hear what it’s like from both sides to make it work well. I can be reached through notaguru52@yahoo.com if you know anyone who would like to give some comments.


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