Since 1998 all my therapy sessions have been on the telephone. Everyone told me it couldn’t be done. They insisted therapy, to be effective, had to be done face to face in the office. I too, once believed that “conventional wisdom,” but I know it isn’t true. I know the work I do with people over the phone, is not only as effective as the face-to-face consultations I did for years, it’s often more effective.

When I moved from Los Angeles to Florida, still believing in the conventional wisdom,  I referred all my clients to local therapists before I left. Shortly after I moved, I got a phone call from an advertising executive who was dealing with a mid-life crisis. After talking to him for a while I offered to refer him to therapists in Los Angeles. When he asked me to treat him on the phone. I declined. He said he’d gotten so much from our brief conversation and his travel schedule made it impossible for him to visit any of these therapists on a regular basis. I agreed to four trial sessions saying if I didn’t think it was effective, I wouldn’t continue. It quickly became evident he was not only struggling with mid-life crisis issues but had a terror of intimacy which made it impossible for him to say what he needed to say in person. He needed the anonymity of the phone to benefit from therapy.

Intrigued by this result. I wrote to my Los Angeles clients telling them I’d be available for phone sessions. I assumed I’d only hear from previous clients, and then, only for emergencies or an occasional “tune-up.” An artist, who’d been a previous client called. After the session he said talking on the phone was “better than in person.” As a visual person, he was distracted by everything he saw, including “the way your earrings moved.” On the phone however, it was as though we were connecting “mind to mind.”

I was surprised when I began to get referrals from people I’d never seen and might never see. It turns out there are many people, like the advertising executive and the artist, who are simply more comfortable on the phone, and others who can’t, or don’t want to, go to an office.

I was further surprised to discover benefits of working on the phone, that don’t exist in the office. In the office, although not intending to, clients want to make a good impression and so they’re on good behaviour. This is especially true of couples. One of the drawbacks of seeing people in the office is they are reporting the problem. They are describing what they said, heard, felt, and did. On the phone, in the comfort of their home, they can’t help acting the way the usually do. As a result, they spontaneously demonstrate behaviours they never would when, dressed up and facing me. They have the fight they would have reported next week at their regular session. Unfortunately, memory can be flawed, and even if their memory is accurate some people, now embarrassed by what they said or did, are reluctant to admit to it. So, you get conversations like “You said…, No I didn’t, yes you did, you always say that, No I don’t.” And it’s virtually impossible to tell what the truth is.

On the phone these arguments happen spontaneously. There’s no way to dissemble. In addition, precisely because they know I can’t see them, they tattle on each other. They say things like “he’s rolling his eyes,” “she has that mad face,” “Stop reading your mail, this is what you always do when I want to talk about something important!” In the office they’re usually reporting the problem, on the phone I often get to experience it in real time.

As a result of learning the value of dealing with the real time experience, I tell all my clients, individuals, and couples, to call when they are experiencing the problem – the anxiety attack, the agoraphobic incident, the unexpected fear and of course, the argument.  Luckily, I am always at the other end of the phone.

Working on the phone offers many other advantages not available in an office-based practice. Obviously, scheduling is much easier. No one has to get dressed or go anywhere; I’ve done sessions with clients when they, and I, were in hotel rooms, friends’ homes, moving trains, and airport lounges. One client interrupted a session to go through security at an airport, calling me back when he’d collected his bag and put on his shoes. I’ve treated couples when each was in a different room, home, or country.

I can, of course, only speak from my own experience. I’m an auditory learner, receiving most of my information from what I hear. Subtle changes in the pitch, tone, and the volume of the voice, breathing, hesitations and use of language, all these have meaning for me, and make working on the phone perfect for me. I don’t depend on, and am therefore not as hampered by, the loss of visual cues as a visual learner, to whom facial expressions, and body language is essential.

The Covid pandemic forced many therapists to leave the comfort zone of their offices. Luckily for visual learners, its created opportunities for them to use Facetime and Zoom freeing them, and their clients from the office, and offering them the visual cues they need.