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Alternatives to In-Person Therapy Could Prove Useful For Some

By HERWriter
 
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Phone therapy is almost as effective as in-person therapy for people with depression, a new Brigham Young University study found.

The phone therapy remission rates were 42 percent compared to a 50 percent recovery rate for in-person therapy in a sample of 30 people with major depression, according to ScienceDaily.

These results demonstrate that for those who may have transportation issues or an extremely busy schedule, phone therapy can be a useful therapy option.

However, some people might prefer traditional therapy, and “one-third of eligible participants declined the option for telephone consultations,” according to ScienceDaily.

One psychologist in the article brought up the option of using a webcam, which could lead to the consideration of e-mail and Internet therapy.

Thomas Nagy, an independent practice psychologist in Palo Alto, Calif. And an adjunct clinical professor at Stanford University, has a few issues with phone therapy.

For example, when a psychologist and patient are in different states, this can be a legal issue.

“It’s providing a service in a state where you’re not licensed,” Nagy said, except in cases where a psychologist is licensed in multiple states.

A few years ago, he said there was a tragic case where a psychiatrist in Colorado provided phone therapy and medication to a student in California. Later on, the student committed suicide using the antidepressants the psychiatrist provided.

“For the most part, we feel you have to be face-to-face to evaluate someone to see their non-verbal cues [and] to take their history,” Nagy said. “You can’t even tell when someone is tearful, you can’t tell when they’re avoiding contact, you can’t tell about the changes in their breathing…a lot of things therapists use to make diagnostic decisions.”

Also, it would be especially difficult to tell if someone has an eating disorder by just conducting phone therapy.

Videoconferencing is a better option than phone or Internet therapy, he said, since you can actually see the person.

The only times he has used phone therapy or videoconferencing with patients is if he already saw them in-person and generally if they had moved and still wanted to have him as their psychologist. He is licensed in California and Illinois.

He said Internet therapy should only be used for certain scenarios, like tracking aspects of a person’s behavior in obsessive-compulsive disorder.

“If they have obsessive-compulsive behavior, the Internet or to e-mail is a way of giving feedback to the therapist about how many times a person had an obsessive thought in a particular day or how many times they engaged in a compulsion,” Nagy said.

For phone and Internet therapy, there are also privacy, emergency situations, confidentiality, ethical and informed consent issues, since the therapist might be more willing to take shortcuts on giving information in these types of therapy. Another aspect to consider is if these types of therapies will be covered by insurance.

“The phone can be very useful for certain types of therapy or between therapy sessions and particular patients you already have seen face to face,” Nagy said.

Patients in certain diagnostic categories are not recommended for phone therapy, like those with serious major depression, panic attacks, borderline personality disorder, narcissistic personality disorder and patients dealing with abuse and chemical or drug dependency issues.

“You can give some information that’s generally helpful, but providing actual therapy for that individual I think has to be face to face or videoconferencing,” Nagy said.

Patients who are hesitant to try traditional therapy could benefit from these less traditional forms of therapy still.

“Some people feel uncomfortable at beginning treatment, and so this could be a way of getting an introduction to the whole therapy process,” Nagy said.

People who are agoraphobic and have “such anxiety that they can’t leave their house” could start the treatment process through phone or videoconference therapy, as well as those who are disabled and have difficulty with transportation, he said.

Other studies conducted on alternative forms of therapy include an older study from 2007 showing that those who took antidepressants and used phone therapy improved at a larger rate than those who only took antidepressants.

The respective rates were 77 and 63, according to a Washington Post article, and the same lead author for the most recent study was also involved in this older study.

Another study in 2009 found that videoconferencing and in-person cognitive behavioral therapy for patients with post-traumatic stress disorder (PTSD) were equally effective.

The remission rate was 75 to 80 percent for the 17 patients in videoconference therapy, according to articles from ScienceDaily and PsychCentral. The study also found that the patients actually favored this type of therapy.

However, the therapy still had to be held at a hospital because of the nature of PTSD and a possible negative reaction from the patient due to reliving traumatic events, according to a PsychCentral article. That might be more of a reason why the results were so positive, though the therapist was still at a distance.

Another study found three cases of OCD that were effectively treated by videoconferencing in 2005, so it seems this form of therapy could grow in use over time.

Sources:
http://www.sciencedaily.com/releases/2010/05/100510141729.htm
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/30/AR2007033001831.html
http://psychcentral.com/news/2010/03/24/teletherapy-for-ptsd-found-effective/12351.html
http://www.sciencedaily.com/releases/2007/03/070322105358.htm
http://www.sciencedaily.com/releases/2010/03/100323121759.htm
http://www.ncbi.nlm.nih.gov/pubmed/19235601
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V5W-4J73043-1&_user=10&_coverDate=12/31/2006&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1339906839&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0af6e3968f0dabce37b67f90399700d4

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Rheyanne Weaver
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.