Sessions by Phone? ....

We tend to be very familiar with using phones for business. The likelihood is that we have already been in contact with each client by phone at some stage, so it won't be new to any of us. There are two principal types of phone that we may use: landlines and mobile phones. As we migrate away from face-to-face sessions in the COVID-19 crisis, many of us, and indeed our clients, may opt for phone sessions. Our professional codes of ethics fully apply when we are offering sessions by phone. There are, however, some special considerations that arise in offering supervision or psychotherapy sessions by phone.

  • Changing the Contract - Moving from face-to-face sessions to phone sessions amounts to a major change of contract and the client needs to give free, informed consent for this. The client needs to have the option NOT to avail of phone or online sessions and, just like in face-to-face sessions, needs to know the parameters under which the sessions will proceed - this is an ethical requirement.

  • The Frame -From the beginnings of psychotherapy with Freud, great emphasis has been placed on the "frame" in psychotherapy - this includes the room, the welcoming of the client, the arrangements for the session, the protection of the space  etc. There is an ethical requirement that therapists and supervisors take responsibility for the "Frame". Practitioner's and client's use of sight and hearing are important, and play a vital part in assessing whether the "frame" is holding. In the case of "voice-only" phone calls sight isn't operative, therefore the frame may need to be discussed and described, so that the client and the therapist can trust it. This might just be a matter of the therapist saying that they are alone in their therapy room, with nobody able to overhear what is being said. The way a therapist takes a phone session with a client who is in a car queuing for an appointment at a drive-through COVID-19 testing site might be very different from how they would take a call from a client who is alone in a private room in a family home. Ascertaining the client's physical setting can be important on voice-only calls!

  • A Phone is more than a phone - There are two principal types of phone sessions: calls from landlines to other phones and calls from mobile phones to other numbers. There is an important consideration about landlines, and also one about mobile phones.

    • Landlines calls are simple, though they have never been particularly secure. However, many people use cordless handsets with their landlines and these are actually short-range radios that broadcast to the base unit. If you use one of these as a supervisor or therapist you are broadcasting the session with the possibility that other radios may pick it up. It is hard to see how the use of a cordless phone on a landline could be justified.

    • An issue for mobile phones is that  smartphones are both a phone and a mini-computer which we use for personal and professional business. The phone aspect of our mobile phone makes voice (and video) calls from our number to the number of another phone. There is no problem with mobile to mobile calls as the calls are end-to-end encrypted and security levels are very high. However, our mobile phones are also mini-computers that can also be used to make various types of calls over the internet, these are know as VOIP calls (Voice-Over-the-Internet). Skype, Zoom, Facebook, Whatsapp etc all work through the internet.

    • If we say we are offering phone sessions, it is important that it is what we say it is (i.e. phone to phone and not internet calls). We have an ethical responsibility to be transparent and accurate about this.

    • When we use internet-based calls for sessions with clients the risk of leakage from our personal and business digital life into our client work is significant. Additionally the level of security around the session is an issue. 

    • If we wish to offer video calls to clients (phonecalls with video) this is possible using mobile-to-mobile phonecalls through Google DUO and similar platforms. This has the usual end-to-end encryption of mobile phone voice calls and uses the phone network - the quality of signal is usually very good, but beware of the cost issues that might arise if you do not have a suitable phone plan, as it uses up your phone allowance.