Telephone counselling provides a valuable service to those who are house-bound through physical illness/conditions/disabilities or other conditions such as severe depression or agoraphobia. The client may be in an abusive relationship where control or fear is such that the obstacles to visiting a counsellor are too great. Dependency on others for transport to counselling rooms, living in a remote area and restricted choice of counsellors in the locality may be issues. There are those whose work pattern makes it difficult for them to make time to go to see a counsellor. There are also those who prefer the anonymity of work by telephone where they are not seen.
My experience shows me that the nature of the work is very different. Not being able to see the client poses difficulties. There is a temptation to make an assumption about appearance which is faulty and to make other erroneous assumptions from tone of voice and language content. The usual visual clues in the counselling room of facial expression and body language are not available so that you are unable to see the client’s visual response to what you are saying. With the protection of anonymity, the work can quickly reach a more intense, emotional depth and at the end of a session I often feel more drained than in counselling room work. The freedom and power of anonymity means clients can say whatever they like which can be positive in an empowering way but there may be negative disclosure for example about risk of/ actual harm to others which the counsellor is powerless to act on. Clients can end the session at any time by hanging up which gives them control but can leave the counsellor with ambivalent feelings brought on by the abrupt suddenness of it. In terms of my way of working, we are not able to use any visual methods or techniques such as written exercises, art work or working with stones.
There are counsellor concerns about where the client will be during the session, whether in privacy or whether there are likely to be interruptions and how the client will cope with those. At the end of the session, particularly when it has been at a deep, emotional and complex level, the counsellor will be concerned to know how the client will look after him/herself. Whereas in the counselling room, the client has to physically leave the room and building before adjusting to the rest of the planned day, after a telephone session, there may be no time for ‘coming to’ before continuing with the demands of the day.
The nature of the work seems to be less of equal partners. My experience is that the client has more power in the working relationship which may have a positive effect in terms of the client’s self-esteem, confidence and assertiveness. For me, without the aid of visual clues, visual methods and visual techniques, I can at times feel somewhat de-skilled but it makes me focus more attentively on how I am really hearing what the client brings and in this way enhances my working practice.