Introduction to Telephone Counselling

The telephone has long been considered a professionally acceptable tool for helping counsellors provide their services.  In the past two decades, there has been an enormous growth in technology aided services provided by psychologists, psychiatrists, social workers and counsellors. The use of the telephone has gone beyond answering initial inquiries and scheduling client’s appointments to offering full psychological interventions.

Historically, telephone counselling evolved from psychiatric services and medical triage experiences.  In the late 1950’s crisis hotlines focusing on suicide prevention began to emerge in both Europe and the United States and rapidly expanded to Australia (Ormond, Haun, Cook, Duqutte, Ludowese & Matthews, 2000; Cruz, San Martin, Gutierrez, Farias, & Mora, 2001). These hotlines, despite lack of empirical evidence for their effectiveness, soon became part of community mental health services in many places around the world.

The term commonly used is Telehealth or e-health. Telehealth or e-health are terms used to describe any health related service that is provided remotely via technology-assisted media such as the telephone, computer, or Internet. Telepsychology is one form of Telehealth service that is related to remote psychological services. Other terms also commonly used are e-psychology, e-counselling, web-counselling, telephone counselling or online counselling. All of these terms reflect the nature of remote psychological services (Campos, 2009).

While it is easy to presume that Telepsychology and Helplines provide the same service, there are emerging differences in technology and case management practices that may create distinct differences in the definition of these services. Presently, the difference between Telepsychology and Helplines is in the case management practices of clients. In general terms, Hiplines are community services where people call and talk to someone while remaining anonymous. In the Helpline environment the client chooses the conditions of interaction such as the time and length of the call. Volunteers with little formal qualifications commonly staff these services.  Helplines are usually available to clients at extended hours, often 24 hours a day.  Typically, no fees are charged to the client.

Telepsychology, on the other hand, has come to mean a service that involves a detailed sharing of information between the mental health practitioner and the client. Telephone counselling refers to any type of psychological service performed over the telephone. Telephone counselling ranges from individual, couple or group psychotherapy with a professional therapist. In telephone counselling, as opposed to Helplines, the counsellor aims to provide services over the telephone similarly to the level of service provided in face-to-face consultation at an agreed fee (Campos, 2009; Wang, 2000). While these terms and definitions are used, it must be noted that at present the terms used for such services are not strictly adhered to and as such many terms are still used within the area telecommunication based counselling.

Characteristics of Telephone Counselling

The use of the telephone in counselling therapy may include sessions that are entirely conducted via the phone or may be combined with face to face interventions.  The longevity of the counselling delivery (that is crisis vs. ongoing) and the type of interaction between the client and counsellor, differentiates between the type of counselling provided. Telephone callers may include a variety of individuals. A caller may seek information from a counsellor about any issue or topic of interest including advice about a specific issue, general information, referrals, intervention or crises counselling (Ormand Haun, Cook Duqutte, Ludowese & Matthews, 2000).

Some settings when calling can be less conducive to thoughtful interaction and the discussion of the client’s concerns. As such, clients should be encouraged to set aside specific time to optimise counselling interaction. It is not uncommon for clients to call when they have a limited time for conversation.  In the context of the variations of calls received and issues dealt with through telephone counselling services, in general, telephone counselling can be divided into four characteristics. These are: intake, triage and assessment, relaying information and follow up.


Intake is typically the first interaction between the client and the counsellor during telephone counselling.  It is imperative for the counsellor upon intake to ensure they are actually speaking to the intended client and that the phone call is not recorded and not listened to by anyone else.  Due to the loss of visual cues, it becomes more critical with telephone counselling to use understandable language and encourage the client to describe in detail the issues of concern. The counsellor should listen to understand the client and not interrupt, and should provide the client opportunities to elaborate on the information provided.  The counsellor can use such techniques as open ended questioning to obtain relevant information.

One challenge that therapists face with this style of counselling is to develop quick trust and rapport. The development of rapport may influence the caller’s behaviour and attitude towards therapy.  Just as physical appearance provides first impression about the therapist in a traditional face to face therapy, so does the voice in telephone counselling. The therapist is encouraged to maintain a steady pace with a soft tone in their voice to demonstrate empathy and understanding. Counselling is best viewed if preceded by empathic discussion and questioning (Ormand Haun, Cook Duqutte, Ludowese & Matthews, 2000).

Details to be taken and recorded upon intake include specific demographic information about the client, the date and time of the call, the client’s name, contact information, the specific questions and concerns of the client and the responses given by the therapist.

Triage and Assessment

Following the collection of general information from the client, the therapist should assess the client’s level of knowledge and concern to ascertain the presenting problems and the level of risk. The first primary goal in gathering such information is to determine the client’s suitability for telephone counselling, because some clients may not be suitable for counselling through this mode. The following are some examples of when a client may not be suitable for telephone counselling: when there is high risk of harm, when there are high levels of anxiety, when a review of medical records is necessary or when the client presents with severe problems. If committing to telephone counselling with a client, it is important to contract with them a specific scheduled time for the counselling session whereby they do not call at anytime expecting to be able to talk through issues (Ormand Haun, Cook Duqutte, Ludowese & Matthews, 2000; Reese, Conoley & Brossart, 2006).

Relaying Information

It is also important for the therapist to establish if it is an appropriate time for the client to talk and that the client is in a private location. This is because, unlike face-to-face counselling, the therapist does not have any control over the therapeutic setting in which the client resides for the session. So clarifying the suitability of the place and timing of the session for the client who is calling must occur. It is also very important for the therapist to avoid giving confidential information to a person who is not the client, thus they must refrain from leaving messages on answering machines with identifying information other than name and contact number.

Since there is no face to face interaction between the client and the counsellor, verbal and vocal cues are paramount. The therapist must ensure that information is given at a reasonable pace through the use of clear simple terms that avoids jargon and should include pauses to ensure the client understands and allows space for them to respond (Ormand Haun, Cook Duqutte, Ludowese & Matthews, 2000; Kenny & McEachern, 2004). The therapist should strive to maintain a compassionate unhurried voice and avoid raising the modulation of words at the end of sentences. The counsellor should also be aware of background noises such as computer keyboards and co-workers.

Also, as with any face to face counselling session, continual reassessment of the client’s emotional status is important (Ormand Haun, Cook Duqutte, Ludowese & Matthews, 2000). Because of the difficulty of assessing emotional responses on the telephone, it is particularly important for the counsellor to purposefully elicit such responses.  Before concluding the call, the therapist must summarise the information briefly and reemphasise any follow up that is necessary.

Follow Up

Documentation should occur immediately following the telephone counselling session. The therapist must document the information provided by the client and other pertinent aspects of the call like with any case notes when seeing clients face to face.