My father, a neo-Freudian psychoanalyst, once explained to me why Freud decided that for his new talking therapy he wanted to use a couch and not be face-to-face with his patients.  Why? My father said it was for two reasons: 1) For the patient. The reclining position encouraged uncensored free association, necessary for analytic work. And 2) For the therapist, it helped reduce the distraction of looking at the patient’s face. Freud was actually quoted as saying he simply could not stand being gazed upon for eight hours a day. I guess, if you put it that way…


While some therapists and analysts still use the couch, today most therapy is done upright and face to face. Most recently an even newer modality is being introduced, a sort of throw back to the old faceless couch days: The telephone!

Telephone Based Counseling

Telephone-based counseling first came to my attention years ago when a former patient of mine, who was living in California, contacted me.  A crisis had thrown her off track emotionally and rather than start all over with a new therapist, she wanted to work with me long distance. I was skeptical at first, I was so mired in 20th century thinking that therapeutic boundaries needed to be confined to bricks and mortar. Was I ever wrong! Those telephone sessions worked so well, it became a regular feature of my practice.

Research is supporting my clinical experience. The Lancet, arguably the world’s oldest and most respected medical research journal, recently stated:

“Studies and actual practice have already shown that cognitive behavioral therapy (CBT) does not need to be delivered in a face-to-face setting. Telephone-based CBT programs with live therapists have been proven effective, the study’s authors noted.”
~ August 22 issue of The Lancet

Cognitive Behavioral Therapy Works!

The same article, ‘Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial,’ concluded:

“CBT seems to be effective when delivered online in real time by a therapist, with benefits maintained over 8 months. This method of delivery could broaden access to CBT.”

Which is very interesting but I’m uncomfortable with strictly email or IM based therapy due to 1) online security issues and 2) the written word is subject to much more misinterpretation than spoken words.

So the good news is you needn’t be confined to geography to find a good therapist. Consultation, life-coaching and on-going therapy can all be done effectively long-distance. And Cognitive Behavioral Therapy is particularly well suited to telephone-based counseling. Isn’t that liberating?

If telephone-based counseling is something you’d like to learn more about please feel free to contact me at or call me at 716.308.6683.

dr aletta

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