Calling for Help : Health: The telephone and even the computer have become the links between some therapists and clients. Critics are intrigued--and dismayed.

David was depressed. His girlfriend had just broken up with him, and he felt lonely and helpless.

Spotting a newspaper ad offering telephone counseling any time of day, the 35-year-old New Yorker dialed the 900 number. For the next 20 minutes, at $3.99 per minute, David hashed over his feelings with a licensed, certified therapist ensconced in a San Fernando Valley office building on Van Nuys Boulevard.

By the time he hung up, David said, he felt confident that he could come to grips with the end of the relationship, and he thanked the therapist.

End of session.

If therapy in the 1970s and 1980s enjoyed the indulgence of long-term counseling, the ‘90s may jolt couch potatoes and their therapists to their feet. Capitalizing on a trend in single-session or very short-term therapy, a growing number of mental health professionals are offering counseling by telephone or computer.

Therapists like Tom McWhirter, the Los Angeles-based founder of Psych-Line, a 900-number service, says electronic counseling is quick, convenient, cost-effective and to the point. It fits the times, he says, and it works.

“You can give them some (suggestions) on the phone, some insight into what’s happening and a little bit of support. You’d be surprised about how much that helps people,” says McWhirter, a clinical social worker and founder of the Valley-based California Counseling Center.

Most therapists, however, are not so sure. Their reaction to the newfangled approaches in the tradition-steeped fields of therapy--psychiatry, psychology and clinical social work--is a blend of intrigue, skepticism and dismay.

“It apparently is a national phenomenon,” says Geri Esposito, executive director of the California Society for Clinical Social Work, who recently requested a position paper on electronic counseling from the society’s ethics committee.

“It’s clear to me that there were going to be many inquiries on this both by consumers and professionals, and we had to look at it. It’s an area which bears a lot of scrutiny.”

In a 1986 American Psychological Assn. position paper on electronic counseling, Palo Alto psychologist Thomas F. Nagy suggested it may not be ethical.

“They are popular because they are convenient,” says Nagy. “But the worst-case scenario is blatant misdiagnosis.” For example, he said, a client who sounds coherent on the phone and in need of a little reassurance may actually be underweight and unkempt, which can indicate a more serious emotional problem, such as clinical depression.

Electronic counseling appears powered by several trends that, together, are dramatically reframing how psychological services are delivered nationally:

* Health insurers have placed tight spending caps on mental health services.

* Consumers are demanding quickness, convenience and anonymity.

* There is increasing recognition by mental health professionals that therapy sometimes becomes less effective over a long period and that short-term counseling can succeed.

* More Americans claim they could use therapy, but few obtain it.

“Twenty percent of the population has suffering and symptoms that require therapy,” says Los Angeles psychoanalyst Roger Gould. “At most, 5% get in therapy. They are afraid of the cost or the stigma or the dependence to get what they need.”

Gould is the founder of a chain of centers that provides computer-assisted counseling interspersed with face-to-face therapy. It is a less radical concept than telephone counseling and has attracted favorable attention. He says he may soon explore home-based, computer-only counseling and argues that electronics is the wave of the future.

“It’s a critical and crucial time in the evolution of therapy,” Gould says. “Part of it is being driven by insurance reimbursement; long-term therapy is proving to be financially impractical for most people. And studies on long-term therapy show that after 18 to 20 visits, there are diminishing returns. This is a more efficient and effective way. This is a demystification of therapy.”

Leading proponents of telephone counseling say their services are ethical. Consumers can call an 800 number first to get information on how the phone line works, McWhirter says. And strict guidelines bind the counselors--licensed, certified therapists--about what cases to accept and how to deal with clients.

The service is meant for people with short-term, specific problems like relationships, employment, anxiety or depression, avoidance or denial. McWhirter calls them “I’m-just-having-trouble-dealing-with-my-boss” kinds of problems. He says research shows that short-term anxiety or depression make up more than 90% of the emotional problems taken to therapy.

It is not intended for people seeking long-term analysis or long-term psychotherapy or for those with personality disorders or addictions or who are suicidal.

“Any problem not appropriate to deal with on the phone, we’ll make a referral,” he says.

McWhirter estimates that most sessions will take fewer than 30 minutes and that callers will use the service infrequently.

“If we let someone go on and on and we don’t help them, they’re going to be an unhappy customer,” he says. “We need to stay focused with them and what problem they have.”

Donna, an administrator in a large Los Angeles business, was skeptical when she first called Psych-Line to talk about her stressful relationship with a boss. But, she says, “the higher you go up in management, the less you can talk. But I really needed someone to talk to.”

The confidentiality of a phone conversation and its convenience--Donna called after midnight--were other reasons.

“I would have terminated very quickly if I had thought this was not authentic,” she says.

But after less than half an hour, Donna says, she felt better and had become an enthusiastic supporter of telephone counseling: “It gives you a sense of sounding things off. It offers immediate access. It’s definitely the treatment of the yuppie generation.”

Surveys show that people mainly avoid making appointments with therapists because they fear being pressured into an expensive, long-term commitment, McWhirter says:

“People want structure, a directive type of approach. They don’t want to sit and talk forever about some unspecified goal for an unspecified time. They just want to get over the pain and go on.”

Computer-aided counseling is also based on a problem-solving approach, says Gould, who has four centers in Los Angeles County and has plans for 10 more in Southern California.

“The computer serves many purposes,” he says. “It takes this process which can go in all different directions and brings it into focus. It allows the patient to prepare before they see the therapist and afterward remember what went on.”

Clients at Gould Centers, who are mainly referred by HMOs, begin their therapy by typing the history, causes of stress and current events of their lives into a computer. With printout in hand, the client then meets with a therapist for an hour.

Each subsequent visit with the therapist is preceded by computer work and a printout detailing the client’s thoughts, feelings and plan of action. The average client completes the therapy in about six sessions, Gould says. The $80 per-session cost includes computer time.

Gould says he believes telephone and home-based computer counseling can succeed.

“I think telephone counseling could be quite useful if the counselor has an approach like ours, a problem-solving approach,” he says. “But there is potential danger in a free-ranging approach without a format.”

Gould says his clients have no trouble spilling their guts to a computer. Indeed, electronic counseling appears to be no big deal to Americans who have long called radio or television therapists like Joyce Brothers, David Viscott or Dr. Ruth Westheimer.

And other 900 counseling services, like “Ask the Lawyer” or “Ask the Pharmacist,” have flourished for years. Telephone counseling lines for referral, information and crisis intervention are a mainstay in American society.

Viscott, whose therapy centers offer short-term counseling in one to four visits, decided to offer telephone services after a deluge of calls from people who lived too far from a center.

“David Viscott built up his notoriety with quick responses to people on the air. He was used to problem-solving with that,” says Matthew Small, president of the Viscott Centers. “Telephone therapy probably makes up about a quarter of our practice. I’ve heard it said for years that it can’t work. But we haven’t seen that there is any down side to the people who use the phone versus the people who come in.”

Small and other electronic therapists argue that their method forces the client into a more assertive role while discouraging dependence on the therapist. The relationship between therapist and client is less intimate, more businesslike.

“It puts the onus on the therapist to be collected, to-the-point, straightforward and professional for two hours,” he says. “There is no time to be b.s.-ing,”

The lack of a therapist-client relationship, however, troubles others.

“One of the concerns I would have about this is, do you really have all the information you need on the person? Picturing the person makes a difference,” says Gary Schoener, a Minneapolis clinical psychologist who has studied consumer complaints and professional ethics.

Many therapists say they learn much about a client from visual cues: slumped shoulders, excessive thinness or obesity, red eyes, trembling, even needle tracks. The lack of such information handicaps a therapist, says Palo Alto psychologist Nagy:

“You’re sacrificing information. And with a computer . . . just having content without any voice modulation, the therapist has lost an awful lot of information.”

Judi Striano, a Santa Barbara therapist and author of “How to Find a Good Psychotherapist,” says not seeing the patient can lead to misdiagnosis.

She says one client complained over the phone of anxiety, and Striano urged her to come into the office. Once there, Striano noticed the woman’s bulging eyes and suspected a thyroid disorder. Tests confirmed that the physical disorder had caused the anxiety.

“You need all the information you can gather to make an informed diagnosis,” she says. “Part of that information comes from face-to-face contact.”

But McWhirter says his telephone counseling service is designed for callers with specific problems, such as someone being anxious about delivering a speech to colleagues next week.

“We’re not dealing with a lot of subtleties here,” he says. Moreover, the telephone can help timid individuals who otherwise might never seek help.

“With the anonymity they have, clients can say things that they may have much greater difficulty dealing with if they were sitting in the same room with someone,” he says. “And I found I could be more direct, and they could handle it better. So I think it’s a powerful medium for specific problems.”

If the cut-and-dried approach is to succeed, however, the therapist must be disciplined in the technique, Nagy says: “The issue is competence. You are only supposed to do what you’re trained and supervised to do. Many psychologists are not trained in telephone therapy with a patient they’ve never met before.”

The bottom line for consumers considering electronic therapy is to first check into the therapist’s credentials and experience, says Minneapolis psychologist Schoener:

“The average therapist would not be well equipped to do this.”