Thirty-five years ago I got my first paid therapist job as a second-string telephone counselor for an enlightened radio station in Sydney, Australia. The radio station ran a daily one-hour program called “Kid’s Careline,” and my boss was the first string counselor who fielded on air calls from the radio audience. She was so brilliant at it that she kept three of us second stringers busy 9 to 5 fielding the calls that did not make it onto the air.

It was in this job that I began to learn about the unique power of telephone counseling. Stints of supervising and fielding crisis phone calls at Suicide Prevention and Parental Stress Services in Oakland enriched my learning. These experiences eventually culminated with me adding telephone counseling to my private practice, which I have done for the last 20 years.

I have an Intersubjective/Relational approach and specialize in working with individuals whose traumatic childhoods have burdened them with Complex PTSD. I am excited by my accumulating anecdotal evidence that significant attachment repair work can be done over the telephone. I have especially noticed this with clients whose trauma is so extensive that they are incapable of handling the anxiety of face-to-face work. Some of my clients have lived reclusive lives but sought me out because my website articles explain how their childhood traumas created their attachment disorders.

Complex PTSD survivors typically operate from a deep belief that “people are dangerous,” and feel less endangered on the phone because they know that they can escape in a second if necessary. Moreover, the phone seems to offer them enough protection, that they are able to drop into authentic and vulnerable relating quite quickly with me—often more quickly than new clients in face-to-face sessions. Once again, I believe this is because phone work offers them a greater sense of safety.

Telephone therapy can foster a uniquely rapid building of trust. In best case scenarios, as with in-person work, this eventually encourages some clients to look elsewhere for similarly trustworthy relationships. More than a few of my telephone clients have experienced enough relational repair within two years of weekly sessions to venture out successfully into the world of real live relating. Often this starts with participating in online support groups, and then expands into joining in-person groups.

I believe that part of the healing dynamic in phone work is that voice contact can be as soothing and brain-changing as the eye contact that seems so fundamental to forming attachments. I wonder, in fact, if voice contact is even more fundamental than eye contact, as the soothing sound of a mother’s voice may be laying down the framework for bonding long before the baby is born. Moreover, as most seasoned therapists know, voice tone, timbre and pitch carry a great deal of emotional communication. The client’s voice can tell us a great deal about her unexpressed distress. And our voice can carry our good will, compassion and, dare I say it, love to the client.

As I write this I flash back guiltily to my adolescence and my dog, Ginger. I once unconsciously experimented with teasing her with the tone of my voice. I soothingly and sweetly told her “You are a very, very bad dog Ginger!” and her dog smile lit up her face as her wagging tale oscillated furiously. Then I switched to an angry tone: “Good dog, Ginger, Good dog!” As I vituperated she fawned nervously and her tail disappeared between her legs. Now I flash on my mother lambasting me throughout my childhood: “Of course I love you!” and 60 years later, I feel my whole body contract and imagine my ears lowering like Ginger’s.

And now let me free associate further. I think of three different friends whose parents read to them as kids, and who still love to be read to. My parents, on the other hand, frequently spoke in tones of anger and disgust, and despite a great deal of attachment recovery, I still find little pleasure in being read to. My nine-year-old son, however, drinks it up like soda. When I come home and sit on the couch he often leans into me and croons: “Read to me, Daddy!,” and lucky man that I am, I still get to read to him for hours every week. We’re on our ninth Gordon Korman book this year. (Gordon Korman is a brilliant children’s author whose books are wise, funny and replete with emotional and relational intelligence.)

Coming back to the issue of therapy, I feel I now understand why traditional psychoanalysis works so well for some clients, despite the analyst sitting out of view behind the couch, and despite the criticism some attachment therapists express about it lacking the intimacy of eye contact.

File under: The Art of Psychotherapy