Effective and Accessible Telephone-Based Psychotherapy and Supervision

The COVID-19 pandemic forced clinics to quickly shift service provision and supervision of students to remote operations. Mental health services for people facing barriers. including those who live in extreme poverty, remain a critical need, especially when considering the direct and indirect consequences of a global health crisis. The focus of this paper was to examine the effectiveness of psychotherapy treatment and clinical supervision, via telephone delivery (i.e., audio-only calls), from March to July of 2020 in a university training clinic, which primarily serves a low-income, community population. Participants (n = 33) were ethnically diverse, adult, outpatient psychotherapy clients from a large, urban setting and the university community. Primary diagnoses included major depressive, anxiety, and posttraumatic stress disorder. Student clinicians (n = 14) were novice psychotherapy providers, mostly in their second or third year of training. Qualitative data indicated that 1-third of clients met treatment goals and successfully terminated during this period, while another third made significant progress toward these goals (operationalized as objective observations by the clinician and supervisor, self-reported changes by the client, and observations by the clinician and supervisor of in-session skill use). Smaller proportions of the sample were referred out for relocation or rotation changes, dropped out of care prematurely, or were transferred to a higher level of care. Clinician report of supervision affiance (SWAI-T), satisfaction, and other supervisory variables during remote supervision were comparable to in-person supervision and reflected good alliance and satisfaction for both modalities. These data suggest that use of audio-only rails for supervision and treatment provision can be effective for training and care, especially when clients have established therapeutic relationships with their clinicians. As telehealth services and remote training are likely to expand into the future. these findings provide preliminary support for the use of this modality as an option for clients with significant barriers to access and sufficient supervisory support to novice clinicians.