by John D. Perry, PhD, BCIAC and Lesley T. May, MS, RN Key West, Florida
The "Patient Hot Line" is an inexpensive, low-tech method of generating accurate patient reports and compliance with homework assignments. Essentially it consists of a dedicated telephone line and a conventional telephone answering machine, preferably one with "time and date stamping". Used with appropriate patients, it provides dramatic therapeutic advantages.
The inspiration for the Hot Line came from frustration with a particularly recalcitrant insomnia patient. Despite excellent progress at weekly in-office biofeedback-assisted relaxation sessions, he continually reported extreme difficulty falling asleep at home. In a classic "chronic illness" mode, he continued to insist that he had not had a single good night's sleep "all week", just like every other week of his life(!). I was convinced that he was simply failing to remember those few new exceptions which should have reinforced his practice and accelerated his therapy.
I remembered an early experiment, probably by Peter Nathan, in which desktop computers were programmed to "interview" incoming counseling patients and compile a narrative patient history. One of the more interesting results was the finding that patients admitted to significantly higher rates of alcohol consumption when asked by an inanimate computer, compared with a living interviewer. Apparently the inability of the computer to make judgmental responses made it easier to confess excessive drinking. [It is, after all, a liturgical principle that "assurance of forgiveness" precedes "confession of sin".]
An unused telephone answering machine - but no telephone - was connected to an unused incoming telephone line in our clinic. The patient was instructed to call every morning upon arising and report on his success in falling asleep the previous night. In addition, he was instructed to call in and complain (to the machine) if he was unable to fall asleep within an hour. He was assured that there was no telephone "bell" that would bother anyone, even if he called in the middle of the night, which he sometimes did.
Immediately the patient took a turn for the better. The very first week he had reported two reasonably good nights of sleep, and his progress accelerated in the following weeks. Moreover, at his weekly therapy sessions he abandoned his "all night are equally bad" story and began to report his experiences accurately for the first time. We concluded that he could no longer tell little white lies, since he knew that we knew better than he what he had actually reported to the machine on a daily basis. We believe that the Patient Hot Line was an important part of his eventual recovery.
Subsequently the Hot Line has been used for many other types of patients, such as urinary incontinent patients. In our 1988 BSA paper on biofeedback for pelvic muscle rehabilitation (BFB&SR, March, 1988, 13(1), p.86), we speculated that the Hot Line may have helped contribute to the substantially better than average results we obtained. It is especially useful for any conditions that patients are embarrassed to report, such as failure to carry out assigned exercise, occurrence of urinary or fecal accidents, and the like. It is essential that the patients understand the rules of operation for the Hot Line, including who will transcribe the messages and when. In two years we had only one patient attempt to cancel her appointment, and one left a suicide threat. In both cases, we concluded that the Hot Line mis-selection was both deliberate and calculated, and the implications were fruitfully explored in psychotherapy.
An incoming-only telephone line is less expensive than a regular (two-way) line, and it provides inexpensive peace of mind for the therapist who is dealing with a new or unpredictable patient. It sometimes helps to identify mistaken homework assignments before a whole week has passed. Patients should be given written instructions on when to call and what to say. Over time, we also learned to insist that their reports be kept concise and to the point.
© 1995 John D. Perry, PhD