Long (good) article

Alan Karbelnig, Ph.D.
National Psychologist, May/June 2007


Hopefully signaling the peak of an epidemic of excessive
self-protection, many psychologists now sport recorded voicemail
messages that advise callers to hang up and dial 911 in case of
medical emergency. Such warnings presumably inform unwitting callers
that psychologists cannot provide emergency medical services. These
911 outgoing messages must be proliferating out of fear that
psychologists could be sued by someone who expected to find cardiac
defibrillation, gastric lavage, suturing, or other emergency medical
procedures at the end of psychologists' phone lines. Failing to do
so, these psychologists fear, callers could become injured in some
fashion and then sue them for negligence.

Yet no such legal, ethical, or commonsensical protective
standard for psychologists exists. At their best, such outgoing
voicemail greetings reveal ignorance of the basic striving for
self-reliance that underlies and unifies all the varied
psychotherapeutic approaches; at their worst, these greetings insult,
demean, or confuse callers. They reveal blatant psychologist
self-protection, not concern for patient welfare.

Working to increase personal empowerment is one of the most
basic foundations underlying all psychotherapeutic approaches, from
the most cognitive-behavioral to the most psychoanalytic. Individuals
experiencing psychological symptoms disrupting the academic,
occupational, or social realms of their lives seek the assistance of
mental health professionals to reduce their discomfort and increase
their functionality. They select psychologists who then, utilizing
one method or another, work to increase their autonomy and
self-reliance.

Consumers of psychotherapeutic services obviously differ in
terms of level of impairment: The most disturbed may be acutely
psychotic or suicidal. They could have marked cognitive and
intellectual impairments. They may require a high level of external
structure, including direct support and guidance, environmental
manipulation, psychotropic medication, and even psychiatric
hospitalization. The least disturbed, in contrast, may seek
psychotherapy solely out of a desire for personal growth. However –
and this is where, again, all psychotherapies overlap with one another
– all forms of psychological treatment work to increase the capacity
for independent functioning. Patients need to be met at their unique
developmental levels. But all psychotherapeutic approaches
nonetheless work to increase their capacities for independent
functioning, regardless of their presenting status.

By offering on their outgoing voicemail messages information
most three-year-olds have already mastered, psychologists send their
callers a most counter-therapeutic message. They communicate numerous
anti-autonomous, anti-self-reliant ideas, including that these
callers: 1. lack sufficient intelligence to call 911 directly if they
are having a medical emergency; 2. lack sufficient judgment to make
such a discrimination before calling; 3. lack sufficient autonomy that
they would need psychologists to advise them of such information; and
4. are functioning at such a low cognitive and social level that their
very capacity to operate a telephone, to call anyone, is questionable.

Psychologists with these outgoing messages of course also
communicate about themselves. These messages suggest, first and
foremost, that they hold these potentially degrading beliefs about
their callers. They also reveal a certain grandiosity, specifically
the belief that they are medical professionals (or firefighters or
police) when, in fact, they are not.2

If callers were prone to anger, they might feel outraged at
being treated in such a demeaning fashion. If they were prone to
feeling insecure, they might receive the recording as a further sign
of their own inadequacy. If they were in fact feeling suicidal, they
might reasonably reach the conclusion that the psychologist would
impulsively transfer them to a medical professional if their
self-destructive feelings intensified. If they were psychotic, the
911 warning could well elicit confusion, i.e. do I need to call 911
now that worms are eating away at my internal organs?

Why, other than for protection against a wildly remote lawsuit,
would psychologists believe they need to offer such an option? It
would be difficult to find an individual, even an intellectually
compromised one, who would expect to receive emergency medical
treatment from psychologists. If psychologists feel compelled to warn
callers that they are not emergency room physicians, then should they
also inform callers that they are not lawyers, accountants,
veterinarians, or insurance sales people? Could psychologists be sued
because a caller was hoping for legal advice and instead received an
interpretation, or was hoping for financial advice and instead
received empathy? One wonders where this absurdity will stop.

These 911 voicemail warnings communicate inadequacy, not
self-reliance. They condescend rather than empower. They create
distance and formality rather than openness and acceptance. In short,
they contradict every basic, foundational aspect of psychological
practice regardless of theoretical orientation. As such, they should
be immediately discontinued by all psychologists that use them.