دانشگاه اصفهان پژوهش های علوم شناختی و رفتاری 2251-7642 15 1 2025 08 23 Optimizing Telephone Psychotherapy Service Quality Based on Therapists' Experiences: A Qualitative Study بهینه‌سازی کیفیت خدمات روان‌درمانی تلفنی بر پایۀ تجربیات درمانگران: یک مطالعۀ کیفی 143 166 30221 10.22108/cbs.2026.147389.2110 FA فهیمه باهنر استادیار گروه مشاوره، دانشکدۀ علوم تربیتی و روانشناسی، دانشگاه شهید بهشتی، تهران، ایران. محیا صنیعی منش دانشجوی دکتری رشته مشاوره، دانشکده علوم انسانی و اجتماعی، دانشگاه کردستان، سنندج، ایران Journal Article 2025 11 12 Given the increasing expansion of psychotherapy services delivered via telephone and the importance of ensuring the quality of these services, attention to the factors affecting their effectiveness is essential.This research aimed to explore and deeply interpret therapists' experiences in order to extract practical insights for optimizing the quality of telephone psychotherapy services. The present research employed an applied methodology using an interpretive phenomenological qualitative design. The study population consisted of active therapists in Tehran during the years 2024-2025. Purposeful criterion-based sampling was used and continued until data saturation was reached, ultimately selecting 15 therapists. Participants underwent semi-structured interviews. Data analysis was performed using Colaizzi's seven-step method, with MAXQDA.20 software utilized for coding. Data analysis resulted in the identification of 80 initial concepts, 11 sub-themes, and 4 main themes. To examine the validity and accuracy of the research data, four measurement criteria were used, including credibility, transferability, dependability, and confirmability. The main themes included: Therapists' Personal Competencies (Basic counseling skills, Psychological capacities of therapists, Therapists' mental health management, Objective indicators of effectiveness), Effective Contexts in Telephone Counseling Services (Infrastructural and Psychosocial), Individual Therapist Strategies (Physical self-care and Psychological-spiritual self-care), Macro-level Strategies (Operational support, Psychological support, and Professional development). The identification of the "need for organizational psychological support" for therapists is highlighted as a novel achievement of this research. The present findings represent a significant step toward improving remote psychological services, and given the expansion of such services, they call for the attention and planning of policymakers and center managers, particularly in the area of systematic support for therapists. Introduction Teletherapy, which involves the use of text-based or audio/video tools to connect clients and counselors remotely, has been recognized as a legitimate means of conducting psychotherapy (Calkins, 2021). This approach, characterized by its accessibility and rapid responsiveness, has gained particular popularity among certain groups (Paul et al., 2016). Overall, the topic of telephone-based psychological services — including their advantages, disadvantages, and potential improvements — has long been of interest to researchers (Haas, 1996). Moreover, given the professional role of psychotherapists in society and the occupational challenges they commonly face, the need for strategies aimed at improving their working conditions is evident. Although the body of research on online therapy continues to expand (Khan et al., 2021), there remains a notable lack of qualitative studies that explore how to enhance or more effectively utilize the potential of this method—particularly in Iran, where distinct cultural characteristics may influence its application. Therefore, the researchers in this study sought to address the following question: How can the quality of telephone-based psychotherapy services be optimized from the perspective of professionals active in this field? Method This study employed a qualitative approach using the interpretative phenomenological analysis (IPA). The study population consisted of counselors and therapists practicing in Tehran Province during the years 2024–2025. Accordingly, participants were selected using purposive sampling. Participants were recruited through public announcements on social media and direct researcher presence at telephone counseling centers officially registered with the Iranian Psychological and Counseling Organization. Data were collected using a semi-structured, researcher-designed interview whose main focus was to explore therapists’ perspectives on factors contributing to success. For data analysis, the Colaizzi’s Method was applied, and MAXQDA 20 software was used. Findings The average age of the participants was 33.35 years. About 80% held a Master’s degree, one participant held a Ph.D., and the rest were Ph.D. candidates. About 73.33% worked in the public sector, whereas 26.66% were employed in private telephone counseling centers. The average years of experience in telephone counseling was 4.5. Most participants worked in the fields of family counseling or clinical psychology. Table 1. Main Themes, Sub-Themes, and Initial Concepts of Participants’ Experiences Main Themes Sub-Themes Number of participants expressing this theme Initial Concepts Therapists’ Personal Competencies Basic Counseling Skills 14 keeping knowledge up to date; continuous learning; active listening ability; clear expression; calm tone; verbal fluency; empathy; appropriate reflection; work experience; time management; unconditional acceptance; managing transference and countertransference; observing professional ethics Therapist’s Psychological Capacities 10 patience; acceptance of diverse clients; awareness of own emotions; awareness of own beliefs; behavior management; resilience; use of emotional intelligence Therapist’s Mental Health Management 9 having a personal therapist; consulting with colleagues; taking leaves or breaks; sharing emotions; reducing mental preoccupation; closing client cases after completion of counseling Objective indicators of improvement 11 client satisfaction level; providing continuity of treatment; reduction in complaints; improvement of clients’ symptoms; accurate diagnosis Effective Contexts in Telephone Counseling Services Infrastructural 13 eliminating geographical limitations; saving time; clients’ comfort in expressing problems; broad population coverage Psychosocial 7p Reducing social stigma; Increasing honesty; Psychological safety; Compatibility with modern lifestyles Therapists’ Individual Strategies Physical Self-care 10 exercise; attention to sleep and nutrition; practicing muscle relaxation; focusing on proper breathing Psychological-Spiritual Self-care 15 learning from experienced professionals; reading/studying; traveling; resting ; listening to instrumental music; maintaining friendships; timely service to clients; mindfulness; gratitude; meaning reconstruction Macro-level Strategies (Organizational and Counseling Center) Operational Support 13 holding necessary workshops for therapists and specific internships in telephone counseling; receiving supervision; promoting telephone counseling culture; reducing prank or nuisance calls; managing call volume; allocating sufficient time for counseling; financial support for therapists; providing supervisor feedback; continuous monitoring; ensuring transparency of the counseling process for clients Psychological Support 12 motivating therapists; addressing job burnout; professional incentives; considering occupational acceptance and suitability Professional Development and Improvement 13 obtaining professional telephone counseling certifications; creating personalized client portals; forming a specialized telephone counseling committee; developing a comprehensive telephone counseling protocol; establishing a client feedback rating system on counseling quality; establishing a therapist feedback rating system on service quality; creating secure digital platforms; implementing client follow-up systems; enabling audio and video communication systems; developing performance evaluation systems; improving workplace environments; providing dedicated physical spaces for counselors Discussion The aim of the present study was to examine ways to optimize the quality of telephone psychotherapy services based on therapists’ lived experiences. The first main theme identified was therapists’ personal competencies. This theme indicates that a therapist’s competence is not solely based on theoretical knowledge; rather, it involves an interconnection of skill, capacity, and well-being, which together make it possible to optimize therapy in the context of telephone-based psychotherapy. The two concepts of basic counseling skills and objective indicators of effectiveness are consistent with the findings of Khan et al. (2021). The second main theme, unlike the first—which was at the micro level—was identified as effective contexts in telephone counseling services. This theme aligns with many previous studies. Convenience and ease due to the absence of geographical and temporal restrictions (Bird et al., 2019), as well as continuous accessibility (Zainudin et al., 2021), are among the capacities of this therapeutic modality that have contributed to its increasing use. Moreover, comfort and anonymity, reduction of stigma and labeling (Nagarajan & S, 2021), flexibility of the therapeutic process (Khan et al., 2021), and the creation of a safe therapeutic environment (Cipolletta & Mocellin, 2021) are additional characteristics that have expanded the application of online services, particularly telephone psychotherapy. The third main theme consisted of individual strategies that, according to therapists, could enhance the success and optimization of telephone psychotherapy if implemented. Emphasis on self-care—both physical and psycho-spiritual—as a factor that can improve this therapeutic process has not been explicitly mentioned in previous research within the Iranian cultural context, making it a novel contribution of the present study. This is significant because self-care also has a cultural dimension: In some cultures, mental health professionals are encouraged toward excessive self-sacrifice, which can be detrimental (Ko & Min Lee, 2021). Finally, the fourth main theme concerned macro-level strategies (organizational and counseling center). This theme emphasizes the necessity for institutions to evolve from being service-oriented organizations to learning organizations, where support is multidimensional and continuous. It underscores that quality improvement interventions must simultaneously target all three levels. Counseling centers and organizations can enhance therapeutic service quality by supporting therapists through the triad of operational strategies, psychological support, and professional development initiatives. با توجه به گسترش روزافزون ارائۀ خدمات روان‌درمانی از طریق بستر تلفن و اهمیت تضمین کیفیت این خدمات، توجه به عوامل مؤثر بر اثربخشی آن ضروری است. این پژوهش با هدف کشف و تفسیر عمیق تجربیات درمانگران به منظور استخراج بینش‌های کاربردی برای بهینه‌سازی کیفیت خدمات روان‌درمانی تلفنی انجام شد. روش پژوهش حاضر کاربردی و از نوع کیفی پدیدارشناسی تفسیری است. جامعۀ آماری این پژوهش شامل درمانگران فعال شهر تهران در سال 1403-1404 بود. نمونهگیری به صورت هدفمند از نوع ملاکی بود و تا مرز اشباع دادهها و در نهایت، انتخاب 15 درمانگر ادامه یافت. با شرکتکنندگان به مدت 7 ماه مصاحبههای نیمه‌ساختاریافته انجام شد. به منظور تحلیل داده‌ها، از روش هفت‌مرحله‌ای کلایزی و نرم‌افزار MAXQDA.20 برای کدگذاری استفاده شد. تحلیل داده‌ها به شناسایی 80 مفهوم اولیه، 11 مضمون فرعی و 4 مضمون اصلی منجر شد. برای بررسی اعتبار و صحت داده‌های پژوهش، از چهار معیار سنجش شامل اعتبار، انتقال‌پذیری، اطمینان‌پذیری و تأییدپذیری استفاده شد. مضامین اصلی شامل شایستگی‌های شخصی درمانگران (مهارت‌های پایه‌ای مشاوره، ظرفیت‌های روان‌شناختی درمانگر، مدیریت سلامت روان درمانگر و شاخص‌های عینی بهبود)، بسترهای مؤثر در خدمات مشاورۀ تلفنی (زیرساختی و روانی-اجتماعی)، راهکارهای فردی درمانگران (خودمراقبتی جسمانی و خودمراقبتی روانی-معنوی) و راهکارهای کلان (حمایت‌های عملیاتی، حمایت‌های روان‌شناختی و به‌سازی حرفه‌ای) بودند. شناسایی «نیاز به حمایت روان‌شناختی سازمانی» برای درمانگران به ‌عنوان یک دستاورد نوین این پژوهش برجسته بود. یافته‌های حاضر گامی مهم در راستای ارتقای خدمات روان‌شناختی از راه دور است و با توجه به گسترش این نوع خدمات، توجه و برنامه‌ریزی سیاست‌گذاران و مدیران مراکز را به ‌ویژه در زمینۀ پشتیبانی نظام‌مند از درمانگران طلب می‌کند.

https://cbs.ui.ac.ir/article_30221_7b0d7f8f4ac7fead4f17fa006e2e0cc1.pdf