Psychologist Self-Protection Over the Edge

February 26, 2008

The Absurdity of 911 Voicemail Warnings

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.

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.

By Alan Karbelnig, Ph.D.

(Dr. Karbelnig, a past Member of the CPA Board of Directors and current Chair of the Ethics Committee of the San Gabriel Valley Psychological Association, practices psychoanalytic psychotherapy and forensic psychology in South Pasadena, California.)

Originally Published as:

Karbelnig, A. (2007). 9-1-1 Voicemail Messages Insulting. The National Psychologist, 16 (3):6,9.

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