Chapter 6 - Telephone and Online Crisis Counseling

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CASE HANDLING ON TELEPHONE CRISIS LINES

1. Still important in crisis work2. Used most often in suicide intervention3. "first-order intervention"4. "psychological first aid"5. Most prevalent intervention for initial contact

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CASE HANDLING ON TELEPHONE CRISIS LINES

Why so popular?* Convenience - phones/cell phones, most 'hot lines' are 24/7, real time?* Client Anonymity * Client controls the when and how, looks don't matter)* Immediacy of access (anywhere there is a phone)* Cost effectiveness (for client and community)* Therapeutic effectiveness (trained volunteers)

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CASE HANDLING ON TELEPHONE CRISIS LINES

Why so popular? (cont.)* Access to support systems, networks, support groups* Avoidance of dependency issues (short term relationships)* Worker anonymity (absence of counselor image/expressions etc. may be helpful)* Availability of others for consultation or emergency services* Availability of other services (information, guidance, social services, special resources)* Service to large and/or isolated geographical areas and population (rural, homebound, elderly, disabled, etc).

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TELEPHONE COUNSELING STRATEGIES

* Dependent on content, voice tone, pitch, speed and emotion* Often ambiguous* Requires great care and effort

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TELEPHONE COUNSELING STRATEGIES

Strategies: * Making Psychological Contact (quick, nonjudgemental, credible connection)* Define the problem (understanding the event/picture)* Ensuring safety and Providing support* Creating alternatives and formulating a plan* Obtaining commitment to plan (simple, specific and time limited)

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NEW HELPERS:

* You are not an expert or omnipotent* Talking about 'it' does not make 'it' happen* Some callers are manipulative (but often with purpose)* You are not their mothers* They can be complainers, from prior experiences with helps (may have trust issues)* Many have fixed alternatives in their minds

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REGULAR/ABUSIVE CALLERS:

* Time consuming to helpers* Draining to helpers* But may be very lonely, isolated, and reaching out for help* May require setting limits of 10-20 minutes (control)

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REGULAR CALLERS AGENDA:

* Often want reaffirmation that their problems are unsolvable.* May become dependent on helper to sustain their problem* Worker: needs to be aware and not allow this type of manipulation

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REGULAR CALLER TYPICAL DISORDERS:

* See p. 127 for Description & Strategies

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SEVERELY DISTURBED CALLER:

* Disorganized, disoriented and disabling* Mentally ill* May be delusional and hallucinatory* May lack insight or judgment* May be manipulative, resistant and hostile* May cause helpers to have discomfort, anxiety, and fear * Distant from reality

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DEALING WITH DISTURBED CALLER:

* Slow emotions down - focus on 'here-and-now' (concreteness and reality)* Do not share hallucinations and delusions (affirm the delusion is real without agreeing)* Determine Medication usage, and get them to their Dr. to adjust or reinstitute)* Keep expectations as a helper realistic by attempting to restore a minimum amount of control and contact with reality (you cannot change them in one call)* Keep professional distance (boundaries) - clients can trigger helpers own issues* If need be, get help from coworker or supervisor* Don't placate or inappropriately sympathize* Assess lethality - homicidal or suicidal ideation, many times they are trying to put distance between their thoughts and the actions

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OTHER PROBLEM CALLERS:

* Rappers - talkers (set limits but with support)* Covert callers -asking for help for another, may actually be asking for help for self (assume the call is about the caller, but never attempt to prove otherwise)* Pranksters or Nuisance callers - (take all calls seriously)* Silent callers (show acceptance, and attempt to remove what may keep the person from communicating)* Manipulators (playing games or tricking workers to get information) -focus on the the callers unmet needs* Sexually explicit callers (for personal satisfaction) - State that the crisis line does not tolerate that kind of behavior* Legitimate Sexual Problems - May be difficult for many workers to handle....Providing options and information about 'responsible' sex may be an option

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HANDLING PROBLEM CALLERS:

* Open-ended questions (may help defuse the problems)* Set time limits when helper cannot refocus the client* Terminate abuse (when escalated in abusiveness)* Switching call to another worker* Covert Modeling (Ask client to use mental imagery to picture either reinforcing or extinguishing a particular behavior)* Formulate Administrative Rules to extinguish abusive behavior for workers to follow.

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TYPES OF 'HOTLINES':

* Warm Lines (less-than-life threatening topics)* Hot Lines (life threatening or endangering)* Time-limited hotlines - like disaster relief (specified period of time, situation, or population)* Continuous National Hotlines - like troubled youth, domestic abuse (specialized, toll free, providing information for help)* Local crisis hotlines - all kinds of calls, usually volunteers

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INTERNET: Some potential but also some issues

*Behavioral telehealth - the use of telecommunication and information technology to provide access to behavioral health*Assessment, intervention, consultation, supervision, education and information* Email, chat rooms, websites, videoconferencing, instant messaging, virtual reality etc.* Problems: Confidentiality issues, clarity of communication, unethical/illegal practices, emergency id* May have greater self disclosure* May be greater emotional processing by reading

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