1. Chapter 6 - Telephone and Online Crisis Counseling 1

2. CASE HANDLING ON TELEPHONE CRISIS LINES 1. Still important in crisis work 2. Used most often in suicide intervention 3. "first-order intervention" 4. "psychological first aid" 5. Most prevalent intervention for initial contact 2

3. 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) 3

4. 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). 4

5. TELEPHONE COUNSELING STRATEGIES * Dependent on content, voice tone, pitch, speed and emotion * Often ambiguous * Requires great care and effort 5

6. 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) 6

7. 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 7

8. 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) 8

9. 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 9

10. REGULAR CALLER TYPICAL DISORDERS: * See p. 127 for Description & Strategies 10

11. 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 11

12. 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 12

13. 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 13

14. 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. 14

15. 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 15

16. 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 16