Fix my son, tell me what to do!: Daily challenges for a Helpline Worker Sam Poynter- Drugs / HIV Helpline, Dublin, Ireland.

The Drugs / HIV Helpline  Statutory Service, nationally accessible  10yrs in existence  Two helplines in one  Open 5 days a week between the hours of 10am-5pm

Our Helpline…… Does NOT tell callers what to do, but instead we create a supportive space for the caller to discuss their next step forward. We respect that all callers are self-determining and to take this away from them only dis- empowers them.

Statistics Total of 46,449 calls in 10 years (mid 97-mid 07) 42% of all calls are about drugs/ alcohol 42% of all calls are about drugs/ alcohol 13% of all calls are from mothers 13% of all calls are from mothers 2.5% fathers; 2% partners; 2% siblings 28% of all drug calls are about cannabis 28% of all drug calls are about cannabis 21% heroin; 12% cocaine; 10% alcohol ; 21% heroin; 12% cocaine; 10% alcohol ;

Reported effect of cannabis calls on my colleagues  Feeling Bullied  Feeling ‘put on the spot’  Being pushed for personal opinions, “What do you think I should do?” “What do you think I should do?”  Being dragged into a ‘debate’ about the seriousness of cannabis use  Pushed to take sides  Problematic alcohol use was minimised, But I don’t mind him having a drink”  Frustrated

The nature of helpline work  No appointment necessary/ no waiting – Just Call!  Free or low cost  No contract signed and negotiated  Callers preception of the service- They will ring and get an answer!  Caller may not be telling you the whole truth  The caller may have an agenda prior to calling  Callers sense of urgency/ may be in crisis, this affects their ability to take in information  The Helpline relationship is once off/ not ongoing  The caller may feel that other help didn’t work

Common issues that arise in Irish drug calls  Family breakdown / Separation / Divorce  Active addiction in the family home  Systemic Issues – Adult children living at home. “I know he’s 35 but he is immature for his age!”  S ‘mothering’ – Not letting Go  Learnt Helplessness

Challenges  Context of call – Is the caller distracted? Have they just had an argument or confrontation? Is their son upstairs? Is the caller distracted? Have they just had an argument or confrontation? Is their son upstairs?  Clash Of Agendas- Caller wants me to be directive  Anger  Fear  Frustration – these may be masking other feelings such as fear and helplessness

Empathy & Rapport

Transference, Projection & Projective Identification

Transference  Sigmund Freud – Early 1900’s  Origins in Psychoanalysis  A Definition, “A process by which a patient displaces onto his analyst feelings, ideas, which derive from previous figures in his life, but which he relates to his analyst as though he were some former object in his life” Rycott (1979)

Projective Identification  Melanie Klein – Child Psychoanalyst (1946)  A definition, “ The client may project this dis-owned part of themselves onto another; to which the person who is at the receiving end of this will adopt this dis-owned aspect of the self” Clark (1995) Clark (1995)

Projection  A definition, “Projection is a psychological process that involves the attribution of unacceptable thoughts, feelings, traits or behaviours to others that are characteristic of oneself” Crawley & Grant (2005) Crawley & Grant (2005)

Helpful Interventions Helpful Interventions Exploring Power Dynamics Helpline Example: The caller may have tried everything to make him stop and he still hasn’t. This can make the caller feel tired, powerless and frustrated The caller may have tried everything to make him stop and he still hasn’t. This can make the caller feel tired, powerless and frustrated A Helpful Intervention might be; “I sense that you are feeling powerless over this, what is that like? “I sense that you are feeling powerless over this, what is that like? You are demonstrating your EMPATHY You are MIRRORING their experience You are LISTENING to them

Name what is happening in the call Helpline example: Have you ever been on a call and it is going no-where or the caller is repeatedly asking you what they should do? A Helpful Intervention might be: “ So we’ve discussed some options and not really come up with any answers, what is your sense of that now?” Helpful Interventions Helpful Interventions

The caller may organise their relationship with you Helpline example: Sometimes the caller may have questions and make a presumption that we are the experts and project this onto us; Intervention: “Before you came on the call, did you have an idea what you would do?” Caller: “You’re the experts!, that’s why I am ringing you” Caller: “You’re the experts!, that’s why I am ringing you” Helpline worker: “Maybe it doesn’t feel like it now but you are the expert in dealing with your son or daughter. How have you dealt with challenges in the past?…..” Helpline worker: “Maybe it doesn’t feel like it now but you are the expert in dealing with your son or daughter. How have you dealt with challenges in the past?…..” Helpful Interventions Helpful Interventions

Helpful Interventions Asking for our personal opinions Helpline example: “Is this something that I should be worried about? Do you think it is a dangerous drug?” Intervention/ technique: Side Stepping and de-personalising it – Helpline Person: “Well there is a school of thought that says this… and a school of thought that says this….”

Our toolbox of skills- Analogy  Use of Analogy / Play on words to explore ideas with caller Exploring Powerlessness & Control – “You can drag a horse to water “You can drag a horse to water but can you make him drink it?” but can you make him drink it?” Exploring their management of situation “I sounds like you are juggling lots of things there, how is that for you?” “I sounds like you are juggling lots of things there, how is that for you?”

Our toolbox of skills Our toolbox of skills  Empathy: tone, pace, verbal nods, silence  Being non-judgemental  Staying in ‘the here and now’. We have only the information that is available to us in the call.  Having a focus on caller and his/her needs.  Having policies and guidelines to follow  Being the ‘constant’  Using ‘we’ rather than ‘I’.

Our toolbox of skills Our toolbox of skills  Using Clinical Supervision – This is a reflective space to look at your skills and explore how calls may impact on you  Being aware of how your body is feeling after a call- Are you frustrated? Are you bored by what they were saying to you?

And Finally………  Accepting that we are not miracle healers or magicians! Your intervention may not fix their son or tell them what to do but it may be planting a seed for them to think about looking at other aspects of the situation Your intervention may not fix their son or tell them what to do but it may be planting a seed for them to think about looking at other aspects of the situation

References  Grant, J., & Crawley, J., (2002) Transference and Projection: Mirrors to the self. 3 rd Ed. Open University Press. UK.  Kahn, M, (1997) Between Therapist & Client. 2 nd Ed. Henry Holt & Company, New York.