HOTLINE CALLS Crisis & Hotline Myths, Fantasies, Delusions, or Everything you ever feared about phone work, but were afraid to admit. Omnipotence- “We have to do something” You pick up the phone and suddenly you are on the spot. There is a crisis and it seems up to you to provide an instant, expert, final, once and for all answer. Variations of this delusion are: “But all I’m doing is listening” - Until you have listened, you have no business even trying to be omnipotent. Many times all the caller wants is someone to listen.

 “If I talk about it, it may happen.”- Callers are not nearly as fragile as you think. If you think the caller is suicidal, ask, don’t pussyfoot around.  “ What if I’m being manipulated?” - When dealing with desperate people, it may be all right to be manipulated. This is not the time to be confrontational.  “ If only I were a psychiatrist, psychologist, social worker, medicine man-- then I could help. If only I had read….or Why didn’t someone tell me about…”- In reality, you most therapeutic tool is you and the relationship you establish over the phone.

 Thinking you need to have the “ultimate answer” Will your referral be the “perfect referral”? It may not work out for the caller; they may have to call you back. Continue to explore alternatives with them.

 Calls come into the hotline for:  An emergency  Referrals/information and/or  Emotional support

 Three stages of a crisis  Rise in tension  Rise in anxiety/injury/shock, perhaps to the point of being confused, overwhelmed, angry, feeling helpless, and existing coping strategies are not working  Resort to different coping strategies, one of which may be calling the hotline

 What is the caller feeling?  Anxiety This is the feeling most often elicited by the caller. Any substantial threat to well- being produces anxiety. A normal amount of anxiety is expected and healthy when a person feels alarmed about life circumstances. However, severe anxiety produces confusion, impaired judgment, distortion and very often destructive behavior. Anxiety is the emotion crisis line workers deal with most often.

 Helplessness When internal and external events pile up, leaving the caller in a position where the old familiar ways of coping no longer work, the result is often an overpowering feeling of helplessness. Many times, feelings of guilt or shame overcome the caller, along with a lessening of self-esteem. The caller may not be able to see that there are choices to be made, and becomes dependent upon others to help with decision-making.

 Anger The caller may need to express feelings of anger. The anger may be directed toward an event in the life of the caller or toward another person. It may be directed inward, or it may be directed toward the hotline worker. Anger is a legitimate emotion and must be expressed. However, anger is seldom expressed assertively and may manifest itself as hostility, hurt feelings or by a denial of any feeling.

 Ambivalence The decision to make a first crisis line call often comes out of desperation. There is an inward struggle of dependence vs. independence. Such feelings leave the caller vulnerable. A caller in crisis often behaves impulsively, letting emotions lead the way. This is why some callers act demanding, or manipulative. These are defense mechanisms, which are used to protect them from feeling anxiety, helplessness, guilt, and incompetence.

 By relieving some of the anxiety, helping the caller to regain control and by reassuring the caller that there are choices in any situation, the worker can direct the caller to realistic problem solving behaviors.  Hotline Advocate’s Role  Supporter Give empathetic but non- judgmental support to the caller

 Listener Relieve the caller’s emotional distress. Offer the caller an opportunity to express feelings, explore fears or concerns, and vent anger.  Clarifier Help the caller to identify the most import issues first.  Information and Referrals Identify and explain the many services that are available in our community  Remember!! You cannot change others. Your job is not to give advice, your role is to delineate options for the caller to make their own choices and regain control over his or her own life.

 Be yourself. “The right words” are unimportant. If you are concerned, you voice and manner will show it.  Speak in a calm voice. Control your breathing to breathe slowly and evenly to remain calm. 1. Listen. Let the person unload despair, ventilate anger. Draw out the caller’s emotions and respond with empathy.

 Use the caller’s name.  Be empathetic, non-judgmental, patient, accepting. Let the caller know that he/she has done the right thing by calling.  Normalize the person’s situation; let him or her know that they are not alone and not crazy.

 Assure the caller of confidentiality.  Avoid arguments, problem solving, advice giving, quick referrals, belittling. It is not how bad the problem is, it is how bad the caller feels it is.  When the caller has expressed a thought, pause for a few seconds before responding.

 Use open-ended questions. These are questions that require more than a one-word response. “Please tell me how you feel when that happens?”  Speak to the caller’s feelings about the situation (i.e. lonely, sad, angry, discouraged, etc.)  Remain in control of your own feelings. You have to be objective in order to be helpful.

 Relate the problem and feelings in a simple way through paraphrasing. “ It sounds as if you are feeling….” Active listening  Don’t give your solution! “If I were you…”  Find out what the caller has already done and what he or she can do for themselves.  Support the effort. “Will you call back and let us know how it worked out?”

 Close-ended questions are used to get a short response.  They are used to:  Assess danger  Assess Safety Options  Gather basic identifying information (name, address, phone number)

 If the caller is saying, “ I’m so depressed, I can’t go on.” Ask the QUESTION: “Are you having thoughts of suicide?” It is not putting ideas in his or her head, it shows concern.  If yes, you can begin asking:  Get person’s name address and phone number.  Have you done anything already?  Do you have within sight, a weapon, pills, etc.?  Call 911 and keep the caller on the line until help arrives Even if it is against the person’s will!

 Get another person to call the number that the caller gave you to make sure it is busy!  Would you unload the gun, flush the pills? (If the caller will not, do not push) repeat the question periodically.  Get the details of what the person took and how much

 If the person has not already done anything, ask questions like:  Do you have a plan?  Is the plan available  Will you agree to stay alive while we talk?  Have you thought about when you would do it?  Would you like to talk about what is going on? What made you call me today?

 Explore options (including feelings) Don’t lay a guilt trip on the caller.  Explore reasons to live  Get the person to make specific plans for the future.  What do you plan to do tomorrow?  What will you do if you feel like killing yourself again?  Do you promise to call the hotline if you feel suicidal again

 Warning signs  Using euphemisms (I’m going away, I can’t take it anymore.)  Getting affairs in order  Making a will  Giving away belongings  Flat effect  Sleeplessness or sleeping all of the time  Loss of appetite or overeating  Crying all of the time or inability to cry.

 Past suicide attempts  Telling of other family members who have committed suicide  Latch on to the will to live. The caller wants to die as evidenced by suicidal thinking. The caller wants to live as evidenced by the fact that he or she called you.  Hotline Training Completed Click Here Hotline Training Completed Click Here