TELEPHONE AND ONLINE CRISIS COUNSELINGChapter Six
CASE HANDLING ON TELEPHONE CRISIS LINES Convenience/Immediacy of Access 24 hour hotlines Time-limited hotlines Hotlines vs. warmlines Continuous national vs. local crisis hotlines Cell phones Client/Worker Anonymity Control Client can terminate the telephone call at any time Cost Effectiveness For both the client and the community Therapeutic Effectiveness Possibly as effective as traditional modes of therapy
CASE HANDLING CONT. Access to Support Systems Avoidance of Dependency Issues Do not want to develop dependency on a crisis worker Availability of Others for Consultation More than one crisis worker on site Availability of an Array of Services The LINC Service to Large and Isolated Geographic Areas May have a service area of 150 miles
TELEPHONE COUNSELING STRATEGIES Making Psychological Contact Providing support is a priority Defining the Problem Have a list of feeling words that describe emotions Have a list of standard questions to review Keep notes on the client Ensuring Safety and Providing Support Ask questions that start with do, have, and are
TELEPHONE COUNSELING STRATEGIES CONT. Looking at Alternatives and Making Plans Alternatives should be simple and concrete Use role play/verbal rehearsal techniques Obtaining Commitment Commitment should be concrete and time-limited Errors and Fallacies You are not perfect If you feel you are being manipulated, you probably are
THE SEVERELY DISTURBED CALLER Important things to remember: Behavior is always purposeful and serves motives that may be either conscious or unconscious. Behavior is comprehensible and has meaning even though the language used may not. Behavior is characteristic and consistent with personality even though it is exaggerated. Behavior is used to keep a person safe and free of anxiety.
HANDLING THE SEVERELY DISTURBED CALLER Slow Emotions Down Focus on “here and now” Refuse to Share Hallucinations and Delusions Affirm the paranoid delusion are real but do not agreeing to its validity Ask “when” questions rather than “why” questions Determine Medication Usage Changing, forgetting, or disregarding medication Physician’s Desk Reference
HANDLING THE SEVERELY DISTURBED CALLER CONT. Keep Expectations Realistic Maintain Professional Distance Countertransference is not uncommon Use owning statements Seek supervision Avoid Placating Be empathetic not sympathetic Assess Lethality
OTHER PROBLEM CALLERS Rappers Calling just to talk Covert Callers Asking for help for someone else Pranksters or Nuisance Callers Silent Callers Be patient, acknowledge the difficulty in speaking, and let them know if you need to terminate the call.
OTHER PROBLEM CALLERS CONT. Manipulators Questioning the worker’s ability, role reversal, and harassment Sexually Explicit Callers Transfer call to a same-sex worker Callers With Legitimate Sexual Problems Remember to Treat all Callers Respectfully and Seriously.
HANDLING THE PROBLEM CALLERS Pose Open-Ended Questions Set Time Limits Terminate Abuse Switch Workers Use Covert Modeling/Conditioning Formulate Administrative Rules
THE INTERNET’S GROWING ROLE IN CRISIS INTERVENTION Resistance by many professionals Ethical concerns Limited training Lack of humanistic values Many consumers are willing and eager to use a technologically-based form of therapy. “Digital native” vs. “digital settler”
BEHAVIORAL TELEHEALTH The Appeal of Online Counseling Feedback Frequent emails or instant messaging Disinhibition Clients may open-up more quickly than in a traditional setting Problems of Online Counseling Confidentiality HIPPA Charlatans Identity verification Licensing and Insurance Learning the Language Acronyms “Text talk” “Netizens”
BEHAVIORAL TELEHEALTH CONT. Netiquette Civil and appropriate rules of discourse when operating on the internet Some typos are okay, but not too many Check with your client regarding emoticons Be clear when using acronyms Keep your text/font neutral Be intentional when responding, do not engage in inflammatory remarks Predispositioning Can be very difficult on the telephone and even more so via the computer Need for Training Virtual Reality May be used to treat panic attacks, phobias, anxiety, obsessive- compulsive disorder, etc.
LEGAL, ETHICAL, AND MORAL ISSUES More Research is Needed Caller Identification/Tracker Features Caller logs Liability of volunteer hotline workers