Hot-Line Counselling

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Whom? When? Where? What? How? …

Whom? When? Where? What? How?
Definition of telehealth and Hot-Line Counselling.
Describe the potential benefits and risks associated with telehealth services.
Explain the role of professional ethics codes and guideline
Establishing an effective provision of mental health services via telehealth.
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  • 1. Hot-Line Counselling
    Maliheh Taheri
    Psychologist
    mali@malihehtaheri.com
    www.malihehtaheri.com
  • 2. Over View
    Introduction
    Telehelth or Hot-Line Counselling
    Whome, Where, When, What, How?
    Counselling Skills
    Crisis Managment
    Forms, Record Keeping
    Ethics
    Reference
  • 3. Telehealth services in UK
    Sumaritans, the best-known telephone service over 40 years old
    The first UK Directory of Helpline was lunches in 1996 with 800 national, reginal and local services to follow accepted helpline standards for good practice
  • 4. Telehealth activities may include:
    Using the telephone for crisis intervention
    Conducting telephone sessions with patients who are not able to attend in-person sessions for a period of time.
    Providing clinical services entirely by telephone to an individual in a different geographical area
    Using email for in between in-person session contacts with clients or with no in-person contact
    Providing services to an individual in a different location utilizing interactive televideo communications technolog
  • 5. Different Interventions
    Traditional Interventions:
    Psychotherapy, Coching, Counselling, Telephone, Videoconferencing
    E-Therapy:
    Telethealth, Videoconferencing, Chat, Email
    Helpline: Telephone,
  • 6. Benefits & Chalenges
    Accessibility, who lives anywhere
    Homebound Clients, may not wish to be seen by local counsellor
    Transportation
    Ultimate Power over the counsellors
    Confidentiality, Bounderies
    Training and Competency
    Crisis Managment
    Ethics
  • 7. Benefits & Chalenges
  • 8. Challenges
    Loss of important non-verbal information including:
    Body language
    Eye contact
    Appearance
    Posture
    Grooming
  • 9. What is Counselling by Phone
    A service whereby a trained counsellor works with a client, by telephone, to enable the client to explore personal situations, problems or crises in one-off or in an ongoing longer term theraputic relationship.
  • 10. Who can give and receive telephone counselling
    Not all counsellors will find that they are able to work effectively on the phone; simply that the telephone medium does not suit them.
    Similarly, not all clients will find the telephone a comfortable medium.
  • 11. How can they make a therputic relationship
    Some times must be taken, during a preliminary session parhaps, for bothe parties to get used to each other's voice tones, accent, patterns of speach and other aspects of contact which would be obviuosly or easily integerated if they met, such is visual impression of each other.
  • 12. Thelephone Counselling Streches the Skills and the Mind
  • 13. What kind of Counselling services can be provided by Phone
    Advice Giving
    Advocacy
    Information
    Support
    Befriending
  • 14. Advice Giving
  • 15. Advice Giving
    When the caller is offered a course of action to follow. In response to a question or a situation being explained by the caller, action can be suggested. Straightforward call with callers seeking advice,...
    If I were you I'd....
    You must
    Can I have your details please
    Example: Children, elderlies...
  • 16. Advocay
    Requeires the counsellor to answer the phone to support and to act on behalf of the caller. To be advocate needs to be able to knowlage of issue being discussed and be able to interperate or assess and know how to progress the inquiry.
  • 17. Advocay
    Example: Child Abuse, Voilence
    Yes you can speack in confidence, but if you give us details of a child who is at risk, we have a responsibility to act to ensure the protection of the child.
    Wold you like to give me a general idea of what your concerns are?
    Explore how eurgent the concerns is,
    Be able to make judgment
    May encourage the caller to disclose more information and take action
  • 18. Information
  • 19. Information
    Delivery of facts about the situation, in answer to a question or presenting circumstances.
    Friendly tone of voice, yet not engaging in any in-depth conversation.
    Access to the information
    Example; Centre's services, workshops
    I'd be pleased to help you...
    Where you wanting to know about anything else?
    Yes, of course. We run a group ...
  • 20. Support
    Involves responding with empathy.
    Some have this ability naturally
    It can not be taought. But training anables to develop an awareness of the natural instinct and how to use it with client. To be able to be alongside someone without jumping in to an offer sympathy.
    Skills to listen, empathise with caller
    Provide factual information for furthur help
  • 21. Support
  • 22. Support
    Example: Depression, Stress
    Yes, I am Mali. How can I help?
    It is very hard to be toled ... and there can be a lot of things to think about...
    It is very difficult time... may I know..
    Mm... it is ok. Take your time
    Many people find it helps to talk to someone else who's had it.
  • 23. Support
    The supporter has to identify with the caller situation.
    Share his/her from own experiance
    Provide a safe environment
    Not to interaupt the caller
    Let the callr to release the emotions
    No pressur
    Acknowledging the feelings they have
  • 24. Befriending
  • 25. Befriending
    This more looking for emotional support giving unnconditionaly by one human being to another.
    Active listening skills
    Encorage to talk further if they wish
    No judgement, prescribtion, analysis or advice.
    Absolutely confidential
  • 26. Integrative skills
    The counsellore must be appropriately trained in order to be able to move comfortably between the services for specific parameters such as ciris intervention, support, information or advice giving.
    Therefore, the terms of telephone counselling may means a service which has an active listening and supportive focus, provides factual information or a combination of any of these.
  • 27. Important
    Abusive or difficult callers:
    They might call because they are lonely, isdolated, or wish to talk...They prevent genune callers from reaching the service
    Who does this service seek to help? How and why?
    For whom is this service inappropriate and why?
    Counsellor should has enough integrity to provide a high quality service
  • 28. Skills and Attitudes
  • 29. Skills and Attitudes
    Of course, having the skills alone does not make for a good telephone counsellor. Other factors like, voice, pitch and tone of voice, environment etc... are important.
    Also there are some challenges like lack of visual contact means it is very easy to believe in all that client says.
    The counsellor own fantasis might be examined in supervision.
    Counsellor needs to be aware about his/her usual telephone manner or behavior .
  • 30. Telephone Counselling Skills
    Assesment Skills:
  • 31. Telephone Counselling Skills
    Assesment Skills:
    The most Important part of the work.
    Counsellor's level of performance during a session is relates to the accuracy with which the counsellor conceptualises the issues raise during the session.
    It is not a case of being able to diagnose; it is essential to be able to use assessment in an interactive way with client
  • 32. Telephone Counselling Skills
    Assesment Skills:
    using more questioning than face to face that the client is clear about the purpose of the session.
    The counsellor has to introduce the client in to the counsellor's style of working; not in-depth
  • 33. Telephone Counselling Skills
    Welcoming the Client:
  • 34. Telephone Counselling Skills
    Welcoming the Client:
    Making a good relationship or a risk!
    If the counsellor's tone, words, pattern of speach or accent are very different from what the cleint expect.
    Listen to the client greeting and if possible adapt language or tone. (Singlish)
    Extra care and attention to the first few seconds of the call can make all the difference to the rest of the session.
  • 35. Telephone Counselling Skills
    Welcoming the Client:
    Do not rush! It makes the client out of the track
    Pick up the call
    State Greeting
    Your Name
    Organization name
    Pause
  • 36. Telephone Counselling Skills
    Listening and Responding Skills:
  • 37. Telephone Counselling Skills
    Listening and Responding Skills:
    Interactive Approche
    Extra listening skills to cover the lack of visual contact
    Unsaid: what is not openly expressed
    Ask more open questions, reflect, paraphrase and summarise.
    Not to push the client to your way
    Minimal encouragers; mmm, yes, I see, Go on, aha
  • 38. Telephone Counselling Skills
    Listening and Responding Skills:
    Alow time for the client to finish thinking or discribing without jumping to finish...
    Listening to silence;
    Actual words spoken, slang, pitch and tone of voice
    Sound may seems stronger over the phone
    Imagined picture and mind's eye
  • 39. Telephone Counselling Skills
    Listening and Responding Skills:
    When to intrupt the client; repeating, clients seems to be confused,
    Can we just go back
    Direct questions; back ground noise,
  • 40. Telephone Counselling Skills
    Understanding Silences:
  • 41. Telephone Counselling Skills
    Understanding Silences:
    It might be necessary for the counsellor to break them in some way or it could somethins be necessary to leave them to be.
    Silence seems longer
    Experiance; indevidual 's style and relationship
    It may result in anxiety for the client
  • 42. Telephone Counselling Skills
    Understanding Silences:
    Telephone is safe and easy to releave, but some times it is new for some people to express their feelings, thoughts etc...
    No jugement it would be easier to break the silence
    Go to what has been already said, last issue, reflecting the session or providing a clue for what might be the reason of silence
  • 43. Telephone Counselling Skills
    Recognising and responding to feelings:
  • 44. Telephone Counselling Skills
    Recognising and responding to feelings:
    If there is no obvious clues such as crying, how can a counsellor pick up on a client's feelings?
    Listening for sighs, pauses, hesitations,
    Tone and pitch of voice
    Rushed tone
    Do not intrupt the flow of emotions, it might be faster and deeper than face to face
  • 45. Telephone Counselling Skills
    Recognising and responding to feelings:
  • 46. Telephone Counselling Skills
    Recognising and responding to feelings:
    Reassure the client that is O.K to express the emotions and that the counsellor will wait.
    Angry client may displace the anger and defensive counsellor may fuel the client's fire.
    Counsellor awareness about his/her reaction, tone and pitch of voice,...
  • 47. Telephone Counselling Skills
    Trancfrence & Fantasy:
  • 48. Telephone Counselling Skills
    Trancfrence & Fantasy:
    Medium of telephone lends itself to assumptions, judgments and projections of which the counsellor must be constantly aware.
    Counsellor's perceptions of client's situation and avoid adding their own views or feelings, continuing insted to work with the client's interprat
    Relate to the previous client and project inaccurate impression or fals assumption.
  • 49. Telephone Counselling Skills
    Trancfrence & Fantasy:
    Several clients with similar issues; differenriate between all the clients, respondingto each individual, unique and distinct from anyone else.
    Too busy counsellor
  • 50. Telephone Counselling Skills
    Time Keeping:
  • 51. Telephone Counselling Skills
    Time Keeping:
    It is one of the key bounderies.
    Session ending, client and counsellor feelings, hurry, boring,
    Session endings can give rise to many difficulties or fantasies if they are not handled carefully.
    It is very improtant to tell the client when the session is drawing to a close, 5 mins warning, 2 mins,...
  • 52. Telephone Counselling Skills
    Time Keeping:
    Should decide beforehand and not to have an open-ended session
    Ongoing and developing relationship must have clear parameters, such as length of a session etc...
  • 53. Telephone Counselling Skills
    Developing a Relationship:
  • 54. Telephone Counselling Skills
    Developing a Relationship:
    Building and increasing the intensity of the contact by not interrupted by external distractions.
    Literally Mouth to Mouth and not Face to Face
    Use of the handset and hands-free; echo, distracttion, moving away.
    Skill of hearing unsaid and being aware of onself; projection, assumption
  • 55. Telephone Counselling Skills
    Developing a Relationship:
    All the attention is devoted to the telephone and the person at the other end of the connection.
    Bond of Trust; level of attention and focus
    A key issue for developing a client-counsellor relationship is that of the client feeling valued. Counsellor needs to be aware of what might be interpreted as rejection
  • 56. Telephone Counselling Skills
    Confidentiality:
  • 57. Telephone Counselling Skills
    Confidentiality:
    The question of when must be very clear for the client.
    How to deal with a telephone client who expresses suicidal feelings?
    Training, relationship, or ask the client what they would like you to do; Clarke and Fawcett reviewed risk factors and 10 spes for detecting and guiding suicidal attitude.
    Be aware and Prepare of the posibility,
    Anxiety, Supervision
  • 58. Telephone Counselling Skills
    Personal & Social Skills:
  • 59. Telephone Counselling Skills
    Personal & Social Skills:
    Tone of voice, pitch, and speed of talking, counsellor accent and words used will quickly convey an impression on the clinet.
    Ovehrearing others on the phone with a child, business, close friend; expression of the emotion etc...
    A warm friendly manner is essential in order to offer a welcome.
    Counsellor's feelings; tiredness, stress, pressure
  • 60. Telephone Counselling Skills
    Personal & Social Skills:
    Not too jolly, too friendly, too common, too eager, the client may put off.
    Professional voice, soft or low which not exhabit the emotion on any level. It may possible to get along with the client.
    Not commercial, but up-beat professional counselling tone.
    Be Confident
    Be Honset
  • 61. Telephone Counselling Skills
    Working Conditions:
  • 62. Telephone Counselling Skills
    Working Conditions:
    Working from home, any one answers your phone? Seperate number,
    Reduce Background Noise, counselling must be in a quiet room. Alone and undisturbed.
    Same discipline if working face to face.
    The counsellor priority is the client and the session is not disturbed
  • 63. Telephone Counselling Skills
    Working Conditions:
    Working from office, to be alone, or partitioned-off area, reduce the background niose.
    A break before another client
    Able to walk around
  • 64. Telephone Counselling Skills
    Taking Notes:
  • 65. Telephone Counselling Skills
    Taking Notes:
    Experienced helpline report the distressed callers often have extremely acute hearing, so the movement a pen can be detected and can highten anxiety.
    Why you are writing things down?
    Keeping notes and records with regards to confidentiality needs to be clear.
    Jot notes about the session as soon as it is over
  • 66. Telephone Counselling Skills
    Taking Notes:
    Can be used for supervissionperposes,the reviewing with the client themself.
    Copious note taking certainly affects the concentration and the client will soon pick up on this.
  • 67. Telephone Counselling Skills
    Awareness:
  • 68. Telephone Counselling Skills
    Awareness:
    Awareness of projection and transference and the possible impact of these on the sessions, together with awareness of personal working conditions.
    Work without the guidance of visual clues. It stimulationg to learn how to listen more acutely.
    Itis not only interesting but it enhances listening skills in face to face practice too.
  • 69. Telephone Counselling Skills
    Awareness:
    If you find that you can not literally understand each other's words/mode of speech, it is your responsibility to suggest alternative sources of help for the client.
    The counsellor must be aware of her/his feelings and dealing withe different issues.
  • 70. Telephone Counselling Skills
    Awareness:
    One example is in the area of sexuality and sexual practice. Anne L. Horton considers how some counsellors own ignorance, embarrassment or and sexuality can lead to clients feeling rejected and discouraged from seeking help.
  • 71. Telephone Counselling Skills
    Awareness:
    Either the counsellor's or the client's religious beliefs, attitudes towards disability, or towards older people or young people etc... can influence whether or not they are able to work effectively together.
  • 72. Resources
    Online Continuing education, Zur Institute, LLC
    http://ww.zurinstitute.com/
    Counselling by Phone
    Maxine Rosenfield
  • 73. Questions?
  • 74. Thank You
    Maliheh Taheri
    © 2010 haiku Centre Pte Ltd
  • 75. Look Forward to See You soon again