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6 telphone and online crisis counseling


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6 telphone and online crisis counseling

  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. REGULAR, SEVERELY DISTURBED, AND ABUSIVE CALLERS Paranoid Schizoid Schizotypal Narcissistic Histrionic Obsessive-Compulsive Bipolar Dependent Self-Defeating Avoidant Passive-Aggressive Borderline
  7. 7. 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.
  8. 8. 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
  9. 9. 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
  10. 10. 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.
  11. 11. 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.
  12. 12. HANDLING THE PROBLEM CALLERS Pose Open-Ended Questions Set Time Limits Terminate Abuse Switch Workers Use Covert Modeling/Conditioning Formulate Administrative Rules
  13. 13. 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”
  14. 14. 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”
  15. 15. 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.
  16. 16. LEGAL, ETHICAL, AND MORAL ISSUES More Research is Needed Caller Identification/Tracker Features Caller logs Liability of volunteer hotline workers