1. TELEPHONE AND
ONLINE CRISIS
COUNSELING
Chapter Six

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. 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. 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. 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. REGULAR, SEVERELY DISTURBED, AND
ABUSIVE CALLERS
 Paranoid
 Schizoid
 Schizotypal
 Narcissistic
 Histrionic
 Obsessive-Compulsive
 Bipolar
 Dependent
 Self-Defeating
 Avoidant
 Passive-Aggressive
 Borderline

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. 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. 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. 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. 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. HANDLING THE PROBLEM CALLERS
 Pose Open-Ended Questions
 Set Time Limits
 Terminate Abuse
 Switch Workers
 Use Covert Modeling/Conditioning
 Formulate Administrative Rules

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. 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. 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. LEGAL, ETHICAL, AND MORAL ISSUES
 More Research is Needed
 Caller Identification/Tracker Features
 Caller logs
 Liability of volunteer hotline workers