- 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. Resources

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