Crisis intervention strategies chapter 6
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Chapter 6 - Telephone and Online Crisis Counseling
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CASE HANDLING ON TELEPHONE CRISIS LINES
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Still important in crisis work
Used most often in suicide intervention
"first-order intervention"
"psychological first aid"
Most prevalent intervention for initial contact
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CASE HANDLING ON TELEPHONE CRISIS LINES
Why so popular?
* Convenience - phones/cell phones, most 'hot
lines' are 24/7, real time?
* Client Anonymity
* Client controls the when and how, looks don't
matter)
* Immediacy of access (anywhere there is a
phone)
* Cost effectiveness (for client and community)
* Therapeutic effectiveness (trained volunteers)
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CASE HANDLING ON TELEPHONE CRISIS LINES
Why so popular? (cont.)
* Access to support systems, networks, support groups
* Avoidance of dependency issues (short term
relationships)
* Worker anonymity (absence of counselor
image/expressions etc. may be helpful)
* Availability of others for consultation or emergency
services
* Availability of other services (information, guidance,
social services, special resources)
* Service to large and/or isolated geographical areas and
population (rural, homebound, elderly, disabled, etc).
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TELEPHONE COUNSELING STRATEGIES
* Dependent on content, voice
tone, pitch, speed and emotion
* Often ambiguous
* Requires great care and effort
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TELEPHONE COUNSELING STRATEGIES
Strategies:
* Making Psychological Contact (quick,
nonjudgemental, credible connection)
* Define the problem (understanding the
event/picture)
* Ensuring safety and Providing support
* Creating alternatives and formulating a plan
* Obtaining commitment to plan (simple, specific
and time limited)
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NEW HELPERS:
* You are not an expert or omnipotent
* Talking about 'it' does not make 'it' happen
* Some callers are manipulative
(but often with purpose)
* You are not their mothers
* They can be complainers, from prior experiences
with helps (may have trust issues)
* Many have fixed alternatives in their minds
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REGULAR/ABUSIVE CALLERS:
* Time consuming to helpers
* Draining to helpers
* But may be very lonely, isolated, and
reaching out for help
* May require setting limits of 10-20
minutes (control)
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REGULAR CALLERS AGENDA:
* Often want reaffirmation that their problems
are unsolvable.
* May become dependent on helper to sustain
their problem
* Worker: needs to be aware and not allow
this type of manipulation
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REGULAR CALLER TYPICAL DISORDERS:
* See p. 127 for Description &
Strategies
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SEVERELY DISTURBED CALLER:
* Disorganized, disoriented and disabling
* Mentally ill
* May be delusional and hallucinatory
* May lack insight or judgment
* May be manipulative, resistant and hostile
* May cause helpers to have discomfort, anxiety, and fear
* Distant from reality
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DEALING WITH DISTURBED CALLER:
* Slow emotions down - focus on 'here-and-now' (concreteness and reality)
* Do not share hallucinations and delusions (affirm the delusion is real without
agreeing)
* Determine Medication usage, and get them to their Dr. to adjust or reinstitute)
* Keep expectations as a helper realistic by attempting to restore a minimum
amount of control and contact with reality (you cannot change them in one call)
* Keep professional distance (boundaries) - clients can trigger helpers own issues
* If need be, get help from coworker or supervisor
* Don't placate or inappropriately sympathize
* Assess lethality - homicidal or suicidal ideation, many times they are trying to put
distance between their thoughts and the actions
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OTHER PROBLEM CALLERS:
* Rappers - talkers (set limits but with support)
* Covert callers -asking for help for another, may actually be asking for help for
self (assume the call is about the caller, but never attempt to prove otherwise)
* Pranksters or Nuisance callers - (take all calls seriously)
* Silent callers (show acceptance, and attempt to remove what may keep the
person from communicating)
* Manipulators (playing games or tricking workers to get information) -focus on
the the callers unmet needs
* Sexually explicit callers (for personal satisfaction) - State that the crisis line
does not tolerate that kind of behavior
* Legitimate Sexual Problems - May be difficult for many workers to
handle....Providing options and information about 'responsible' sex may be an
option
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HANDLING PROBLEM CALLERS:
* Open-ended questions (may help defuse the problems)
* Set time limits when helper cannot refocus the client
* Terminate abuse (when escalated in abusiveness)
* Switching call to another worker
* Covert Modeling (Ask client to use mental imagery to picture
either reinforcing or extinguishing a particular behavior)
* Formulate Administrative Rules to extinguish abusive
behavior for workers to follow.
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TYPES OF 'HOTLINES':
* Warm Lines (less-than-life threatening topics)
* Hot Lines (life threatening or endangering)
* Time-limited hotlines - like disaster relief (specified period of
time, situation, or population)
* Continuous National Hotlines - like troubled youth, domestic
abuse (specialized, toll free, providing information for help)
* Local crisis hotlines - all kinds of calls, usually volunteers
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INTERNET:
Some potential but also some issues
*Behavioral telehealth - the use of telecommunication and
information technology to provide access to behavioral health
*Assessment, intervention, consultation, supervision,
education and information
* Email, chat rooms, websites, videoconferencing, instant
messaging, virtual reality etc.
* Problems: Confidentiality issues, clarity of communication,
unethical/illegal practices, emergency id
* May have greater self disclosure
* May be greater emotional processing by reading
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