Week 3 Discussion: Client Case, Summary & Reflection Chapter 4,5&6

CHAPTER 6: TELEPHONE AND ONLINE CRISIS COUNSELING

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

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

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

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

REGULAR, SEVERELY DISTURBED, AND ABUSIVE CALLERS

 Paranoid  Schizoid  Schizotypal  Narcissistic  Histrionic  Obsessive-Compulsive  Bipolar  Dependent  Self-Defeating  Avoidant  Passive-Aggressive  Borderline

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.

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

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

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.

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.

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

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”

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”

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.

LEGAL, ETHICAL, AND MORAL ISSUES

 More Research is Needed  Caller Identification/Tracker Features  Caller logs  Liability of volunteer hotline workers