Counseling Case Handling on Telephone Crisis Lines ConvenienceImmediacy of Access 24 hour hotlines Timelimited hotlines Hotlines vs warmlines Continuous national vs local c risis hotlines ID: 633485
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CHAPTER 6: Telephone and Online Crisis CounselingSlide2
Case Handling on Telephone Crisis Lines
Convenience/Immediacy of Access
24 hour hotlines
Time-limited hotlines
Hotlines vs.
warmlines
Continuous national
vs.
local
c
risis 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 therapySlide3
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 milesSlide4
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 areSlide5
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 areSlide6
Regular, Severely Disturbed, and Abusive Callers
Paranoid
Schizoid
Schizotypal
Narcissistic
Histrionic
Obsessive-Compulsive
Bipolar
Dependent
Self-Defeating
Avoidant
Passive-Aggressive
BorderlineSlide7
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.Slide8
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 ReferenceSlide9
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 LethalitySlide10
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. Slide11
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.Slide12
Handling the Problem Callers
Pose Open-Ended
Questions
Set
Time
Limits
Terminate Abuse
Switch Workers
Use Covert Modeling/Conditioning
Formulate
Administrative RulesSlide13
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”Slide14
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”
“
N
etizens”Slide15
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. Slide16
Legal, Ethical, and Moral Issues More Research is Needed
Caller Identification/Tracker Features
Caller logs
Liability of volunteer hotline workers