Crisis intervention strategies chapter 6

CASE HANDLING ON TELEPHONE CRISIS LINES1.. CASE HANDLING ON TELEPHONE CRISIS LINESWhy so popular?. CASE HANDLING ON TELEPHONE CRISIS LINESWhy so popular?. * Access to support systems, ne

Chapter 6 - Telephone and Online Crisis Counseling

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CASE HANDLING ON TELEPHONE CRISIS LINES

1. Still important in crisis work

2. Used most often in suicide intervention

3. "first-order intervention"

4. "psychological first aid"

5. Most prevalent intervention for initial contact

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)

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)

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)

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

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

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.

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