1. CHAPTER 6: Telephone and Online Crisis Counseling

2. 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

3. 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

4. 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

5. 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

6. Regular, Severely Disturbed, and Abusive Callers
Paranoid
Schizoid
Schizotypal
Narcissistic
Histrionic
Obsessive-Compulsive
Bipolar
Dependent
Self-Defeating
Avoidant
Passive-Aggressive
Borderline

7. 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.

8. 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

9. 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

10. Other Problem Callers Rappers Covert Callers
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.

11. 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.

12. Handling the Problem Callers
Pose Open-Ended Questions
Set Time Limits
Terminate Abuse
Switch Workers
Use Covert Modeling/Conditioning
Formulate Administrative Rules

13. 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”

14. Behavioral Telehealth
The Appeal of Online Counseling
Feedback
Frequent s 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”

15. 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.

16. Legal, Ethical, and Moral Issues
More Research is Needed
Caller Identification/Tracker Features
Caller logs
Liability of volunteer hotline workers