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THE REGULAR CLIENT
Clients must also be told that the therapist is willing to spend time with them on the phone, but that there are limits. The counselor might say, "If I have five minutes, I will gladly talk with you, but then I will have to go." It is a good idea to be direct and honest with the client and to let him know of the time limits. For personal survival and comfort the counselor must be able to structure a call so that it does not go on and on.
It is essential to focus on the critical issues, find alternatives, and set a course of action. Only so much material can be adequately discussed on the phone and the client must realize this; the counselor has to tell the caller that a given topic will have to wait until the next session. Both parties must accept responsibility for finding the primary issues and setting priorities for discussion.
In each instance, a portion of the next regular counseling session must be used to debrief the previous crisis call. This helps show the client that he is responsible for his actions. It is also a way in which the client can learn new skills for dealing with emergencies. The educational aspects of counseling must always be kept in view. There is always a danger that responding to a crisis call can set a dangerous precedent; for the client, finding someone to rescue him can easily become a game. There is also a possibility that the counselor would be teaching clients to act helpless so they will get service.
A primary goal of any counseling intervention is to impact the client in a positive manner. The crisis caller is a likely candidate for change because of the high degree of emotionality. It is at these times that clients are the most emotionally accessible. In non-crisis situations the defenses are frequently up, and it is more difficult to get the client to work from his emotional base. Consequently, while the risk is high and there is high danger, there is opportunity for the client to come to some emotional understandings that might otherwise not be achieved if it were not for the emergency. Given this fact the counselor could well press on certain issues if it seemed that there was a good chance for therapeutic gain.
Because of the potential for crisis calls, it is important that all counselors develop good habits in regard to returning phone calls. Due to the press of time, many counselors have different systems for returning calls. It is our belief that calls should be returned within the hour, and messages should not be allowed to accumulate. Secretaries should be trained so that they can detect the real emergency and pass the message on to the counselor immediately.
Secretaries and receptionists are the first line of defense in handling initial contacts with clients. For both cases of face-to-face as well as telephone contact, it is critical for a positive impression be made. Office personnel must be warm and responsive to clients. It is their sensitivity, intuition, common sense, education, and special training that works in combination so they can separate the routine client from the emergency. After they have assessed the nature of the call, they must be able to make a smooth referral to the appropriate staff member. For instance, in the event of a counselor being tied up they could say, "Mr. Jones is seeing a client now, but he will be able to call you at the hour."
Answering services also should be selected with care. Some services answer a call by saying the phone number, "This is 385-4141." Others will give your name, "Dr. Jones' answering service, may I help you?" We believe that the personal approach is best. The counselor must be confident that the service will be able to judge how best to refer emergency calls.
The telephone can be used
to the client's advantage or disadvantage. It is an important counseling tool;
consequently, all counselors should review the systems that are used in their
DEPRESSION MANAGEMENT TOOL KIT
- Barrett, MD, James. Depression Management Tool Kit. Depression & Primary Care, 2009, p . 5-44.
Depression in adolescence
- Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. Lancet (London, England), 379(9820), 1056–1067. doi:10.1016/S0140-6736(11)60871-4.
Reflection Exercise #2
Online Continuing Education QUESTION 8
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