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Treating Male Suicide & Depression
Male Suicide & Depression continuing education psychologist CEUs

Section 25
Use of the Telephone in Treatment
of Suicidal Clients

CEU Question 25 | CE Test | Table of Contents | Depression
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs, Nurse CEUs

For most counselors the telephone is used primarily in crisis situations. The client is communicating by the mere act of telephoning that he is experiencing a difficulty that he thinks needs immediate attention. In all probability the client is experiencing intense discomfort. He is most likely to be in a fearful panic state and having difficulty thinking in a rational manner. Feelings of helplessness and a fear of losing control are common. A primary goal for the client is to be rescued; he believes that he is not capable of dealing with his current situation by himself.

If it is the first contact the counselor has ever had with the client, the first goal is to establish some sort of relationship. It is at this point where such basic counseling skills as active listening, nonjudgmental responses, reflection of feeling, and paraphrasing are important. As the counselor assists the caller to talk about his situation, the beginnings of a helping relationship are developed. Some level of readiness is indicated by the fact that the client has chosen to call.

Using the phone as a means to help someone in crisis is somewhat different than talking with him face to face in the office. All of the skills that are used when the counselor is interviewing a client in person are used when he is using the telephone. Active listening and assertive communication skills are essential. The counselor's task is to put together a great deal of information based on just the voice of the caller. Whispers, choked replies, crying, rise and fall of tone, hesitancies in replies, inflections, and expressions of doubt, to mention but a few, must be responded to in an active fashion. The client also has fewer cues to respond to; consequently, the counselor must be able to use his voice to convey a great deal of acceptance and understanding. The counselor can use changes in tone, inflection, and volume to show that he is working hard at understanding. He must be willing to ask questions and respond from intuition. Statements like "Do I hear tears in your voice?" can help the caller say more about what is being experienced. The counselor searches for more information by asking, "Do I hear doubt in your voice?" or "You sound frightened." For a counselor who is used to seeing as well as hearing a client, phone counseling can be very difficult.

All of the counselor's energies are aimed at building the relationship and sense of rapport. This can be done by showing the caller that the counselor is, indeed, paying attention and that he cases. Since head nodding will not do, the counselor must indicate his acceptance in a verbal manner. This involves direct communication that is conveyed by such statements as "I understand" or "I hear what you're saying." Also, by active questioning the counselor moves on to help the client clearly identify the problem, just exactly what is happening to the person and what is he reacting to. Resources available to the caller must be identified, assessed, and eventually mobilized. When a person is alone with just a phone as a link to the outside world, other individuals can be important sources of support. Finally the specific plan of action must be determined. The client must think and feel that there is some hope; that the effort to call was worth the expended energy.

Telephone work requires that the counselor be creative in the use of his voice. A sense of competence and calmness must be quickly conveyed. This can be done in many ways: speaking calmly, softly, being accepting and gentle, or being firm and rational are all examples.

The counselor must be ready to suggest and inform. Panic can arise from a lack of information; knowing facts can be reassuring. Keeping the caller talking is a major goal. If nothing else, the counselor is buying time. By talking, the client is slowing down his thinking and thereby gaining a better perspective. The rush of ideas becomes slower and easier to deal with. Positive action steps somehow seem to become more of a possibility.

It is important for the counselor to remember that he is not trylng to solve all of the client s problem is during this conversa tion. Solution to only the major reason for panic is the primary goal. If this is not possible, the objective becomes the assurance of the client that the obstacle can be dealt with in counseling. The details of the precipitating sequence can all be debriefed at a later date. It is not important to seek information that will not be helpful at the moment. The life line that is being thrown to him is not intended to keep him going forever, but to keep him alive long enough for him to take a more logical look at the immediate situation or to get him involved in counseling. Unfortunately, in some instances the counselor will not have another contact with the individual The conversation is intended to slow down the client's rush toward death; happy endings are not guaranteed.

When the caller is' in the midst of a suicidal crisis, it is essential for the counselor to find out as much basic information about the individual as possible. There is no certainty that the counselor will be able to provide all of the assistance necessary, so information must be obtained that will be helpful in getting the client appropriate help. It must be determined exactly who is calling, where they are calling from, and what is the phone number. Questions to elicit this information can be woven into the contents of the call, or the data can be asked for directly. If nothing else, an example of honesty and directness is being set for the client. If the client has done something to injure himself, the counselor should. find out the method and the extent of the injury; for example, in the case of an overdose, one should ask what pills were taken, as well as approximately how many and when. It might even be appropriate to ask the client what he looks like and to describe what he is wearing. In the event that the police need to be called or an ambulance needs to be dispatched, all df this information is essential.

For the counselor who has developed a good professional reputation, it is not unusual to get a number of unsolicited crisis phone calls. Tuckman (1970) has enumerated a number of options that the counselor might initiate. Medical emergencies such as overdoses and slashed wrists should be referred to hospital emergency rooms. Emotional crises with high energy components such as deep depression with suicidal thoughts and low impulse control can be dealt with by establishing contact and hearing the person out. The caller needs to know that he is being taken seriously and that the counselor is willing to provide help. Either a face-to-face meeting or hospitalization might be required. Calls from relatives or friends describing the two previous situations can be handled by assisting the significant other to arrange for either voluntary or involuntary hospitalization. Significant others, seeking guidance, might also call about clients not in your immediate area. In these situations, the therapist can help by hearing the caller out and providing reassurance as well as specific steps as to how to locate sources of support which are closer geographically to the identified client.

It is a common occurrence to get calls from seriously disturbed individuals who are not specifically suicidal and with a concern that is not immediate. These individuals can be listened to, -reassured, and referred for a face-to-face contact with an appropriate agency.

The client whose regular counselor is unavailable or out of town may also be a caller. In these instances it is best to hear the person out, reassure, and provide the immediate assistance that is needed. The caller must be encouraged to contact the regular counselor as soon as possible. The counselor might receive repeated calls from someone who does not seem to be in any physical danger or real emotional crisis. These people need to be encouraged to set a face-to-face appointment with an appropriate agency as soon as possible. It is likely that the caller could suffer from some sort of hysterical disorder, and crisis intervention is not doing him any long-term good.

In each of these instances the counselor attempts to establish rapport, assess the lethality, identify the problem, determine the resources, and establish a plan. A major dependence is placed upon the caller to find, at the end of the call, a source of more long-term assistance. The counselor must be prepared to have the call end with many loose ends not yet accounted for.
- Hipple, John, & Peter Cimbolic, The Counselor and Suicidal Crisis: Diagnosis and Intervention, Thomas Books, Inc.: Springfield, 1979.

Personal Reflection Exercise #11
The preceding section contained information about the use of the telephone in treatment of suicidal clients. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Fildes, D., Williams, K., Bradford, S., Grootemaat, P., Kobel, C., & Gordon, R. (2021). Implementation of a pilot SMS-based crisis support service in Australia: Staff experiences of supporting help-seekers via text. Crisis: The Journal of Crisis Intervention and Suicide Prevention.

Kitchingman, T. A., Wilson, C. J., Woodward, A., Caputi, P., & Wilson, I. (2018). Telephone crisis support workers' intentions to use recommended skills while experiencing functional impairment. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(3), 218–223.

Kitchingman, T. A., Wilson, C. J., Caputi, P., Wilson, I., & Woodward, A. (2018). Telephone crisis support workers' psychological distress and impairment: A systematic review. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(1), 13–26.

Online Continuing Education QUESTION 25
In telephone emergencies, according to Hipple, at what are all of the counselor's energies aimed? Record the letter of the correct answer the CEU Answer Booklet.

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