Telephone Crisis Intervention in Psychology

During World War II, the mental health workforce (psychiatrists and psychologists) had started to see extreme cases of “battle fatigue” in soldiers who participated in the First World War. Due to the urgence to send them as quick as possible to the next war, mental specialists started to treat them with a focused approach. This focused approach is knowed as “Crisis Intervention”; concept introduced by Lemberger Freiwilligern in the 19th Century.

According to Slaiku (1990) cited in Beck (2007), a crisis is definded as “a temporary state of upset and disorganization, characterized chiefly by an individual´s inability to cope with a particular situation using customary methods of problem-solving, and by the potential for a radically positive or negative outcome”. Therefore, crisis intervention is a branch of clinical psychology that its fundamental tools are focused to treat clients “...who are experiencing traumatic life events or are in a state of acute crisis”.

After the World War II, many crisis-intervention organizations had openned, examples of which were the Anti-Suicide Department of the Salvation Army in 1906 in London, the National Save-a-life League in New York City in 1906 and the Suicide Prevention Center in the early 50´s in Los Angeles. The first telephone crisis line was established by the National Save-a-life League. Even thought crisis hotlines did exist, with the openning of the Suicide Prevention Center, telephone crisis intervention or crisis intervention hotlines, began to being widespread for over the United Sates. These first lines used to have as a main target the suicide. These lines started to have a big request of other topics or other types of crisis (not just for suicide). Hence, organizations and the governement began to open new telephone lines for other kinds of crisis, such as rape hotlines, drug abuse hotlines and teen hotlines.

At the present, as many as 34-45 million of crisis calls are making yearly. In addition, significant differences between each hotline exist; differences are related to procedures or techniques.

The main focus that runs throught the essay is telephone crisis intervention: Upsides, downsides and techiques used for it. These techniques are proposed by James and Gilliland in their book “Crisis intervention strategies”.

One of the biggest benefits of using crisis hotlines is the convenience. Telephones make the oportunity easier by making the service 24/7 available and letting the person to call from anywhere. Another upside is the anonymity; users of these services often have feelings related to shame, self-blame, guilt or embarrassment. Owing to anonymity, clients are more likely to use the service. Moreover, the cost effectiveness is a huge benefit. For both, users and organizations, crisis hotlines are cheap. Lastly, the range of scope is larger; therefore, rural communities without mental services are able to recieve this kind of aid.

On the other hand, dowwnsides are related to the dependency “on the content, voice tone, pitch speed and emotional content of the client”. In addition, the worker must have a developed verbal ability in order to stabilizise the client.

As it has been pointed, the strategies that will be described, are proposed by James and Gilliland in “Crisis intervention strategies”:

The first strategy is making psychological contact. This means create as quickly as possible a caring, accepting, emphatic and nonjudgamental relationship with the user. Due to the importance of have client´s trust, workers must provide a suitable environment that permit clients talk and share. For instance, if at the beginnig the user does not want to talk, the worker must not put pressaure over the telephone caller. Instead, they should continue in a gradual ritm, providing time and pacience to their clients. Lastly, having the client´s first name is an essential and big step for the procedure.

As a second step, after established a proitable environment, workers would define the problem with the client. This will include “the what, how, when, where, who”; it means understand the background behind the crisis. Moreover, the step includes reflect client´s feelings, clarify the information and summarize everything. Using calming techniques when the client´s emotion starts to going up is also important during the call. Finally, it is really effective to do an assessment to their crisis; one tool using for that is the Affective Severity scale. It will indicate the level of help that the user needs and the lethality level.

After define the problem, ensuring safety and providing support will be the next step. The step will include know about the availability of support systems around the caller at the moment. For instance, the worker could ask if the client is alone or if the pills are next to her/his. Most of the time, the phone counselor is the merely support system.

The fourth step is looking at alternatives and making plans. By knowing the background, knowing the current environment and trying to understand client´s feelings and situation, the counselor must provide alternatives cautiosuly. In the case of specific tecniques, role play, verbal rehearsal and recapitulate are useful for this step.

As a fifth strategy, obtaining commitment to the alternative plan is crucial. Notwithstanding the client´s commitment, the worker should monitorize the client´s plan. It is also paramount trying to obtain her or his number to do this. In the case that the plan includes an appoinment with an agency, knowing the schedule is part of this step. Overall, the worker would check everything with the client and make shure that the plan will be completed.

Finally, a last strategy will include a work with own workers´feelings and thoughts. It is common for beginners to have doubts about their work; therefore, is important to check what is going on with the counselor. To obtain good results and being a ideal support, the worker should be comfortable and have a psychological equilibrium.

To sum up, telephone crisis intervention has been an excellent response to today´s crisis demands. Benefits of using this tool are avability, anonymity and a larger range of scope; nevertheless, drawbacks are that this kind of psychological attention depends almost only in the voice and verbal ability of the counselor. Based on the strategies or steps proposed by James and Gilliland in 2017, the worker should make psychological contact with the caller, define the problem, ensure safety and provide support, look at alternatives and make plans and lastly, the worker should have a continium own work thoughout her or his career. Generaaly speaking, this is just one approach of telephone crisis intervention; nonetheless, the authors provide an easy serie of steps that will be helpful for workers. In my opinion, by practicing these steps, telephone counselor will provide better attention to the callers and the crisis attention will be widespread to more population.