35. 电话咨询

本章知识点阐述

以下英文内容先直译，再根据信雅达原则进行调整，然后进一步调整为更符合中文习惯的表达方式。最后再根据文中内容进一步阐述知识点。所有内容都用markdown格式的代码呈现： 35 Telephone counselling We would like to ask you, the reader, a question: 'Do you think that it would be harder to be a telephone counsellor or a face-to-face counsellor?' We feel certain that you will have to think hard about this question because the two types of counselling are in some ways similar but in other ways very different. Before reading on, you may wish to think about what the major differences are. One major difference is that the nature of the contact between the counsellor and the person seeking help is obviously quite different in telephone counselling compared with face-to-face counselling, and this is sure to have an impact on the counselling process.

ADVANTAGES OF HAVING VISUAL CONTACT X d A telephone counsellor (TC) has much less information about the person seeking help than a face-to-face counsellor. Because the TC can t see the caller, they are consequently denied a wealth of information. In contrast, a face-to-face counsellor can directly observe the person. From this visual contact they may be able to make tentative judgements about the person’s emotional state, coping ability, age, social status, cultural background and temperament; They are also able to gauge more easily the person’s willingness to share, and their comfort with the counselling relationship. From visual observation the face-to-tace counsellor has the benefit of many subtle clues that are not available to the TC. Most importantly, the c messages. This is much more difficult to do by phone. Have you ever tried to smile down a telephone line? It’s not the easiest thing to do, is it? Have you ever wondered whether the person talking to you by phone was crying or not? In the face-to-face situation those telltale tears would leave you in no doubt.

TCs only have non-visual clues to their caller's reactions

TIME TO BUILD A RELATIONSHIP Another significant difference between the two types of counselling concerns the counsellor’s ability to build a relationship with the person seeking help. The face-to- face counsellor has more time in which to build a relationship by using both verbal and non-verbal cues. Rarely does a person walk out of a counselling session during the first minute or two. But tor the TC the situation is quite different. If some level of trust isn’t established early on in the call, the caller might well hang up, thereby terminating the counselling process!

It is easy for a caller to hang up

In many ways, then, telephone counselling is more difficult than face-to-face counselling. The TC has to have good 'fishing’ skills, t hey need to be able to engage their caller through a gradual process that is active but non-threatening, so that the caller feels safe enough in the relationship to begin and to continue talking.

BEING PREPARED FOR A CALL To be effective, it is important for a TC (Figure 35.1) to be ready to make the most of the first few moments of a call to engage the caller; the first minute or two of the call are often critical. A distressed caller in a highly emotional state will easily be frightened away, and is likely to hang up unless some immediate warmth and responsiveness comes through from the counsellor.

INFLUENCE OF THE COUNSELLOR'S OWN PROBLEMS We counsellors are people with our own needs. If we are preoccupied by our own emotional problems and if our own unfinished business with other people needs attention, then we are very unlikely to be ready to engage with a caller over the phone when it rings. It takes time to put aside our own stuff, and unless we have done that, it will intrude. Sometimes when a person seeking help is coming to a second or subsequent face- to-face counselling session it’s possible for a counsellor to let go of their own preoccupations by owning them openly and saying to the person something like:

Figure 35.1 The counsellor attending to the call ‘I have just had a difficult few minutes and haven’t yet distanced myself from that experience. I’m letting you know this so that 1 can put that experience to one side and give you my full attention without being distracted by intruding thoughts/ Sharing information like this can be useful in two ways. Firstly, it addresses the process occurring for the counsellor and will probably enable the counsellor to focus on the person without the problem of intruding thoughts. Secondly, the counsellor models an appropriate way of displacing, or putting to one side, troubling thoughts. Unfortunately, this technique can’t be used in telephone counselling unless the caller is well-known to the counsellor. The TC—caller relationship is usually too fragile for such a disclosure at the start of a call.

PREPARING YOURSELF FOR A CALL to pay full attention to the caller and to the counselling process. 1 he TC therefore needs to prepare adequately before the phone rings. .... t.......................................... If they are troubled by Worrying or disturbing thoughts, then they need to deal with these in some appropriate way. We are all different and the way in which we prepare ourselves may not work for other people. We need to be ready when the phone rings

1 here are four common ways of preparing for a telephone counselling session. They are: 1 Talking through your own problems with your supervisor. 2 Owning your intruding thoughts by telling a colleague that they exist. 3 Using relaxation, meditation or prayer, depending on your spiritual orientation. 4 Engaging in physical exercise.

TALKING THROUGH YOUR OWN PROBLEMS WITH A SUPERVISOR Owning the problems that are troubling you and talking them through with your supervisor or another counsellor is certainly a good approach. By doing this the problems are not just put to one side but are worked through. This is particularly useful, because if you just put your own problems to one side without working them through then they are sure to re-emerge if the problems of the person seeking help are in some way similar. Working through them first is clearly the ideal.

USE OF RELAXATION, MEDITATION OR PRAYER The use of relaxation, meditation or prayer can be effective in helping a counsellor to feel more prepared for a telephone counselling session. We are all unique individuals and so what suits one person will not be appropriate for another. While some counsellors find the use of structured relaxation exercises helpful, others have learnt techniques for meditating. People who have religious beliefs often find it useful to pray to ask for help in preparing them to receive calls.

USE OF EXERCISE Engaging in physical exercise before a telephone counselling session can be helpful. People who enjoy exercising often find that they are able to feel good and to let go of troubling thoughts in this way. The alternatives are many and include jogging, playing golf, squash, tennis and swimming.

THE CALLER'S PERSPECTIVE Having dealt with the need for appropriate preparation by the counsellor, it is time to consider the caller’s position (figure 35.2). Callers are often anxious and uncertain about what to expect. The act of picking up a phone and dialling a stranger can be worrying for some people. Some callers, being anxious, may have made a few false starts before finally dialling your number and waiting for you to respond. Consequently, the first few words and the way in which you, the telephone counsellor, speak to them are crucial.

Figure 35.2 The person calling for help

THE INITIAL CONTACT Most human beings tend to approach strangel's with caution. We are wary and tentative in establishing relationships. Consequently, if a TC were to pick up the phone at its first ring and to talk quickly, the caller may feel threatened and be frightened away. We human beings approach each other warily and in our natural caution we draw back when someone tries to meet us at a faster pace than we find comfortable. We wonder if you have ever felt taken aback when you have called someone and they have answered the phone before you have heard it ring?

The way the phone is answered is certain to have an immediate influence on the caller

We need to be careful to meet the caller at an appropriate pace, so remember to be calm and relaxed so that the process of joining occurs naturally. We find that picking up the phone after two or three rings and answering caringlv in a way that is warm and non-threatening is useful. At Lifeline centres, TCs often start by saying: ‘Hello, this is Lifeline. Can I help you?7 1 he words are important and so is the tone and pace. The voice quality needs to be calming and inviting without being gushy.

RESPONDING TO 'PRANK' CALLERS Some callers, particularly children, may initially behave in a way that suggests that the call is a prank call (see later in this chapter regarding nuisance calls). However, we need to be careful not to respond inappropriately to such callers, because their behaviour may be their way of attempting to access the counselling service and to test the counsellor’s acceptance of them. It is important that all callers are treated with respect. By doing this it is sometimes possible to achieve useful counselling conversations in calls that initially appear to be pranks.

CONTINUING WITH THE CALL After the initial contact, the process of building a trusting relationship gets seriously under way. Inappropriate responses or inappropriate timing may result in the caller hanging up rather than continuing to talk. The counsellor needs to be tentative, and to recognise and make allowance for the caller’s hesitancy. Lhey need to explore cautiously what is safe for the caller and what is not. l hey have to listen intently and to use all their skills and judgement in an effort to build a comfortable non-threatening relationship, so that the caller is empowered to talk freely. ’The counsellor has to maintain such a level of empathic understanding and warmth that the caller will become more at ease rather than be scared away. With some callers this is no problem, but with others, as explained before, the simple act of picking up the phone has in itself been a difficult step. Too much talking by the counselloris sure to push the caller away, as is too much silence. Yes, telephone counselling is difficult! It involves knowing when to be verbally active, and when to draw back and to listen in silence. Judging the needs of the caller and responding empathically without intruding are what is required.

HANG-UPS One of the advantages of seeking telephone counselling rather than face-to-face counselling is that a caller can easily opt out at any time without embarrassment. Inevitably, some callers who are not used to calling TCs are likely to hang up prematurely in their first attempts to engage in such a counselling process. Don’t despair when a caller hangs up, because it is inevitable that this will happen from time to time. Even so, every’ experienced TC knows how demoralising it can be to lose a call. When it does happen, remind yourself that the caller may have achieved a minor goal by learning that they can cope with picking up the phone, dialling the number and starting to talk. Elaving made what for them may have been a big step, they may then be able to phone back later to talk for longer, if you are becoming worried by callers hanging up, we suggest that you talk through the issue with your supervisor.

ALL TCs experience hang-ups - so don't take this personally!

STAYING FOCUSED Telephone counselling often requires a high level of concentration with intense listening. Frequently, distressed callers will talk quietly and consequently be difficult to hear. Tor new counsellors, there may seem to be too many things to attend to at the same time. The counsellor needs to listen to the spoken words, identify the emotions underlying them, understand or picture the caller’s situation, attend to the process of the call and make suitable responses. Telephone counselling certainly is Very demanding for a counsellor, but it can also be very satisfying for counsellors who sensibly and properly attend to their own personal needs (see Chapter 42).

SKILLS NEEDED 1 he counselling micro-skills described earlier are all needed in telephone counselling just as they are in face-to-face counselling. On the macro scale, the process of a telephone counselling call will be very similar to the process of a face-to-face counselling session, as described in Chapter 15. However, there are some differences at both the micro and macro level. Let us look at each of these in turn.

USE OF MICRO-SKILLS In telephone counselling, all the micro-skills described previously are required. However, in using these skills special attention is required to compensate for the lack of visual and other non-verbal information. The caller can’t see your face, your facial expression or your body posture. In our day-to-day communication, the words we say are moderated, amplified or changed in other ways as a consequence of the non verbal behaviour that accompanies the words. For example, a counsellor may add emphasis to what they are saying by leaning forward as they say it. A caring expression may reassure the person that what the counsellor is saying isn’t meant to be hurtfill to them although it may be confronting.

The caller only has your verbal cues to let them know you are still Listening

TCs need to compensate for the lack of non-verbal cues by adding tone and expression to their voices over and above what would ordinarily be required in face-to-face contact. Additionally, whereas a face-to-face counsellor can listen in silence at times, it is important that in telephone counselling the counsellor should regularly give verbal cues that listening is still occurring. Obviously this shouldn’t be overdone, but it is reassuring for a caller to hear minimal responses such as ‘ah-ha’, 'yes’, 'mm’ coming in response to their own statements. At times during personal telephone calls to friends or family, have you ever had to ask 'Are you still there?’ because the other person has been listening silently? Most people find it disconcerting when they get little or no response while talking to someone on the phone. Certainly, in the counselling situation it is important for the caller to know that the counsellor is still there, and listening intently.

Similarly, the TC can’t see the caller and will sensibly need to check out with the caller information that would, in a face-to-face session, be obvious from the appearance of the person. In a prolonged silence it may be appropriate to ask, 'What is happening for you right now?’ If you suspect that your caller is crying but are unsure, it may be worth waiting for a while and then saying in a quiet, caring tone of voice, : You sounded very sad as you spoke and 1 am wondering whether you are starting to cry.’

A MACRO VIEW: THE OVERALL PROCESS T he process of a telephone counselling call can often be described by the flow chart shown in Figure 16.1 (see page 135). Clearly each call is different, but it can be helpful to recognise, and if necessary influence, the stages through which the call progresses. For example, it can be advantageous to recognise when it is sensible to move from the active-listening stage into the later stages. When doing this a counsellor needs to trust their gut feelings, to be sensitive to the caller, and to be able to recognise whether the overall process of the call seems to be meeting the caller’s needs. It is there that experience and supervision are useful.

INFLUENCING THE PROCESS OF A CALL While you are attending to the caller, take time to recognise where the call is heading and, if appropriate, make decisions with regard to the process. For example, it is not going to help a chronically depressed caller if you continue active listening for too long, particularly if you are reflecting feelings and negative thoughts. In fact you may well succeed in helping the caller to move further down into a trough of despair! Recognise the time to move on and to start using skills which address thoughts and behaviours (see Chapter 31).

It is important, as described in the earlier part of this book, to follow the direction the caller chooses and generally to meet the caller’s agenda in preference to your own. However, these guidelines are not inflexible rilles and need to be seen in the context of the whole call, the caller’s situation, the policies of the counselling agency and the counsellor s own goals for the counselling process.

In our view a caller is more likely to feel helped if some progress is made in the call towards an increased awareness such that there is a likelihood of adaptive change occurring for the caller. To achieve this, the TC may at times have to influence the direction and process of the call. Don’t forget, however, that change usually occurs through increased awareness rather than through the counsellor pushing for change (see Chapter 26 on facilitating action).

If a caller is repeatedly going through the same material, then it is appropriate to raise their awareness of that process by directly confronting it (see Chapter 19). It will often be useful to tell the caller what you notice is happening in a call. For example, a counsellor might say to a caller who suffers from chronic depression, 4 notice that you seem to be becoming overwhelmed by depression’. Once the process has been identified, then the TC has the opportunity to move the call into a new stage. For example, the counsellor might move into the stages where the emphasis is on thoughts (see Figures 16.1 and 16.2) and might use an exception-oriented question from Solution-Focused Counselling as described in Chapter 22. The counsellor might ask, ‘Was there ever a time when depression didn’t overwhelm you?’ 1 his question might be followed by asking, ‘What was different then?’, or 'So there was a time when you knew how to beat your depression?’, and 'Is there anything that you could do now that would be similar to what you did before when you had some control over depression?’ We have used the example of depression because most telephone counselling centres receive a significant number of calls from those people who are troubled by chronic depression. Such people often need to have medical or psychiatric help and it is important to raise this as an option if it is not occurring (for further information on counselling people who are troubled by depression see Chapter 31). You may be surprised that we are implying that TCs may need to pay more attention to control of the process of the counselling session than face-to-face counsellors. We think this is true because telephone callers often do not feel constrained by time, and when they become comfortable with a counsellor some callers are content to chat rather than focus their thoughts in order to use the interaction constructively. Also, FCs frequently only have a single interaction with a particular caller, so there may be no possibility of ongoing work, which more often occurs m face-to-face counselling.

ADDRESSING EACH CALLER'S PERSONAL NEEDS If we refer back to Figures 16.1 and 16.2 (see pages 135 and 136), it is clear that for some callers it may be sufficient to move directly through the process as described in the figures. For other callers, particular stages need to be emphasised if the caller is to be helped. As each call progresses, a picture of the caller and their situation will emerge and you will need to make decisions about how best to help this caller. You may decide that it is sufficient for the call to stay mostly in the active-listening and emphasis-on-emotions stages, with consequent cathartic release for the caller. However, for other calls it may be desirable to gently encourage the caller to move forward into subsequent stages that will enable fuller clarification of the problem, or may facilitate changes in thinking or behaviour.

To be a fully effective and responsible TC you need to be able to assess what is most appropriate for each caller. Unlike face-to-face counselling, you may not get another opportunity to have a counselling conversation with a particular person, so you will need to make the most of your opportunity. However, do not think that you have to achieve life-changing results in one call. If the caller finds it useful talking to you, then they are likely to use a telephone counselling service again. Each call can be seen as one step in an upward flight of stairs where the caller is moving one step at a time.

SOLVING THE CALLER'S PROBLEM A FAIRY STORY Once upon a time in the land of Great Tragedy and Despair there lived a wonderful person who became known as Super-TC. Super-TC was better than most TCs because his calls lasted only a few minutes. He was always able to give good advice and his callers usually politely thanked him for that. His approach was to identify the caller's problem swiftly and then to suggest a solution. Sometimes, when Super-TC couldn't think of a solution himself, although that wasn't very often, he would refer the caller to someone else who might have a solution. Occasionally callers would make it clear that they wanted a longer counselling interaction. In these instances, Super-TC would say to the caller, 'Its clear to me that you have a quite serious psychological condition. You need to make an appointment immediately to see either a face-to-face counsellor or, better still, a psychiatrist.' At times, particularly when tired, it is easy for a TC to inadvertently start behaving in some ways like Super-TC. No one is perfect. It is always tempting to provide a quick solution rather than to suffer the emotional pain of listening to someone else who is suffering. Of course, there are times when it is appropriate and responsible to refer a caller to others. Generally, however, before doing that, it is preferable to allow the caller to deal with their emotional issues in the ‘here and now’. Often when this is done a referral will not be necessary. Some TCs, who have trained specifically for working on the phone, believe that face-to-face counsellors are necessarily more competent than they are, with the consequence that they will refer to face-to-face counselling before helping the caller fully by using the normal counselling skills and processes. Unfortunately, we professional face-to-face counsellors, social workers, psychologists and psychiatrists vary in our competence. Yes, it is appropriate to refer on when you are out of your depth, and it is unethical and irresponsible not to do so. However, give your callers the opportunity to explore their pain fully with you on the phone if that is what they would like to do, in addition to giving them an onward referral if necessary. If you are unsure about what you are doing, we suggest that you might like to talk to your supervisor. When in doubt, consult your supervisor

Unfortunately, Super-'PCs are likely to disempower their callers. By finding solutions for them, Super- fCs may confirm callers’ worst fears by the implied message: ‘You are not capable of running your own life and making your own decisions. You need someone else to tell you what to do.' There are times in our lives when we do need someone to tell us what to do, but usually human beings of normal intelligence prefer to make their own decisions, and can feel good about themselves if they are empowered through the counselling process to do so. If counselling has been really effective, an empowered person who has talked with a counsellor might think: ‘Counselling wasn’t much help, the counsellor didn’t tell me what to do, instead 1 made my own decision. 1 am an OK person and can run my own life.’ It is clear that finding solutions for other people is usually not helpful. However, it can be very’ useful indeed to help people to find solutions for themselves. In this regard readers might wish to use the solution-focused skills described in Chapter 22.

MAKING NOTES DURING THE CALL

Figure 35.3 Genogram x. 2 years 10 years 5 years x z ■X Si Key Female

Male Sex unknown Married ~~ Separated —//— Divorced Yxf Deceased Boundary around people who all live together Note: BiLL was married to Sandra and they had two children, Nicholas and Monique. Sandra and Bill divorced. Later, Bill met Maureen and they have a 2-year-old child.

It is not easy to give a caller your full attention and at the same time to pay attention to the process of the call so that you can facilitate appropriate changes in that process if necessary’. A high degree of concentration is required and it is easy to become distracted and to forget important information. To avoid losing information, and to help in more fully understanding a caller’s situation so that you can see their picture more clearly, it can be useful to make notes during a call. Some TCs add sketches as the call proceeds and find that this helps them to focus on the caller more intently. If a caller is talking about family problems, then it can be useful for a TC to draw the family tree in the form of a genogram. Figure 35.3 is a simple example of a genogram. G eno grams can be useful in helping the counsellor to more fully understand the caller’s background. USING YOUR IMAGINATION As a TC you can’t see the caller, but you can, if you choose, imagine them. While they are talking, you can construct a visual picture and imagine yourself in the caller’s position and situation. If you do this you may be able to experience more fully what it is like to be the caller and consequently he able to respond with noil-judge mental empathy.

ADVANTAGES OF TELEPHONE COUNSELLING Telephone counselling can help people who might not be willing to come to face-to- face counselling

We have made the point previously that in our opinion telephone counselling is more difficult than face-to-face counselling. It is, however, an extremely valuable form of counselling. Some people who would never come to a face-to-face counselling interview will use the phone. From the caller’s perspective, telephone counselling offers the following advantages: • It is safer for the caller because they can if they wish protect their anonymity. This may help them to feel less concerned about the consequences of sharing private thoughts and emotions with a stranger. • The caller knows that if they are feeling too threatened, they can hang up. This is far easier than walking out of a counselling room. • Telephone counselling is easily and immediately accessible (unless the line is engaged) with no waiting list. The caller just has to pick up a phone and dial. • Generally, telephone counselling is of low cost to the caller.

SETTING BOUNDARIES Because telephone Counselling provides a safe environment in which a caller can share their deepest secrets, it also has some hazards. Some people who phone in are alone and have no close friends who can listen to them. Such people can be very vulnerable and may wish they had an understanding friend. Good counsellors are accepting, warm, empathic and non-judgemental. Consequently, lonely callers may build a very’ skewed picture of the person they are sharing with, perceiving the counsellor very positively. It is essential, therefore, to set clear boundaries so that the caller understands that the relationship is a phone relationship and cannot be extended beyond that. To do otherwise is to set up an expectation in the caller that, maybe, there could be the beginnings of a personal relationship. Remember that lonely, unhappy people are often needy and vulnerable. It is totally unethical to take advantage of them. Further, it is unrealistic to think that you could help them if you were to allow the relationship to change from a counselling relationship into a friendship. To do so would damage their ability to trust the counselling process as a safe one that they could use in the future.

DEBRIEFING Debriefing is a process used to enable counsellors to let go of the emotions that they inevitably experience as a consequence of listening to a distressed person. If a counsellor said to you, Till an experienced telephone counsellor — I don’t need to debrief because calls from people seeking help don’t trouble me’, would you believe them? All counsellors, however experienced, need to debrief, especially after particularly stressful counselling sessions. Although we are both experienced professional counsellors, we make it a regular practice to debrief after difficult or emotional counselling sessions. If we were not to do so, the service we provide would inevitably become less effective and we would suffer burnout symptoms. TCs are particularly vulnerable to the emotional after-effects of their counselling work. It is common for people in acute crisis to reach for the telephone to seek help. Consequently, FCs frequently receive calls from people who are in extreme distress and/or panic. Not surprisingly, telephone counselling often leads to crisis intervention (see Chapter 33). Telephone counselling can be stressful for the counsellor Because of the inevitable crisis content of telephone counselling, TCs will sometimes feel drained at the end of a shift on the phone. 1 heir callers’ emotional pain will at times inevitably trigger off personal emotional stress for them. TCs therefore need to be responsible by caring for themselves. After a particularly stressful call, we suggest that it is useful to take a break before accepting another call, and if at all possible talk to your supervisor or another counsellor about the feelings you are experiencing. At the end of each counselling shift, debrief once again by talking to your supervisor or another counsellor for a few minutes. Debriefing need not be a long process but it is an important one.

PROBLEM CALLERS No discussion of telephone counselling is complete unless it gives some consideration to what are best described as problem callers. These are callers who create special problems for FCs. They may have goals that are incompatible with those of the counselling service and consequently may want to use the service inappropriately. Some of them may want to satisfy particular needs that are not being met elsewhere. However, problem callers are people with genuine needs, so TCs need to be able to deal with calls from them in a constructive way which fully addresses their counselling needs. Most problem callers fall into one of the following categories: 1 nuisance callers 2 regular Callers 3 callers who are troubled by chronic depression 4 sex callers.

NUISANCE CALLERS Inevitably, there will be people who will call in to telephone counselling services with the aim of causing annoyance, or maybe of getting a laugh at the FC’s expense. Some of these will repeatedly ring up and then hang up, others will be openly abusive, and there will be those callers who make hoax calls. Sometimes angry or abusive callers will repeatedly knock the phone or slam it down. Such calls will naturally tend to make the counsellors receiving them feel frustrated and annoyed. We need to point out that it is normal to be frustrated, annoyed and possibly angered by such behaviour. Counsellors are human beings and as such we have our own legitimate emotions. Somehow, though, we need to deal with our frustration, annoyance and anger, so that we can feel OK and are ready and able to deal appropriately with these calls and with subsequent calls. 1 he best way of dealing with emotions resulting from nuisance calls is to talk with someone about them. If this is not possible then we suggest that you might like to try to alter the way you think about the caller so that you are more able to be constructive in dealing with them. Can you think of the nuisance caller not just as an annoyance hut also as someone whose needs are not being fulfilled in an adaptive way that enables them to have a satisfactory7 and fulfilling life? The reality is that any person who finds it necessary to harass a telephone counselling service most probably has a Very unsatisfactory and unfulfilled life. Could you be bothered to phone in to a counselling service just to be a nuisance? None of us could; we have much more satisfying ways of spending our time. Here are some suggestions as to why some people make nuisance calls: • They may be angry7 and unable to express their anger in a constructive and adaptive way. • They may be frustrated with life and not know how to deal with their frustration except by annoying others. • 1 hey may be bored and lonely. • They may be young people engaging in what for them is harmless fun. They may also want to impress friends by 'playing a joke1 on a counsellor. • They may be young people 'taking risks’ or acting impulsively but in a reasonably normal developmental way. they may be people who are testing the service before deciding whether or not to talk about more serious issues. Nuisance callers also ' have problemsand need to be valued All of these people have problems in their lives and are searching for something they cannot find. If you are able to think of nuisance callers as people dissatisfied with their lives who are hurting inside, then you may be able to develop constructive strategies for dealing with them. We don’t believe that there can be one correct way of responding to such callers because they are all different. What we try to do is to decide what, if anything, can be achieved when in conversation with such callers. We ask ourselves whether any of the following goals are realistic: • to let the caller know that they are a valued individual • to encourage the caller to talk about their real issues • to let the caller know why we believe that what they are doing is destructive • to let the caller know how we feel • to decrease the likelihood that the caller will repeat their nuisance-calling behaviour • to deal with the underlying issues that result in this unwanted behaviour. Can you think of other suitable goals? If you are able to remember your goals, then you may be able to deal with such callers constructively and effectively. At all times, remember that it is not a part of your role as a TC to be abused. You have a right to tell any abusive caller that you will not listen to abuse and to hang up if that is what you consider to be most appropriate. Of course, there are times when counsellors deliberately choose to listen to the abuse of an angry7 caller in order to allow such a caller to vent their anger and then to move on to dealing with constructive issues. As a counsellor, although the choice about whether to hang up or not will be influenced by the policies of rhe agency in which you are working, it is ultimately your choice, and you have a right to hang up if that is what you choose to do. •

REGULAR CALLERS All telephone counselling agencies have problems with those callers who repeatedly call in over a long period of time. Some of these callers have genuine needs that can be appropriately met by counselling. However, many regular callers re-run the same story7 over and over again. Others try to engage the counsellor by using a variety of different names and stories, often with an underlying theme to their stories. Regular callers can cause a considerable problem for telephone counselling agencies because they take up valuable time that could be used in working with other callers. Also, they are likely to cause disillusionment and increased burnout in counsellors. Agencies that employ many counsellors have particular difficulty7 in dealing with regular callers because their counsellors are sure to find it difficult to recognise the regulars. Although there are exceptions, we do not think that it is helpful to allow regular callers to talk at length. To do this disadvantages other callers. Also, regular callers are more likely to dig themselves deeper into their regular caller’s rut if they are pennitted to talk for an extended length of time. Unfortunately, some regular callers are very adept at manipulating counsellors because they are experienced in talking to a counsellor. In this regard, regular callers commonly use a range of statements with the goal of convincing the counsellor that they should continue to listen. These include: You seem to really understand me. No one has ever been able to get close to me this way before. You are such a warm person that 1 feel so comfortable talking to you. I think I'll kill myself now. I just need to ask your opinion about one more thing. Other callers are much more important than me. Many telephone counselling agencies have lists of regular callers, giving details to assist counsellors in recognising the regulars, and also to give guidelines for handling these calls. If these callers do not receive consistent responses from counsellors then their best interests are not served and additionally they may cause a problem for the agency. It’s sensible to make clear decisions when handling such callers so that their real needs are met and they feel valued as people, and also so that they do not disrupt the service to the disadvantage of other callers. Most agencies set time limits for calls from regular callers, but terminating calls from some of them can be difficult. You may need to be very assertive (see Chapter 12). Regular callers can be frustrating and annoying at times, but we would like you to consider them from another perspective. Regular callers are often sad, unfulfilled people who would not call in if they were able to lead satisfying lives. Among them are the chronically sick, the mentally ill, people with disabilities, lonely people, people who are grieving heavily as a consequence of broken or lost relationships, the chronically depressed and people with significant past histories of abuse, lhey are all different from each other and unique as individuals. They each have their personal needs and deserve to be treasured in the same way that other callers are treasured, l hey have a right to receive care and counselling. ID avid will now describe some examples of regular callers who have been known to him. Caller 1 'Some counsellors at a particular telephone counselling agency felt that they were wasting time listening to an old lady who phoned in several times each day. _hen one day a woman phoned to say that the old lady was her mother and that she had died. The woman said that she was phoning to tell the counsellors how much her mother had valued the warmth and caring they had offered her during the last few weeks of her Life/ Caller 2 'One day, I met face to face with a seriously depressed regular caller who was boring TCs with his monotonous conversation. I was confronted by a sad. disfigured and disabled person who had no friends and was avoided by strangers. He had little chance, if any, of improving his lifestyle. He could hardly stand or walk, his speech was impaired, his conversation was uninspiring, and he had barely enough income from his pension to survive. He lived alone. Almost his only human contact was by phone with the TCs who cared enough to listen.' Caller 3 'Once, to my surprise, a capable TC who was well-known to me confided that before becoming a TC she had for a time been a regular caller herself during a very difficult period in her life. Thanks to the counselling process she had been enabled to deal with her problems and to climb out of her trough of despair. She was now helping others.' T hese examples are, we believe, not unusual. Regular callers are valuable people and require patient caring, although sometimes it is not easy to be either patient or caring when counselling them. It’s easy to say, 'Oh, she’s a regular caller, and 1 really don’t want to listen to her/ It’s harder to say, 4T his is a challenge. Can 1 work with this caller in a way that will be satisfying for them and for me? If you are going to get satisfaction from helping a regular caller, you will need to be clear about your goals for each call. You will also need to be direct in telling the caller clearly what to expect from you. For example, you may say, 'Frank, I’m happy to talk with you for 15 minutes but then 1 would like to hang up so that other callers also have the opportunity to call in.’ By doing this you are being up-front and can use the call caringlv and constructively to achieve a goal. Here are some possible goals: • to raise the caller’s awareness of their 'broken record’ • to help the caller to recognise options • to empower the caller to do something different, however small • to help the caller to feel valued • to provide a listening ear for someone lonely. Can you think of other goals? Counselling goals listed in Chapter 31, about counselling those troubled by depression, may also be appropriate. CHRONICALLY DEPRESSED CALLERS A high percentage of regular callers fall into the chronically depressed category, so we have decided to give them special mention. r These people have Very sad lives and call for a high level of caring from those who counsel them. Strategies for counselling them are in some ways the same as but in other ways different from those used in general counselling. TCs therefore need to have appropriate strategies for working with such callers. Some of these strategies are described in Chapter 31.

SEX CALLERS Unfortunately, telephone counselling agencies are frequently troubled by callers who want to use counselling services to satisfy their sexual needs. In our experience almost all of these callers are male and generally they only want to talk with female counsellors. They7 will either recount a story with a high level of sexual content or may be direct in asking the counsellor if they may masturbate while talking. It is probable that many of these callers are obsessed by sex and have little or no chance of building a satisfying relationship with a partner. For others, sex may be an escape from the reality of a very7 unsatisfactory7 life and they may believe that they7 have no options to enable them to change their lives. We suspect that many of these men lack respect for women and have psychological problems related to their relationships with them. We can see no justification, regardless of circumstances, for a caller to attempt to use a counsellor for their own sexual gratification. For them to do this is sexual abuse, and it can be dealt with as such. However, counsellors need to be careful in assessing whether a caller is a nuisance \sex caller’ or not. There are callers who genuinely seek anonymous counselling help with regard to very7 personal sexual problems. Some of them would be too embarrassed to attend a face-to-face counselling session and may even be hesitant about talking to a TC. Clearly they need counselling help, even if only a sensible referral to a clinic or sex-counselling service. Unfortunately, it’s hard to separate these genuine Callers from the abusers. If a genuine caller is treated as though they are a sexually abusive caller, then their trust in the counselling process may be seriously damaged. We wish that we could tell you how to distinguish between the genuine and the non-genuine caller. We can’t. We suggest that all you can do is to use your judgement, and if you think that a caller is using you to fantasise sexually or to masturbate, then confront him. If the confrontation is done caringly, as explained in Chapter 19, the caller’s attitudes may be challenged and there is a possibility7 that they may seek appropriate help for dealing with their problem. Obviously, sex callers have genuine psychological or life issues. If they didn’t, they wouldn’t attempt to use telephone counselling services in such a way. Consequently, a caring counsellor might choose either to deal with the caller firmly but caringly or to be very7 abrupt and to hang up. Yes, we do believe that it can be caring to give very direct messages about the consequences of inappropriate behaviour. If you are abrupt and hang up, you are giving a clear message. Alternatively, you may decide to be explicit in telling the person how you feel about what they are doing, explaining that you intend to hang up, and in addition giving the caller an invitation to call back if they7 want to talk about real-life issues rather than using you as a sex object. However, it pays to be cautious or you may find the same caller pretending to tell you about ‘real-life issues’ while masturbating. There are some counsellors who will tolerate this. That is their choice, and if they are able to achieve worthwhile goals then their caring is to be admired. They need to be careful, however, on two counts: firstly, that they are not implicitly encouraging inappropriate behaviour that may be detrimental to other counsellors, and secondly, that they are not merely satisfying their own sexual or other needs. Here, supervision can be valuable in identifying the relevant issues. Certainly, all counsellors need to be aware of their own personal rights and to know that they are fully justified in protecting themselves from abuse by refusing to listen.

CREATING COMFORTABLE CLOSURE OF A TELEPHONE COUNSELLING CALL Bringing a telephone counselling call to closure is an art, and if it is carried out expertly the caller will feel comfortable about hanging up, recognising that the call has come to a natural end. In order to achieve this result, the process of ending the call needs to be integrated into the conversation so that it occurs smoothly and is expected. Generally, the process involved in ending a counselling call of average or longer length will follow a sequence of steps. These steps prepare the caller to expect that the call will soon end. Naturally, each call is different and what is appropriate for one call will not fit another. Here are some recommended steps that can be used when ending a call: 1 Decide when to finish a call. 2 Warn the caller that the time to finish is approaching. 3 Summarise the call. 4 Give the caller some positive feedback. 5 l ake control. 6 Tell the caller that you are going to finish the call. 7 Invite the caller to phone back if appropriate. 8 Say 'Goodbye" and hang up. We will now discuss these steps in detail so that you can use them as a guide if you wish. However, remember that you are a unique individual and will need to develop your own way of ending calls. DECIDE WHEN TO FINISH A CALL As you know, there can be no standard rule about how long a telephone counselling call should be. However, we don’t believe that it’s useful to let calls continue after useful work has finished. If the call is losing energy, or not making constructive progress for the caller, then it’s time to move towards ending the call or to look for different strategies so that the call regains its usefulness. Generally, we find that it is not helpful to allow calls to continue for longer than one hour at the most, although occasionally there will be exceptions to the rule. We think that it is worth mentally evaluating what is happening in a call if it is still continuing after about 45 minutes. A decision can then be made about how to influence the process of the call so that the remaining minutes are useful to the caller.

WARN THE CALLER THAT THE TIME TO FINISH IS APPROACHING As with face-to-face counselling, it’s a good idea to warn a caller in advance that the counselling session or call is nearing its end. When you sense that it is appropriate, you may wish to say something like: ‘I realise that we have been talking tor a while now and hope that we have covered some useful ground together. 1 would like to finish our call within the next few minutes, and wonder whether there are some important things that you would like to say before we finish talking together’. This statement gives the caller an opportunity to deal with anything pressing that has been omitted. 1 he caller is also prepared for the impending closure. Notice that the statement is clear and owned by the counsellor: '1 would like to finish our calf. You may not be comfortable using this style and that is OK, because you are different from us. Personally, we like to let the caller know our expectations rather than be indirect. 1 he message is then clear and the caller can deal with it in any way they think fit. Having been warned that the call is nearing its end, the caller may take the opportunity7 to bring in new material. A judgement is then needed as to whether to deal with that material in the current call or whether to say to the caller something like: ‘You have now raised some important new issues and 1 think that they need to be considered carefully. Maybe you would like to phone back another time to talk through those issues. However, today 1 think that we should tty to summarise those things that we have talked about and then finish our conversation.’

It is best to give a clear message in preparation for the ending of a call

SUMMARISE THE CALL AND GIVE POSITIVE FEEDBACK

Many callers will not have received positive feedback from anyone

If the caller doesn’t raise new issues, then you, the counsellor, have the opportunity to move into summarising the content and possibly the process of the call. An example of a process statement included in a summary might be: ‘I notice that you seemed to be very distressed at the start of this call when you were discussing ... and 1 get the impression that you are now more confident of your ability to handle the situation . Notice that in this statement the caller receives positive feedback.

Wherever possible give your caller positive feedback, because people in crisis often do not feel good about themselves and may not be getting positive feedback from others. Sometimes it is hard to think of something positive to say, but it is rare not to be able to find something it you join with the caller effectively. Be careful, however, to ensure that the feedback you give is credible. Here are some examples of positive feedback: I am impressed by the way that you have been able to think through the issues and come to some decisions. ! have heard how you have struggled on your own against many difficulties. You strike me as a fighter; someone who doesn't give in easily. I think that you are remarkable to have done as well as you have when I take into account the negative messages you have received from your family. You must have a lot of internal strength. In spite of the personal setbacks you have suffered, you have persisted in your efforts to do the best you can. I think that you've done well. We do need to recognise that there will be times when a caller will still be experiencing a level of painful emotion at the end of a call. For example, it is not reasonable to expect that the counselling process will take away the sadness of a person who has lost a loved one. In a case like this, the counsellor might close the call by summarising and inviting the caller to call back: ‘You are going through a difficult time having suffered a terrible loss. My guess is that you will need to talk to someone from time to time, so please feel welcome to call back.’

TAKE CONTROL Having given the caller some positive feedback, or having invited them to call back, it is now time for you to take control in order to create a comfortable end to the call. This can often be quite difficult and is often more difficult than bringing a face-to-face counselling session to a close. In the face-to-face session, as discussed previously, it’s possible for the counsellor to stand up and to move out of the room, giving clear signals that the session is over. 1 hese non-verbal signals are not available to the TC. Moreover, we human beings are Conditioned to believe that it is bad manners to assertively break off a conversation, particularly if the other person would really like to continue. Some people love to talk and would happily keep you on the phone for hours. Others just do not know how to close off a conversation. With both types of people it is important to be clear and assertive. Usually it is helpful for the counsellor to take responsibility for ending the call

CLOSING THE CALL l ake control! Tell the caller that you intend to finish the call now and at the same time reassure them that it is OK if they want to phone back. It is very important to do this, because some callers feel guilty about taking up a TC’s time and say things such as: 'There must be other people with much more important problems who need your help.' Such people need to be reassured that it is OK for them to ring up again. When ending a call it is important to avoid asking a question or reflecting content or feelings, because if you do, the conversation is certain to continue. Instead, use a positive statement such as: Thank you for sharing your personal difficulties with me. 1 have appreciated the way you have trusted me enough to be able to share so much. Please feel welcome to phone back if you think that I can be of help. Goodbye. It has been good to talk with you about the issues that have been troubling you. i hope that you will feel free to call back another day. Goodbye. I think that you were sensible to phone; everyone needs to talk about personal matters privately at times. Please call again when you need to. Goodbye. Notice that the statements are clear and end with ‘Goodbye/

Learning summary Telephone counselling is, in some ways, more difficult than face-to-face counselling because the counsellor has Little non-verbal information. TCs need to prepare themselves personally before taking a call. Skill in cautiously building a relationship is paramount or the caller may hang up. Hang-ups are inevitable and are not necessarily bad. All of the counselling micro-skills are important; however, minimal responses are particularly important in telephone counselling so that the caller knows that the counsellor is attending. The TC needs to pay attention to the process of each call and if necessary will Influence that process with the goal of increasing the callers awareness. Each call can be thought of as one step in a flight of stairs being climbed by the person seeking help. The caller needs to be empowered to make their own decisions. Making notes and using the imagination helps to bring the caller's situation into focus. TCs need to set clear limits with regard to their relationships with callers. TCs need to debrief after troubling calls or they will bum out. Nuisance callers, regular callers, chronically depressed callers and sex callers can create difficulties for TCs, and appropriate strategies are required for counselling each of these. When closing a call it is not usually helpful to ask questions or reflect content or feelings.

Further reading R osc n fi cl d, M. 1996, (Counselling by Telephone, S A GE, London. Roseiifickb M. 2013, Telephone (Counselling: A Handbook for Practitioners, Palgrave Macmillan, Houndmills. Sanders, P. 2007, ( 'sing (Counselling Skills on the Telephone and in (Computer-Mediated (Communications., 3rd edn, PCCS, Ross-on-Wye.