35. 电话咨询

电话咨询

我们想问读者一个问题：“你认为当一名电话咨询师比面对面咨询师更难，还是相反？”

我们确信你会对这个问题进行深思，因为这两种咨询方式在某些方面相似，但在其他方面却非常不同。在继续阅读之前，你可能希望思考一下主要的区别在哪里。

一个主要区别是，咨询师与求助者之间的接触性质在电话咨询和面对面咨询中显然有所不同，这肯定会对咨询过程产生影响。

有视觉接触的优势

电话咨询师（TC）比面对面咨询师拥有的信息少得多。由于电话咨询师看不到来电者，因此他们缺少大量的信息。 相比之下，面对面咨询师可以直接观察求助者。通过这种视觉接触，他们可以初步判断求助者的情绪状态、应对能力、年龄、社会地位、文化背景和性格特征；他们也能更容易地判断求助者的分享意愿和对咨询关系的舒适度。从视觉观察中，面对面咨询师可以获得许多电话咨询师无法获取的微妙线索。最重要的是，面对面咨询师可以通过肢体语言和面部表情传达非言语信息。这在电话中很难做到。你有没有试过在电话中微笑？这并不是最容易的事情，对吧？你有没有怀疑过电话那头的人是否在哭泣？在面对面的情况下，那些明显的泪水会让你毫无疑问。

电话咨询师只有 非视觉线索 来判断来电者的反应

建立关系的时间

两种咨询方式之间另一个显著的区别在于咨询师与求助者建立关系的能力。面对面咨询师有更多时间通过语言和非语言线索建立关系。很少有人会在咨询开始的前一两分钟内离开。但对于电话咨询师来说，情况则完全不同。如果在通话早期没有建立起一定程度的信任，来电者可能会挂断电话，从而终止咨询过程！

电话咨询

来电者很容易挂断电话

在很多方面，电话咨询比面对面咨询更困难。电话咨询师（TC）需要有良好的“引导”技巧，他们需要能够通过一个渐进的过程主动但不具威胁地吸引来电者，使来电者在关系中感到足够安全，从而开始并继续交谈。

为来电做好准备

为了有效，电话咨询师（图35.1）需要准备好充分利用来电的最初几分钟来吸引来电者；来电的前一两分钟往往至关重要。情绪激动的来电者很容易被吓跑，除非咨询师立即表现出温暖和回应，否则他们可能会挂断电话。

咨询师自身问题的影响

我们咨询师也是有自己需求的人。如果我们被自己的情感问题所困扰，如果我们与他人的未解决事务需要关注，那么当电话响起时，我们很可能没有准备好与来电者互动。放下自己的事情需要时间，除非我们做到了这一点，否则这些问题会干扰我们的工作。 有时候，当求助者来参加第二次或后续的面对面咨询时，咨询师可以通过坦率地承认自己的困扰，向求助者说一些类似的话来放下自己的烦恼，比如：

• 图35.1 咨询师接听电话 “我刚刚经历了艰难的几分钟，还没有完全从那个经历中抽离出来。我告诉你这一点，以便我可以把那个经历放在一边，全神贯注地关注你，而不会被干扰的思绪分散注意力。” 分享这样的信息有两个好处。首先，它解决了咨询师正在经历的过程，可能会使咨询师能够集中精力关注求助者，而不会被干扰的思绪分散。其次，咨询师展示了适当处理或放下困扰思绪的方式。 不幸的是，这种技巧在电话咨询中无法使用，除非来电者与咨询师已经非常熟悉。电话咨询师与来电者的关系通常太脆弱，以至于在来电开始时不宜进行此类披露。

为来电做好准备

电话咨询师需要在电话响起前充分准备好，以便全神贯注地关注来电者和咨询过程。如果他们被担忧或令人不安的思绪困扰，那么他们需要以适当的方式处理这些问题。我们每个人都是不同的，我们准备自己的方式可能不适合其他人。我们需要在电话响起时做好准备。

电话咨询

这里有四种常见的准备电话咨询的方法。它们是：

1. 与主管讨论你自己的问题。
2. 向同事承认你的侵扰思绪。
3. 根据你的精神信仰，使用放松、冥想或祈祷。
4. 参与体育锻炼。

与主管讨论你自己的问题

承认困扰你的问题并与你的主管或其他咨询师讨论，这确实是一个好的方法。通过这样做，问题不仅仅是被搁置，而是得到了解决。这特别有用，因为如果你只是将你自己的问题搁置而不解决，那么当求助者的问题与你自己的问题相似时，这些问题肯定会再次出现。首先解决这些问题显然是理想的。

与同事分享你的问题

不幸的是，在实践中，有时不可能在电话咨询前讨论你自己的问题。然而，可以使用类似于前面描述的面对面咨询师的方法，但不是告诉来电者你需要放下一些困扰的思绪，而是告诉一位同事。你可能只需要对另一位电话咨询师说：“我意识到我带来了一些关于家庭的困扰思绪。我不想把这些负担加在你身上，因为你可能也有自己的需求，但我稍后会与我的主管讨论。告诉你这些思绪存在有助于我暂时把它们放下，让我感觉更有准备接听电话。”

使用放松、冥想或祈祷

使用放松、冥想或祈祷可以帮助咨询师更好地准备电话咨询。我们每个人都是独特的个体，所以适合一个人的方法可能不适合另一个人。虽然一些咨询师发现结构化的放松练习很有帮助，但也有一些人学会了冥想的技巧。有宗教信仰的人经常发现祈祷有助于他们准备接听电话。

参与体育锻炼

在电话咨询前参与体育锻炼是有帮助的。喜欢锻炼的人常常发现，通过这种方式他们能够感觉良好并放下困扰的思绪。选择多种多样，包括慢跑、打高尔夫球、壁球、网球和游泳。

来电者的视角

在讨论了咨询师适当的准备需求之后，现在是时候考虑来电者的立场（图35.2）。来电者通常对预期感到焦虑和不确定。拿起电话拨打陌生人的号码对某些人来说可能是令人担忧的。一些焦虑的来电者可能在最终拨打你的号码并等待你回应之前已经尝试了几次。因此，你作为电话咨询师说出的最初几句话以及你说话的方式至关重要。

图35.2 求助者打电话

初次接触

大多数人倾向于谨慎地接近陌生人。我们在建立关系时会小心翼翼。因此，如果电话咨询师在电话第一次响时就接起并快速讲话，来电者可能会感到受到威胁并被吓跑。我们人类在相互接近时会谨慎行事，当我们感到不舒服时，会因对方的快节奏而退缩。你是否曾经在打电话时，对方在你听到铃声之前就接了电话，感到措手不及？

接电话的方式肯定会对来电者产生立竿见影的影响。

我们需要小心地以适当的速度迎接来电者，因此请保持冷静和放松，以便自然地建立联系。我们发现，在电话响了两三次后再接起，并以温暖、不具威胁的方式回答是有用的。在生命线中心，电话咨询师通常会说：“你好，这里是生命线。我能帮到你吗？”词语很重要，语调和节奏也很重要。声音质量需要平静且邀请，但不要过于热情。

应对“恶作剧”来电者

有些来电者，尤其是儿童，可能会表现出似乎是在恶作剧的行为（参见本章后面的骚扰电话部分）。然而，我们需要小心不要对这些来电者做出不适当的反应，因为他们的行为可能是试图获得咨询服务并测试咨询师对他们的接受程度的一种方式。尊重所有来电者是非常重要的。通过这样做，有时可以在最初看似恶作剧的电话中实现有用的咨询对话。

继续通话

初次接触后，建立信任关系的过程正式开始。不当的反应或不当的时机可能导致来电者挂断电话而不是继续交谈。咨询师需要小心翼翼，认识到并考虑到来电者的犹豫。他们需要谨慎地探索对来电者而言什么是安全的，什么是不安全的。他们必须认真倾听，并运用所有的技能和判断力，努力建立一个舒适的、不具威胁的关系，使来电者能够自由地表达。咨询师需要保持一种充满同理心的理解和温暖，使来电者更加放松而不是被吓跑。对于某些来电者来说，这不成问题，但对其他人来说，正如前所述，拿起电话本身就是一件困难的事。咨询师过多的讲话肯定会把来电者推开，同样，过多的沉默也会产生同样的效果。是的，电话咨询很难！它涉及知道何时应该积极发言，何时应该退后并静听。判断来电者的需求并同理心地回应而不侵扰是必要的。

挂断电话

寻求电话咨询而非面对面咨询的一个优势是，来电者可以随时轻松退出而无需尴尬。不可避免地，一些不习惯给电话咨询师（TC）打电话的来电者可能会在首次尝试参与此类咨询过程中过早挂断电话。当来电者挂断电话时，不要绝望，因为这种情况时不时会发生。尽管如此，每位经验丰富的电话咨询师都知道失去一个电话是多么令人沮丧。当这种情况发生时，提醒自己，来电者可能已经实现了一个小目标，即学会拿起电话、拨打号码并开始交谈。迈出这一步对他们来说可能是一个很大的进步，他们可能会在晚些时候再次打电话来谈得更久。如果你因来电者挂断电话而感到担忧，我们建议你与你的主管讨论这个问题。

所有电话咨询师都会遇到挂断电话的情况——所以不要把它当作个人的事情！

保持专注

电话咨询通常需要高度的集中力和强烈的倾听。通常，情绪困扰的来电者会低声说话，因此很难听清楚。对于新咨询师来说，似乎同时有太多的事情需要关注。咨询师需要倾听所说的话，识别其中的情感，理解或想象来电者的情况，关注通话过程并作出合适的回应。电话咨询对咨询师来说确实是非常具有挑战性的，但对那些合理照顾自己个人需求的咨询师来说，也可以是非常令人满意的（见第42章）。

所需技能

之前描述的咨询微观技能在电话咨询中同样是必需的，就像在面对面咨询中一样。在宏观层面上，电话咨询的通话过程将与面对面咨询的过程非常相似，如第15章所述。然而，在微观和宏观层面上都有一些差异。让我们依次来看这些差异。

微观技能的使用

在电话咨询中，所有先前描述的微观技能都是必需的。然而，在使用这些技能时，需要特别注意补偿缺乏视觉和其他非语言信息。来电者看不到你的脸、面部表情或身体姿势。在我们日常的交流中，我们说的话会因为伴随的非语言行为而被调节、放大或以其他方式改变。例如，咨询师在说话时向前倾身可以增加他们所说内容的强调。一个关怀的表情可以让对方确信咨询师所说的话并不是有意伤害他们，即使这些话可能令人难以面对。

来电者的感知

来电者只能通过你的口头提示来知道你还在听。

电话咨询师需要通过在声音中加入更多的音调和表情来弥补缺乏非语言线索。此外，虽然面对面咨询师可以在某些时候保持沉默，但在电话咨询中，咨询师需要定期给出口头提示，表明他们仍在倾听。显然，这不应该过度，但听到像“啊哈”，“是的”，“嗯”这样的最小回应，对来电者来说是令人安心的。在与朋友或家人的个人电话中，你是否曾因为对方一直在沉默地听而不得不问“你还在吗？”？大多数人在打电话时几乎或没有得到回应时会感到不安。当然，在咨询情况下，让来电者知道咨询师还在那里并专心倾听是很重要的。

补偿非语言信息

同样，电话咨询师看不见来电者，因此需要向来电者确认在面对面咨询中显而易见的信息。在长时间的沉默中，可以适当地问：“你现在怎么样？”如果你怀疑来电者在哭泣但不确定，可以等一会儿，然后用平静、关怀的语气说：“你说话时听起来非常悲伤，我在想你是不是开始哭了。”

宏观视角：整体过程

电话咨询的通话过程通常可以用图16.1所示的流程图来描述（见第135页）。显然，每个电话都是不同的，但识别并必要时影响通话进展的各个阶段是有帮助的。例如，识别何时从主动倾听阶段进入后期阶段是有利的。在这种情况下，咨询师需要相信自己的直觉，对来电者敏感，并能够判断整个通话过程是否满足了来电者的需求。在这方面，经验和督导是有用的。

影响通话的过程

在关注来电者的同时，花时间识别通话的方向，如果合适，做出有关过程的决定。例如，如果你继续对慢性抑郁的来电者进行积极倾听，特别是当你在反映他们的感受和消极想法时，这不会对他们有帮助。事实上，你可能会帮助他们进一步陷入绝望的深渊！识别何时该继续前进，并开始使用解决思维和行为的技能（见第31章）。

正如本书前面部分所描述的那样，重要的是要跟随来电者选择的方向，一般优先考虑来电者的议程而不是你自己的。然而，这些指导方针不是僵硬的规则，需要在整体通话、来电者的情况、咨询机构的政策以及咨询师自身的咨询目标的背景下灵活应用。

我们认为，如果在通话中取得了一些进展，使得来电者有可能出现适应性变化，那么来电者更有可能感到得到了帮助。为了实现这一点，电话咨询师有时需要影响通话的方向和过程。然而，不要忘记，变化通常是通过增强意识而不是通过咨询师推动变化来实现的（见第26章关于促进行动）。

如果来电者反复讲述相同的材料，那么直接面对这一过程并提高他们的意识是合适的（见第19章）。通常，告诉来电者你在通话中注意到的情况会很有用。例如，咨询师可能会对患有慢性抑郁症的来电者说：“我注意到你似乎被抑郁压垮了。”一旦过程被识别，电话咨询师就有机会将通话带入新的阶段。例如，咨询师可能会进入强调思维的阶段（见图16.1和16.2），并使用解决方案聚焦咨询中的例外导向问题（见第22章）。咨询师可能会问：“有没有什么时候抑郁没有压垮你？”这个问题之后，可以接着问：“那时有什么不同？”或者“所以有一段时间你知道如何战胜抑郁？”以及“现在有什么你可以做的，类似于以前你控制住抑郁时所做的事吗？”我们使用抑郁的例子是因为大多数电话咨询中心会收到大量来自患有慢性抑郁的人的电话。这些人往往需要医疗或心理治疗的帮助，如果还没有发生这种情况，提出这个选项是很重要的（关于咨询患有抑郁的人的更多信息，见第31章）。

你可能会惊讶于我们暗示电话咨询师可能需要比面对面咨询师更多地关注咨询过程的控制。我们认为这是真的，因为电话来电者往往不受时间限制，当他们与咨询师相处得舒服时，一些来电者会满足于聊天而不是集中注意力以建设性地利用互动。此外，电话咨询师通常只与特定的来电者有一次互动，因此没有持续工作的可能性，而面对面咨询则更常发生这种情况。

满足每位来电者的个人需求

如果我们回顾图16.1和16.2（见第135和136页），可以看出，对一些来电者来说，按照图中描述的流程直接进行就足够了。对其他来电者来说，如果要帮助他们，某些阶段需要特别强调。随着每次通话的进展，来电者及其情况的画像将逐渐显现，你需要做出最佳决策来帮助这位来电者。你可能会决定，通话主要停留在积极倾听和情感强调阶段就足够了，从而让来电者获得宣泄的效果。然而，对于其他通话，可能需要温和地鼓励来电者进入后续阶段，以便更全面地澄清问题，或促进思维或行为的变化。

要成为一位完全有效且负责任的电话咨询师（TC），你需要能够评估每位来电者最需要什么。与面对面咨询不同，你可能没有机会再次与某人进行咨询对话，因此你需要充分利用这次机会。然而，不要认为你必须在一次通话中实现改变生活的结果。如果来电者觉得与你交谈有用，他们很可能会再次使用电话咨询服务。每次通话都可以看作是在楼梯上向上走一步，来电者每次都在逐步前进。

解决来电者的问题

一个童话故事

从前，在大悲剧和绝望之地，住着一个被称为超级电话咨询师（Super-TC）的了不起的人。超级电话咨询师比大多数电话咨询师更好，因为他的通话时间只有几分钟。他总是能给出好的建议，来电者通常会礼貌地感谢他。他的方法是迅速识别来电者的问题，然后提出解决方案。有时，当超级电话咨询师自己想不出解决方案时，这种情况并不经常发生，他会将来电者转介给可能有解决方案的其他人。偶尔，来电者会明确表示他们希望进行更长时间的咨询互动。在这种情况下，超级电话咨询师会对来电者说：“很明显，你有一个相当严重的精神问题。你需要立即预约一位面对面的咨询师，或者更好的是，一位精神科医生。”

有时候，尤其是在疲惫的时候，电话咨询师（TC）很容易无意中开始表现出一些像超级电话咨询师的行为。没有人是完美的。提供快速解决方案总是诱人的，而不是忍受聆听他人痛苦的情绪。当然，有时适当且负责任的做法是将来电者转介给其他人。然而，通常在这样做之前，最好让来电者处理他们在“此时此地”的情感问题。通常这样做后，转介可能就不必要了。

有些专门接受电话工作培训的电话咨询师认为，面对面咨询师必然比他们更有能力，结果他们会先将来电者转介给面对面咨询，而不是通过正常的咨询技巧和过程充分帮助他们。不幸的是，我们这些专业的面对面咨询师、社会工作者、心理学家和精神科医生的能力各不相同。是的，当你超出自己的能力范围时，转介是适当的，而且不这样做是不道德和不负责任的。然而，如果来电者希望在电话中与你充分探讨他们的痛苦，请给他们这个机会，同时在必要时提供进一步的转介。如果你对自己的做法不确定，我们建议你与你的主管讨论。

当有疑问时，咨询你的主管

不幸的是，超级电话咨询师（Super-PCs）可能会削弱来电者的自主能力。 通过为他们找到解决方案，超级电话咨询师可能隐含地传达出这样一个信息：‘你没有能力管理自己的生活和做出自己的决定。你需要别人告诉你该怎么做。’ 虽然在我们的生活中确实有需要别人告诉我们该做什么的时候，但通常具有正常智力的人类更喜欢自己做决定，并且如果通过咨询过程获得赋权，会感觉良好。如果咨询真的有效，一个被赋权的与咨询师交谈过的人可能会想：‘咨询并没有多大帮助，咨询师没有告诉我该怎么做，而是我自己做了决定。我是一个不错的人，可以管理自己的生活。’

显然，为他人寻找解决方案通常是没有帮助的。然而，帮助人们为自己找到解决方案是非常有用的。在这方面，读者可能希望使用第22章中描述的解决方案聚焦技能。

通话期间做笔记

• 图35.3 家系图 x. 2年 10年 5年 x z ■X Si 符号说明

• 女性 -----
• 男性 ------
• 性别未知
• 已婚
• 分居 ~~
• 离婚 —//—
• 已故 Yxf
• 围绕在一起生活的人的边界 注：
• 比尔与桑德拉结婚，他们有两个孩子，尼古拉斯和莫妮克。
• 桑德拉和比尔离婚了。
• 后来，比尔遇到了莫琳，他们有一个2岁的孩子。

全神贯注地接听来电

全神贯注地接听来电并同时关注通话过程，以便在必要时促进适当的变化，这并不容易。需要高度集中注意力，很容易分心并忘记重要信息。为了避免丢失信息，并帮助更全面地理解来电者的情况，以便更清晰地看到他们的画面，通话过程中做笔记是有用的。一些电话咨询师在通话进行时添加草图，发现这有助于他们更专注地关注来电者。

绘制家系图

如果来电者在谈论家庭问题，那么电话咨询师绘制家系图是有用的。图35.3是一个简单的家系图示例。家系图可以帮助咨询师更全面地理解来电者的背景。

家系图示例

• 图35.3 家系图

符号 含义 ♀ 女性 ♂ 男性

• 性别未知 —— 已婚 ~~ 分居 —/— 离婚 X 已故 边界 住在同一处的人 注：比尔曾与桑德拉结婚，他们有两个孩子，尼古拉斯和莫妮克。桑德拉和比尔离婚了。后来，比尔遇到了莫琳，他们有一个两岁的孩子。

发挥想象力

作为电话咨询师，你无法看到来电者，但你可以选择想象他们。当他们在说话时，你可以构建一个视觉画面，并设身处地地想象自己处于来电者的位置和情境中。如果你这样做，你可能会更充分地体验到作为来电者的感受，从而能够以非评判性的同理心回应。

电话咨询的优势

电话咨询可以帮助那些不愿意前来面对面咨询的人。

电话咨询的难度与价值

我们之前已经指出，在我们看来，电话咨询比面对面咨询更困难。然而，它是一种极其有价值的咨询形式。有些人永远不会来参加面对面咨询，但他们会使用电话。从来电者的角度来看，电话咨询提供了以下优势：

• 安全性：对来电者来说更安全，因为他们可以保护自己的匿名性。这可能有助于他们减少与陌生人分享私人想法和情感的顾虑。
• 即时退出：来电者知道，如果他们感到受到威胁，可以挂断电话。这比走出咨询室要容易得多。
• 即时可访问：电话咨询易于且立即可访问（除非线路忙），无需等待。来电者只需拿起电话拨打即可。
• 低成本：一般来说，电话咨询对来电者的成本较低。

设置界限

1. 安全环境与风险

• 安全环境：电话咨询提供了一个安全的环境，来电者可以分享他们最深的秘密。
• 风险：因此，它也存在一些风险。一些打电话进来的人是孤独的，没有可以倾听他们的亲密朋友。这样的人非常脆弱，可能希望有一个理解的朋友。

2. 咨询师的角色

• 优秀咨询师的特点：优秀的咨询师是接受的、温暖的、同理心强的、不带评判的。
• 来电者的误解：因此，孤独的来电者可能会对与他们分享的人形成非常歪曲的看法，对咨询师有非常正面的感知。

3. 设置明确的界限

• 重要性：因此，设置明确的界限至关重要，以确保来电者明白这种关系是电话关系，不能超出这一点。
• 避免期望：否则，会在来电者心中建立起一种期望，即可能有个人关系的开始。
• 伦理问题：记住，孤独、不快乐的人往往是需要帮助和脆弱的。利用他们是完全不道德的。
• 现实考量：此外，认为如果你允许关系从咨询关系转变为友谊就能帮助他们是不现实的。这样做会损害他们信任咨询过程作为未来可以使用的安全手段的能力。

复盘

复盘是一个过程，旨在帮助咨询师释放他们在倾听痛苦的人时不可避免地经历的情绪。 如果一个咨询师对你说，“作为一个有经验的电话咨询师——我不需要复盘，因为寻求帮助的人的电话不会困扰我”，你会相信他们吗？ 所有咨询师，无论多么有经验，都需要复盘，尤其是在特别紧张的咨询会话之后。尽管我们都是有经验的专业咨询师，但我们仍然定期在困难或情绪化的咨询会话后进行复盘。如果我们不这样做，我们提供的服务必然会变得不那么有效，我们也会出现职业倦怠的症状。 电话咨询师特别容易受到他们咨询工作的情感后遗症的影响。处于急性危机中的人们常常会打电话寻求帮助。因此，电话咨询师经常接到极度痛苦和/或恐慌的人的电话。不出所料，电话咨询经常导致危机干预（见第33章）。

电话咨询的压力

由于电话咨询内容的必然危机性质，电话咨询师在电话班次结束时有时会感到精疲力尽。来电者的情感痛苦有时会不可避免地触发他们的个人情感压力。因此，电话咨询师需要对自己负责，照顾好自己。在特别紧张的电话之后，我们建议在接下一个电话之前休息一下，如果可能的话，与你的主管或其他咨询师讨论你正在经历的感受。每个咨询班次结束后，再次与你的主管或其他咨询师聊几分钟进行复盘。复盘不需要是一个漫长的过程，但它是一个重要的过程。

问题来电者

不考虑所谓的“问题来电者”就不能完整地讨论电话咨询。这些来电者会给电话咨询师带来特殊的问题。他们的目标可能与咨询服务的目标不一致，因此可能希望不恰当地使用服务。其中一些人可能希望满足在其他地方未得到满足的特定需求。然而，问题来电者是有真实需求的人，因此电话咨询师需要能够以建设性的方式处理他们的来电，充分解决他们的咨询需求。 大多数问题来电者属于以下类别之一：

1. 恶意来电者
2. 经常来电者
3. 受慢性抑郁困扰的来电者
4. 性来电者

本章知识点阐述

进一步阐述知识点

1. 电话咨询与面对面咨询的比较

相似之处

• 目的：两者都是为了帮助求助者解决问题。
• 技能要求：都需要咨询师具备良好的沟通技巧和同理心。

不同之处

• 接触性质：主要在于咨询师与求助者之间的接触性质不同，这会影响咨询过程。

2. 有视觉接触的优势

信息量

• 观察细节：面对面咨询师可以直接观察求助者，获取大量信息，包括情绪状态、应对能力、年龄、社会地位、文化背景和性格特征等。

非言语信息

• 肢体语言和面部表情：面对面咨询师可以通过肢体语言和面部表情传达非言语信息，这在电话中很难做到。例如，微笑和眼泪在面对面交流中更容易被察觉，而在电话中则难以传达。

建立信任

• 视觉线索：面对面咨询师更容易通过视觉线索建立信任关系，而电话咨询师则缺乏这些线索。

3. 建立关系的时间

面对面咨询

• 时间优势：咨询师有更多时间通过语言和非语言线索建立关系。很少有人会在咨询开始的前一两分钟内离开。

电话咨询

• 时间紧迫：咨询师需要在短时间内迅速建立信任，否则来电者可能会挂断电话，终止咨询过程。这要求电话咨询师具备快速建立信任和维持对话的能力。

总结

电话咨询和面对面咨询各有优劣。电话咨询师面临的主要挑战是缺乏视觉线索，这使得他们难以全面了解求助者的情况，也增加了建立信任的难度。而面对面咨询师可以通过丰富的视觉信息和非言语线索更好地理解求助者，建立更牢固的信任关系。因此，电话咨询师需要特别注意通过语言和倾听技巧来弥补这些不足，迅速建立信任，确保咨询的有效性。这些知识点不仅有助于理解两种咨询方式的差异，还能指导咨询师在实际工作中更好地应对各种挑战。

进一步阐述知识点

1. 来电者很容易挂断电话

挑战

• 主要挑战：电话咨询的一个主要挑战是来电者很容易挂断电话。这要求电话咨询师具备高度的敏感性和反应能力。

技巧

• 引导技巧：电话咨询师需要有良好的“引导”技巧，能够通过渐进的过程主动但不具威胁地吸引来电者，使来电者在关系中感到足够安全，从而开始并继续交谈。

2. 为来电做好准备

关键时期

• 前一两分钟：来电的前一两分钟往往至关重要。情绪激动的来电者很容易被吓跑，除非咨询师立即表现出温暖和回应，否则他们可能会挂断电话。

准备工作

• 心理准备：放下自己的担忧和不安，确保自己处于最佳状态。
• 环境准备：确保周围环境安静，没有干扰。
• 技术准备：确保电话设备正常工作，网络连接稳定。

3. 咨询师自身问题的影响

自身需求

• 情感问题：咨询师也是有自己需求的人，如果被自己的情感问题所困扰，可能无法有效与来电者互动。

处理方式

• 自我反思：在接电话前进行自我反思，确保自己处于最佳状态。
• 求助同事：在必要时寻求同事的支持和建议。
• 开放沟通：在面对面咨询中，咨询师可以通过坦率地承认自己的困扰来放下烦恼，但这在电话咨询中通常不可行，除非来电者与咨询师已经非常熟悉。

4. 为来电做好准备

心理准备

• 最佳状态：电话咨询师需要在电话响起前充分准备好，确保自己处于最佳状态，能够全神贯注地关注来电者和咨询过程。

具体措施

• 处理个人问题：如果被担忧或令人不安的思绪困扰，需要以适当的方式处理这些问题。
• 个体差异：每个人都是不同的，准备自己的方式可能不适合其他人。咨询师需要找到适合自己的方法。
• 随时待命：确保在电话响起时做好准备，能够迅速进入工作状态。

总结

电话咨询与面对面咨询相比，具有更多的挑战性。电话咨询师需要具备高度的敏感性和反应能力，能够在来电的前一两分钟内迅速建立信任关系。为了有效应对这些挑战，电话咨询师需要在电话响起前做好充分的准备，包括心理准备、环境准备和技术准备。此外，咨询师需要处理好自己的情感问题，确保自己处于最佳状态，能够全神贯注地关注来电者。这些知识点不仅有助于理解电话咨询的特殊性，还能指导咨询师在实际工作中更好地应对各种挑战。

[进一步阐述知识点

1. 电话咨询的四种常见准备方式

• 与主管讨论你自己的问题

  • 目的：通过与主管或其他咨询师讨论，将问题解决而不是仅仅搁置。
  • 好处：避免在处理相似问题时旧问题重新浮现，确保咨询师在最佳状态下工作。
  • 具体步骤：
    • 承认问题：承认自己当前的困扰。
    • 讨论问题：与主管详细讨论这些问题。
    • 解决问题：通过讨论找到解决问题的方法。

• 与同事分享你的问题

  • 目的：通过告诉同事自己的困扰想法，暂时放下这些想法。
  • 好处：减轻心理负担，提高接听电话的准备程度。
  • 适用场景：在无法与主管讨论时，可以与同事分享。
  • 具体步骤：
    • 承认问题：告诉同事自己当前的困扰。
    • 暂时放下：通过告知同事，暂时放下这些想法。
    • 后续处理：计划在稍后与主管详细讨论这些问题。

• 使用放松、冥想或祈祷

  • 目的：通过放松、冥想或祈祷来帮助咨询师更好地为电话咨询做好准备。
  • 好处：根据个人的精神取向选择合适的方法，提高心理状态和专注力。
  • 具体方法：
    • 放松：进行结构化的放松练习。
    • 冥想：学习和实践冥想技巧。
    • 祈祷：对于有宗教信仰的人来说，祈祷是一种有效的准备方式。

• 参与体育锻炼

  • 目的：通过体育锻炼来放松身心，提高接听电话时的状态。
  • 好处：释放压力，提升心情，增强身体和心理的准备。
  • 具体活动：
    • 慢跑：简单的有氧运动，有助于放松身心。
    • 高尔夫：轻松的户外活动，有助于缓解压力。
    • 壁球、网球：高强度的运动，有助于释放紧张情绪。
    • 游泳：全身运动，有助于放松肌肉和心理压力。

2. 与主管讨论你自己的问题

• 重要性：通过与主管讨论，不仅可以解决当前的问题，还可以预防未来类似问题的再次出现。
• 具体步骤：
  • 承认问题：承认自己当前的困扰。
  • 讨论问题：与主管详细讨论这些问题。
  • 解决问题：通过讨论找到解决问题的方法。

3. 与同事分享你的问题

• 适用场景：在无法与主管讨论时，可以与同事分享。
• 具体步骤：
  • 承认问题：告诉同事自己当前的困扰。
  • 暂时放下：通过告知同事，暂时放下这些想法。
  • 后续处理：计划在稍后与主管详细讨论这些问题。

4. 使用放松、冥想或祈祷

• 个性化选择：根据个人的精神取向选择合适的方法。
• 具体方法：
  • 放松：进行结构化的放松练习。
  • 冥想：学习和实践冥想技巧。
  • 祈祷：对于有宗教信仰的人来说，祈祷是一种有效的准备方式。

5. 参与体育锻炼

• 心理和生理双重益处：通过体育锻炼释放压力，提升心情。
• 具体活动：
  • 慢跑：简单的有氧运动，有助于放松身心。
  • 高尔夫：轻松的户外活动，有助于缓解压力。
  • 壁球、网球：高强度的运动，有助于释放紧张情绪。
  • 游泳：全身运动，有助于放松肌肉和心理压力。

6. 来电者的视角

• 来电者的焦虑：来电者往往焦虑且不确定会发生什么。
• 应对策略：
  • 第一句话：电话咨询师的第一句话非常重要，需要表现出温暖和关心。
  • 说话方式：用平和、友好的语气与来电者交流，让他们感到安全和舒适。

总结

电话咨询前的准备对于确保咨询的有效性至关重要。咨询师可以通过与主管讨论问题、与同事分享困扰、使用放松和冥想技巧或参与体育锻炼来做好准备。这些方法不仅有助于咨询师在最佳状态下工作，还能提高来电者的信任感和安全感。通过这些准备，电话咨询师可以更好地应对来电者的焦虑和不确定性，确保咨询过程顺利进行。这些知识点不仅有助于理解电话咨询的准备工作，还能指导咨询师在实际工作中更好地应对各种挑战。 ]

[进一步阐述知识点

1. 初次接触

• 谨慎的态度：大多数人在初次接触时都会谨慎行事，因此电话咨询师在接电话时也需要保持这种谨慎态度。
  • 接电话的方式：
    • 速度：不要在电话第一次响时就接起，最好等两三次铃声后再接。
    • 语气：以温暖、不具威胁的方式回答，例如：“你好，这里是生命线。我能帮到你吗？”
    • 声音质量：声音需要平静且邀请，但不要过于热情。
    • 影响：接电话的方式会立即影响来电者的感觉，因此需要小心处理。

2. 应对“恶作剧”来电者

• 行为表现：有些来电者，特别是儿童，可能会表现出似乎是在恶作剧的行为。
  • 处理方式：
    • 尊重：不要对这些来电者做出不适当的反应，尊重他们的行为。
    • 理解：他们的行为可能是试图获得咨询服务并测试咨询师对他们的接受程度的一种方式。
    • 对话：通过同理心和尊重，有时可以在最初看似恶作剧的电话中实现有用的咨询对话。

3. 继续通话

• 建立信任：初次接触后，建立信任关系的过程正式开始。
  • 注意事项：
    • 不当反应：不当的反应或不当的时机可能导致来电者挂断电话。
    • 小心翼翼：咨询师需要小心翼翼，认识到并考虑到来电者的犹豫。
    • 探索安全：谨慎地探索对来电者而言什么是安全的，什么是不安全的。
    • 认真倾听：认真倾听并运用所有的技能和判断力，努力建立一个舒适的、不具威胁的关系。
    • 同理心：咨询师需要保持一种充满同理心的理解和温暖，使来电者更加放松而不是被吓跑。
    • 平衡：咨询师过多的讲话或过多的沉默都会把来电者推开。电话咨询需要知道何时应该积极发言，何时应该退后并静听。

总结

电话咨询的初次接触非常关键，需要咨询师保持冷静和放松，以适当的速度和温暖的方式接电话。应对“恶作剧”来电者时，咨询师需要保持尊重和同理心，有时可以在看似恶作剧的电话中实现有用的咨询对话。继续通话时，咨询师需要小心翼翼地建立信任关系，认真倾听并运用技能和判断力，确保来电者感到安全和舒适。电话咨询是一项复杂的工作，需要咨询师在言语和沉默之间找到平衡，判断来电者的需求并同理心地回应。这些知识点不仅有助于理解电话咨询的关键步骤，还能指导咨询师在实际工作中更好地应对各种挑战。 ]

[进一步阐述知识点

1. 挂断电话

• 优势：电话咨询的一个优势是来电者可以随时轻松退出而无需尴尬。
  • 原因：一些不习惯给电话咨询师打电话的来电者可能会在首次尝试时过早挂断电话。
  • 应对：
    • 不要绝望：当来电者挂断电话时，不要绝望，因为这种情况时不时会发生。
    • 小目标：提醒自己，来电者可能已经实现了一个小目标，即学会拿起电话、拨打号码并开始交谈。
    • 后续：他们可能会在晚些时候再次打电话来谈得更久。
    • 支持：如果你因来电者挂断电话而感到担忧，建议与你的主管讨论这个问题。

2. 保持专注

• 高集中力：电话咨询通常需要高度的集中力和强烈的倾听。
  • 挑战：
    • 低声说话：情绪困扰的来电者可能会低声说话，因此很难听清楚。
    • 多任务处理：新咨询师可能觉得同时有太多的事情需要关注。
  • 技能要求：
    • 倾听：倾听所说的话。
    • 识别情感：识别其中的情感。
    • 理解情况：理解或想象来电者的情况。
    • 关注过程：关注通话过程。
    • 作出回应：作出合适的回应。
  • 满足感：电话咨询对咨询师来说是非常具有挑战性的，但对那些合理照顾自己个人需求的咨询师来说，也可以是非常令人满意的。

3. 所需技能

• 微观技能：之前描述的咨询微观技能在电话咨询中同样是必需的，就像在面对面咨询中一样。
  • 宏观过程：电话咨询的通话过程与面对面咨询的过程非常相似。
  • 差异：
    • 微观差异：在使用微观技能时，需要特别注意补偿缺乏视觉和其他非语言信息。
    • 宏观差异：在宏观层面上，电话咨询和面对面咨询的过程相似，但在细节上有所不同。

4. 微观技能的使用

• 补偿非语言信息：在电话咨询中，来电者看不到你的脸、面部表情或身体姿势，因此需要特别注意补偿缺乏视觉和其他非语言信息。
  • 例子：
    • 强调：咨询师在说话时向前倾身可以增加他们所说内容的强调。
    • 表情：一个关怀的表情可以让对方确信咨询师所说的话并不是有意伤害他们，即使这些话可能令人难以面对。

总结

电话咨询中，挂断电话是一个常见的现象，咨询师需要保持冷静，不要将其视为个人失败。保持高度的集中力和强烈的倾听是电话咨询的关键，新咨询师需要学会同时处理多个任务。电话咨询所需的微观技能与面对面咨询相同，但在使用这些技能时需要特别注意补偿缺乏视觉和其他非语言信息。通过这些技巧，电话咨询师可以更好地与来电者建立联系，提供有效的支持。这些知识点不仅有助于理解电话咨询的挑战和应对方法，还能指导咨询师在实际工作中更好地处理各种情况。 ]

[进一步阐述知识点

1. 影响通话的过程

• 识别方向：在关注来电者的同时，花时间识别通话的方向，如果合适，做出有关过程的决定。
  • 避免过度倾听：例如，对慢性抑郁的来电者进行过度的积极倾听，特别是反映他们的消极想法时，可能会帮助他们进一步陷入绝望。识别何时该继续前进，并开始使用解决思维和行为的技能。
  • 灵活应用：这些指导方针不是僵硬的规则，需要在整体通话、来电者的情况、咨询机构的政策以及咨询师自身的咨询目标的背景下灵活应用。

2. 增强意识

• 促进变化：如果在通话中取得了一些进展，使得来电者有可能出现适应性变化，那么来电者更有可能感到得到了帮助。
  • 增强意识：变化通常是通过增强意识而不是通过咨询师推动变化来实现的。电话咨询师有时需要影响通话的方向和过程，但要注重增强来电者的意识。

3. 处理重复内容

• 直接面对：如果来电者反复讲述相同的材料，直接面对这一过程并提高他们的意识是合适的。
  • 提高认识：告诉来电者你在通话中注意到的情况会很有用。例如，对患有慢性抑郁症的来电者说：“我注意到你似乎被抑郁压垮了。”
  • 新的阶段：一旦过程被识别，电话咨询师就有机会将通话带入新的阶段。例如，进入强调思维的阶段，并使用解决方案聚焦咨询中的例外导向问题。
  • 具体问题：咨询师可以问：“有没有什么时候抑郁没有压垮你？”“那时有什么不同？”“所以有一段时间你知道如何战胜抑郁？”“现在有什么你可以做的，类似于以前你控制住抑郁时所做的事吗？”

4. 特殊情况

• 抑郁案例：我们使用抑郁的例子是因为大多数电话咨询中心会收到大量来自患有慢性抑郁的人的电话。这些人往往需要医疗或心理治疗的帮助，如果还没有发生这种情况，提出这个选项是很重要的。
  • 时间管理：电话来电者往往不受时间限制，当他们与咨询师相处得舒服时，一些来电者会满足于聊天而不是集中注意力以建设性地利用互动。
  • 单次互动：电话咨询师通常只与特定的来电者有一次互动，因此没有持续工作的可能性，而面对面咨询则更常发生这种情况。

总结

在电话咨询中，咨询师需要在关注来电者的同时，花时间识别通话的方向，并在合适时做出有关过程的决定。避免对慢性抑郁的来电者进行过度的积极倾听，而是识别何时该继续前进，并开始使用解决思维和行为的技能。变化通常是通过增强意识而不是通过咨询师推动变化来实现的。如果来电者反复讲述相同的材料，直接面对这一过程并提高他们的意识是合适的。通过提高认识，咨询师可以将通话带入新的阶段，使用具体的解决方案聚焦问题。在处理特殊情况下，如慢性抑郁，咨询师需要关注医疗或心理治疗的帮助，并注意时间管理和单次互动的特点。这些知识点不仅有助于理解电话咨询的关键技巧，还能指导咨询师在实际工作中更好地应对各种挑战。 ]

进一步阐述知识点

应对每位来电者的个人需求

1. 个体化处理

• 直接过程：对于一些来电者来说，直接按照标准咨询流程进行可能就足够了。这些来电者可能只需要基本的支持和建议。
• 特别强调：对于其他来电者，某些阶段需要特别强调，以帮助他们。这些阶段可能包括主动倾听、情感强调、问题澄清、思维和行为改变等。

2. 动态评估

• 逐步了解：随着通话的进展，你会逐渐了解来电者及其情况，并需要做出最佳帮助的决策。
• 情感宣泄：你可能会决定，通话主要集中在主动倾听和情感强调阶段，从而为来电者带来情感宣泄。
• 逐步引导：对于其他通话，可能需要温和地鼓励来电者进入后续阶段，以便更全面地澄清问题，或促进思维和行为的改变。

3. 高效且负责任的电话咨询师

• 评估需求：为了成为一位高效且负责任的电话咨询师（TC），你需要能够评估每位来电者最合适的处理方式。
• 一次性机会：与面对面咨询不同，你可能没有机会再次与特定的来电者进行咨询对话，因此你需要充分利用这次机会。
• 渐进式帮助：不要期望在一次通话中实现改变生活的结果。每次通话都可以被视为一个向上爬楼梯的步骤，来电者每次只前进一小步。

解决来电者的问题

1. 快速解决方案的诱惑

• 超级电话咨询师：超级电话咨询师（Super-TC）通常能够迅速识别问题并提供解决方案。这种方法虽然高效，但并不总是最合适。
• 情感支持：提供快速解决方案总是诱人的，而不是忍受聆听他人痛苦的情感。然而，情感支持同样重要，甚至更为关键。

2. 适时引荐

• 适当引荐：当然，有时适当且负责任的做法是将来电者引荐给他人，特别是在你感到力不从心时。
• 专业差异：不同的专业人士在能力上各不相同。不是所有的面对面咨询师、社会工作者、心理学家和精神科医生都比电话咨询师更有能力。
• 综合支持：在必要时提供进一步的引荐，但也要给来电者机会在电话中充分探索他们的痛苦。

3. 自我监督和改进

• 不确定时的求助：如果你不确定自己的做法，建议与你的主管谈谈。这不仅可以帮助你提高专业能力，还可以确保你提供最合适的帮助。

总结

电话咨询师需要具备灵活应对每位来电者的能力，根据来电者的需求和情况做出最佳的决策。通过动态评估和逐步引导，电话咨询师可以有效地帮助来电者处理情感问题，逐步推进问题的解决。在必要时提供进一步的引荐，但也要给来电者机会在电话中充分探索他们的痛苦。如果你不确定自己的做法，及时与主管沟通，以确保提供最合适的帮助。

进一步阐述知识点

1. 赋权的重要性

• 避免削弱自主权：超级电话咨询师（Super-TCs）通过为来电者提供快速解决方案，可能会削弱他们的自主权。这种做法传达了一种隐含的信息，即来电者没有能力管理自己的生活和做出自己的决定。
• 自我决策：通常情况下，正常智力的人类更喜欢自己做决定。通过咨询过程获得赋权，来电者会感觉更好，并且更有可能对自己产生积极的评价。

2. 有效的咨询

• 赋权的效果：如果咨询真正有效，来电者会感到自己有能力管理自己的生活。他们可能会认为咨询并没有直接告诉他们该怎么做，而是帮助他们自己做出了决定。
• 自我效能感：通过咨询过程，来电者会增强自我效能感，相信自己有能力应对生活中的挑战。

3. 帮助来电者自己找到解决方案

• 解决方案聚焦技能：帮助来电者自己找到解决方案是非常有用的。在这方面，读者可以参考第22章中描述的解决方案聚焦技能。
• 积极影响：通过这种方法，咨询师可以帮助来电者增强自信，提高解决问题的能力，从而在长期中获得更好的效果。

4. 通话中做笔记

• 家系图：家系图是一种图形工具，用于记录家庭成员之间的关系和重要事件。通过家系图，咨询师可以更全面地了解来电者的家庭背景。

• 符号含义：

  • ♀ 表示女性
  • ♂ 表示男性
  • • 表示性别未知
  • —— 表示已婚
  • ~~ 表示分居
  • —/— 表示离婚
  • X 表示已故
  • 边界表示住在同一处的人

• 具体案例：比尔曾与桑德拉结婚，他们有两个孩子，尼古拉斯和莫妮克。桑德拉和比尔离婚了。后来，比尔遇到了莫琳，他们有一个两岁的孩子。通过家系图，咨询师可以清晰地看到比尔的家庭关系变化，从而更好地理解他的情况。

总结

在电话咨询中，咨询师需要避免提供快速解决方案，而是通过赋权帮助来电者自己做出决定。这不仅有助于增强来电者的自我效能感，还能提高咨询的长期效果。在通话过程中，做好笔记，特别是使用家系图等工具，可以帮助咨询师更全面地了解来电者的情况，从而提供更有效的支持。如果在咨询过程中遇到疑问，应及时咨询主管，确保提供最合适的帮助。

进一步阐述知识点

全神贯注地接听来电

1. 注意力集中

• 难度：全神贯注地接听来电并同时关注通话过程，以便在必要时促进适当的变化，这并不容易。
• 高集中度：需要高度集中注意力，很容易分心并忘记重要信息。

2. 做笔记的重要性

• 避免信息丢失：为了避免丢失信息，并帮助更全面地理解来电者的情况，通话过程中做笔记是有用的。
• 更清晰的画面：通过做笔记，咨询师可以更清晰地看到来电者的画面，更好地理解他们的背景和情况。

3. 添加草图

• 增加专注度：一些电话咨询师在通话进行时添加草图，发现这有助于他们更专注地关注来电者。
• 视觉辅助：草图可以作为一种视觉辅助工具，帮助咨询师更好地理解和记忆来电者的信息。

绘制家系图

1. 家庭问题

• 适用场景：如果来电者在谈论家庭问题，电话咨询师绘制家系图是有用的。
• 示例：图35.3是一个简单的家系图示例，展示了比尔的家庭关系变化。

2. 家系图的作用

• 全面理解：家系图可以帮助咨询师更全面地理解来电者的背景，包括家庭成员之间的关系和重要事件。
• 视觉化：通过家系图，咨询师可以更直观地看到家庭结构和关系，从而更好地支持来电者。

发挥想象力

1. 设身处地

• 想象来电者：作为电话咨询师，你无法看到来电者，但可以选择想象他们。
• 构建画面：当他们在说话时，你可以构建一个视觉画面，并设身处地地想象自己处于来电者的位置和情境中。

2. 体验感受

• 更充分的体验：如果你这样做，你可能会更充分地体验到作为来电者的感受。
• 非评判性同理心：通过这种方式，咨询师能够以非评判性的同理心回应来电者，提供更有效的支持。

电话咨询的优势

1. 接触更多人群

• 扩大服务范围：电话咨询可以帮助那些不愿意前来面对面咨询的人。
• 便捷性：电话咨询提供了便捷的服务方式，使更多人能够获得心理支持。

总结

在电话咨询中，全神贯注地接听来电并同时关注通话过程是一项挑战。通过做笔记和绘制家系图，咨询师可以更全面地理解来电者的情况，避免信息丢失。发挥想象力，设身处地地理解来电者的感受，可以帮助咨询师以非评判性的同理心回应。电话咨询的优势在于其便捷性和广泛的服务范围，能够帮助更多需要支持的人。

进一步阐述知识点

电话咨询的难度与价值

1. 电话咨询的难度

• 更高要求：电话咨询比面对面咨询更困难，因为它要求咨询师在没有视觉线索的情况下全神贯注地倾听和理解来电者。
• 高度集中：需要高度集中注意力，避免分心，并确保准确捕捉和理解来电者的信息。

2. 电话咨询的价值

• 接触更多人群：电话咨询可以帮助那些不愿意或无法前来面对面咨询的人。这些人可能因为各种原因（如地理位置、社交焦虑等）不愿意亲自前往咨询中心。
• 优势：
  • 安全性：对来电者来说更安全，因为他们可以保护自己的匿名性。这可能有助于他们减少与陌生人分享私人想法和情感的顾虑。
  • 即时退出：来电者知道，如果他们感到受到威胁，可以随时挂断电话。这比走出咨询室要容易得多。
  • 即时可访问：电话咨询易于且立即可访问（除非线路忙），无需等待。来电者只需拿起电话拨打即可。
  • 低成本：一般来说，电话咨询对来电者的成本较低，这使得更多人能够负担得起心理支持。

设置界限

1. 安全环境与风险

• 安全环境：电话咨询提供了一个安全的环境，来电者可以分享他们最深的秘密。
• 风险：因此，它也存在一些风险。一些打电话进来的人是孤独的，没有可以倾听他们的亲密朋友。这样的人非常脆弱，可能希望有一个理解的朋友。

2. 咨询师的角色

• 优秀咨询师的特点：优秀的咨询师是接受的、温暖的、同理心强的、不带评判的。这些特质使来电者感到被理解和接纳。
• 来电者的误解：由于咨询师的这些特质，孤独的来电者可能会对与他们分享的人形成非常歪曲的看法，对咨询师有非常正面的感知。这种感知可能导致来电者对咨询师产生过度依赖或误解。

3. 设置明确的界限

• 重要性：因此，设置明确的界限至关重要，以确保来电者明白这种关系是电话关系，不能超出这一点。
• 避免期望：否则，会在来电者心中建立起一种期望，即可能有个人关系的开始。这种期望可能导致来电者对咨询过程的误解和失望。
• 伦理问题：记住，孤独、不快乐的人往往是需要帮助和脆弱的。利用他们是完全不道德的。咨询师应该始终保持专业态度，避免任何形式的不当关系。
• 现实考量：此外，认为如果你允许关系从咨询关系转变为友谊就能帮助他们是不现实的。这样做不仅无法有效帮助来电者，反而会损害他们信任咨询过程作为未来可以使用的安全手段的能力。

总结

电话咨询虽然比面对面咨询更困难，但它是一种极其有价值的咨询形式，可以帮助那些不愿意或无法前来面对面咨询的人。通过设置明确的界限，咨询师可以确保来电者明白这种关系是电话关系，避免产生不切实际的期望。这不仅有助于保护来电者的利益，也有助于维护咨询过程的专业性和有效性。

进一步阐述知识点

复盘

1. 复盘的意义

• 释放情绪：复盘是一个过程，旨在帮助咨询师释放他们在倾听痛苦的人时不可避免地经历的情绪。
• 必要性：所有咨询师，无论多么有经验，都需要复盘，尤其是在特别紧张的咨询会话之后。复盘有助于保持咨询师的心理健康，防止职业倦怠。

2. 专业实践

• 定期复盘：尽管我们都是有经验的专业咨询师，但我们仍然定期在困难或情绪化的咨询会话后进行复盘。
• 效果与健康：如果不进行复盘，我们提供的服务必然会变得不那么有效，我们也会出现职业倦怠的症状。

3. 电话咨询的特殊性

• 情感后遗症：电话咨询师特别容易受到他们咨询工作的情感后遗症的影响。处于急性危机中的人们常常会打电话寻求帮助，因此电话咨询师经常接到极度痛苦和/或恐慌的人的电话。
• 危机干预：电话咨询经常导致危机干预，这要求咨询师具备处理紧急情况的能力。

电话咨询的压力

1. 压力来源

• 危机内容：由于电话咨询内容的必然危机性质，电话咨询师在电话班次结束时有时会感到精疲力尽。
• 情感触发：来电者的情感痛苦有时会不可避免地触发咨询师的个人情感压力。

2. 自我照顾

• 休息与复盘：在特别紧张的电话之后，建议在接下一个电话之前休息一下，如果可能的话，与你的主管或其他咨询师讨论你正在经历的感受。
• 定期复盘：每个咨询班次结束后，再次与你的主管或其他咨询师聊几分钟进行复盘。复盘不需要是一个漫长的过程，但它是一个重要的过程。

问题来电者

1. 特殊问题

• 目标不一致：不考虑所谓的“问题来电者”就不能完整地讨论电话咨询。这些来电者会给电话咨询师带来特殊的问题。他们的目标可能与咨询服务的目标不一致，因此可能希望不恰当地使用服务。
• 特定需求：其中一些人可能希望满足在其他地方未得到满足的特定需求。

2. 建设性处理

• 真实需求：问题来电者是有真实需求的人，因此电话咨询师需要能够以建设性的方式处理他们的来电，充分解决他们的咨询需求。
• 分类：大多数问题来电者属于以下类别之一：
  1. 恶意来电者：故意打扰或骚扰电话咨询师的来电者。
  2. 经常来电者：频繁拨打热线的来电者，可能因为依赖或习惯。
  3. 受慢性抑郁困扰的来电者：长期受抑郁症困扰的来电者，需要长期支持。
  4. 性来电者：有性需求的来电者，可能需要转介到专业的性健康咨询师。

总结

复盘是电话咨询师必不可少的一部分，有助于释放情绪、保持心理健康和防止职业倦怠。电话咨询师需要认识到电话咨询的特殊性，特别是在处理危机干预时。面对问题来电者，咨询师需要采取建设性的方法，充分解决他们的需求，同时保护自己的心理健康。通过定期复盘和自我照顾，电话咨询师可以更有效地提供高质量的服务。

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.

SHARING YOUR PROBLEMS WITH A COLLEAGUE Unfortunately, in practice it is not always possible to talk through one’s own problems prior to a telephone counselling session. It may, however, be possible to use a similar method to that described previously for face-to-face counsellors, but instead of telling the caller that you need to put aside some troubling thoughts, you could tell a colleague. It might be sufficient to say to another TC: ‘1 realise that I have brought with me some troubling thoughts about my family. 1 don’t want to unburden them on to you because you may have needs of your own at this time, but I will talk them through with my supervisor later. Telling you that these thoughts exist helps me to put them to one side for the time being, so that i feel better prepared to answer the phone.’

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

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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.