Serving Dfficult Callers - AIRS



Each of us has our own reasons for doing the work we do. There are the reasonable hours, the thrill of working with the latest up to date technology and, of course, the monetary incentive. However, almost universally, people in the field will mention the personal satisfaction they get from helping Callers solve their problems. When we help reunite the runaway with their family; when we help the single mom get the rent assistance she needs to stave off eviction; when we involve the elderly shut-in involved with a program that provides home visitation, when we help the suicidal Caller decide on a more adaptive way of dealing with their pain we feel good because we “done good”. We “like” all our Callers because they allow us the opportunity to feel good. Or do we?

The answer is we don’t. While we would like to maintain that we are not affected by such interactions they do, in fact, engender negative feelings in us. We tend to identify the Caller as being “Difficult”. Once we do that we become judgmental which violates the core concept of Unconditional Positive Regard. This places us at odds with not only the Caller but ourselves and our basic training. We come to view the situation as something being done to us. We come to a point where we are no longer “interacting” but are reacting. We forget or, more pragmatically, fail to admit that feelings of helplessness and frustration can and do result from certain types of calls. In addition, viewing the Caller as difficult introduces the danger that someone in actual need may not receive the full benefit of the services the agency is able to offer.

It is also important to be aware of the boundaries of Crisis Intervention:[1]

• The Crisis Intervention Specialist must clearly understand the boundaries of Crisis Intervention, what they can reasonably expect themselves to accomplish and what is beyond their control.

• Feelings of helplessness often result when certain types of calls occur over and over and over again, together with a sinking feeling that there is never going to be a long-term solution for certain inquirers. And that whatever you do, it is not going to be enough and that the inquirer is never going to feel it is enough.

• Crisis Intervention Specialists must accept that there is not an ideal solution for every problem, and some problems may have no solution.

• Crisis Intervention Specialists have no control over whether an inquirer follows through or whether they will eventually receive the help they need from an agency that they do contact immediately. It is important for Crisis Intervention Specialists to set reasonable expectations for themselves, and that those expectations relate to the aspects of their work that are under their control -- making accurate assessments and providing appropriate referrals.

• Crisis Intervention Specialists must always be aware of their personal triggers – the types of problems and the types of inquirers that cause stress that may be out of all proportion to the situation.

• Debriefing with colleagues and/or supervisors is an important mechanism in dealing with potential burn-out.

• A Crisis Intervention service cannot “turn people’s lives around”; although it may help people take the first steps in this direction. An Crisis Intervention service listens to people, sometimes for the first time, and directs them to agencies that can turn their lives around. A Crisis Intervention program is a critical part of a system of services – but it is not the entire human services system.

• Every day in every Crisis Intervention, there are numerous inquiries to feel very good about. With the help of the Crisis Intervention team, people are being helped. And that is the feeling in which to frame the memory of every day.

Every one of us working in the field has our list of Callers that have the effect of fingernails on a chalkboard when we hear them. We will term such Callers “Difficult Callers”, as some other appellations we have for them may not be acceptable in mixed company. While we may not freely admit it, this is the reality. Maybe Will Rogers never met a person he didn’t like but he wasn’t doing Crisis Intervention for a living.

Having admitted that there are such Callers. How do we identify them? With each of us having our own list, how do we define who they are? From experience it seems the following definition describes who the “transgressors” are. For our purposes we will define Difficult Callers to be those Callers:

1. Who call for purposes other than Crisis Intervention

2. Whose needs, conditions, or manner of presentation induces the Crisis Intervention Specialist to feel they lack the skills to address the situation

3. Whose contact is motivated by a problem they are unwilling or unable to identify or address

4. Whose behavior, lifestyle, or personality we find personally unattractive.

In addition there are definite differences in the way Difficult Callers interact with us as opposed to our usual Callers. The following chart delineates some of those differences.

|Typical Crisis Intervention Caller: |Difficult Caller: |

|Calls in response to a current situation they are unable to cope |Calls in response to a situation in their past that is still not |

|with. |resolved or a current ongoing chronic situation. |

|Works actively with the Worker to attain problem resolution. |Actively resists being involved in the Crisis Intervention |

| |Process. |

|Responds as if the Crisis Intervention Process is a new |Seems to possess an awareness or knowledge of the Crisis |

|experience for them. |Intervention Process. |

|Is unsure of what information the Worker needs to help them. |Provides detailed information about themselves and their |

| |situation. |

|Responds to the reflection of feelings but generally doesn’t use |Uses feeling words in discussing their situation. |

|their own feeling words. | |

|Is interested only in changing their situation. |Is mostly interested in the transitory relief offered by talking.|

|Generally, respectful of the Worker and appreciative of their |While not necessarily disrespectful of the Worker and their |

|efforts. |efforts they can be aggressive, angry, manipulative, and/or |

| |demanding. |

|Wants to know how or if they can change their situation. |Wants to know about the Worker. |

|Unaware of what help is available to them. |Is very aware of the help available to them. |

|Views the Worker as a facilitator. |Views the Worker as a friend, acquaintance, or captive audience. |

|“What can I do for myself?” |“What can you do for me?” |

|“Is this a Help Line?” |“Is this a Talk Line?” |

|“Yes, that may work. I’ll try it.” |“Yes, that may work . . .But . . .” Alternately, “Been there . .|

| |.done that. . .nothing works”. |

|Seeks realistic resolutions. |Demands miraculous/impossible resolutions. |

|Helps the Worker to understand their situation. |Blocks the Worker from understanding their situation. |

|Contact is linear with a beginning, middle, and end. |Contact is circular moving from beginning to beginning. |

|Accepts problem-solving input. |Resists problem-solving input. |

|Will accept formal counseling or treatment as a viable |Rejects formal counseling or treatment as a viable resolution. |

|resolution. | |

|Has conscious control over their contacts. |Contacts are a result of habitual need. |

|Maintains hope that things can get better. |Maintains the belief that there is no hope things will get |

| |better. |

In looking at the above definition and chart we must recognize that it is the behavior of the Caller and our reactions to that behavior which define the Difficult Callers. What this says to us is that Callers are difficult not only because of who they are but how we perceive and react to them. This means that in order to interact effectively with these Callers we need to not only understand them and their motivations but ourselves also.

Using the above criteria there seems to be 12 different types of Difficult Callers that we will refer to as the Difficult Dozen. So without further adieu:

The Difficult Dozen

1. Abusive Callers are those who abuse, malign, or victimize us or our agencies through either their words or their behavior. Their contacts are not for Crisis Intervention but rather for the purpose of expressing a personal opinion. The abusive behavior is most likely triggered by the inability to cope with a past or present life situation but the Caller’s focus is on expressing their opinion not on problem resolution. It is important to recognize their behavior is directed at us not a life situation.

It is also important to differentiate the Abusive Caller from the Caller who contacts us dealing with issues of abuse. The abused or those who are abusers who are contacting us in an effort to change their situation can be stressful for us to interact with. By working with such Callers non-judgmentally it can help us to maintain our emotional integrity while providing them the level of service they require.

2. Angry Callers are those who express anger at a specific situation or circumstance that affects them, as opposed to expressing it towards us. The situation addressed is generally the result of a life situation but the focus on the expression of the anger frequently interferes with the problem-solving process. Their method of expression and intensity of emotion frequently makes it difficult for us to not want to distance ourselves from interacting with them.

Sexuality Issue Callers contact us about issues regarding their sexuality and are seeking concrete methods to address those issues. Among the issues they contact us about are STD’s, pregnancy, sexual identity issues, and victimization. The difficulty in dealing with these Callers stems from the comfortability we have in addressing their issues and their manner of expression. It is import to make a differentiation here. Sexuality Issue Callers contact us to resolve an issue regarding their sexuality and as such deserve the full benefit of our talents and resources. However, given that each of us has our own perception and comfortability with our own sexuality the nature of the subject matter, the manner of presentation, or other intangibles may make the Specialist may feel uncomfortable during the interaction. As a result it is important that we be aware of any biases we may have and interact with these Callers in an accepting, non-judgmental manner. The danger here is that our biases may result in us misidentifying a Sexuality issue Caller as a Sexual gratification Caller. Sexual Gratification Callers contact us to derive personal pleasure from the interaction. As their contact is not focused at all on resolving a given issue it is important we tell them that ours is not an appropriate forum for their contact.

Sexual Gratification Callers (Sex-grat Callers) are those who engage us as unwilling partners in obtaining their own gratification. These Callers are usually male and are frequently overt in their behavior but will also present fantastical situations as actual in order to engage the us as unwilling participants in their quest for self-pleasure. While their behavior can be the result of a particular life issue, past or present, they are not interested in solving a problem. Interactions with this group of Callers are stressful for Specialists who can come to feel used, abused, and angry.

Sex-grat Callers can be obscene callers who calls to say obscene words or makes lewd suggestions to the Specialist or someone who gains sexual stimulation from hearing the voice of a Specialist, and/or through the telling of a sexual fantasy. There are two types of Sexual Gratification Callers:

• Type I who openly admits to wanting to masturbate or is already in the process of masturbating. They plead with the Specialist to stay on the line, talking until they have finished.

• Type II who (a) tells a fantasy problem that is presented as being real. It is usually, but not always, of an overt sexual nature. While discussing this “problem” with the Specialist, they masturbate; or (b) also presents a fantasy problem, but rather than masturbating during the call, they use the call as a stimulus to masturbation after the call.

It is the position of this presenter that such interactions should be ended as soon as identified. In the case of the Type I Caller this should occur immediately at the first admission of masturbatory behavior. In the case of the Type II Caller the call should be ended as soon as an assessment reveals the Caller’s actual purpose for calling. This assessment is an important step as it ensures that a call with issues of sexuality is not misidentified.

However there are two schools of thought on the matter. The first postulates that sex-grat call be ended as soon as they are identified as such. The arguments for this practice are that:

• Sex callers identify their behavior as a compulsion, or an addition. Talking to them serves to enable them, and demonstrates to them that there are no consequences for making sex calls. If there are no consequences the caller is just going to keep calling. An addict usually has to “hit bottom” - feel as bad as possible - before they take steps to recover.

• Engaging sex callers sets up unrealistic expectations for them that other people will be able to see beyond their behavior and understand. Ending the call stresses that they need to take responsibility for their behavior, and for helping themselves. It shows them that, if they really want to stop, they have to ask directly.

• Ending the call right then and there stresses that this behavior is not appropriate behavior and that it is abusive to others. That’s the reality, whether the caller likes it or not.

• Sex-grat callers report that they actually want to be stopped. They feel compelled to call, but they know that it’s wrong, and want Specialists to help them stop themselves. Ending the call as soon as possible is a way of helping someone who can’t help themselves.

• Ending the call once it is identified as a Sex-grat call serves to empower the Specialist who can feel abused and victimized by such interactions

The arguments for continuing to stay on the line and engaging sex-grat callers are:

• Sex callers don’t tend to have insight into their behavior. They don’t know why they make these calls, but feel helpless to stop themselves. They need our help understanding that making sex calls is a sign of a problem that they would need outside help to recognize and fix.

• Sex callers are so distrustful and afraid of being found out that they are very unlikely to seek outside counseling. Our being kind and respectful might help them to see that counselors can accept them, and might make them more likely to risk seeking outside support.

• Staying on line with the sex caller will make it more possible to inform them that they are not the only ones who struggle with this compulsion. It’s not likely that they have friends in their lives to which they can confide, due to their shame and distrust of others. They might feel like the “only ones” otherwise. Also, if they find out that there are more people like them who struggle with this compulsion they might be more likely to seek outside help.

• Low self-esteem is a primary issue for sex callers. Showing them that we value them enough to still try to work with them, even after recognizing that they were attempting to exploit us by making a sex call, can have tremendous healing potential.

As there are these two diametrically opposing views it is best if the agency decide which view they support and develop a written policy which explains their support of the view they chose. A written policy serves to delineate firm boundaries, establishes consistency in service provision, and empowers the workers to deal with these interactions in an assertive manner.

There are a number of “rules” a worker can use to manage interactions with Sex-grat Callers. They are:

• Use a lot of silence, and keep all statements brief. Put responsibility for the majority of the talking on the caller.

• Focus on feelings not the details of the presented scenario.

• Set limits as needed. Do not allow callers to share sexual details. Do not feel obligated to behave or do as the caller dictates.

• Adjust your voice tone. Do not speak in a soft, “counselor” voice. Instead maintain a vocal “distance” by using a flat tone.

• Do not give sexual information or advice.

• Do not promise callers anything before you know what the promise will entail.

• Do not engage a Type One sex caller (or an obscene caller).

• Identify and address any possible indicators that the caller is a sex caller.

• Wait for sufficient data (three indicators) before confronting the caller.

• Be direct when confronting the caller, and tell the caller why you are hanging up.

• Follow through with hanging up immediately after you have said you are going to do this. Do not debate with the caller after you have said you are hanging up.

• Prior to actually ending the call, invite the caller to call back, should he (or she) want to discuss his compulsion to make sex calls.

• If you are unsure as to whether a caller is a “sex caller”, treat them as a legitimate caller.

When confronting the Sex-grat Caller about the purpose of their call be sure to have a “script” of phrases. The reason for this is that you will most likely be feeling upset and stressed at the time of confrontation. Having a “script” will ensure you have the right words available to you at the right time. Some standard responses are:

• I’m getting the impression that you enjoy talking about this.

• I get the impression that sharing this is stimulating to you.

• I believe that this is a sex call.

• I believe that you are masturbating right now. We are not here for that purpose.

• Because your call is inappropriate I am going to end the call now.

Type II Sex-grat calls have certain characteristics that can identify them as such. While no single indicator is sufficient to definitively identify a sex-grat call as such groups of indicators occurring in the same interaction can lead to a confident identification. To prevent the possibility of someone calling about issues of sexuality being misidentified as a sex-grat Caller it is prudent to require a specific number of characteristics be identified before making the determination. Generally three or four indicators will be sufficient. A list of indicators appears below.

• Will ask to speak to a person of the opposite gender

• Voice is devoid of emotion or seems forced and melodramatic

• Speaks haltingly, or is generally hesitant to speak

• Gives first name immediately

• Asks for the counselor’s first name immediately, and throughout the call if not provided

• Asks personal questions about the counselor

• Resists resolving the presented issue

• Presents with innocence about sex

• Uses the word “embarrassed” with frequency

• Uses other key, sexual words with frequency (i.e., “diaper”, “spanking”)

• Gives detailed sexual descriptions

• Uses very formal or very childlike language to describe anatomy and sex acts

• Resists resolving the presenting issue

• Breathes heavily, or holds phone away from mouth so that breathing isn’t detected

• Tries to get counselor to do all of the talking

• Offers common sex caller themes: incest, sexual abuse, transgenderism, sadomasochism, exhibitionism, voyeurism, fetishism, concerns about size or functioning of anatomy

• Uses common opening lines: “Will you talk to me?”, “Can I talk about anything?”, “Is there a man/woman I could speak to?”, “I’ve never called before”, “I have an embarrassing problem”, “I’m lonely”

• Story grows and grows as the call progresses

• Only wants to share details of the situation, not feelings

• Caller is unable to identify and/or explore feelings

• Provides inconsistent information

• Affect doesn’t match the situation presented. Their motional tone doesn’t match the situation presented

• Voice tone remains unchanged throughout the call

• Obvious characteristics don’t seem to match the presented scenario (as when the caller sounds significantly older or younger than the stated)

There are Do’s and Don’ts for interacting with suspected Sex-grat Callers

• Do treat all calls as real until shown to be otherwise.

• Do reflect and focus on feelings.

• Do use silence.

• Do point out indicators and inappropriate behaviors as they occur.

• Do allow the Caller to respond to the pointed out indicators and inappropriate behaviors.

• Do maintain a neutral voice tone.

• Do set firm limits.

• Do keep your responses brief.

• Do review indicators and behaviors when enough are discovered.

• Do maintain your objectivity and composure.

• Do end such contacts in a firm and respectful manner.

• Don’t ask questions.

• Don’t “search” for indicators or behaviors.

• Don’t respond emotionally.

• Don’t lecture.

• Don’t continue the call once it is identified as being inappropriate.

3. “Yes…, But…” Callers request solutions to their specific situation or condition but reject any constructive input. They are resistant to being an active participant in the Crisis Intervention Process as they have already “been there, done that, and it didn’t work.” Generally they seem hopeless of ever resolving their problem and want our company in their feeling of hopelessness.

Intoxicated Callers are those Callers who contact us under the influence of some substance(s) that impairs their ability to interact in a coherent or rational manner. The ability to interact with these Callers is dependent on the level of their intoxication and their tolerance of the substance ingested. While many agencies have policies regarding interactions with these Callers making a blanket statement that we cannot or will not interact with Inebriated Callers is not appropriate. We must assess the Callers ability to meaningfully communicate and proceed accordingly. It is important to remember that some psychotropic medications as well as physiological conditions can make Callers sound intoxicated. There is also the possibility the synergistic effect of some combinations of drugs may create a life-threatening situation. The following are thoughts to be considered in working with the inebriated caller:

1. Some medications people take can made them slur their words and sound inebriated. To end the interaction without assessing the reason for the person sounding the way they do sends a negative message regarding their medication compliance. An appropriate way to address this would be to point out the behavior and inquire about the reason for that behavior. In other words..."I am having a hard time understanding you because you are slurring your words (running your words together, jumping from topic to topic or whatever behavior you notice that is making them sound inebriated) can you tell me the reason for this?" The person reacting to their medication will tell you they had taken their meds. In this case the call should proceed as usual.

2. It is possible the person may have a physiological reason for sounding the way they do. As in the first case simply pointing out how they sound and asking about the reason can clarify the situation and allow you proceed accordingly.

3. It is possible that the consumption of the alcohol or drug making the person sound inebriated is part of a suicidal plan thus representing a potentially life threatening situation (emergency). Again ask the person for the reason they sound the way they do and inquire about what other, if any, substances they have consumed. The next step would be to inquire about the reason for consuming the substance(s). Depending on the reply (and particularly if they are consuming multiple substances) it would be appropriate ask if they were suicidal . If they reply affirmatively you would follow your suicide protocol which appears to connect the caller to NSPL. However, I do have one caveat. A person consuming substances to end their lives is in life-threatening danger as we have no idea as to the amount they have consumed or the synergistic effects of various substance combinations. In such cases it might be most prudent to get emergency assistance to the caller. Read: Forget about the transfer to NSPL and send in the cavalry.

4. Another concern is that someone who sounds inebriated may not be suicidal but the amount consumed can be toxic (deaths on college campuses during binge drinking come to mind). An assessment as to how much has been consumed and whether this is a normal amount of consumption. Basically this is a judgement call on behalf of the worker. I would suggest that if the worker feels the amount consumed may be toxic we should assume it is and express that concern to the caller and suggest emergency intervention.

5. We also need to keep in mind that people have varying tolerance levels and there may be those who will be able to participate in "problem solving" while inebriated. This is more of a gut feeling assessment. Basically if the person seems to be hearing the worker there would be no reason to continue.

In those cases where the caller is not able to participate in the process and there is no danger to life indicated (I think in today's vernacular it is called "drunk dialing") it would be appropriate to point out to the caller that the substance they have consumed is interfering with your ability to help them and explain that they need to call you back when they are able to participate in the process. I refrain from using the word sober because it is possible that may not be something the caller can accomplish. The script for this situation might be..."At this time it seems you are not able to hear the help I am trying to give you. However, we would really like to help you deal with what is going on. So I am going to invite you to call us back when you're thoughts are clearer. Do you have our number written down? (depending on the answer you may try to get them to write down the number...but that may not be successful) I am now going to end this call and hope you will call us back when you feel better. "

One other thought to keep in mind. Because there are so many variables in this situation it can be helpful to ask the person if there is someone else around them who may not be as inebriated as they are. If there is offer to speak to that person. If things are life-threatening they can be an asset in getting help for the caller.

4. Donor / Stakeholder Callers would seem not to present a difficulty to us so why include them in the Difficult Dozen? The reality is they usually aren’t problematic. That is, at least, until we remember they are the people who are paying the freight and we feel that we have to invent that non-existent magic solution that will solve all their woes. On a level we come to feel our performance is being judged and that the agency’s future lies in our hands. There are also those in this group who feel entitled to preferential treatment and will make demands we are not able to fulfill.

5. Distracted Callers are those Callers who seem unable to focus on their situation because of reasons or circumstances outside their control. Their distraction can be the result of environment, emotional or psychological disabilities, medication, substance abuse, or a singular focus on the precipitating situation which blocks meaningful interaction.

6. Silent Callers are those Callers who, at the time of their contact, are unable to verbalize what is going on that induced them to call or are unsure of how to initiate the Crisis Intervention Process. The difficulty lies in the fact it is hard to interact on the telephone with someone who will not speak.

7. Prank Callers are those Callers who contact us to gain personal enjoyment or simply the fun or thrill of being able to manipulate or “put one over” on a perceived authority figure. While we might dismiss these contacts as “inappropriate” we must keep in mind that the call could be a test of our service, a cry for attention, or the emotional release of feelings which are the result of a some situation in the Callers life. We also should recognize that the making of prank calls, in the case of young people, could be considered normative behavior. If we keep some key perspectives in mind about Prank Calls we can mitigate the effect they will have on us over time.

• Today’s Prank Caller is tomorrow’s Crisis Caller. Pranking may just be a way that young Callers test our service.

• Every time we pick up the phone, we are representing the entire service. We should strive to maintain an appropriate, professional demeanor.

• Some fantasies shared by Callers may be reflective of serious, emotional or psychiatric problems.

• Sometimes calls fall into a “gray area” - the presented situation may be a fantasy, but the caller may still need some kind of help.

• Making prank calls is normative adolescent behavior - most teens do it, and most people who were teens did it. It may be an expression of rebellion against authority, an acting out of depression or stress - issues that are commonly experienced by adolescents.

Many prank calls are obvious…”Is your refrigerator running?” type of interaction or the Bart Simpson calling Moe’s Bar asking for Al Coholic. These calls reflect an expectation on the Caller’s part that the inappropriate nature of the call will be immediately recognized. These calls appear to be generated more for entertainment value, and appear to be less reflective of pathology. To manage obvious prank calls the Specialist should:

• Employ an empathic tone, and point out that when Callers make calls as such to the Agency, it keeps people who really need help from getting through. Raising the tone of voice or expressing anger and frustration provides the prank callers desired effect and will ensue in additional calls

• Specialists will then explain to the Caller that they are going to terminate the call, but invite the caller to call back if they are ever in need of assistance. This models the behaviors of respect and non-judgmentality to the caller and let’s them know we are there to help anyone calling in actual need

• Specialists are then to immediately hang up. Staying on the line provides a tacit acceptance of the behavior which will encourage the Caller to continue.

There is a secondary type of prank call we will refer to as the In-obvious Prank Call. The In-obvious Prank reflects a desire to engage and trick the Specialist, and is more likely to be reflective of pathology. As with Sex-grat Calls it can be helpful to the workers if the agency has a written policy covering how they are to be handled. When confronted with this type of prank, the Specialist must point out potential indicators that the call is a prank to the Caller as they are observed, then explore them, all the while employing an empathic voice tone. The reason for collecting and pointing out the indicators is to preclude instances of misidentifying Callers in actual need as prank calls. After the Specialist has identified four indicators, explored them, and concluded that the call is a prank, the Specialist is to list the indicators again. Then, while employing an empathic voice tone, the Specialist is to explain that the indicators lead them to conclude that the call is a prank, and thereby an inappropriate use of the service. As this type of call could be either the result of some pathology or a testing of the service the Caller and should be offered an opportunity to explore their reasons for making such calls to the line. If the caller is amenable to such a discussion, and is willing to address legitimate issues, the worker is to take them through the Crisis Intervention process as usual. Otherwise, the Specialist is to end the call. Keep in mind that it is important to remain calm and resist any desire to scold or lecture the Caller as this will only serve to exacerbate the situation.

Some indicators of In-obvious Prank calls are:

• The Caller speaks haltingly, or is generally hesitant to speak.

• The Caller’s tone remains unchanged throughout the call.

• The Caller gives first name immediately.

• The Caller asks for counselors name immediately.

• The Caller asks personal questions about the counselor.

• The Caller resists resolving the presenting issue

• The Caller tries to get counselor to do all of the talking.

• The Caller’s tone is devoid of emotion, doesn’t match the situation described, remains unchanged throughout the call, and/or seems forced or melodramatic.

• The presented story seems to grow and grow as the call progresses.

• The Caller only wants to share details of the situation, and no feelings.

• The Caller is unable or unwilling to identify and/or explore feelings.

• The Caller provides inconsistent information.

• Observed or presented facts don’t seem to match the presented scenario, as when the Caller sounds significantly older or younger than their stated ages, or they claim to be calling from home, despite the sounds of a highway in the background.

• The Caller is whispering to someone or laughing, or someone else is whispering to the caller, or laughing in the background.

To ameliorate the impact of prank calls the Specialist should:

• Use a lot of silence. Prank Callers want the Specialist to do all the talking. They will find silence frustrating, and be dissuaded from continuing to call.

• Focus on feelings. Prank Callers are ready with stories, but generally aren’t able to identify or explore feelings. Encouraging pranks to elaborate on feelings makes them have to do most of the talking, which, again, defeats their purpose.

• Pace themselves. If the pranks are getting to you, take time between calls, take a break, or debrief with a supervisor - take steps to maintain objectivity and composure.

• Come up with an appropriate but rote response to deliver to pranks, so that they can be rehearsed and prepared for the confrontation, and thereby be less reactive. Example: “When you make prank calls people needing help can’t get through, because you tie up the line. If you ever have a problem, feel free to call back, but right now, I’m going to hang up”.

• Hang up immediately upon informing the Caller that they plan to do so.

• Treat all calls, including suspected pranks, as legitimate crisis calls, unless four indicators have been identified and explored with the Caller.

8. “Nobody Can Help” Callers are those who feel there is no way out of their life situation. This perception may or may not be reality but the helplessness they feel is and we find that we can get trapped in said feeling. With these Callers we have a tendency to don our SIRS (Super Information & Referral Specialist) cape and use our superhuman powers to make people better. This presents difficulty because we always do what we can to help our Callers. Trying to be superhuman only serves to build false hope and expectations creating more helplessness which not productive for either the Caller of ourselves.

9. “It’s Not Over ‘Til I Say It’s Over” Callers are those Callers who can sometimes be confused with “Yes…, But…” Callers but the difference is that they are willing to engage in the shared responsibilities of the crisis intervention process. They are ready to move on to the next step but for some reason can’t bring themselves to say goodbye.

So this is my Difficult Dozen list. As with any list is by no means definitive (how did they leave Stevie Van Zandt off Rolling Stone’s 100 top guitarists list?) But our goal is not to have the perfect list. It is to develop a group of tools we can use to mitigate the “difficult” in Difficult Callers.

We do have a basic set of tools. Whether we are doing Crisis Intervention or Crisis Intervention we engage in what we term “Empathic Listening” or, alternatively, “Active Listening”. These processes are based on Carl Rodgers Client Centered Theory which, whether it was called that or not in your training, was what you learned to do. By way of review there are three tenets of Client Centered Theory, which maintain:

The Worker and Caller interact as equals

The Caller dictates the pace of the call while making their own choices and decisions

The Worker mirrors[2] the Caller by using the Active Listening Skills, which are:

• Silence

• Reflection

• Paraphrasing

• Summarizing

• Clarification

• Restatement

• Encouraging statements

There are also four fundamentals governing Client Centered Interactions. They are:

• Acceptance[3] (being non-judgmental)

• Respect[4]

• Empathy[5]

• Hope[6]

Through training, role-play, and actual use we learned to use these basics to help most of our Callers find help with their presenting problems. But when the same skills are applied to the Difficult Dozen the result is frustration. What is the reason for this? Part of the reason is derived from our definition. Their motivation for making contact is different than the majority of our Callers. Our basic training teaches us to deal with Callers requesting Crisis Intervention, not persons who call for other reasons. However, being aware of a few rules that supplement our basic training can help us develop a technique to interact with Difficult Callers without migraine pain. Some of those rues are listed below.

Things They Didn’t (necessarily) Teach You In Crisis Intervention Specialist School:

The Ten Simple Rules For Working With Difficult Interactions

Be Aware of Your “Buttons”

It is ironic that we profess to abide by the rules of equality and acceptance yet we are discussing “Difficult Callers”. That we are differentiating these Callers form the bulk of the people to whom we provide Crisis Intervention indicates that we are assuming a superior (unequal) and judgmental stance. But, the reality is that we are just regular people and as regular people we have, and are entitled to, our own views regarding people, situations, and topics. Allowing that we must recognize that those feelings are our own and are not to be shared with the Caller. This can be easier said than done but with practice it becomes easier and easier to do. The process is much like trying to swim as far as you can underwater. At first you don’t get too far but perseverance enables you to eventually make it across the pool with breath to spare.

Another thing to remember is not to deny the effect certain Callers have on you. Doing so ensures that eventually the pent up feelings will explode and we all know that never happens at a good time. You will not be comfortable with every Caller and situation. But if you accept that fact and practice techniques to use with Callers that have a negative effect on you, you will be able to capably service all the Callers you deal with without frazzling yourself.

Remain In the Present

George Santayana wrote: “Those who do not remember their past are doomed to repeat it.” Yes, the Caller’s past is important to the Crisis Intervention Process, but Santayana says we need only to remember it, not relive it time and time and time again. When a Caller stays rooted in what has been it is difficult to progress to the “what can be”. Once a you have reached a consensus with the Caller about the events that have lead up to their current situation there is no reason to review them again. Should the Caller opt to go back to a rehashing of that which has been, it is appropriate to:

• Remind them you understand what has happened in the past by summarizing what they have shared with you.

• Re-reflect their feelings about it.

• Remind them that changing the past is not something that is possible.

• Point out that they can do something about the present if they stop focusing on the past.

Doing the above in a respectful manner usually will move the Caller along in the process but some Callers will need to be reminded several times. For those few that will insist on remaining in the past refer to Point Out Behaviors and Breaking the Unbroken Circle.

Assertive Confrontation

We have a tendency to feel that confrontation in a call is not appropriate. The reality is that it is when done in a firmly[7], focused, concise manner. There are times when what the Caller says to us doesn’t “add up”. This can be attributable to the stress of the moment or it can be an indicator the Caller is calling for something other than Crisis Intervention.

When confronting a Caller we review the facts we are questioning, inform the Caller the facts don’t seem to add up and then state the confusion that represents for us and then explain the reason for the confrontation. For example take the Caller who seems well versed in the methods and capabilities of your agency and whose situation and voice sound vaguely familiar. Yet they claim to have never contacted you before. We might be tempted to “confront” them by asking, “Have you called us before?”. The “Yes” or “No” response elicited by this question does little to assist the flow of the call. Better, we might tell them we are confused by the fact they say they have never called before, yet they speak in a manner which indicates they know how your agency operates, and their situation and voice seem familiar. We would then explain that we need to know if they have called previously so that we don’t duplicate referrals that seemed to have not worked before. Confrontation in this manner lets the Caller know we are not judging them but we need the facts to serve their needs best.

Some examples of confrontational statements are listed below[8]. A Warning! These phrases are confrontational in nature. This is intentional as they are designed to provoke the Difficult Caller who is resisting change to make a choice to embrace change. However, as they are confrontational they may evoke a response from the Caller you either will not be ready to respond to or comfortable with. Do not attempt this form of confrontation unless you are sure you will be able to address any response the Caller may make to them. Often the Difficult

Caller is comfortable in their situation and will resent your attempt to make them consider changing it. If this does happen it’s OK because once the interaction with the Caller ends maybe they will think back and look at their situation with a new insight.

• "As I hear what you're saying, I begin to sense a pattern. It seems you've been repeating the same thing over and over again. Can we talk about how you see that as helpful?"

• "You seem to see yourself as a (victim, bad guy, loser, second class citizen, unwanted child, etc.). Let’s talk about how you came to see yourself that way?"

• "I get the feeling that as painful as being a (victim, bad guy, etc.) is for you, you get something out it. Let’s talk about the benefits of being in that position?"

• "It seems you shoot yourself in the foot every time you begin to get what you want. Do you have an idea about what makes that happen?"

• "You really seem much more comfortable with doing what you've always done. That's more familiar. When you try something new, you seem to be frightened. Let’s talk about what makes new things so scary for you?"

• "From what you have been saying it seems you're really saying you're afraid to change. Tell me about that."

• "It seems staying the way you've always been is easier even if it gets you into trouble sometimes."

• "It seems you have a sense of what its going to take to change and you're not so sure you want to do all that."

• "It seems you really want to prove that I can't help. Then you can sort of sit back and say 'Well, I tried. Nobody could help me'. Is that your goal"

Point Out Behaviors and Their Results

Often when we actively listen we become “passive” in the interaction. We spend so much time focused on the empathic piece we forget that there are tangibles the Caller is relating to us that we can use to assist them. One tangible is behavior. For example let’s consider the Caller who seems to be content with relating their past again and again even after you let them know you understand where they are coming from. It can be helpful to point out (concretize) what is happening. We might say something like: “It seems that you keep returning to what has gone on for you in the past and we have spoken about how we understand that was painful for you. It seems discussing the past is more comfortable for you than trying to make new changes.” The Caller’s response to this would most likely be that they are not happy with the past and will proceed with dealing with moving on.

Focus On Focusing

Client Centered interactions are usually described as being non-directive. In practice that is an accurate and appropriate description. This most likely where the concept of “talking is good”. The reality is that talking with the idea of coming up with a solution is good; talking with the intention of simply hearing one’s voice is neither good nor cathartic.

When a Caller seems to be focusing on talking about every event that has occurred in their lives as opposed to the issue at hand it is helpful to encourage them to focus on moving forward. The way to do this is to acknowledge that it seems there has been a lot that has affected their lives. The next step is to point out your “read” on what the core issue is and encourage them to work with you in deciding how they are going to resolve it. Which brings us to…

“I” Is a Letter Not a Person

The Crisis Intervention process maintains that the two persons involved in the process are equals. Once we use the personal pronoun “I” we cancel that equality. We need to realize that anytime we say “I” we present a judgmental, exclusionary stance to our callers. While it may not be possible to eliminate this particular pronoun from our vocabulary, it is desirable we attempt to communicate with our callers on a generalized, inclusive level. This is a difficult yet extremely powerful concept to master. Think about it a bit. As a suggestion you may want to think of “I” in terms of “you” or the inclusive “people”. As an example: Instead of, “I think you need to talk to your worker”, we might say, “In a situation like this some people might think about talking to their worker."

Another reason for refraining from “I” is that its use places the responsibility for the success or failure of the Caller’s outcome on your shoulders. This can be frustrating for you and does nothing to foster the Caller’s growth towards independence.

“Is Normal To…”?[9]

Like us, each of our callers has their own concept of normal. Mathematically, normal is a point of perpendicularity tangent to a specific type of curve. There are statistical normals, cultural normals, societal normals, political normals. . .In short there are many kinds of “normal”. All of which makes as much sense to us as it would to our callers.

When asked about normal we need to answer with the caller’s viewpoint in mind. If the caller thought their situation normal they probably would not be on the phone with us. Their calling indicates the situation feels less than normal to them. This means we would not judge their sense of normalcy by saying something is or is not “normal”. More appropriately, we could reply that their call indicates they feel the situation does not feel normal for them and they feel uncomfortable being in the situation. In short, nothing is normal. . . situations are either comfortable or uncomfortable. When we insert our judgment as to what is or isn’t normal we can create an argumentative atmosphere which is not conducive to situational resolution.

Another thought about normalcy stems from our tendency to judge a Caller's behavior during the call as being normal. This is exemplified when we tell a Caller who cries during a call that it is normal to cry. We must remember that while we, as crisis workers, may see tears as normal in a given situation the caller may not feel the same way. A more appropriate response would be to observe that people sometimes cry when in situations such as the Caller’s. We would then reflect the sadness or isolation the tears represent.

Questions and Answers

While there is a need for questions in the Crisis Intervention Process it is important to limit their use. The reason for this is that our Callers have probably been asked bunches of questions before they contact us. Hearing another barrage of questions serves to create an “Oh boy, . . .Here we go again” atmosphere that serves to distance the Caller from the Process. A valuable rule of thumb is to ask yourself, before you ask a question, “Will the answer to this question help me help the Caller?” If the answer is yes go right on ahead and ask. If not, then don’t ask it. Additionally, it is preferable to ask questions in an open-ended manner or to attach them to an applicable reflection. In this manner the Caller is engaged in the information gathering process as opposed to feeling interrogated. Questions that can be answered by a yes or no response are not acceptable except when addressing issues of personal safety, abuse, or suicide.

Another thing to keep in mind about questions is that when you are dealing with Callers who are calling for purposes other than Crisis Intervention (read Sex-grat and Prank Callers) you provide them a road map for the “successful” completion of their mission. If you are sensing the Caller is not being genuine do yourself a favor; don’t ask questions.

As for answering questions: Callers have a natural curiosity about us, our services, and the agencies we refer them to. Answering their questions is usually not problematic but it can be helpful to have a sense of the reason for the question before answering it as certain Difficult Callers use questions as a means of engagement. Also, keep in mind is that “I don’t know” is an appropriate response. Let’s take a quick look at some typical questions.

• “Hi . . .How Are You?" - Politeness is usually the driving feeling behind this question and we have the tendency to politely reply that we are OK. While this might be appropriate we need to be aware there is a risk the caller may get an, ”I’m OK . . .you’re not” message. Realizing we want to interact with our callers as equals we need to respond in an equivocating manner. This is not an easy one but something like, “It’s nice of you to ask . . .how are you? It sounds like you’re feeling . . .” allows the caller to feel heard and opens the door to interaction.

• “Can I Talk To A Male / Female?” - This is another very common question and the response to it is usually covered by an agency policy. However, even if covered by policy, it helps to explore the Callers motivation for asking the question. First of all most of our Callers are looking for help and getting that help is more important to them than who gives it to them. If they are looking for a person of a particular gender understanding the reason may provide valid insight as to the reason for their call. Also, this is a canard frequently used by Sex-grat Callers. When a female answers the phone they will ask to speak to a male. A reply that no males are available gives them the green light to “do their thing”. Before answering yes or no try to have an understanding of the reason for the question.

• “Do / Don’t You Give Advice?” - While advice giving is the purview of Dear Abby our Callers see us as advice providers. Unfortunately, while advice is a piece of what we do, this perception skews the equality between Caller and worker. Additionally, it places the onus of the success or failure of the outcome on our shoulders. Also it is helpful to keep in mind that advice is generally something the giver sees as a viable course of action. That does not mean the Caller will see it that way or that said advice would be appropriate for the Caller. One way to respond to this question is to explore what advice the Caller has received previously to determine what has and hasn’t worked. This will give you a clearer indication of which way to proceed with the call then simply saying you do or don’t give advice.

• “If I Need, Can I Call Back And Talk To You?”- Once again the answer to this question is usually covered by agency policy and there are times when it is advantageous that the Caller speak to the same worker. But there are a number of issues surrounding the answer to this question.

First of all if the answer is “Yes” is it because of policy or is it “Yes” because you feel a responsibility for the Caller? If it is the result of a sense of responsibility you are placing a weight on your shoulder that can become quite burdensome.

Another issue is that a positive reply cuts down the resource pool available to the Caller. What does the Caller do when you are not available? Additionally, many of our contacts are calling us because the one person they relied on is no longer available to them. By setting ourselves up as the replacement for that person we sow the seeds for potential disappointment should we become unavailable.

A third issue a positive answer raises is that it can interfere with the success of the Caller’s planned outcome. Even after we do our remarkable work with the Caller the job is not finished. The Caller must finish the process. By making ourselves too available we create the potential to inhibit the growth process we have initiated with the Caller.

With all this in mind it is possible that our response should be more involved than a simple “Yes” or “No”. The response should include an acknowledgement of Caller’s satisfaction with the interaction, a review of the plan, a statement that the next steps may not be easy, and an appreciation of the Caller’s ability to follow through resolve the issue confronting them.

• “Can I Call Back Anytime?” - The short answer: “Sure you can call anytime”. But like the previous question, we don’t want to run the risk of creating an inappropriate dependency. When replying to this question structure it in such a way that allows the caller to understand that contacting you is only the first step in solving their problem and they need to allow the plan time to succeed. However, if need be, your agency is available whenever they are in need.

• “What’s your name?”- We may be tempted to say we don’t give out our names or provide the requested information. While this might be appropriate, we risk having our message be heard as, “It’s none of your business." Worse, it may force a struggle over the caller’s right to know or not know the requested information. A more powerful way of responding might be to say, “It can be scary to share what your going through with a stranger . . .Let’s talk about what’s making you hurt." This identifies and focuses the caller on their fear and loneliness and lets them feel heard. Thus the name issue is usually forgotten. Keep in mind that most Callers seeking help could care less about your name. They view you as a facilitator not as a personality. All they want is help with their problem. If they are persistent in asking this question it might be helpful for you to explore their motivation for calling keeping in mind this is a common ploy used by Sex-grat Callers.

• “Can We Talk About Anything?”- We tend to answer this question with an immediate, “Yes” or, “We’re here to listen." In both cases these are well meaning, but not honest, replies. Depending on the caller's motivation and subject matter there are some things we will not address. If we attempt to explain this to the caller the call’s focus might become, “Well is this or that OK and if that ain’t OK is whatchamacallit OK?” Possible replies may be, “Sounds like you have something on your mind you want to talk about” or, “It sounds like you feel upset no one will talk to you about what is going on for you." Responses such as these allow you to discover what the caller has to say without trapping yourself in an inappropriate situation without invalidating the caller. Many Sex-grat Callers will open their interactions with this question.

THE VOICE

Those of us in the field have two voices. One is the voice we use day in and out to order lunch, scold the kids, talk to our friends and so on. The other voice, “THE VOICE”, is the one we use to engage and interact with our Callers. It is generally smoother, softer, and lower than our regular voice. When dealing with someone we feel is a Difficult Caller if can be helpful to alter this voice to suit the situation. A screaming Caller will usually lower their volume when you do an “almost whisper” when talking to them. A clinically distant affect will usually dissuade the Sex-grat Caller as will silence. It is important to not let THE VOICE express what you are feeling by is volume or intonation.

Know When To Say “No”

It’s funny but when we learn the skills necessary for Crisis Intervention we seem to delete the concept of “No” from our consciousness. It seems we assume “No” is judgmental and therefore inappropriate to use in our interventions. Interestingly, we continue to use “Yes” which is equally judgmental. The truth of the matter is that “No” within the proper context is an appropriate response and, perhaps more importantly, a more honest response. Some examples:

• The friendly neighborhood Sex-grat Caller asks, “Will you talk to me while I masturbate?” Somehow, responding, “It sounds like you are lonely” doesn’t address the situation. The correct response is “No, that is not the purpose of this line. Goodbye.”

• You’ve given the Caller a referral that will address their presenting issue, which they explained to you, ad nauseum. You try to close the call and the respond they need to tell you yet one more thing about their past. You let out a quiet sigh & listen to the same iteration of events you’ve already heard at least five times. Alternatively you can say, “No. It’s not necessary.” Then restate their issue back to them citing that they have previously agreed you understood the situation so further clarification on their behalf is not needed and suggest it is now time to stop talking about the situation a take action by utilizing the provided referral.

So there we have it The Ten Simple Rules For Working With Difficult Callers. Actually, they are actions you have most likely integrated into your “style” but by addressing them in this manner we can consciously develop new ways to use them in situations with Difficult Callers. Will using them ensure that you will never have that, “Why did I have to pick up THIS call?” feeling. No but they can help you feel less helpless and frustrated with Callers who are on your Difficult Caller List.

That said, let’s look at some Do’s and Don’ts in addressing Difficult Callers.

• Do maintain a professional distance. The anxiety and frustration of the Difficult Caller can be contagious and disabling. The situations they describe are tragic. Their pain is palpable. Their intense level of anxiety can be intolerable. The disturbed Difficult Caller creates a tornado about themselves that seems to suck in everything around it. If you begin to feel as overwhelmed and anxious as the Caller you have not maintained the emotional buffer. While this situation is representative of a high level of empathy, it is not helpful to either you, as the Worker, or the Caller. When this does happen to you, reflect the sense of being trapped by the “situation” to the Caller. Then address the specific facts regarding the Caller’s situation that is making them feel this way. To prevent this requires a high degree of self-monitoring. Supervision can serve as an excellent means for maintaining boundaries and restoring a professional perspective.

• Do recognize that interacting with Difficult Callers is a fertile ground for intense personal reactions on the part of the Worker. The experience these Callers have in dealing with hotlines makes them quite capable in plugging into the vulnerabilities or strengths of the Worker. Strong reactions to these Callers, either positive or negative provide them a means to exploit the worker and should be discussed in supervision.

• Do keep your expectations of what can be accomplished in the interaction realistic and share them with the Caller. There is no way any one of us is going to cure a psychosis or long term situation in the span of a single or several phone interactions. Acknowledge that you understand they would like all the bad things to go away. Then explain to the Caller that we can realistically only deal with the anxiety of the moment and its immediate cause.

• Do keep your interventions focused, pragmatic, concrete, and oriented toward problem solving. The Difficult Caller, overwhelmed by their situation, does not have the tools to effectively problem-solve. It is appropriate to make direct suggestions for dealing with the crisis of the moment, caution or urge the Caller not to do something, or actively encourage the Caller to seek appropriate help.

Do use a calm but firm voice tone to communicate both caring and certainty to the Caller. This can be calming and provide direction to the Caller whose feelings are at a fever pitch.

• Do acknowledge feelings but do not allow them to be the focus of the conversation. Instead get a sense of the facts of the Caller’s situation, summarize them, validate that the contact indicates the desire to change, and engage the Caller in discussing what they want to do to change. If the Caller returns to or dwells on the retelling of their personal history explain to them you understand their past and firmly, yet respectfully, explain you will not discuss it with them.

• Do let the Caller know if you are familiar with them and their situation it you have spoken to them before. Summarize your familiarity and invite them to explore what is happening for them in the present.

• Do accept that your skills work for the majority of your Callers but maintain the pragmatism to recognize they may need to be adapted for the Difficult Caller.

• Do recognize that change can be difficult, scary, and tiring. Validate this for the Caller adding that they have probably faced difficult, scary, and tiring things in the past and succeeded.

• Don’t ask the Caller how they thought you could help them. You already know the answer to that question . . .They want us to make things better. It is more effective to point out to the Caller that their call indicates they want us to help them and reflect their frustration that their attempts to resolve the issue at hand have not been successful.

• Don’t strive to uncover feelings that lie beneath the surface. Generally, the Difficult Caller is flooded with or overwhelmed by too many feelings and needs a way to put a lid on those feelings. The most effective way to confront this situation is to reflect the Caller’s sense of being overwhelmed and explore the issue inducing the helplessness as opposed to exploring the helplessness.

Don’t enter the “world” of the delusional or hallucinatory Caller. If they ask you if you can “hear” or “see” what they are experiencing reply in a direct and firm manner that you cannot. Entering the delusion or hallucination serves little purpose in telephone Crisis Intervention and extricating yourself at a later point can prove problematic.

Don’t give, or allow yourself to be manipulated into giving advice or information about a topic you are not familiar with. We are not all knowing and questions which you are not versed in should be referred to the appropriate professionals. We can acknowledge that that answers to the Caller’s questions are important while reinforcing that the people best qualified to provide an answer is the referral.

• Don’t be surprised if these Callers make you feel confused and helpless. The empathic level in which we interact with our Callers gives us passage into the Caller’s world which is, by the Caller’s design, quite different then your own. The safety net of your own ego will prevent you from being totally engulfed by the Caller’s world. However, maintaining our own sense of self can be a draining and exhausting process. Make sure you know your limits and when you approach those limits establish clearly defined boundaries. It is reasonable and acceptable to let the Difficult Caller know what you are and are not willing to discuss with them. It is also a more honest manner of interaction.

• Don’t invalidate the Caller by replying you are not a talk or chat line if they ask your purpose. Most Callers equivocate the terms talk line, chat line, help line, and crisis line. They are all places to call when they feel alone and need help. It is more appropriate to simply reply that you are a place people call when they need help with problems.

• Don’t allow the Caller to dictate to you how the interaction should be carried on. For example, if the Caller insists you listen and provide no input while they talk you can respectfully explain that such a request indicates that they seem frustrated they have no one to talk to the moment. Generally, this will encourage the Caller to open up to input. If it does not, allow the Caller to talk until you have a sense of their situation, summarize your understanding, and explain to them that we need to end the interaction.

• Don’t get trapped in the Callers rehashing of what has been already discussed. If this happens point out to the Caller that you are covering old territory and suggest they work with you to explore what they want to do to resolve the issue. If the Caller insists on reviewing “old stuff” point out to them that is seems more important to relay the story than do anything about it and the frustration evoked by that.

• Don’t reinvent the wheel. People usually do not contact hotlines as a primary or secondary resource for coping. If the person appears to be an experienced with the operations of hotlines point out to them that they sound like someone who has tried many ways to deal with their issue. Specifically mention their method of presentation makes it seem they have either contacted hotlines before or they have been in therapy. Explore with them how they felt they were treated and what help they did or did not receive. This exploration precludes a search for a service you may not be able to find or a duplication of services.

In closing:

• Remember to keep in mind that you can and you do good work.

• There will be people you will have to interact with who you will not like.

• That does not mean you cannot interact with them in a respectful manner. It does mean you will need to adapt your “style” to meet the “demands” of certain Callers.

• Be realistic in your assessment of what you can and can’t do. There is no one of us who can do it all.

• Make use of the staff support your agency provides. None of us in this field have to go it alone.

• When working with a Difficult Caller establish firm but respectful boundaries.

• Keep in mind that the basic tenets of the Crisis Intervention Process provides for equality and respect . . .and that applies to the Caller as well as us.

And last but not least. You may not have control over who is on the phone each time you pick it up. But, you do have control over how you will adapt to dealing with that Caller and how you will allow the interaction to affect you. Your choices are two in number.

Either this.

Or This. (Turn page)

The choice is really up to you.

The Never-ending Ever-present Crisis: Dealing With the Experienced Caller

Introduction:

As we learned in our basic crisis intervention training, crisis is a situation that exists for our Callers within a finite time frame that their usual coping mechanisms can’t resolve. Crisis has a definite beginning and end. We learned that effective intervention can result in a Caller who can develop enhanced coping skills allowing them to transcend their situation and thrive. This is a process, which is beneficial to the Caller and satisfying to the Crisis Worker. In this view crisis is not a clinical disorder.

However, not all crises are confronted effectively and the “crisis” becomes a chronic situation. While not a clinical disorder, a severe or protracted response to personal crisis may lead to a clinical disorder such as major depression or an adjustment disorder. Frequently, we are faced with Callers who present their lives as one continuous crisis having no definable beginning or end. Their contacts seem to be structured to provide momentary relief from a usually undefined situation with no desire to engage in resolution. Dealing with such Callers, which we will term “Experienced Callers”, can be challenging. The challenge is the results from the fact that we are not addressing a personal crisis. Experienced Callers present a chronic, on going, never changing situation. The Crisis Intervention Model structured to deal with the Crisis Caller doesn’t maintain its effectiveness when used with the Experienced Caller. We can use our usual crisis intervention skills to interact with the Experienced Caller but we cannot and should not expect The Model to work in its usual fashion.

It is the intent of the following presentation to:

• Define which Callers are “Experienced Callers”

• Discuss behavioral concepts as they relate to our Callers.

• Discuss coping defenses as they relate to our Callers.

• Develop a strategy for effective interactions with Experienced Callers.

Who Is an Experienced Caller?

To discuss the Experienced Caller we must first understand the Crisis Caller. The basic definition of the Crisis Caller holds that they are a person who has encountered a change in their life’s situation they are unable to address using their usual coping skills. The Theories of Crisis Intervention maintain that effective and timely intervention can enable the Crisis Caller to confront and understand the issue precipitating the crisis and, in doing that, that they can develop new or enhanced coping tools. This allows them to move beyond the paralysis of crisis and continue with their life. Central to this concept is the theme that crisis is finite with a beginning, middle, and end and that crisis represents an opportunity for growth.

For our purposes the Experienced Caller is one who has entered the continuum of crisis but failed, for whatever reason, to successfully resolve that crisis. As a result their coping skills have not advanced. Instead they try to resolve their “issue” over and over using the same defenses they have used, unsuccessfully, in the past. This places them in a never-ending cycle of anomie. They most likely have had extensive contacts with various hotline services under the pretense that, “Talking is good”.

While hotline contact for a Crisis Caller can be an adaptive means of coping, the Experienced Caller’s repeated contacts is a blind pursuit to thrive for the moment. For the Experienced Caller, hotline contact becomes a maladaptive means of coping because it helps them avoid needed (adaptive) formal counseling or treatment. Their hotline contacts become “on demand” temporary relief. Frequently, they will have either a physiological or psychological diagnosis or both.

Having all experienced crisis at one time or another we have an empathic understanding of the Crisis Caller. This understanding allows us to assume the fulfilling role of caregiver. We do not see the Experienced Caller in the same light. Depending on their level of distress we view them as primitive, disorganized, disoriented, and dis-enabled. The Experienced Caller presents themselves in many ways. They can be flamboyantly bizarre, vividly hallucinatory, or frighteningly and dangerously out of control. They can also present themselves as simple and childlike, speechless, immobile, or regressed to a seemingly vegetative state. Persons presenting themselves in such a fashion generally elicit discomfort and anxiety from us. They seem to be completely unlike us. These are the people we cross the street to avoid. These are the people we lock away in institutions pumped full of drugs intended to turn their mania into docileness. Their behavior seems so much different from what we accept as “normal”. However, if we view their behavior as an attempt to cope with life’s stressors we can accept that the behavior is comparable to our own personally logical and understandable strategies for living and surviving. In short, the difference between Crisis Callers, Experienced Callers, and us is all a matter of degree.

Behavioral Concepts and How They Relate To Hotline Callers

In talking about the “Experienced Caller”, and Callers as a whole, we must keep certain generalities regarding the behavior of all people:

• A person’s behavior is purposeful. Even those behaviors that seem not to have an obvious purpose may have a motivation that is either conscious or unconscious to the Caller. The Crisis Intervention Process is structured to help the Caller identify and confront behaviors in an effort to initiate resolution.

• All behavior is understandable. Even the delusions and hallucinations of the psychotic individual are understandable if we take the time and possess the skill and humanity to nurture the openness necessary to understand what is being communicated. Just because the Caller is talking with us in a manner we don’t immediately understand or we are uncomfortable with, doesn’t mean we can’t understand what lies behind the presentation if we make the effort.

• People respond predictably to the fear, stress, and anxiety of crisis. As individuals develop they evolve their personal coping style. They establish methods of coping (defenses) consistent with their personality. People in crisis do not independently invent new coping styles. Their emotional state will often exaggerate the proportion in which they implement their established methods of coping causing them to appear new when they are not. However, appropriate, supportive intervention can help a person amend or change their coping style.

• People generally hide from their feelings. This is especially true if they see their feelings as jeopardizing their personal sense of well being, their self-esteem, or the esteem of those around them. It is this hiding from feelings which makes the skill of reflection so powerful in Crisis Intervention.

• Anxiety and fear, while seemingly related, are actually two different feelings. When a person is “afraid” they can concretely identify the source of their fear. Callers will talk of fearing the breakup of a relationship; a fear of confronting superiors; a fear of snakes; a fear flying. In each of these cases and many other situations there is a definite “something” the Caller fears. Anxiety is different from fear in that the Caller is unable to concretely identify the source of their dread. There is “something” of which they are afraid but it is nameless and vague. The un-identifiability of the dread creates an anguish that can become paralyzing.

Sources of Anxiety are:

• The loss, actual or perceived, of someone on which the individual is dependent. In the most severe manifestation of this feeling the loss places the individual's existence in danger.

• The loss of love from someone important to the individual. Alone, lost, abandoned, empty, meaningless are but a few of the feelings associated with this source of anxiety. The need to maintain the “good will’ of the person becomes overwhelming.

• The fear of bodily injury. These takes the form of exaggerated worry about one’s own body and are demonstrated when the individual is in imminent physical danger or, perhaps, an invasive medical procedure is likely.

• The loss of self-esteem by failing to live up to internalized standards and mores. This is often expressed as a sense of failure perceived through the individuals own eyes rather than those of the people around them.

What all this says is there is a universality in which all people strive to flourish. We do not do anything without a purpose and that which we do attempt is predictable and understandable by the person who takes the time to understand us. Accepting and understanding the basic consistency of behavior among all people provides us a stepping off point from which Crisis Intervention can be initiated. The Caller in crisis may feel their behavior surrounding a situation is motivated by serendipity and is irrational. Accepting the above, we can help them discover and understand there are reasons they are doing what they are doing. While their behavior may not seem clear to them, defining and exploring the issue at hand can help them attain clarity. We can point out to them that their response to their situation is just like anyone else’s. We can help them understand that feelings are a valid reaction to situations and they exist to motivate us to change. They also exist to validate acceptable behaviors. When we work with a Caller and their fears we can help them develop specific methods of addressing the issues evoking those fears. Helping a Caller explore their anxieties allows them to concretize the realities creating their generalized apprehension. Doing this opens the door to potential resolution.

Coping Defenses

In our field we frequently speak of coping defenses. An understanding of the manner in which coping defenses work can establish a basis upon which we can build a method for understanding, accepting and dealing with Experienced Callers.

Coping defenses are designed to protect the individual from consciously experiencing anxiety and engage automatically when the homeostatic balance of our thoughts, feelings, and behaviors is upset. When the person’s established pattern of defense is initiated and is working they do not experience the pain of anxiety and therefore would not seek the help.

When a person reaches out for help it is an indication their anxiety level has become untenable and their usual defenses are not working. The reason for this situation lies in the fact that coping styles are adapted to a specific developmental period in the Caller’s life. The youth who used denial to cope with their life situation as a pre-teen will find denial doesn’t alleviate the anxiety of their current crisis. This is because they do not take into account that there are more mature or effective manners of coping. The basic reasoning here is, “If it worked before it has to work again”.

An interesting dynamic occurs when a person reaches out for help. Because of their automatic implementation The Caller is most likely not aware they are employing any coping defenses. Since they are not conscious of their attempt to cope they call hoping, if not directly asking, to be told what to do. If it is pointed out that they have initiated their defense system they will respond in a defensive manner. The automatic implementation of their defense strategy is transparent to the Caller and they see their lack of awareness of its existence as a sign of personal weakness.

We have been talking about defenses in general terms. But just what exactly are these “defenses”. The following is a list and description of the major coping defenses used by all of us, Crisis Worker, Crisis Caller, Experienced Caller when we deal with life’s stresses and anxieties:

• Avoidance: Involves the individual rearranging their life in a manner that allows them to avoid whatever it is that causes them stress. A Caller who is uncomfortable with close relationships will not enter into a situation where there is a risk of intimacy.

• Delusions: When an individual presents a personal belief system or ethic that has little or no grounding in reality they are experiencing delusion. Generally, delusions are either delusions of grandeur (“I am the King of the World”) or persecution (“The UN is after me because I have the nuclear secrets”). Delusions are attempts to resolve problems by a person whose personality and sense of self is in severe disintegration.

• Denial: Involves the individual saying that something too painful to bear just isn’t so. The statement, “I don’t believe it!”, by a Caller faced with the death of a loved one is really saying, “I don’t want to believe it!”

• Displacement: When the individual expresses emotions caused by one person or situation toward another person or situation they are exhibiting displacement. A familiar situation might be the person who has a flat tire and kicks their car.

• Dissociation: Think of the times you’ve left someplace and ended up at your destination but can’t recall exactly how you got there. The sense of being on “autopilot” is an example of dissociation. Amnesia or the sense of experiencing something from outside the individual’s body is more serious manifestations of dissociation.

• Hallucinations: When the individual substitutes sensory fantasies for a painful or conflicted reality they are exhibiting coping thorough hallucination. Generally, the hallucinations are initially a respite from whatever is causing the pain but they can become threatening to the individual. As with delusion, hallucination reflects serious personality disorganization.

• Intellectualization: The individual who discusses issues in a “hyper-intellectual” manner is defending themselves from hurtful feelings by not allowing them into the consciousness. Everything is analyzed in minute detail from every possible and impossible angle. Humor is not a possibility for these individuals.

• Isolation of Affect: When the individual defends their emotions by splitting their thoughts and how they feel about them they are demonstrating Isolation of Affect. The EMT who can discuss an accident scene in coolly and calmly in clinical terms is adaptively using Isolation of Affect. Isolation of Affect is related to Intellectualization.

• Projection: Involves the individual disowning painful or uncomfortable thoughts and emotions. The statement, “I am not angry. You are angry at me”, demonstrates projection by a Caller who may be angry with a teacher because they didn’t get the grade they felt they deserved.

• Rationalization: Rationalization is when the individual offers sound, seemingly well thought out reasons for a particular behavior or pattern of behaviors. This permits the person to keep the actual, less acceptable, behaviors out of conscious awareness.

• Reaction Formation: Involves the individual turning behaviors that are forbidden into something eminently acceptable. An example would be someone who has an alcohol abuse problem yet participates actively in measures and actions that would prohibit drinking. The key here is that the involvement is generally unrelenting and rigid.

• Repression: The individual dismisses the painful issue from conscious awareness. All the psychological defenses mentioned here have a component of repression to a greater or lesser degree.

• Somatization: The individual translates an emotional conflict into a physiological symptom. A mother who speaks of headaches and ulcers caused by an unruly child is demonstrating somatization.

• Splitting: When the individual identifies uncomfortable parts of themselves and separates them from their total persona by burying them in a seemingly inaccessible part of their personality they are practicing splitting. It is as if the person surgically removes a piece of who they are that they are uncomfortable with and throws it “away”.

• Suppression: While similar to repression, suppression is different in that it is a conscious effort to forget that which is painful. The individual who says’ “I’m don’t want to think about that”, is practicing suppression.

While the list is by no means complete we can see the defenses individuals utilize to cope are many and varied. Germane to our discussion is the fact that the defenses are used day in and out by persons, including ourselves, whom we consider “normal”. However, the list delineates behaviors that are symptomatic of any of a number of psychological disorders our “Experienced” Callers are diagnosed with. The only difference between the typical Crisis Caller and them is a matter of degree. However, we tend to view the “Experienced” Caller in an entirely different light. We equate the Experienced Caller’s repetitious behavior with their expectation of a different outcome as an indication of their “insanity”. Our frustration with this category of Callers is evidenced in our unnecessarily pejorative references to them as Chronic Callers, Repeat Callers, Demanding Callers, Babblers and so on.

Many reasons are given for this dichotomy:

• Our fear of being similarly incapacitated

• Our fear of being overwhelmed by the proportion of their defense

• Our anger at being overwhelmed by their presentation

• Our fear of the extreme degree of implementation of their defenses

• Our anger at feeling manipulated and used

• Our personal resistance to change

• Our projection of our own ability to resolve significant issues in our lives

All of the above affects our interactions with the Experienced Caller. The list could go on but for our purposes it is important that we look at the list and understand the counter-transferential issues presented. Our interactions with the Experienced Caller leave us stressed, anxious, lost, overwhelmed, frustrated, and angry. . .much like the Caller.

In every call both participants, the Worker and the Caller, bring “stuff” to the interaction. Both react to this stuff and those reactions set the tenor of the interaction. While we might pride ourselves in our “ability” to keep our own feelings out our interventions we must be aware that such pride is merely a delusion. Even though we are trained professionals our feelings “leak” into our interactions. This is the basic nature of empathy. Usually, this leak helps establish trust and assures a smooth intervention. However, there are times when the leak is counterproductive. The leak allows the intense feelings of the Experienced Caller into our emotional environment and we find it uncomfortable and it changes the substance of our interactions.

It is frequently said the Crisis Hotline is not the appropriate venue for the Experienced Caller. That there is nothing the hotline can provide the Caller. This is a myth. Crisis hotlines were developed with three levels of preventive intervention in mind.

• The Primary Prevention level is the one we are most familiar with and find most satisfying to both the Caller and ourselves as professionals. The person experiencing developmental or situational crises call and with the focused exploration of their situation The Crisis Intervention Model provides are able to develop the personal, social, cultural, or professional resources to address their crisis and get on with their lives. This intervention is intended to prevent the development of psychiatric illness.

• The Secondary Prevention level accepts that a psychological disorder has manifested itself. It is the goal of this level to mitigate the severity and duration of the disorder or risk of relapse. In this case it is the purpose of the intervention to enable the Caller to engage local services geared toward the primary treatment of the disorder impairing the Callers functioning.

• The Tertiary Prevention level is aimed at reducing the level of disability created by the psychiatric disorder suffered by the Caller. This is the prevention level designed to assist most of those people we have termed Experienced Callers. At this level the Crisis Worker works with the Caller who has early or acute mental illness. The intent is to prevent suicide and promote recovery for those whose vulnerability and life stressors have upset the homeostatic balance of their treatment modality.

What this says is, even though we may assume the needs of the Experienced Caller are beyond our scope of operation, there is a valid therapeutic precedent for interacting with them. The question now becomes. . .”But how?”

A Strategy for Interacting with Experienced Callers

In order to work effectively with the Experienced Caller we must come to accept the following regarding all Callers:

• The Caller is doing the best they can. They are doing all they know how to do to resolve their situation. It is the task of the Crisis Worker to validate this then engage the Caller in an exploration of what they can do differently to effect resolution

• The Caller wants to improve. If the Caller were comfortable in their anomie they would not reach out. The Crisis Worker needs to point out to the Caller that their call indicates they are not satisfied with the status quo and validate the desire to change.

• The Caller needs to do better, try harder, and be more motivated to change. Having validated that the Caller is doing the best they can the Crisis Worker now needs to point out and explore, with the Caller, what aspects of their lives they need to change in order to effect the enhanced coping they desire.

• The Caller may not have caused all their own problems but they have to solve them. In short, “There ain’t no free ride”. This is useful when working with the Caller expecting a miraculous resolution. We can validate that it is true they did not create their situation. We can then engage them in empowering themselves to effect change.

• The Caller’s life is unbearable to them as they are currently living it. If everything were OK they would not be reaching out.

• The Caller can’t “fail” the interaction. This is a trap we frequently fall into when working with the Experienced Caller. In an accepting, non-judgmental environment there can be no failure.

This is all wonderful theory and generally acceptable to us for the vast number of our Callers, including some Experienced Callers. There is a continuum of functionality that marks the genesis of psychosis. We all have Experienced Callers we enjoy working with. Generally the only issue involved in dealing with them appropriately is that of boundaries and accepting that we are limited in what can be accomplished in a phone call.

On the other end of the spectrum are those Callers that make us wonder what possessed us to pursue work in the field of Crisis Intervention. These are the Callers representing the psychotic end of the spectrum. These are the individuals with Impaired Reality Testing, Thought Disorders, Inappropriate Affect, or Poor Impulse Control. Callers exhibiting Delusions and Hallucinations, or living in the Borderline State are challenging because their reality and functioning is significantly different from that with which we are accustomed. Because there is a clinical term associated with these people we deem them different and lower functioning. The truth is they are not different and they are functioning. They are attempting to ensure the survival of their personality using the coping defenses we have previously reviewed. Remembering that these coping defenses are used by all of us should remind us that these Callers are not different. That they are endeavoring to “strive and thrive” shows an elevated level of functioning. The reality is that we replace the person’s identity with the identity of their diagnosis. In our thoughts the diagnosis becomes the person or a description of the person. The reality is that the diagnosis tells us what the person has, not who they are or what they are trying to cope with. To develop a method of interacting with these Callers let’s start by understanding their diagnoses.

• Impaired Reality Testing: Everyday of our lives we are in a constant testing of our perceptions of our reality. We reach consensual validation with the world at large that a bus is a bus, a chair is a chair and so on. Interestingly, there are times when our reality testing is impaired (meaning not consistent with the actual global reality). When we are in the Dream State we reside in a reality our subconscious creates. In our dreams “fairy tales can come true” and the only reality we need to validate is our own. The person experiencing impaired reality testing has lost the ability to reach consensus with their environment. The person feeling helpless feels they can fly. The victim feels they can be a superhero. What this represents to the individual is isolation from the actual world. They feel misunderstood because they interact with us in terms of their reality. . .a reality we don’t understand. This misunderstanding contributes to a generalized sense of isolation or abandonment. The misunderstanding, isolation, and abandonment become the commonality we can use to interact with such Callers, as these feelings are universal in both of our realities. Depending where the Caller is in their state, it might help to re-establish contact with the more universally accepted reality of society by testing their reality against societal norms. The danger here is invalidating the Caller or the possibility they may be so entrenched in the validity of their reality they feel attacked and communication shuts down.

• Thought Disorder: Thought disorders or severe thinking disorders are related to the loss of reality testing. In this instance the internalized representation and organization of the individual's perceptions is altered. Logic disappears. Para-suicidal behaviors might be engaged because consequences are ignored or underestimated. For this person 2+2 equals anything except 4. Conclusions bear no relationship to presented or observed facts. Obvious conclusions or answers are ignored or invisible. The idiosyncratic thought process of the individual, just as with impaired reality testing, is isolating because the logic the person incorporates bears no resemblance to accepted norms. Attempts to point out the lack of logic will prove fruitless as the Caller’s views their logic system as the true logic. Additionally, engaging the Caller within their own reality or logic is not helpful because it serves to validate a thought and value system which can prove ultimately harmful to the Caller. In this case we can interact with the Caller by addressing the behavior represented by their contact. This means we would point out the fact they called represents a frustration or anxiety they are unable or uncomfortable dealing with. This provides a commonality for focused engagement.

• Inappropriate Affect: A person’s emotional response (affect) generally reflects a person’s psychological equilibrium. We laugh and are joyful when we are happy. We cry and are sad when we are hurt by life’s circumstances. The emotional response of the person exhibiting Inappropriate Affect is not congruent with the situation or environment that evoked them. An example would be laughter during a time of death or disaster. Those around the person exhibiting Inappropriate Affect view the behavior as being bizarre and will tend to distance themselves from the person creating feelings of isolation and abandonment. This sense of loss and isolation can become the focus of the interaction instead of addressing the Caller’s demonstrated emotional response.

• Poor Impulse Control: The ability to observe situations and react or interact in an emotionally and societally appropriate manner in an effort to attain a desired end is a critical skill we learn as we develop. Persons with severe psychological disturbances loose this ability and their action take on an impulsive quality that, ultimately, could be dangerous to the person and/or those around him. In working with this type of Caller it is important to assess possible danger and act accordingly. In working with the Caller with Poor Impulse Control it can be helpful to point out how they feel those around them are reacting to their behavior and how they experience and feel about that behavior. It is important accept the behavior without attaching a personal judgment. All behavior is neutral. It is the emotional reactions of the person and those around them, which lends substance and meaning. This provides the even playing field we need to interact with such Callers.

• Delusions: Delusions are a system of beliefs held by the Caller that represent a severe distortion of reality. The delusional person accepts the delusions as real and clings to them tenaciously, frequently arranging their lives to accommodate them. Delusions frequently represent a desire for grandiosity (I’m the King of the World”) in an effort to compensate for feelings of low self-esteem. In short, delusions represent a method for the Caller to cope with internal emotional conflicts by reshaping the reality of their perceived environment. This could be a common ground for interaction but care needs to be taken not to invalidate the Caller. Generally, the delusional individual progresses from delusions of persecution (“The FBI is hiding in my closet”) to delusions of grandiosity. It is important to remember the person feeling persecuted might be prone to impulsive behavior designed to protect themselves from their persecutors. This means we must evaluate the danger to the person or others should the Caller opt to act impulsively. Callers who present grandiose delusions represent a lower risk of impulsive behavior as their reality has placed them above the perceived threats or turmoil. However, it is good practice to explore that they don’t plan to use their power to hurt others. Delusions of invincibility represent a danger in that the Caller may not be aware of the real dangers involved in their actions. Again, this is an area to explore. Engaging the Caller in an exploration of the inappropriateness of their “reality” is invalidating and generally fruitless because the reality we present as appropriate does not exist for them. It is preferable to accept their reality (providing it doesn’t represent a physical danger to the Caller or those around them) and address the stressors it creates for them in living their day to day life.

• Hallucinations: Hallucinations can affect any of the five senses but the most common are visual and auditory. The Caller who is hallucinating sees or hears things that are not there yet they are convinced the perceptions are real. Hallucinations represent a major splitting off of parts of the persona the Caller experiences as unacceptable. Frequently, forbidden thoughts and impulses take a hallucinatory form with a life and force of their own (“It’s not that I want to die. The voices are telling me I have to die.”). Hallucinations and delusions may seem bizarre to us but we must keep in mind they are an attempt of the individual to maintain the life force of their personality. The initial hallucinations and delusions represent a kinder, gentler reality for the Caller. They seem to take on the role of escape from a harsh and brutal reality the Caller feels they have no control over. Unfortunately, all to often the sanctuary afforded by the original hallucinations and delusions become transformed by the unresolved crisis it become more cruel and frightening than the reality they were designed to replace. The Crisis Worker may feel it beneficial to enter the Caller’s reality. While in a therapeutic setting this may be appropriate it is not appropriate in our venue. Our posture in the interaction with these Callers should be to assess immediacy issues regarding the safety of the Caller and those around them and addressing any stress and anxiety presented. It is interesting to note the hallucinatory or delusional Caller frequently will not present any stress or anxiety as their state has bought them comfort from the pain of their existence. In this case it is sufficient to explore how the Caller feels they are coping with current issues.

• The Borderline State: Originally the Borderline State was thought to be the last ditch defense of the personality on route to psychotic decompensation. It was seen as a transitional stage between higher level functioning and psychotic functioning. Recent thinking places the Borderline State on the pathology continuum as being less disturbed than psychosis but closer to that level of disturbance than the other disorders we have discussed. The person in the Borderline state has managed, although not altogether successfully, to master the basic developmental tasks of Body Boundaries, Basic Trust, and Object Constancy. The primary emotional conflict involved seems to be rage and frustration at not having created a fully formed core identity. Borderlines often present themselves as depressed, feeling dead or lifeless inside, empty, without energy, without goals. They are not dysfunctional in the sense of being unable to hold down a job or even enter into a stable, long-term relationship. It is the lack of zest, the lifelessness of these people that suggest the severity of their disturbance. While not psychotic, they may often have periods when they behave, think, and experience the world psychotically. They are often highly suicidal and it is not unusual for them to become actively suicidal and require hospitalization. The borderline represents a large number of Experienced Callers. In working with these Callers it is helpful to explore and validate the positive responses they present. We must remember the positives presented might be as “trivial” as waking up in the morning or as important as finding employment. Completing the task of remembering to take ones medication can be a milestone. In any case it is helpful point out the positive and engage the Caller in a discussion how they might take that positive and apply it in another area of their life.

With all that has been presented what can we develop as a strategy for effectively interacting with the Experienced Caller? Previously we listed six assumptions regarding our interactions with all Callers. Let’s apply those assumptions specifically to the Experienced Caller.

❖ The Caller is doing the best they can.

➢ We can point out and validate that the Caller is doing all they can to cope. Even if we are aware of other things they could do we must realize the Caller either not be aware of them or their anomie is preventing them from seeing other possibilities. There may also be constraints due to economic or physical ability preventing them from following through on anything else. Remember, even the delusional Caller is doing something to cope with their situation.

❖ The Caller wants to improve.

➢ This is a given. If the Caller was satisfied with their lot they would not be on the phone. Point this out to them. This can open the door to exploring what they have done or considered doing in the past or an exploration of what has worked or not.

❖ The Caller needs to do better, try harder, and be more motivated to change.

➢ This can be ticklish but we can point out that the Caller that they have tried many things and they still feel stuck. What can follow can be a discussion of how maybe they were expecting an instant solution to a long-term problem. A discussion of the Caller’s perception of their self-value might be engaged. For example: “It seems like the frustration has you feeling worn out. Yet it seems you feel you deserve better. Maybe you can decide to try again to make changes for yourself”. Also, recognizing that trying to change is emotionally hard work we might mention that the Caller feels comfortable with the way they feel because it is easier not to change than change.

❖ The Caller may not have caused all their own problems but they have to solve them.

➢ This comes into play when dealing with the Caller who demands that the Crisis Worker solve their problem. Point out to the Caller that it is clear circumstances that are beyond their control may have precipitated their current situation but those influences were in the past. In the present there is only one person who will ultimately create a resolution and that person is them. At this time it can be helpful to point out they don’t have to go the road alone and appropriate referrals or interventions could be introduced.

❖ The Caller’s life is unbearable to them as they are currently living.

➢ This is helpful with the Caller who is doing your basic “pity party”. Point out the Caller’s dissatisfaction with there state. You can then point out that if they choose they can get concrete help to change. In most cases the reply will be that they have tried everything and nothing worked. In this situation it can be helpful to point out that they do, in fact have a choice. They can either accept nothing will work and do nothing. In that case nothing will change. The choice is that they can try to make a change and have a chance that trying may in fact work this time or not. However, if they don’t try “nothing” is guaranteed to happen.

❖ The Caller cannot fail therapy.

➢ Again this is helpful with the Caller who is from the Been There – Done That – Nothing Works school of thought. We can validate their feeling that nothing is working but offer that it’s not solely the fault of the Caller. We can then point out that just as there was a lot of stuff that got them to the point they are at it takes a lot of stuff to make things better. That things didn’t work out right doesn’t mean they didn’t do their job. All it means is that they need to try again. Everybody who has ridden a bicycle remembers the first time they tried it without training wheels. The following poem illustrates this concept:

AUTOBIOGRAPHY IN FIVE SHORT CHAPTERS

By Portia Nelson

I

I walk, down the street.

There is a deep hole in the sidewalk.

I fall in

I am lost.... I am helpless

It isn't my fault.

It takes forever to find a way out.

II

I walk down the same street.

There is a deep hole in the sidewalk.

I pretend I don't see it.

I fall in again

I can't believe I am in the same place but it isn't my fault.

It still takes a long time to get out.

III

I walk down the same street

There is a deep hole in the sidewalk.

I see it there.'

I still fall in.... it's a habit, my eyes are open.

I know where I am.

It is my fault.

I get out immediately.

IV

I walk down the same street.

There is a deep hole in the sidewalk.

I walk around it.

V

I walk down another street.

Chronic Callers

Chronic Callers, Repeat Callers, Frequent Flyers, or whatever names we assign to this category of callers are a fact of life in the field of telephone Crisis Intervention. It is this presenter’s experience that calls from Chronic Callers is generally between 8% and 12% for most telephone Crisis Intervention services. When asked about Chronic Callers, our workers respond “acceptably” and say they are to be treated the same as any other Caller: non-judgmentally, respectfully, and empathetically. Unspoken is the generally held (and more truthful) feeling that Chronic Callers are a waste of time, draining on both an emotional and a resource level and in general, a pain n the nether regions. Workers feel that since there is no way to help this class of Caller to change their situation why bother interacting with them at all? But, like it or not, we do interact with them.

The movie “Broadcast News” has a line that says, “Wouldn’t it be great if depression and low self-esteem made us more lovable instead of less?”[10] If this were the case we would be singing the praises of Chronic Callers. Admit it or not, we interact differently with Callers we “like” or feel we can help. Our voice tone and patience level is different with the Caller we feel is working with us to resolve their situation. When the Caller is lost in a sea of helplessness, haplessness, and hopelessness which we personally see no way out of, the negativity is transferred to us and this makes us angry and frustrated. Who are they, those Chronic Callers, to rain on our parade?

In this section we will discuss:

• Why Chronic Callers call

• How to identify Chronic Callers

• The frustrations Chronic Callers elicit in us

• Reasons for letting Chronic Callers call

• How to make your staff aware of who is a Chronic Caller

• Models for working with Chronic Callers

• How to interact with Chronic Callers when establishing policy

• How to become an effective Chronic Caller.

WHY ARE YOU CALLING US – AGAIN AND AGAIN?

Intuitively we know which of our Callers will develop into Chronic Callers almost from their first contact. Even newly trained Workers quickly develop a sense of which Callers may become problematic. However, until we are sure a particular Caller is a “Chronic” we extend them the full range of our services. Why? Because that is what we are trained to do. Invariably, all of us involved in Crisis Intervention do it because we “want to help”, or we “want to make a difference”. It is this training and desire to “do good” that helps us to create new Chronic Callers and foster the old ones. Let’s look at what we do to start the cycle.

• We tell them to call us

First of all there is our advertising. Usually our publicity identifies our agencies as places to call and talk and get help. This sends a tacit message to the Potential Chronic Caller that we want them to call us. Also think about how you usually end your interactions with Callers. Almost universally we invite them to call us back should the need arise. To the typical Caller this gets put in a mental file as a way to get help should the need arise again. To the Chronic Caller this says “Call us back anytime you want”. It almost seems they don’t want to disappoint us and dutifully make those extra calls.

• We listen

A basic teaching in Crisis Intervention is that of assessment which requires listening. Without dwelling too deeply on the psychology of the Chronic Caller (and many have a psychological diagnosis) generally they are people who have, for whatever reason, failed to resolve the precipitating situation (crisis). In their failure to move beyond the initial situation they have frequently isolated themselves or have caused themselves to be isolated by alienating those closest to them. In their isolation they feel unheard until they pick up the phone are listened to by the voice on the other side of the connection. Being heard is both validating and comforting on several levels so the foundation is set for numerous calls.

• The “Warm and Fuzzies”

The “high touch” interaction used in Crisis Intervention achieves, through the use of Active Listening, a feels good feeling for our Callers. It enables our regular Callers to connect with us to allow an examination of their situation and needs and then move on to resolution. This form of interaction just plain feels good to the Chronic Caller. When something feels good to us what do we do? We try to duplicate the experience as often as we can. This is exactly what our Chronic Callers do.

• Inconsistent Reinforcement

As mentioned before most Crisis Intervention workers have a sort of sixth sense that warns them a certain Caller is Chronic, or about to be, without being aware of a contact pattern. Many workers control this sense and interact in the usual fashion with such Callers. However, there are others who subtly, and probably without an awareness of what is happening, alter their usual call taking style into a style that is “appropriately” abrupt and/or aloof. This second experience is not satisfying to the Caller and they will repeatedly call until they can duplicate the desired sense of satisfaction. Because of the inconsistency of the contact experience the power of the desired outcome is heightened which mitigates the disappointment experienced when the interaction does not proceed as hoped for by the Caller. The message the Chronic Caller processes is “The more I call the better the chance I will get what I want”.

• We like them

While we profess to remain nonjudgmental and try to avoid identifying with individual Callers we do form opinions about them. This is human nature and to deny that this happens is unrealistic. Certain Chronic Callers do exhibit qualities we can find “endearing” and we find it enjoyable talking to them. It is conceivable that there is no Crisis Intervention worker who at one time or another wondered what happened to “that” Chronic Caller who has not maintained their usual contacts. Another dynamic working here is that many interactions with Chronic Callers are “low pressure”. There is no expectation of an outcome, so the time spent on the phone with them is more relaxed…a Chronic Caller timeout.

• We have to talk to everyone that calls

This is quite a frustrating reality for Workers especially when a Caller reminds them of it. Even if a Caller falls outside an agency’s catchment there is that time spent explaining the mission of the agency and, generally, a referral to a more appropriate resource. The Chronic Callers know we don’t hang up on people and see that as an encouragement to make contact.

There are most certainly other reasons Chronic Callers contact us. What is important to take from this discussion is that most of the reasons Chronic Callers call are something we do to invite the contacts. Granted there are some cases where the Chronic Callers psychological diagnosis precipitates the repeated contacts but by in large, it is what we do and how it is perceived by the Caller that begins the cycle. Accepting that our actions play such a role in the issue we can come to develop a means for “controlling” the situation. Before we discuss that let’s next define….

WHO IS A “CHRONIC CALLER”?

As mentioned previously we, as Crisis Intervention providers, do not view our Chronic Callers in the same light as our regular inquirers. In public we are very “correct” in how we speak about them. In private the discussion is quite different. We see them as annoyances that sap our energy and resources. We also see them, and ourselves, as failures as a result of our interactions with them. We see

Chronic Callers as failures because they “refuse” to change their situation or get better. We see ourselves as failures because we can’t make them “better”. This worker perception of failure represents a source of worker frustration and burnout.

What we often forget is that Chronic Callers are people whose regular functioning patterns and perceptions are different from ours and the majority of our Callers. This difference may be, or most likely isn’t, within their control. The actual difference between Chronic Callers and our “Regular” Callers is that "They", for whatever reason, cannot move beyond the state of affairs that precipitated their situation. They pose a different set of problems for the worker. Chronic Callers use the hotline frequently, presenting the same situation in the same manner time after time after time. They seem to call for no other reason other than to chat or hear the sound of their own voice. As a group they do not seem to receive the benefits a hotline is structured to provide.

The following criteria can be used to define and identify a “Chronic Caller”:

• They call frequently over an extended period of time.

Most of our inquirers call with specific needs that we address in our interaction and then provide a referral to an appropriate agency. Often this is accomplished in a single call but there are occasions where multiple calls are needed to resolve a given situation. This we find acceptable because the Caller is contacting us about the precipitating issue and is focused actively trying to resolve it. We, and the Caller, can see that there will come a time when resolution will occur. On the other hand the Chronic Caller will make numerous contacts, frequently addressing the same issue, without seeming to take the steps they need to change the “problem”. As no steps to effect change are being made the Caller finds themselves in a repeating cycle of calling

• The general content of their calls tends to be consistent from call to call.

How does the song go? “It’s still the same old story, a fight for love and glory, a case of do or die….”. However, it is important to note that should the “same old story” change it could be an indication the Caller is in need of assistance.

• Their manner of presentation is the same from call to call.

Again a change in presentation could indicate a need for help.

• They exhibit either an unwillingness or inability to effect concrete situational resolution.

An interesting insight to this dynamic is that often the Chronic Caller, while claiming not to be satisfied with their situation, finds a comfortability in the constancy of their situation. We generally accept that change is difficult and fear inducing. For the Caller whose situation is the same day in and out the “problems” change represents are nullified and the constancy of the situation becomes a “comfy pillow”.

• They seem to be aware of the mechanics of the Crisis Intervention process.

Repetition can be a great teacher. We all have had interactions with Chronic Callers who actively listen as well as we do.

• Their contacts seem to be more the result of habit than actual crisis.

We all have had contacts with Callers whose morning routine seems to be wake up, brush teeth, make coffee, call hotline.

• The manner in which they present their situation seems to indicate the “story” has been repeated time after time.

For those that have children the first bedtime reading of Dr. Seuss doesn’t have the same delivery and verve the 50th time around. Sam I Am becomes rote, to say nothing of those green eggs and ham.

WORKER FRUSTRATION

That Chronic Callers create negative feelings in Crisis Intervention Workers is a fact. Feelings of frustration, anger, inadequacy, resentment, helplessness are frequently expressed by hotline Workers when they talk about Chronic Callers. This does not say anything negative about the Workers or their skills. It does say that their feelings are generated not by what they are doing but what they sense is being done to them. The following are some of the reasons cited by Workers for their unhappiness with Chronic Callers

• Chronic Callers Make Me Feel Trapped

It is easy for the Worker to feel trapped by the Chronic Caller. We don’t have the luxury of selecting which calls we are going to answer. When someone contacts us and asks if they can talk to someone our usual response is to say. “You can talk to me”. Saying that leaves us no easy way out of the interaction once we realize we are talking to a Chronic Caller. Adding to the frustration is that we know that the Caller knows we “have” to talk to them. The phrases, “Well your there to help people” or “You have to talk to me” come to mind. It is reasonable in such circumstances for Workers to feel not only frustrated but also angry.

• Chronic Callers Make Me Feel Like a Failure

Let’s be realistic. People don’t become Crisis Intervention workers because they want to become millionaires. We enter the field because we want to help people. When we have interactions where we can see inquirers receiving the services they need we feel good. With the Chronic Caller the worker feels robbed of this opportunity to feel good and anger and frustration ensue. Another side to the failure issue is that the worker, feeling trapped by the Chronic Caller, feels they are failing the Callers who can’t get through while they are on a call which they see to be unproductive. This is a double whammy.

• Chronic Callers Are Crazy

Another reality is that most Chronic Callers have a psychological diagnosis. While our Workers are quite capable of providing for the needs of most of their Callers they are frustrated with thee Chronic Caller because they feel their skills are not equal to the task. A sense of inadequacy sets in which adds to the frustration and anger.

• Why Don’t They Do Something…Anything?!

A frequently mentioned frustration with Chronic Callers is their inability or seeming lack of desire to change. They refuse to, or can’t, take the simple steps to improve their lives that seem so obvious to us. In short we see them as resistant. The Crisis Intervention Worker can clearly see what has to be done to effect change and can’t imagine the Caller wouldn’t take those steps.

• Chronic Callers Are Different

Another frustration is encountered when we deal with the Chronic Caller who does not seem to agree with generally accepted values, beliefs, and priorities. It is interesting that our workers will deal effectively with Callers whose value system is not congruent with theirs but when they are confronted with a Chronic Caller who constantly reminds them of the difference they become resentful.

• I Can Change This Chronic Caller

There are Workers who will feel that they have the skills needed to move a particular Chronic Caller to a higher functioning level. It is possible that in some rare cases this does occur. But in the majority of instances all it leads to is a frustrated Worker and a more strongly bonded Chronic Caller.

What is interesting about the listed frustrations is they all stem from judgements we make about this category of Callers. It is not so much what the Callers do to us but what we think and feel about what they do. We do not have real control over the actions of Chronic Callers. We do, or should be able to, have control over our reactions to them. So a sound first step in trying to work with Chronic Callers is to work with our staff regarding their feelings about such Callers and the skills they can develop to address those feelings.

WHY DO WE LET THEM CALL?

So with all this negativity surrounding the issue of Chronic Callers why not just refuse to talk to them. Case Closed. Done Deal. But it is not that easy as we will see in the following.

• Because We Have Invited Them to Call

Simply because of the nature of our services and our advertising we invite people to contact us. Even if we make it known we only serve a specific cachment people outside tar cachment will call and we will refer them on to a more appropriate agency. We don’t say that we will only talk to a Caller a certain number of times or length of time. Also, until a specific call pattern is ascertained we don’t consider limiting contacts.

• Because They Can

Short of blocking their calls there is no effective way of stopping a particular Chronic Caller’s contacts. Call blocking can be effective but what if the Caller is calling from a payphone that means other inquirers will not be able to access your service. Also, some Chronic Callers have changed their numbers to combat the block or will use other phones.

• Because Sometimes Even Chronic Callers Need Help

There are times when the Chronic Caller’s usual method of presentation will change. This is a good indicator they are in need of help with a current situation. Experience has shown that assistance offered at such times is readily accepted and followed through with. However, once the situation is resolved the accustomed pattern of contact is restored. This raises the question about denying an individual services when they are in need just because past behavior has led us to not want to talk to them.

• Because It Makes It Easier to Work with Them

Making policy that certain Callers can’t call your agency can be somewhat effective but it can also lead to game playing. It is not unusual for a Chronic Caller who has “banned” from a hotline to change their contact pattern, story, and presentation which leads to confusion and a new beginning to the contact cycle. It also models negative behavior for the Chronic Caller in that it demonstrates deception can have its rewards.

****Exception to the Rule****

In the case of a Chronic Caller who is threatening or abusive it would be reasonable to no longer engage them or block their calls. By allowing them to persist in the maladaptive behaviors of making threats or being abusive we foster the behavior by rewarding them with the ability to contact us at will. This neither helpful to the Caller nor the hotline. However, keep it in mind that blocking the calls does not necessarily mean you will not hear from the Caller again. Also in cases of severe threats or abuse there may be legal action available to you but such decisions should be handled on a case to case basis.

MODELS FOR WORKING WITH CHRONIC CALLERS

Most agencies have specific policies (Models) regarding Chronic Callers. However, the number of times the issue is bought up or asked to be addressed indicates that we are not satisfied with what we have in place. The hope is that there is one single Model that will solve the problem and Chronic Callers will go away. Sorry, but that is not going to happen. The best we can hope for is a Model or combination of Models that will address the situation in such a manner as to make the contact manageable. Some Models are:

• Chronic Callers Do Not Exist

This is alternatively called the Altruistic Model. While it is based on the principle that helping agencies exist to help any and all inquirers it denies the fact that such Callers do exist. While we may feel we are serving them appropriately by allowing unlimited access we may, in fact, be doing them a disservice.

• Don’t Do Anything

In this model we admit there are such Callers but don’t address the issue assertively. The helpfulness of this model to the Caller is questionable as it has the potential for the workers to interact with the Callers in any manner the see fit. Some will willingly “work” with the Chronic Callers while others will opt not to not be so understanding. This inconsistent re-enforcement is not beneficial to the Caller who receives a mixed message about their contacts. This inconsistency leads to game playing and worker frustration.

• Don’t Engage Anymore Once Identified

This is the simplest Model to put in action but it does have drawbacks that we have already discussed. There is also the risk that a non-Chronic Caller may be identified as a Chronic. The potential for this to happen might be low but that it could happen at all is something we would want to avoid.

• Agency Dictated Contact Policy

Many agencies, once a certain Caller is identified as Chronic, will establish guidelines for interacting with that Caller. Quite often this is a decision by the agency administration with input from the staff. An agreement is made as to the most effective (expedient?) method for working with the Caller in question and a policy is instituted. When the Caller next calls they are informed of the policy. This can be effective but the fact the Caller is not involved in the process can create problems. Major among these problems is the Caller may see this action as something being “done to them”. The life situations of many Chronic Callers make them feel they are not in control of their lives. Making contact policy without the Caller’s involvement will most likely make them angry and they will act that anger out. Usually that acting out takes the form of abuse of the hotline that will eventually subside but is not helpful while it is happening.

• No Therapy – No Contact

The basis for this Model lies in the fact that the “Warm and Fuzzy” feeling the Caller receives through their repeated contacts can interfere with their reaching out to a more appropriate resource to resolve their situation. While not being able to contact the hotline may induce some Chronic Callers to get the longer-term assistance they need others will refuse. Then you are either stuck with Model #1 or are back to square 1.

• Note From the Therapist

This is a variation of the No Therapy – No Contact Model that addresses the Caller who is already in therapy. Those Callers who have become Chronic are asked to arrange for their service provider to contact the agency to discuss the Caller’s contacts and develop a plan that would benefit both the Caller and the Agency. There are even cases where the therapist will request the agency not allow the Caller to contact them as the contacts are interfering with the therapeutic process. There are issues of confidentiality involved with this Model but it is surprising how many Chronic Callers and therapists actually agree to such a process.

• Interactive “Let’s Talk About Your Calls”

This Model is very “High Touch” in that it makes the Caller a participant in the establishment of a contact policy. In this Model the Caller is told that the agency is aware of their Chronic Call pattern. It is further explained that in order to continue calling they will need to speak to an administrator about their calls as well as the need to establish a plan that will meet the needs of both the Caller and the agency. Generally by time this step is taken the agency will have a good understanding of the Caller and their issues. While some Chronic Callers will refuse to partake in the process the majority does, in fact, comply. When the Caller is connected with the administrator it is explained that the agency is aware of the many contacts by the Caller and how those repeated contacts preclude others from contacting the hotline. It is also explained that the repeated contacts indicate that the Caller’s needs may not be being met. While the interaction is an empathic process where the Caller’s feelings are reflected and validated it is also very focused on establishing a contact policy (that has, admittedly, already been decided on by the agency). What makes this Model successful is that the Caller feels they are part of the policy making process and they appreciate the honesty and candor with which the policy is presented. They feel they are “doing” something as opposed to something being done to them. It also sends a message that contacting the agency is a privilege. This understanding is important because the Caller will tend to adhere to the policy rather than risk losing the privilege. Usually the process is completed in the one call but sometimes it may take several contacts especially when it has been determined that therapy or a therapist contact may be required. In the rare case where the Caller opts not to participate the options are to let things continue until they are ready to do so or to go with the No Contact Model.

There is at least one agency that has used this Model with an added twist. When policy is made regarding a specific Chronic Caller they offer that instead of the Caller contacting them they will contact the Caller. This works out well because they can schedule the contacts for when they are best staffed. They also use it as a training tool for new workers who may not be 100% ready to answer the hotline itself. It affords the new workers an opportunity to develop the skills they learned in training without the stress and anxiety of not knowing what kind of call is coming in next. For this agency this program then evolved into a respite service for the elderly and homebound.

HOW TO MAKE YOUR STAFF AWARE OF WHO IS A CHRONIC CALLER?

This is not as hard as it might seem. Experience has shown that the hotline staff is generally well aware of which Callers are chronic even before they are formally identified as such. The following system can be effective in making sure all staff, new and old, is aware of which Callers are Chronic. The system has five components which are described below:

• Basic Information

This component lists the name of the Chronic Caller or the alias the staff recognizes the Caller by and other basic information you would track for any other Caller. One notable addition would be a place to note the time and date of the Caller’s last contact.

• Identification Profile

This is a brief description of the Caller including their basic story-line, identifying characteristics such as accent, frequently used phrases, or anything in their presentation that makes them stand out for your other Callers. (Note: If you set up the system on your computer system you can arrange to do a keyword search that will permit Workers to enter information about a suspected Chronic Caller and the search will display a list of Chronics fitting the search.)

• Background and History

This is an in-depth narration of the contacts the Caller has had with your agency. This is helpful to have as it allows the worker to know the Caller’s “story” in detail. Having this knowledge is helpful in two ways. First, it allows the Worker to focus the Caller on current issues without having to rehear the whole story. Secondly, it will allow the Worker to note any changes in the Caller’s situation that Caller may need actual assistance with.

• Current Life Issues

While the Chronic Caller generally does have the same issues to present call to call this section will review what those issues are and what the Caller is doing (or not) to address them. As, or if, the Caller’s issues change this section should be updated.

• Support System and Strengths

This section will detail what supports the Caller has. This could include any counselors, churches, support groups, parents, siblings, pets…in short anything the Caller uses to cope or stabilize themselves when times are tough. Also, Chronic Callers do have certain internal strengths they use to get on in life such as hobbies, pastimes, prayer or even other difficult situations they have survived in the past.

• Plan (Limit, Focus and Rational)

This is where the Worker would learn about what policies the agency has taken regarding the particular Chronic Caller in question. Establishing contact policies involves both a “Limit” and a “Focus”

• Limit addresses the number and duration of the calls during which we will engage the Chronic Caller. The Limit is not an arbitrary choice. It is not intended to be punitive. It is a limit intended to balance the Caller’s needs and the agency’s ability to accommodate those needs. It is a limit we feel the Caller can understand and accept. It is set only after a thorough review of the Caller’s history and discussion with Workers who have had interactions with the specific Caller. The Limit can be in terms of calls per day or week as well as a time limit. When a Chronic Caller exceeds their Limit it is sufficient to remind them they have used their calls for the day/week and they can call when their Limit next allows them. Some callers will only use a portion of their “time” during a call then will call back saying they are owed the time not used. In this case we will tell them this is unfortunate but not acceptable and we will end the call explaining they can call when their Limit next allows them. Many Chronic Callers’ contacts follow no discernible pattern or the contacts are intermittent. In these cases there is no Contact Limit assigned since establishing a daily contact limit would encourage them to make more calls.

• Focus addresses what we will discuss with the Chronic Caller during their contacts. Part of the “chronic” nature of our Chronic Callers is their steadfast focus on what has happened in the past or situations that are beyond their control. Since we are aware of the Caller’s history we need not focus on endless reiterations of it. A focus on the past or uncontrollable issues obstructs attempts to effect change. This is not helpful to our Chronic Callers. With this in mind we will not engage them in rehashing “Old News”. Instead we can explain to the Caller that since we are aware of their past they don’t need to explain it to us and encourage them to talk about what is happening in the present and what they are doing to cope with it. When the time limit is reached we will respectfully remind the caller of the plan they agreed to and end the call. This does not mean we will “just listen” to the Chronic Caller for their allotted time. It does mean we will interact with the Chronic Caller in a manner defined by the boundaries of their Limit and Focus.

Another aspect of Limit and Focus has to do with the propriety of a Caller’s contact. Callers who exhibit inappropriate or abusive behavior will be told what behavior is and is not acceptable when they are informed of their contact policies. Should the caller choose to be inappropriate the behavior will be pointed out to them and they will be given an opportunity to behave appropriately. If the behavior continues the call will be ended promptly and respectfully explaining they are not behaving acceptably. Inappropriate calls count toward Limit totals.

• Rational delineates how the Plan was created. This is important for two reasons. First of all it give the workers something to refer to should a particular Caller question a Plan that is being used. The second purpose for including this in the Plan is that it allows workers who may feel “attached” to a certain Chronic Caller to understand that the Plan was not something arrived at arbitrarily. They will be able to see that the Caller was treated respectfully and in a manner that took into account the needs of both the agency and the Caller. This understanding will help ensure the Plan will be implemented uniformly.

The clarity with which this system allows Chronic Callers to be documented and identified goes a long way in reducing Worker stress in coping with Chronic Callers. It allows them to be certain in their identification of the specific Caller and provides them the background they need to interact with the Caller in a focused manner.

Once policy for a Chronic Caller in instituted it is just as important for the staff to adhere to it as the Caller. Believe it or not some staff members get “attached” to certain Chronic Callers. They may see the institution of policy as a punitive action and will be resistant to following the policy. In other cases certain staff may feel the policy, or any policy that allows contact, is not appropriate and will hesitate to follow the installed policy. To ensure staff compliance help them understand the reasons for the policy and any conditions attached to it. It also helps to explain the process the administrator and Caller engaged in so the staff can see the decision was mutual and the policy was instituted to benefit both the Caller and the agency. Consistency of Worker enforcement of policy is important to the Caller as it helps them to remain compliant. In fact, there will be time the Chronic Caller will remind the Worker of the policy. For example, if the Limit includes a time limit of 10 minutes and the interaction goes over the limit the Caller will remind the Worker of the fact and voluntarily end the call.

It is also important to remember that Chronic callers, just like any other person, can have situations that occur that will place them in crisis or in need of some kind of assistance. This places us in the situation of having to determine if their presenting situation is part of their defined chronic behavior or an actual need. Remember that our definition of a Chronic Caller states they are consistent in their manner of presentation and content. Any appreciable change in either of these criteria can indicate the particular Chronic Caller has entered a crisis. It is this situation we will define as “Immediate Need”.

When a Chronic Caller is in Immediate Need we will treat them as a regular inquirer. We will offer them the full complement of our skills and resources. We can use Phelix as an example. In past calls Phelix has spoken about his worry of what would happen to him should his mother die. In the event this should happen, this situation would not be part of his defined profile. This would be an Immediate Need for Phelix. We would work with him to resolve his situation and refer him to appropriate assistance. Once the situation is resolved Phelix would be spoken to about going back to his contact policy. Should the situation become long-term (chronic) it would then become part of his profile and a new policy would be instituted. This would be explained to him and we would work with him accordingly.

HOW TO INTERACT WITH CHRONIC CALLERS WHEN ESTABLISHING POLICY

The first thing acting in your favor is that you will probably not be the first hotline seeking to establish a contact policy with the Caller. Very few Chronic Callers utilize one hotline to meet their “needs”. It will surprise you the number of times Chronic Callers will wonder why it took you so long to take the step.

When addressing policy with Chronic Callers it is very important to remember your active listening skills. They are the only tools you possess to overcome the resistance the Caller will have to establishing policy. Empathy and reflective responses will allow the Caller to feel they are part of the process and they are being heard. Also keep the discussion focused on the Caller and their needs. They will sometimes try to shift the focus to you or back to their situation. Maintain the focus of the interaction on the task at hand.

However, being empathic does not mean lack of focus. Focus is very important. Plan ahead of time how you would like the interaction to go. Try to anticipate possible areas of resistance the Caller will have and practice responses. If they start to reiterate their “story” explain to them that you are aware of it and offer a succinct synopsis of it. Then explain that the purpose of your current interaction is to address their frequent contacts and how it is affecting your agency. You can then segue into how it can be so frustrating to constantly call and have nothing change. If you get the ever popular “talking is good” argument you will want to ask them to explain how it is good. You would then go on to expand on the talking is good piece by adding that talking with the goal of change is preferable to simply talking.

Allow the Caller to tell you what they think would be fair. If they come up with something that you could both agree to (they sometimes do), go with it. This way when, in the future, they object to the policy it can be explained it was their suggestion. If the suggestion is not acceptable tell them what it is you want to see happen and why. It may be necessary to mention that the other option is that they will not be allowed any contact.

This also a good time to address the issue of therapy or having their therapist contact you regarding their calls. This can be explained by pointing out that by either having more people working with the Caller or by working in concert with their service provider they will be able to use their time with your agency to greater advantage.

These interactions are not the easiest to accomplish and they do require someone with confidence in their skills but with practice it becomes easier. Interestingly, the Caller will usually work with you in establishing contact policy, because they do not want to risk loosing the privilege of being able to access the line.

HOW TO BE AN EFFECTIVE CHRONIC CALLER

Being a Chronic Caller is not an easy task. The Crisis Workers expect to hear from you regularly and you have other things to do in your life. They can be very inconsiderate in this manner. They can be short and abrupt. They can seem to try to ignore you. They will try to limit and focus you. But you know your duty; your goal in life is to be the best Chronic Caller you can be. It’s not something you consciously chose. It’s your destiny. In short, it’s a dirty job but someone has to do it. So what can you do to be an effective Chronic Caller. The answer is to train and practice. After all, someone has to mold and nurture crisis hotline workers to be receivers of chronic calls. Why shouldn’t that someone be you? What follows is a basic training manual to start you on your way to Chronic Caller stardom.

To begin your training let’s see how the theory and skills for a Chronic Caller compare with those of the Crisis Worker.

Crisis Workers are taught about the rules of Client Centered Counseling. They are:

1. The Caller and Crisis Worker are equals.

2. The call proceeds at the Caller’s pace and the Caller is able to make their own choices and decisions.

3. The Worker mirrors what they hear from the Caller.

This may work for the Crisis Worker but you want to be a Chronic Caller. What exists as basic rules for you? Actually, there are rules you can adapt from the ones used by the Crisis Workers. We will refer to these rules as the rules of Self-Centered Client Counseling. As you will see, it closely parallels the theory the Crisis Workers use. This means they it should not be hard for them to adapt to your style.

According to the rules of Self-Centered Client Counseling the following applies:

1. The Caller and Crisis Worker are equals. But the Caller is more equal than the Crisis Worker.

2. The call proceeds at the Caller’s pace, the slower the better. Also the Caller is able to make their own choices and decisions, but may choose not to.

3. The Caller mirrors what they hear from the Worker only if they feel like it or it helps to manipulate or frustrate the Worker.

Coupled to the Client Centered rules the Crisis Workers are taught about the Four Fundamentals of the Client Centered Counseling are:

1. Acceptance

Acceptance maintains the Worker will interact non-judgmentally with a Caller. Regardless of what they think or feel about a Caller or the Caller’s actions or situation they will make no determination of good or not good.

2. Respect

This means the Caller, at all times, will be treated in a respectful, dignified manner.

3. Empathy

In order to establish an objective view of the Caller’s situation and actions the Crisis Worker will interact on a feeling level that creates an emotional “mirror” which enables the Caller to interact with and problem solve with the Worker.

4. Hope

This is the belief that another person can survive, regain control, and thrive following the setback of crisis.

As with the basic rules followed by the Crisis Workers the Fundamentals of Client-Centered Counseling can be adapted to field of Self-Centered Client Counseling as follows:

1. Acceptance

Acceptance maintains the Chronic Caller will assume (judge) that most Crisis Workers are incapable of assisting in creating meaningful change. While there are some few good Crisis Workers most of them only answer phones at crisis hotlines because they can’t do anything else.

2. Respect

Holds that the Crisis Workers are to treat all Callers with respect means they have to respect the Chronic Caller’s right to call whenever and as often as they want. The Workers also have to respect our right to talk about whatever trivialities we feel like discussing.

3. Empathy

This fundamental provides that we can induce our own feelings of frustration, helplessness, and hopelessness in the Crisis Worker. This is considered the effective use of the Parallel Process.

4. Hope

While the Crisis Workers may buy into the ability to survive, regain control, and thrive we, as future Chronic Callers, see that there is really no hope, just the promise of another phone call.

The Crisis Workers follow a five step Model that allows for:

1. The definition of a problem

2. The exploration of goals

3. The generation of alternatives

4. The planning of solutions

5. Closure and Termination

The purpose of this Model is to both physically and psychologically orient the Worker and Caller. It allows the Caller to understand they have the undivided attention of the Worker and allows them to use their precious Active Listening Skills. The Model also invites Caller openness and trust enabling the exploration of the issues at hand. That the Model facilitates a focused, cohesive method of crisis resolution with a clear beginning and ending means the Chronic Caller must resist being involved in the process. However, The Model can be adapted to our use in the following manner:

1. The definition of all problems – real or perceived – in minute detail

2. The establishment that there can be no goals

3. The recognition, that with no goals, there can be no alternatives

4. The explanation that no plan ever has or will ever work

5. Start all over again, again

With this in mind you can see how easy it is to engage the Crisis Worker and bend them to your will. Step Five allows that the process, once started, can become never ending. It should be sustainable for hours, days, weeks, months, and even years.

Crisis Workers have seven listening skills they use to interact with Crisis Callers. In this instance you as the Chronic Caller have them beat. There are ten time proven techniques (skills) you can use to engage Crisis Workers in what will be, for them, frustrating, difficult, unproductive calls. Employ these techniques and you to will attain Chronic Caller stardom.

Manipulate. This is a proven technique. Remember that it is you who called them. It’s your phone call. They may have their “Model” but you extend yourself to reach out to them. You have to direct the call and make it impossible for them to enforce their “Model” on you. There are three ways to do this:

• Ramble and stray. Start with one issue but don’t stay with it too long. If you do the Crisis Worker will define and explore the issue, generate a plan, and end the call. This is not acceptable. As soon as you feel the Crisis Worker has a sense of what you called about switch to another topic. The less related to the first topic the better. When they understand that topic switch to yet another, then another. In this manner you might be able to tie up a Worker for and hour or more.

• “Yes. . .but”. The Crisis Worker will attempt to present alternatives for you to pursue in dealing with your presenting issue. By saying “yes” you validate their attempt by agreeing that their suggestion is an option. This will help the Crisis Worker to feel a sense of accomplishment. As soon as you sense this feeling go to the “but” part of your “yes. . . but”. It’s sort of a been there done that thing. Recognize the timing of the “but” is crucial and when stated at the appropriate moment the frustration endured by the Worker is a pleasure to behold. The rule here is to reject anything, no matter how promising, that resembles an alternative or a solution. If you begin to feel you are playing a game of cat and mouse you are well on your way to adding this technique to your repertoire.

• Life Is Hard. The Crisis Worker in interested in you and your situation. Use this to your advantage. Present to the Worker your life-long problems that you’ve never done anything about. Even if you have done something about them or plan to, present them anyway. The Crisis Worker doesn’t have to know all the facts.

Blackmail. You want to draw the Crisis Workers into your web of frustration, helplessness, and hopelessness. Being frustrated, helpless and hopeless is no fun on your own. These feelings were meant to be shared. There are three surefire ways to engage a Crisis Worker by using blackmail.

• Intimidation. Make sure the Crisis Worker feels totally responsible for your being stuck in your situation. “I guess not even you can help me”, is effective in accomplishing this. A superstar Chronic Caller will not only create a sense of responsibility for past issues in the Worker but they will make them feel responsible for your future situations or actions. A classic line to accomplish this is, “If you don’t stay on the phone with me I don’t know what I’ll do with this gun”. For a real thrill demand to speak to a Supervisor.

• Flattery. That blackmail has such a negative connotation makes flattery such a strong engagement tool. The person being blackmailed doesn’t recognize it as such when we flatter them. “No one has ever listened to me like you are”, and, “You’re helping me so much”, are basic examples of flattery as blackmail. The accomplished Chronic Caller can combine intimidation and flattery into a potent combination as exemplified by; “Thank God you’re such a great listener. Being able to talk to you is my only reason for living”.

• Be A Victim. Let the Crisis Worker know you are totally victimized by your situation or circumstance. Make sure they understand you have absolutely no personal strengths, abilities, or resources. Since everyone feels sorry for a victim the Crisis Workers will devote all their skills and time to you.

Expect Inappropriate Services or Help. You know that you know what services are available to you. You know that you know what things you have tried to bring change to your life. What’s really great about making calls to a crisis line is that the Worker doesn’t know what you know. Use this to your advantage in the following ways:

• Demand Magic Solutions. The Crisis Workers are there to serve you. That’s why they get paid so much. Since they get paid so much it’s up to you to be sure the agency they work for gets their money’s worth. Do this by insisting they find a quicker, easier way for you to cope with your situation. Even if you know there is nothing else that can be done they don’t know that and you will engage them for hours on end day after day after day after day.

• Demand Advice. Tell the Crisis Workers to tell you what to do. Dear Abby, Anne Landers, Dr Joyce Brothers, Sally Jesse Raphael, and Oprah give advice. Why can’t they? After they are the trained professionals. A little sarcasm goes a long way here.

Make Outrageous Requests for Help. The more outrageous or unreasonable the better. Telling the Worker you’re hungry and want them to send emergency services to take you to the restaurant up the block is a reasonable outrageous request. Asking how do people go about making meaningful relationships is another example and is really effective if you then go into, “Yes. . .but. . .” mode.

Chat. The crisis worker is probably some lonely, maladjusted person who really can’t get a better job. Couple that with the fact you are a really kind, interesting person and you have the framework for a nice chat session. Let the Worker know you are concerned about them by asking them about themselves, their lives, and the place where they work. They will cherish your attempts to be friendly and eagerly await your call each day. It’s like a Koffee Klatch without the coffee since the Workers shouldn’t have coffee at their desks.

Be Hesitant, Silent, Resistant, And Untrusting. You are taking valuable time out of your day to call the hotline. As compensation, make that Crisis Worker work. Otherwise they would not call them workers. Make them beg you to cooperate with them and don’t give up until they do. Don’t give in a single inch on this one. Although it shouldn’t have to be said, you must remember that once they beg, you must refuse to comply.

Don’t Listen To A Word They Say. Who are they to assume they have something of value to offer? If they did they would have a column in the newspaper, a book deal, or their own talk show. You’re only calling because they need your call to keep their statistics up. Don’t forget you are helping them. This means you don’t have to listen if you don’t want to. After all what’s more important? Being heard or solving a problem? Breathing exercises that enable you to talk non-stop for minutes at a time can be really helpful here.

The Pity Party. Pathos is the operative word here. “No one else cares. So why should you?”, “It’s no surprise you want to hang up because my life is so sad/empty/lonely/etc.”, are two basic examples. A nice touch to use in this technique is to employ blackmail by throwing in a little guilt such as, “I’m not surprised you hate me. My family, pastor, pet hamster, and the last 17 hotlines I called today all brushed me off”.

Dazzle Them with Boredom. Anyone can change their situation and thereby their story. It takes a real professional Chronic Caller to bore the Worker into oblivion. Tell them the same story, every day, week, month, & year. The rule here is once you have a tale that works don’t change it. The right story can be repeated word for word for decades. Some basic tears and whining go a long way here also. Above all don’t let the Worker get a word in at all. Hey, you know the story. You’ve rehearsed and rehearsed. You presented to innumerable hotlines innumerable times. Don’t let them ruin you’re performance. It really gets to them if you recite the story in a manner that indicates you could care less about what they think.

Persevere. Rome wasn’t built in a day. Neither are star quality Chronic Caller skills. The operative word here is practice. Being and staying on the phone is the only way to gain the attention of the Crisis Workers of the world. When you’re finished with one, call back and talk to a different worker. Then another and another and another.

If at first you don’t succeed try, try, try again. If you can’t achieve Chronic Caller stardom at your choice of hotlines take out the phone book and look for others. If you have Internet access all the better as there are literally thousands of hotlines that can be found there and they are all ready, willing, and able to take all of your calls. Happy hunting!

Remember Crisis Intervention Specialists are like potato chips. . .”Bet you can’t frustrate just one”. If you are lucky you’ll catch the agency after a training and they will have new people who don’t know you. Such days are legend among the ranks of Chronic Callers. Once you have the basics how do you attain the ultimate goal of getting a helpline Limit and Focus? It’s just like getting to Carnegie Hall. . .Practice. Start small. . . Practice. . . and one day you too may have a Limit and Focus Policy at the helpline.

John Plonski

Database Coordinator

Covenant House International

President NYS AIRS

jplonski@

Voice: (212) 727-4040

Fax: (212) 727-4964

Hotline: (800) 999-9999

TTY: (800) 999-9915

-----------------------

[1] Adapted from The ABC’s of I&R: An Introduction to Information and Referral. Published by The Alliance of Information and Referral Systems, Inc. 2006

[2] The concept of mirror addresses the action of the Crisis Worker enabling the Caller to objectively view their situation by allowing them to identify, and therefor objectively experience, the feelings engendered by the situation.

[3] Maintains that regardless of what we think or feel about the Caller we will not judge them, their situation and actions, or their ability in any way. Acceptance maintains that people, situations, actions, and abilities are things to be acknowledged, not judged. Without the risk of judgment people feel safe and become able to communicate freely.

[4] Once we accept the need to be non-judgmental we can then embrace the idea of respect. Acceptance means we will respect each person’s unique individuality. It maintains that the worker will respect the Client enough to accept they can, with appropriate facilitation, resolve the crisis at hand.

[5] When we become accepting and respectful of the Client we can then communicate with them on a basic feeling level. This is a powerful fundamental because we seldom communicate with others on an empathic level. Once a person experiences communication on this level the novelty of the “reflective” experience, within the perceived safety of the accepting, respectful environment, a bond is produced which permits open interaction and effective problem solving.

[6] The fundamental of hope has its basis in the concept that each person has, within themselves, the power to change, survive, thrive, and regain control of their situation.

[7] It is important to remember that “firm” does not mean being angry or punitive. Firm means we are stating our observations with the intent of clarifying that which we don’t understand for both the Caller and ourselves.

[8] Barry Greenwald, Ph.D.

[9] Actually the equation to the right is normal. [pic]

[10]

-----------------------

[pic]

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download