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Steps for Telephone Crisis Intervention
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In the last section, we discussed five important components of the ending phase of the crisis interview. These five components are the 1-2-3 technique, success leads to success, the focusing technique, the time factor, and the ending phase in subsequent sessions.
In this section, we will discuss a three-step model for telephone crisis counseling based on the three-step crisis interview model examined in sections 2, 3, and 4. These three steps are the beginning, middle and ending phases.
Regina, 32, had been seen previously for general depression related to events in her early adulthood that had culminated in a suicide attempt at the end of her last year of college. Regina called in one Friday just as the office was closing, and stated to the receptionist that she had ‘had a black period’ and suddenly it came to herself that she realized she was standing in the kitchen with a knife to her wrist.
I have found that whether the crisis involves a client’s suicidality (sue-i-si-DAL-i-tee) or not, crisis interviews over the phone can be structured to fit the same beginning, middle, and end model as practiced in face to face crisis counseling.
3-Step Model for Telephone Crisis Counseling
♦ Step #1: Crisis Call: Beginning Phase
The first stage of a crisis call, the beginning, naturally begins the moment that the phone rings. Clearly, the task with Regina was to establish as much rapport as possible in as little time as possible without seeming insincere or hurried. During this time in a crisis call, I try to isolate crisis themes and assess the caller’s level of distress. In Regina’s case, clearly the crisis theme was her acute suicidality, and her level of distress extremely high.
I often find crisis calls like Regina’s highly stressful for me in the beginning stage, because all of the visual cues I usually receive in face to face crisis counseling are absent, and I am forced to rely on vocal and nonvocal sounds, often difficult to pick out, to assess the client. I try to focus on voice inflections, background noises, and the like in order to reduce this handicap. In Regina’s case, as she began to talk to me, I heard the sound of the knife dropping onto the floor. I was able to confirm with Regina that she had dropped the knife, and through this observation and other vocal cues, was able to determine that her level of distress was decreasing.
As in any face to face crisis interview, I offered Regina only as much structure as she required. Since Regina immediately became very talkative, I refrained from interfering as much as possible, and let Regina guide the direction of our discussion in the beginning stage of her crisis call.
♦ Step #2: Middle Phase
The second, or middle stage, which parallels the model discussed on section 3, is the main body of the telephone crisis counseling process. I attempted to strike a balance with Regina between enabling her to talk about herself and issues on her mind, but not permitting her to ramble. I found that Regina tended to lean towards focusing on long-standing and chronic difficulties. Regina stated, "When Larry took the new job, I felt kind of like I did when Paul left to study in France! With Paul I felt that I was helpless… I would never see him again and he never meant to marry me!" I stated, "Earlier you said your boyfriend Larry took a new job. Tell me more about that."
I feel that a telephone crisis call should focus upon rapid resolution of the crisis situation, and that it is not necessarily productive to discuss chronic situations. While in face-to-face counseling I would certainly give more focus to these issues. When I am conducting a telephone crisis call, I am mindful of the fact that I may have only one opportunity to deal with the caller, who may be referred to a different therapist for long-term care. I feel it is my duty in a telephone crisis call to focus all my attention on the immediate resolution of the prominent issue of the crisis.
♦ Step #3: Ending Phase
The third, or ending stage develops in the same fashion as the ending phase of face to face counseling. I focus on summarizing the issues we have discussed, and the formation of a crisis resolution plan. However, the formation of a crisis resolution plan in a telephone crisis call usually includes an attempt to match the client with appropriate resources for follow-up care, whether this involves scheduling a session myself or referring the client to another community resource.
I also feel that the ending stage of a telephone crisis call should involve letting the client know that I will be making a follow-up call in the near future. During the follow-up call, I can see how the client is doing, determine whether she or he has followed up on the referral, and review the client’s current status.
♦ Technique: Benjamin’s Self-Assessment
To continue to check my skills regarding conducting telephone crisis interventions, I use Benjamin’s self-assessment technique to review my performance during the crisis call.
4 Self-Assessment Questions:
1. Did I help the caller to look squarely at his own life situation and to explore and express it, or did she or he perceived him or herself through the eyes of someone else?
2. Did I enable the caller to tell me how he or she genuinely feels and how things truly look to him?
3. Did I let the client explore what he or she wanted to in his or her own way, or did I lead her or him in a direction you chose for him or her?
4. Did I help the caller to formulate and evaluate the range of options and choices open to her or him, limitied as the options may be?
How does the current self assessment technique you are using for your telephone crisis calls compare to Benjamin’s technique.
In this section, we have discussed a three-step model for telephone crisis counseling based on the three-step crisis interview model examined in sections 2, 3, and 4. These three steps are the beginning, middle and ending phases.
Peer-Reviewed Journal Article References:
Bryant, R. A., & Harvey, A. G. (2000). Telephone crisis intervention skills: A simulated caller paradigm. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 21(2), 90–94.
Gilmour, M. B. (2001). A model for a telephone response system to disaster and trauma. Traumatology, 7(3), 120–124.
Kitchingman, T. A., Wilson, C. J., Caputi, P., Woodward, A., & Hunt, T. (2015). Development and evaluation of the Telephone Crisis Support Skills Scale. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36(6), 407–415.
Mazzer, K., O'Riordan, M., Woodward, A., & Rickwood, D. (2021). A systematic review of user expectations and outcomes of crisis support services. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 42(6), 465–473.
Rowen, J., Giedgowd, G., & Baran, D. (2021). Effective and accessible telephone-based psychotherapy and supervision. Journal of Psychotherapy Integration.
Satin, G. E., & Fisher, R. P. (2019). Investigative utility of the Cognitive Interview: Describing and finding perpetrators. Law and Human Behavior, 43(5), 491–506.
Why is it sometimes necessary to be more directive in telephone crisis counseling?
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