Have you ever called a crisis hotline? (or answered calls for one?)
May 30, 2014 9:36 PM   Subscribe

Can you please tell me about the best (and worst) things about your experience? Ideas of things to say, what NOT to say if answering hotline calls...what helped you (as a caller), or what didn't?

I'm about to complete a volunteer certification program as a crisis counselor/advocate for a local hotline (as well as going on hospital/police/court accompaniment, but I'm mostly focusing on the hotline work for this question). My exam is on Tuesday, which includes a mock call, and I'm just looking for a bit of outside advice from people who have experience either calling a crisis hotline or answering the calls. (I can add what kind of crisis specifically if that would help but wanted to keep it more general for now). Can you please tell me about the best (and worst) things about your experience? Ideas of things to say, what NOT to say if answering hotline calls...what helped you (as a caller), or what didn't?

I feel like I have the advocate part down and a good handle on the different procedures someone who has experienced this particular type of crisis might go through, as well as all the local resources that would be available be available to them, but I feel still feel a bit shaky on the actual counseling part. The part where you calmly help someone who's in crisis instead of stumbling through all the new info you've just learned, and worrying about saying the wrong thing (hopefully I'm not as out of my element as I feel!)

So what I'd like to know is if you've ever called a crisis hotline -- what was your experience like? What was most helpful to you? What was least helpful? Obviously, this will vary person to person. or if you've ever worked for a crisis hotline, do you have any advice?

(And if this sounds weird that my exam is Tuesday and I'm asking very basic questions...the primary focus of the class was about facts/statistics/issues and local resources. It seemed to almost take for granted that the volunteers would be either be people in school studying things like counseling or people who worked in the field. I feel a bit out of my element because I have no counseling experience).

Anyway, any help would be greatly appreciated! Help me to help them!
posted by Shadow Boxer to Human Relations (15 answers total) 25 users marked this as a favorite
Here's a post on captainawkward.com that's written for potential callers on what to expect from calling a hotline, written by a hotline volunteer. Lots of useful info there. Congrats on getting your certification!
posted by foxjacket at 10:08 PM on May 30, 2014

I trained on two crisis lines, worked on one (had to quit the other before finishing the training). The main skill crisis line counselors use is active listening (pdf). That hand-out has good examples of things to do as well as things not to do.
posted by jaguar at 10:13 PM on May 30, 2014 [5 favorites]

Holy crap, where to start? I was training coordinator for a crisis hotline for about seven years ... I'm shocked that your training hasn't included lots of role playing and mock calls. This was a previous career and it's been awhile, so I'll probably end up making a couple posts as I think of things. Off the top of my head:

1. First thing: determine if this is an acute crisis. As in: is someone at risk of dying in the next ten minutes? Don't guess. Ask. "Are you safe right now?" If the answer is no (they're not safe), move into immediate problem solving: get the police, an ambulance, a crisis outreach worker, someone on site ASAP while you stay on the line. Or help them find a safe place if they are in a risky situation.

2. Otherwise, exhale and take your time.

Good things:

Keep the focus on the other person.
Offer empathy continually.
Validate their emotions.
Focus on the details: what, where, how, who, when. Get them to tell you their story.
More empathy
More validation.
Even More empathy. It's natural to feel you're not doing enough. You have no idea how much a kind ear can help a person.
Keep check of your own emotions and reactions to a call.

As you establish rapport:
Explore their own support systems. Start with the family. Move out to friends. Then institutions (school, church, etc). Check back in about family. Then if all else fails, are there professionals in their life (therapists, psychiatrists, etc)

Story time: One of the earliest calls I had was a suicidal teenage girl. She had almost attempted the night before, and was worried that tonight she would follow through. Her boyfriend was raping her, he was involved with gangs, and she was terrified to report him. She had talked to her friends, but they were as intimidated by the gangs as she was.

We slowly went through the people in her life. There was no way she could talk to her family. We talked about her different teachers. None she could trust. I had zero idea how this could turn out well. We went back to her family. Maybe, she thought, she could talk to her older sister. But no she couldn't. Well maybe. She was scared to talk to her. But she could try.

We ended the call with a 'contract' - she agreed to talk to her older sister when we got off the line, and to call me back to tell me how it went.

Three hours later she called back from her aunt's house. Turns out the sister had been raped in school too, and had never talked to anyone. This time the sister took action: call to the police, call to the principal to threaten a lawsuit if he didn't act to protect his students, call to the NAACP to back that up, call to the Aunt to get the younger sister out of town, and then she spent the night sleeping in the same bed with her to help keep her safe.

I used to tell this story to my trainees as an example of a level of intervention that no therapist, no cop, no crisis worker could ever take. And as an example of what seemed like a totally hopeless situation that ended in a good resolution - and a resolution we would have never found if I had leaped right into problem solving.

With that, avoid problem solving.

This is the hardest part for beginning counselors. We want to help. We want to save people. We want their pain to end. But we don't really know their whole story, so what use is our advice?

It's also natural to have a little panic at the beginning of each call, a sense of "oh shit I have no idea how to help this person." Recognize it in yourself, and that this is ok. Your job isn't to save the person (unless it's an acute crisis). Your job is to hold their hand while they walk themselves through the darkness.
posted by kanewai at 10:16 PM on May 30, 2014 [33 favorites]

The part where you calmly help someone who's in crisis

What the active listening techniques (and philosophy) help you do is realize that you don't need to know how to solve anyone's crisis; that's not even your job. Your job is to help the person talk through what's going on, and to offer support and resources as appropriate based on what they're asking for.
posted by jaguar at 10:17 PM on May 30, 2014 [1 favorite]

I forget the other "avoid"

Don't ask 'why?" e.g. why are you scared, why are you sad, why are you crying, why are you having a panic attack, why do you feel that way ...

Banish the word from your vocabulary.

There are two reasons. The first is that it is too big. Why am I sad? How do I even answer that? When am I sad? I can tell you that. How long have I been said? Easy to answer also. But why? How do I effin' know? I might try to stumble through an answer, but it would be more frustrating than helpful at this point.

The second is that there is an implied judgement when we ask why. Why are you like that? Even if you don't mean it like that at all, the caller could very well hear it like that.
posted by kanewai at 10:29 PM on May 30, 2014 [14 favorites]

I used to volunteer for the National Domestic Violence Hotline. One thing that surprised me was how many calls we got from people who weren't themselves in violent situations but were calling because they had a friend/sister/coworker/etc. who was in an abusive situation and they wanted to know how they could help them. It was hard to not be able to give people the answer they wanted to hear, and to have to tell them instead "here are some resources for you, the best thing you can do is stay connected and supportive and be ready if and when they decide to make a change for themselves."

For people calling for themselves, it was useful to try to get a handle on where they were at. As kanewai says, establish first that they aren't in immediate danger, and if they aren't safe go into acute crisis mode to help them get into safety or get police/ambulance/other help to get into safety.

But aside from those situations (which were rare in my experience), people are calling from various stages. Sometimes people were calling just to talk for a few minutes, in which case good protocol was active listening, empathizing, validating, and letting them know that the hotline and/or other resources would be there for them when/if they were ready for more resources. Sometimes they were almost ready to take action/leave the abusive relationship and they were calling to find out what steps they should take and where to get more help - in which case, it's a combination of listening and validating and giving them concrete information.

Sometimes they had already done things to get out of their crisis and they were calling with very specific requests for help - in which case, easy, look up the resource in the database and connect them to it (while also being empathetic, etc., of course).

Seriously, just empathy and willingness to listen - without jumping to Solve The Problem! - is really valuable. Don't discount how often just the fact of being able to talk to someone who is listening compassionately to you is a healing and helpful part of a long journey.
posted by aka burlap at 10:58 PM on May 30, 2014 [2 favorites]

I spent two years volunteering on a suicide hotline and am as surprised as others that you aren't doing lots and lots of mock calls and active listening as part of your training. Here are some key things we learnt:

We always answered with 'Organisation name - can I help you?'
Get a name as early as possible and use it.
Share your name early also if that's policy for this organisation
Lots of open ended questions
No judgements on the person or their situation
Lots of empathy - not just a barrage of questions
Don't us 'why' questions if possible
Slow your voice right down and speak calmly
Reflect back as much as possible to show you are listening and check you have heard them correctly
Don't try to advise or problem solve
Ask questions that open up possibilities, suicidal or vert depressed people tend to shut down their options.
Don't minimise what they feel with too much reassurance, it can sound like you don't understand how bad it is for them
And the hardest one for most new volunteers - silence is OK - give them space to get their thoughts out. If you keep jumping in to fill any silence you will miss stuff. This feels really awkward at first but is important.

Good luck! It's rewarding work but not for everyone so don't feel bad if you decide it's not for you.
posted by Dorothia at 3:02 AM on May 31, 2014 [4 favorites]

I've called two crisis lines before, both for a strong impulse to kill myself. The first number I called was a local line, and I got a busy signal. That was very encouraging.

I later called a national line, and the arc of that call was very similar to what kanewai has outlined above (who knows, maybe it was kanewai?) - the woman tried to get an in-depth grasp of the problem, its immediacy, and quizzed me about my support network. For whatever reason I had a "fuck you for helping" attitude toward the whole thing, because I wanted to die, but she was totally unshaken and, like kanewai, asked me to enter into a 'contract' of sorts to either speak with a therapist or friend about this. I ended up speaking with a few friends about it, and that probably did successfully prevent an attempt on my part (at least for those next few months).
posted by sidi hamet at 5:34 AM on May 31, 2014 [1 favorite]

Thanks so much for all your responses!

And sorry that was unclear - we actually DID do a couple sessions of mock calls as part of our training...but the calls being done with our classmates with just a little guidance from the trainers, I still feel unsure. Especially after the most recent session last week which after weeks of focusing on police and court procedures and things like that left me feeling especially rusty. We did indeed go over most of the things everyone's mentioned, so my uncertainty might be stemming more from my lack of experience than adequate training.
posted by Shadow Boxer at 8:09 AM on May 31, 2014

I think the importance of empathy cannot be stressed enough. I called a distress line once decades ago, when I couldn't see a way out of my life to the life I wanted to live. I didn't even know what I wanted from the call. I was just desperate to talk to someone who cared. I still remember how my feeling of utter hopelessness faded somewhat just by having the other person on the line display empathy and compassion. It was enough to carry me through the night and eventually led me to getting the help I needed a few years later, which turned things around for me.

That was 25 or so years ago. Now I’m living the life I always dreamed about back then. I really feel I owe it all to some stranger listening at the right moment and offering warm words. So yeah, I’m a big fan of empathy.

Also, big hugs for anyone who works at one of these lines. You’re doing good.
posted by peterdarbyshire at 8:16 AM on May 31, 2014 [2 favorites]

Hi - I work for a local hotline/crisis line organization in my city, and we train a lot of volunteers. While there are a lot of specific, practical skills to know for the specific nature of calls you are taking, which it sounds like you've covered, I would say the big things are the soft skills - what we call warmth, empathy, and genuineness.

These are a big part of how rapport is built, and rapport is critical to doing the work of a crisis line. Because you won't have anything other than a voice (no non-verbal communication or cues), building it can be challenging but it is also critical because it is that rapport that will allow for the difficult conversations to happen, and for the caller to reveal what they need to reveal. Remember that they are usually in an incredibly vulnerable place, emotionally, and respect that. So:

-listen attentively; don't spend time thinking about what you are going to say next, just listen to the caller. Do not be afraid of silence on the call (it's usually anxiety provoking when silence enters a conversation) - if you can be comfortable with a moment of silence, the caller will usually fill it and keep talking and telling you about their situation.
-use minimal encouragers - little things like "yes" or "uh huh" to let the caller know that you are still listening without breaking in, interrupting.
-acknowledge their emotions - name them, identify them, ask about them - "wow, it sure sounds like you are angry" or "I can understand why you are angry". This is a huge step that I often see our newer volunteers rushing through on calls (and I used to as well); not dealing with/acknowledging the emotions will often cause the call to start running in circles - the caller and you can't move into co-operative problem solving/planning without having done this. So if a call starts to feel circular, go back and talk about emotions.
-in your voice tone, convey warmth. Not over the top warmth, but be accepting of what you are hearing (and you will likely hear stuff that pushes your own buttons or is uncomfortable personally in this work); being non-judgmental is important (and I'm assuming your crisis line has some policies in place about certain boundaries and when safety concerns or other legal issues need to be addressed). Jessamyn has a great statement about everyone's burden being their greatest burden - remember that in doing this work; crisis is self-defined and what you might be able to cope with has exceeded the other person's resources. Don't judge them for that.
-empathy - being empathetic is different from sympathy - see this video for a good discussion
-don't overlook exploring risk - for suicide, but also for things like abuse, self-harm, child abuse. I often see our newer volunteers do a fantastic job asking about suicide, but overlook the fact that the caller is in a domestic violence situation in terms of assessing risk from that perspective; i.e., they will strategize with the caller about that situation, but won't check on safety of the caller and/or children in the home at that time. It's an overemphasis/under-emphasis on certain things in our training that we are working to correct.
-collaborative problem solving - don't give advice, don't tell the caller what to do next (unless it's a really clear situation in terms of safety or the policies of where you volunteer); instead, find out what strategies the caller has already - what has worked before? Might it work now? What other ideas do they have? Will those work? What barriers might there be? What strengths are you hearing that the caller has? Name those!
-be yourself - be genuine. By which I mean, don't share personal information (unless it's really on topic/on the nose and you are comfortable with it - the call is always about them and not about you), but respond to them naturally, with your own personality. They will hear and know when you do something false/out of character, believe me.
-focus on the now/present - don't get into their past traumas too far; crisis is about what is happening now. What prompted the call today? What happened/what changed in their situation? That's where the focus needs to be.

Remember that people in crisis are overwhelmed and unable to cope temporarily. They do have strengths and coping strategies that will still be of benefit, but in the moment the emotional overload has caused them to either (a) abandon these strategies or (b) cling to a strategy that is not working/not appropriate and not be able to see alternatives.

Because of this emotional state, you will deal with people who are angry and abusive at times. Remember, it's not about you - you just happen to be a target because you are accessible and because your role is to "be there". Again, there should be some policies in place for you around dealing with abusive callers and how to manage/disconnect from those situations if it is excessive.

Lastly, I'll give you a link to this article, which talks about the Roberts 7-stage crisis intervention model. Note that you don't really move through 7 linear stages - but we find it usually provides a good framework for thinking about the call and what you should be working through with the caller.

That's all I can think of on a Saturday morning - if you have more specific questions, Memail me, and if anything else comes up in my not fully caffeinated brain, I will come back. Good luck! And thanks for volunteering with this organization - they are lucky to have you.
posted by nubs at 8:41 AM on May 31, 2014 [6 favorites]

so my uncertainty might be stemming more from my lack of experience than adequate training

As a society, we tend to put so little value on just listening to other people and overvalue jumping in and problem-solving, so it can be a bit disorienting to shift into a mode where you are really mostly listening and to realize how powerful an effect purely listening to people can have. It's totally normal for you to be wondering "Huh, is this it? But what am I supposed to be doing for callers???" It can help to remember that just being there, listening, is the number-one most effective intervention.

I'm also suspecting from the advocacy/accompaniment part of the job that you may be working with rape or IPV survivors, and if that's the case it's quadruple-y important to remember that your job is to help survivors reclaim their power by making their own decisions, which means that your role is to be supportive as all hell and not step in and problem-solve unless they are in immediate danger (like, call-911 immediacy). In all cases, but especially with assault survivors, your not trying to solve their problems for them is both a recognition that their problems are not easily-solvable (which is validating) and a recognition that they have the strength and intelligence and power to find solutions on their own, preferably with an army of resources behind them (which is empowering).

More about the empowerment model (Word doc, I am so sorry, but it's a good write-up):

the individual is not blamed for his or her problems but is responsible for generating a solution....

Because Intimate Partner Violence (IPV ) often removes the feeling of control and power in a victim’s life, one of the first goals of crisis intervention in the empowerment model is to validate the experience and recognize the innate power in the victim and their survival strategies. The empowerment model recognizes that IPV is not the fault of the individual, and works to bring back the individual’s power and control by providing them with the information to do it themselves. Information and tools without judgment are consistently provided in services. The empowerment model also strongly aligns with the desires and expectations of victims who want to gain back confidence, set their own pace, and make their own decisions. By both fulfilling desired needs and addressing issues specifically identified in IPV care, the empowerment model in many fields has been shown to correspond with positive results.

posted by jaguar at 9:07 AM on May 31, 2014 [2 favorites]

Just as something not to do for the love of everything do not talk about your personal life. Seriously. I called this crisis line more so because I wad in a PTSD crisis than anything else. She talked about Her kids (she had 3) that she volunteered like 16 hours a week that she had anxiety problems. I finally just called another crisis line because she was terrible and I was a mess.
posted by AlexiaSky at 9:41 AM on May 31, 2014 [1 favorite]

I volunteered for a few years at a crisis line. The most I could add to jaguar's fine link above about reflective, active listening is to practice, practice, practice. Practice on your friends, co-workers, the grocery store clerk...anyone you come into contact with. Folks are exactly right when they say that empathy is what is therapeutic. Communicating empathy is a skill. Like all skills it requires practice.

For the most part people let me know if I've got it right and will correct me if I'm off base. They'll stay with me if I've been able to communicate that I'm close enough and care enough to put real effort into understanding them, even if I don't get it just right the first time.

Active, reflective listening is my life-preserver too. It helps me keep my bearings when someone is directing all their anger at me or when I feel overwhelmed, freaked-out or of my depth by the force and visceral rawness of someone's feelings. Focusing my response to their feelings helps distract me from my own. The more I practice the easier it is for me to respond to my own anxiety by listening to the person and not whatever squickieness I'm experiencing at that moment.
posted by space_cookie at 3:08 PM on May 31, 2014

I've worked at a domestic violence shelter since 2000-- I'm still learning how to respond to hotline callers, and likely always will be.

A paper I recently read is turning into one of my favorites-- John Plonski's "Difficult Interactions" (also a doc file). He writes with a combination of empathy, honesty, professionalism, and sarcasm, and it's honestly one of the best human services descriptions I've read yet.
posted by ElaineMc at 7:51 PM on May 31, 2014

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