Improving Your Helpline Work

As a volunteer or paid helpline worker, we all endeavour to improve our work on the lines. Whether you have 100 or 1000 hours on your helpline there will always be things you can learn and strategies that you can apply to better connect with callers.

Listed below are a few strategies you can implement immediately and over your next few shifts to improve your work on the lines.

More Accurate Reflections

WHAT ARE THEY: Reflections, as you may recall, are restatements of what a caller has said with a focus on their feelings and emotional state.

EXAMPLE: If someone tells you there dog has just passed away, a paraphrase (which focuses on content rather than emotion) might be “You had to put your dog down”, while a reflection, which focuses on the emotional message behind the words may be “You’re feeling very alone.” (Or another emotion they’ve displayed depending on the context.)

HOW TO IMPROVE: Improving your reflections starts with learning more emotional words. Keeping a list of emotional words (which is perhaps a bit too big) can help you learn to use words like chaotic, shocked, neglected and empty more often than common emotional reflections like “frustrated” and “stuck” which we may rely on unintentionally when we can’t think of anything.

Additionally, there has been some support (e.g. Naar & Suarez, 2011) for the idea that dropping the “stems” may improve how people feel about reflections. Stems are things like, “It sounds like. . .”, “What I’m hearing is . . .” and so on. Since I haven’t seen any definitive research examining this I’ll leave it up to you. While stems help demonstrate to others that you’re using empathy, they may leave the caller feeling a bit alienated and “therapized.”

More Effective Suicide Risk Assessments

WHAT IS IT: Suicide risk assessment, of course, is assessing a person’s danger level and likelihood of attempting suicide in the near future. It is certainly a scary topic for both the caller and the helpline worker who is responding. Unfortunately, a lack of confidence and sometimes cause workers to simply shy away from the subject entirely, which can cause them undue anxiety and prevent workers from being the most effective.

Improving your suicide risk assessment skill will increase your ability to work with callers safely and make you a more confident helpline worker.

EXAMPLE: A caller tells you that they’re feeling stressed out and when they get like this they sometimes “have bad thoughts.”

HOW TO IMPROVE: The first step is to assess exactly where your knowledge of suicide risk is. Using a tool like the Suicide Intervention Response Inventory can help you learn where you make mistakes and what part of suicide risk you need to improve on.

Next, reviewing existing literature on suicide risk assessment is helpful. I have an article briefly outlining the CPR Suicide Risk Assessment process, and it is worth a read. There are books like the Suicide Risk Assessment and Intervention Handbook from CAMH that can provide a helpful overview. Reviewing case studies can allow you to practice your skills on similar-to-life clients.

Structured risk assessment tools like the Nurses Global Assessment of Suicide Risk (NGASR) can help you plan out a suicide risk assessment. This tool is designed for inpatient workers but can be suitably applied to work over the phone.

Mishara (2011), noted that a lot of Centres certified by the American Association of Suicidology (who should be required to ask clients about suicide on every call) actually only asked less than 50% of the time. His research determined that the failure to ask clients about suicide meant they missed suicide attempts in progress (who later identified during the call they were attempting on the line) and likely missed other suicidal clients who may go on later to attempt.

Learn Strategies for Specific Crisis Situations

WHAT IS IT: Specific crisis situations sometimes call for specific, directive information. Beyond connecting individuals with appropriate referrals, gaining an understanding of domestic violence, financial issues, child custody concerns or the emotions surrounding breakups can improve.

EXAMPLE: A 30 year old caller with $20,000 in personal debt calls in and tells you that he has just lost his job.

HOW TO IMPROVE: The Distress Centres of Ontario (DCO) offers a website called Learning Forums for participating organizations, these are 30-60 minute videos that volunteers can watch taught by experts. If you don’t have access to this kind of resource, you can still learn helpful strategies from websites like YouTube.

Listed below are some YouTube videos on topics relevant to helpline work:

Bibliography

Mishara, B.L., Chagnon, F., Daigle, M., Balan, B., Raymond, S., Marcoux, I., Bardon, C., Campbell, J.K., Berman, A. (2007) Journal of Suicide and Life Threatening Behaviour. 37(3); 291-307

Narr, S., Suarez, M. (2011) In “Motivational Interviewing with Adolescents and Young Adults.” Guilford Press. pg 33.

Cite this article as: MacDonald, D.K., (2015), "Improving Your Helpline Work," retrieved on April 24, 2018 from http://dustinkmacdonald.com/improving-your-helpline-work/.

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Declining Empathy in Social Work Students

I read an interesting article recently, from the Journal of Social Work Education, the title was “An Evaluation of Prepracticum Helping Skills Training for Graduate Social Work Students.” The abstract is reproduced below:

“Although foundational practice classes play a key role in helping prepracticum students develop counseling skills, we know little about the effectiveness of this form of helping skills training. This study assessed the effect of helping skills training delivered in foundational practice classes on proximal indicators of counseling skills acquisition, including measures of counseling self-efficacy, empathy, anxiety, and hindering self-awareness or rumination. Participating students made significant gains in counseling self-efficacy that were maintained at 3-month follow-up. Reductions in anxiety, rumination, and personal distress in interpersonally challenging situations were observed at follow-up, indicating that students made a successful transition to the field following training. The frequency of large-group role plays in particular was related to gains in students’ counseling self-efficacy.”

The purpose of the study was to examine basic counselling training completed by graduate social work students who had not completed a practicum, and whether students maintained those gains at follow-up. Additionally, they wanted to know if particular training methods of training were better at producing positive outcomes.

One really interesting element that was noted in this study, which has been observed in other professionals (e.g. physicians, see Neumann et. al, 2011), is a reduction of empathy as they proceed through training. In Gockel & Burton’s study, they administered the Interpersonal Reactivity Index (IRI). This tool has four subscales: Perspective-Taking, Fantasy, Empathic Concern, Personal Distress.

The Personal Distress subscale, which measures feelings of unease and anxiety around people showing strong emotion, showed a decrease as the social workers proceed through training. This resulted in an overall decrease in the IRI score of the students, which appeared as they had less empathy, but in reality they were simply becoming more comfortable with their clients.

This is really exciting, because it shows that the students did not experience a decrease in empathy as has long been documented. It also suggests that better tools to measure empathy may be necessary, or the IRI scores used should exclude the Personal Distress scale.

The other interesting thing was that the IRI scores on the other three subscales which were already very high did not increase or decrease. This was explained as the students likely entering with high levels of empathy, but hopefully a tool could work with the ceiling effects.

Other notes that I made while reading the article, that may be useful to people working on helplines, in counselling, etc.:

  • Roleplays only help skill development if the roleplay is successful; if it’s unsuccessful it can interfere with skill development and confidence and so should be used once individual skills have been mastered
  • Other tools used included the Counselor Activity Self-Efficacy Scale (CASES), the State-Trait Anxiety Inventory (STAI), the Reflection Rumination Questionnaire (RRQ)
  • Large group roleplays increased helping skills self-efficacy, while instructor examples did not

 

All in all, super interesting article! Good read.

Bibliography

Gockel, A., & Burton, D.L. (2014) An Evaluation of Prepracticum Helping Skills Training for Graduate Social Work Students. Journal of Social Work Education. 101-119

Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M.R., Wirtz, M., Woopen, C., Haramati, A., Scheffer, C. (2011) “Empathy decline and its reasons: a systematic review of studies with medical students and residents”. Academic Medicine. 86(8):996-1009 doi: 10.1097/ACM.0b013e318221e615.



Cite this article as: MacDonald, D.K., (2015), "Declining Empathy in Social Work Students," retrieved on April 24, 2018 from http://dustinkmacdonald.com/declining-empathy-social-work-students/.

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Marge Simpson and Church Counselling

In the long running show, “The Simpsons”, the main characters Homer and Marge take on a variety of jobs across the series. These virtually always finish with the main characters back in their careers at the end of the episode, Marge as a housewife and Homer as a Nuclear Safety Technician, but they provide an interesting venue for exploring how people react in different situations.

In episode 4F18, “In Marge We Trust”, Marge Simpson decides to volunteer for the church. When the Reverend finds himself unwilling to take calls from his congregation, Marge picks up the phone and identifies himself as the “Listen Lady.” She becomes a respected lay counsellor before the Reverend rediscovers his passion and Marge relinquishes her role.

Although Marge is portrayed as an effective counsellor in this episode, is she really? I thought I would take this opportunity to examine Marge’s contact with the community in this episode from a non-judgemental perspective.

Clergy as Counsellors

Church counselling runs the gamut from untrained counsellors who donate their time, to paraprofessionals (like distress line workers with 10-30 hours training) all the way up to Masters-level clinicians trained in therapy. Most church professionals have some degree of training in mental health and counselling through their professional education (Royal, 2003).

It’s important that individuals working in spiritual services who wish to provide counselling, whether as laypeople or as professionals, seek the appropriate training and supervision to make sure that they do not harm their clients.

Marge Simpson’s Church Counselling

Marge first observes Reverend Lovejoy answer the following exchange:

Lovejoy: Lovejoy here.
Skinner: Reverend, this is Principal Skinner. I’m facing a crisis, and I didn’t know to whom to turn.
Lovejoy: All right.
Skinner: Mother’s gone too far. She’s put cardboard over her half of the television. We rented Man Without a Face. I didn’t even know he had a problem! – What should I do?
Lovejoy: Well, maybe you should read your Bible.
Skinner: Um, any particular passage?
Lovejoy: Oh, it’s all good.
Skinner: All right. Thanks anyway.

She notes that his advice is not particularly helpful. Rather than empathizing with his feelings, he merely redirects him to a resource, without any guidance. This is obviously not a tailored response and Skinner does not feel heard.

Later, when Lovejoy refuses to pick up the phone, Marge does, and the following happens:

Marge: Who is this? Oh, well, this is, um, the, uh- the Listen Lady.
Moe: Yeah, well, listen, lady. I got so many problems l-I don’t even know where to begin here.
Marge: Okay. Uh, why don’t you start from the top?
Moe: All righty. Uh, number one, I’ve lost the will to live.
Marge: Oh, that’s ridiculous, Moe. You’ve got lots to live for.
Moe: Really? That’s not what Reverend Lovejoy’s been tellin’ me. Wow! You’re good. Thanks.

While Marge’s reassurance of Moe that he has lots to live for is more helpful than telling him he doesn’t it also comes off as dismissive. Marge calls his suicidal thoughts ridiculous, and has done no exploration of his problems before jumping in with her interpretation. In real life, Moe would probably not feel heard at all by this interaction.

Marge’s next counselling session is with Lenny Leonard:

Lenny: See, all along, I’ve been telling Carl I’m married to a beauty queen. Now he’s coming over for dinner.
Marge: Oh, Lenny, I’m sure he’ll like your wife no matter what she looks like.
Lenny: No, no, no, no! It’s worse than that! I don’t even have a wife. I just said I did to, you know, be a big shot.
Marge: Oh. Well, it’s time to start telling the truth. Now, when I have to tell my husband the truth I cook him a big delicious dinner. By the time he’s done eating, he’s too full and tired to care what I have to say.
Lenny: Wow, that’s great! When Carl comes over I’ll stuff him till he don’t know what’s what.

Again, Marge skips the exploration to run right into interpretation and solution-finding. Minimal self-disclosure is helpful here, but do we know if Carl even has a big appetite? Also, Marge’s “Oh” was accompanied with a frown and a judgemental tone which would certainly dissuade Lenny from disclosing information like that in the future.

Later, Marge receives a call from Lovejoy’s wife, Helen.

Marge: Hello, Listen Lady.
Helen: Marge, people say you’ve got a real knack for solving problems. Well, this is a little awkward but, um, Tim came home from church so despondent today. He’s just been playing with his trains all afternoon.
Marge: We all need a little time to ourselves, Helen. Just give him a day or two, and I’m sure he’ll be back to his old dynamic self! Okay.

Rather than asking Helen if his behaviour is unusual, if he’s ever felt this way before, or exploring what she thinks might be causing his depressed mood (to say nothing of Helen herself talking to her husband about what he’s doing through), Marge simply tells her it’s a phase that will pass. Not good!

Problems begin to mount when Ned calls Marge to talk to her about some teenagers outside his store:

Marge: Listen Lady.
Ned: Uh, I’m in some hot soup here, Marge. Some teenagers are hanging out in front of the store. l-I think they could start slacking at any moment.
Marge: Well, Ned, you don’t have to stand for that. You just march right up to those youngsters and tell them to vamoose.
Ned: Yeah, well, if you’re sure that’ll help.

By taking ownership of the situation, Marge has not given Ned any dependence. She hasn’t explored any options or asked Ned what he thinks would be most effective. Unfortunately her oversight gets Marge in a lot of trouble, as we hear later:

Marge: Listen Lady.
Ned: Uh, Marge, I appreciate your advice but things have gotten- well, th-they’re, uh, a lot worse. [cut to boys riding their minibikes around Ned, who is standing on top of an overturned garbage can
Marge: Now, Ned, troubled boys need rules and discipline. They crave it! You just lay down the law!
Ned: [Stammering] Yeah, I know but they’re on their minibikes and all!
Marge: Oh, all right. Let me talk to them. Put me on with the lead boy.
Ned: Boys, there’s a call here for ya. [boy cuts phone cord]
Marge: [hearing dial tone] Hmm. Oh, well.

Because Marge failed to explore the situation properly, she didn’t learn that Ned was in danger, and she makes no attempt to follow up or explore his situation.

Later, when Marge goes to Lovejoy to explain that she’s put him in danger:

Marge: Reverend, I gave Ned Flanders some bad advice. Now he could be in real trouble.
Lovejoy: Oh, what happened now? Did he swallow a paper clip?
Marge: No, he’s disappeared. Oh, I’m in way over my head. I mean, where do the helpers turn when they need help?

Finally as the episode closes, Ned is rescued from the gas station he stopped at (the boys had been chasing him all night), and Marge gives up her role as church counsellor. It’s obvious that her work was very solution-focused and spent little time on exploring emotions. This clearly caused Marge a lot of issues, and other lay counsellors would be wise to avoid making similar mistakes.

Bibliography

Royal, C. (2003) “Knowledge of Suicide Intervention Skills: Do Crisis Line Volunteers and Clergy Differ?” MA Thesis. Trinity Western University. Accessed at http://www2.twu.ca/cpsy/theses/royalchristine.pdf on January 26, 2015.

Cite this article as: MacDonald, D.K., (2015), "Marge Simpson and Church Counselling," retrieved on April 24, 2018 from http://dustinkmacdonald.com/marge-simpson-church-counselling/.
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