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:
- Developmental Disabilities / Cognitive Impairment
- Physical Disabilities
- Immigration / Newcomers
- Interpersonal / Relationship
- Financial / Occupational
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.