Active Listening Process on Crisis Lines

Introduction

The Active Listening Process (ALP) is a set of skills, or what is called by Ivey, Ivey & Zalaquett in their 2014 book Intentional Interviewing and Counselling as “microskills are the fundamental skills used to perform the basic skills of displaying empathy and understanding what your caller or client is saying. The ALP is one of the tools used in the basic helpline training adopted by the Distress Centre and other organizations.

Deliberate Practice (Rousmaniere, 2016) describes the work done outside of the therapy or call room. By practicing the basics, therapists and others who are required to use empathy and active listening in their work will be able to improve the skills that are most associated with client improvement (Lynch, 2012).

Three Facilitative Conditions

The three “facilitative conditions” (Rogers, 1957) were developed by Carl Rogers, a pioneer in the field of person-centered therapy. These facilitative conditions are empathy, acceptance (or unconditional positive regard) and genuineness. Empathy describes an effort to understand the caller or client from their perspective and truly see things the way they do. Acceptance or unconditional positive regard means to see the caller as they are, while genuineness means being yourself and not putting on a “therapist” front or trying to be different than who you really are.

Active Listening Process

Different organizations will use a different form of the active listening process. A version of the Active Listening Process used at the Distress Centre includes the following skills in the active listening process:

Opening the Conversation

Opening the conversation describes the first 5 minutes of the conversation. These are the critical first steps that the helpline worker takes as they begin working with the caller.

Voice Tone

Voice tone describes the pitch, volume and intonation of one’s voice. A voice tone that is forceful and assertive may be helpful in policing but may come across as aggressive or overpowering to a helpline caller. On the other hand, when needing to collect information in emergencies, a more assertive tone may be required to keep a caller alert and paying attention.

Pace

Pace describes the speed in which you speak, as well as when and if you interrupt. Interrupting or talking over a caller may damage your rapport with them, while speaking too quickly may create a sense of anxiety or panic in a caller. Instead, letting the caller lead will help them tell the story at their own speed

Setting the Climate

Setting the climate refers to the first few seconds when you pick up the phone. Ensuring a lack of distractions and sound from other calls or activities, and gently saying, “Hello, Distress Centre” or something similar will help your caller feel at ease by helping give them a sense that it’s just you and the caller.

Collecting Information

Collecting information refers to what happens after you’ve established a connection with the caller. The first minute or minutes have gone by and the caller is starting to tell their story. In order to understand it better, you must ask a variety of open and close-ended questions.

Open Ended Questions

Open-ended questions are those that begin with “What?” “How” “Tell me about” and others that cannot usually be answered with yes or no answers. For instance, “Tell me about what’s been troubling you”, “How long have you been feeling this way?” and “What do you usually do when things get tough?” are examples of open-ended questions.

Close Ended Questions

Close-ended questions are those that are designed to collect specific pieces of information from callers. These begin with “Where”, “When” and “Did”, “Do”, or “Does.” For instance, “Where did you live when that happened?”, “Do you feel like talking to him?” and “When did that begin?”

These close-ended questions are important in emergencies or crisis situations when you need to collect specific information but are much less useful when trying to have an open conversation with someone in distress.

Demonstrating Understanding

As you ask open-ended questions and the caller begins to tell their story, you have to demonstrate that you understand what they’re saying. As explained above, the three facilitative conditions are the most important elements of outcome in therapy and on the crisis line they are associated with a decrease in distress. (Mishara & Daigle, 1997)

Empathy Statements

Empathy statements are statements that highlight a feeling word. For instance, “You must be feeling really overwhelmed.” In this case, overwhelmed is the feeling word. Other feeling words you might use include angry, frustrated, devastated, lost, sad, ruined, alone, and so on.

Empathy statements wrap the other statements that we make while actively listening to continually check in with the caller and make sure that we’re on the same page. Even if your empathy statement is incorrect, the caller will explain to you what the correct feeling they are experiencing is, therefore increasing your understanding.

Clarifying

Clarifying refers to questions that are asked to increase your understanding of the content the individual is experiencing. For instance, if a caller says they went to a therapist recently for therapy and then indicates that they received a prescription from that visit, you might ask them if they made two different appointments, or if they saw a psychiatrist.

Clarifying will be more important on crisis chat or text because this form of communication limits how much information can be communicated at one time.

Paraphrasing

Paraphrasing refers to restating what an individual has told you to make sure that you understand what they’ve said. Paraphrases capture both the emotional information and the content of the story. For instance, a paraphrase might be “Since you lost your dog you’ve been feeling really alone and you’re considering whether to adopt a new pet.” This paraphrase has captured an emotion (loneliness) and content (loss of dog, adoption of new pet.)

Wrapping Up

Summarizing

Summarizing is similar to paraphrasing but it is done at the end of a conversation or a significant component in the conversation. A summary is a little longer than a paraphrase and may include contents of a safety plan, referral, follow-up or other tasks that will be completed when the conversation ends.

Referrals

Referrals, resources, community agencies or other terms refer to the helpline worker providing the names, phone numbers and other information about organizations that can be helpful to the caller. Examples include counselling, food banks, or employment support.

Winding Up

Winding up is the end of the conversation. This refers to the end of the conversation when you thank the caller for calling, let them know that you have to let them go for now (or they tell you they need to go) and invite them to call back. This can be challenging for some callers to accept but is a necessary part of the process.

Further Reading


Other posts on my blog that might be useful:

While Gerald Egan’s The Skilled Helper (see right) may be used to practice these core counselling skills.

References

Ivey, A.E., Ivey, M.B. & Zalaquett, C.P. (2013) Intentional Interviewing and Counselling. 8th Ed. Brooks Cole: Pacific Grove, CA.

Lynch, M.M. (2012) “Factors Influencing Successful Psychotherapy Outcomes” Master of Social Work Clinical Research Papers. Paper 57. Retrieved on May 3, 2017 from http://sophia.stkate.edu/msw_papers/57

Mishara, B. L. & Daigle, M. (1997). Effects of different telephone intervention styles with suicidal callers at two suicide prevention centers: An empirical investigation. American Journal of Community Psychology. 25, 861-895

Rogers, C. (1957) The Necessary and Sufficient Conditions of Therapeutic Personality Change. Journal of Consulting Psychology. 21. 95–103. Retrieved on May 5, 2017 from https://app.shoreline.edu/dchris/psych236/Documents/Rogers.pdf

Rousmaniere, T. (2016). Deliberate practice for early career psychotherapists. Psychotherapy Bulletin, 51(3), 25-29. Retrieved on May 4, 2017 from http://societyforpsychotherapy.org/deliberate-practice-early-career-psychotherapists/

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Active Listening on Crisis Lines

The core of emotional support, which is the service provided on crisis lines, is called active listening. Active listening is a special type of listening, distinct from the regular listening we do everyday.

Active listening should also be separated from the work that counsellors and therapists do, which is called professional listening. While therapists and counsellors certainly use active listening, they also use additional advanced skills not covered here (such as interpretation and challenging.)

Active listening is made up of a number of individual skills that include:

  • Demonstrating attending behaviour
  • Using empathy statements
  • Paraphrasing
  • Reflecting
  • Summarizing

These are reviewed below.

Although active listening skills may seem like common sense, it takes conscious practice to develop use of these skills to be second nature. As is often said about this topic, it’s common for people to “wait to talk” instead of truly listening. They’re not hearing the emotions under the content, they’re just waiting for a pause to jump in with their next sentence.

Attending Behaviour

Attending behaviour refers to your non-verbal behaviours used to show that you’re listening. This includes things like eye contact, where your body is pointed, your posture, and so on. The acronym SOLER is one that is used to summarize attending behaviour. It is important to keep in mind that attending behaviour is culture-specific, and this is written with Western cultures in mind.

Other cultures may have different standards for what is considered attending behaviour. For instance, eye contact is often rude and intrusive in Asian cultures, while in North America it is rude to not maintain eye contact.

SOLER is not relevant to crisis lines (because you’re working over the telephone) but is still covered here because occasional in-person clients may occur in some organizations.

SOLER

  • S – Sit Squarely
  • O – Open Posture
  • L – Learn Towards the Client
  • E – Eye Contact
  • R – Relax

Sit squarely refers to your body positioning, which is to point your body towards client so that they know you’re listening, rather than pointing your body away from the person you’re speaking to.

Open posture refers to keeping your arms and legs open. Crossed arms or legs put together are considered closed body language and are off-putting to clients. Instead, keep your legs apart (though not enough that it could appear unprofessional) and keep your arms at your sides or in your lap rather than closed.

Lean towards the client sounds like what it says – to show interest when a client is speaking, lean towards them rather than leaning back which communicates disinterest.

Eye contact, as well, is important for showing interest and building rapport in western cultures. Keep in mind that some other cultures may place different value on eye contact and so it’s important to know the culture you’re working with.

Relax – Relax! No need to be tense, your discomfort may be interpreted by your client as disliking them, so make sure to take a deep breath, be honest with your client if something bothers you, and always keep the lines of communication open.

Empathy Statements

Empathy statements are the core of emotional support. These are feeling words that allow you to communicate that you have an idea what another person is going through. Empathy is defined as “the ability to understand and share the feelings of another”, which is different from sympathy, which is “feelings of pity and sorrow for someone else’s misfortune.”

With empathy, you are highlighting feelings as if you are experiencing them yourself. Examples of empathy statements are:

  • That sounds really scary
  • You must be feeling so frustrated
  • If I were you in shoes I would be devastated

Empathy statements may initially sound un-genuine or forced, but with practice they will get second nature. You may find it helpful to look at a list of feeling words to develop your skills. For additional practice please see my article Empathy Statements in Helpline Work.

Paraphrasing

Paraphrasing is defined as “express[ing] the meaning of (the writer or speaker or something written or spoken) using different words, especially to achieve greater clarity.” In the emotional support context, paraphrasing means to restate the content that a person has said.

An example of this would be, if someone tells you that their dog died. An example of a paraphrase would be “You lost your pet.” Paraphrasing is used to ensure you’ve heard the content that a person has said while they speak to you.

Reflecting

Reflection is similar to paraphrasing but the goal is to reflect the emotion underlining the statement that a person has said. This is quite a bit different than paraphrasing. For instance, if we return to our example of someone telling you that their dog died, the paraphrase was “You lost your pet.” The reflection would be, “You’re feeling really alone right now.”

A reflection highlights an emotion, and is used frequently to check in to make sure that your empathy statements are on point.

Summarizing

Summarizing is similar to paraphrasing or reflecting but it is a longer statement used to sum up several minutes of conversation. Many counsellors use summaries to open their sessions by reviewing the previous week’s conversations, and periodically throughout their sessions.

An example of a summarize that could apply to our dog-grief conversation would be like follows: “So, from what we’ve been discussing, you lost your dog last month and it’s weighing really heavily on you. You feel alone because your house is empty and you don’t know how to cope.” This highlights some emotional items (feeling alone, weighing really heavily on them) and some content items (dog lost last month, empty house.)

Silence

Silence is an important element in active listening and is often overlooked. Silence can be used to help a person process what has just been discussed – it is not necessary, nor desirable to fill every moment of a conversation with words. Sometimes just sitting with someone and being witness to their pain is helpful.

Advanced Active Listening Training

If you’re interested in developing your active listening skills you may want to join a crisis line, or consider taking an Introduction to Counselling course at a local college or university to build your theoretical skills and practice roleplaying with others.

As well, please my article on Building Communication Skills and on Improving Your Helpline Work.



Cite this article as: MacDonald, D.K., (2016), "Active Listening on Crisis Lines," retrieved on September 21, 2017 from http://dustinkmacdonald.com/active-listening-on-crisis-lines/.

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