Providing Emotional Support Over Text and Chat

Introduction to Text and ChatRoleplay Transcript

With text and chat services increasingly moving online, emotional support work – the core element of the work of crisis lines is needing to be adapted to work in new formats that require a change in your perspective and technique. On the telephone, there are a number of ways of providing a warm, genuine experience. For instance, your voice tone and pitch communicates a lot, as well as the speed in which you talk, whether you speak over the caller or let them lead, and so on. There is a lot of non-verbal communication that happens on the phone.

In contrast, online all you have is text. So many of the dimensions that are used to promote warmth, communicate empathy and demonstrate caring are simply absent. This makes it more difficult to build rapport with these visitors and be effective.

The elements of active listening, or the active listening process are the same, although of course it seems unusual to call it “listening” since you aren’t using your ears. There is still an effort made to be alert for and respond to communication, however. Some people prefer “emotional support” instead.

Chat and Text Length

Chat and text conversations tend to be longer than telephone conversations; an average telephone call may be 20 minutes while a crisis chat or text conversation will be 45-60 minutes. This is due to the time required for you to send a text, for the visitor to receive it, read it, decide what they’re going to write, and then write back. You may not send a lot of  messages in this 60 minutes, but that doesn’t mean that you aren’t accomplishing a lot – which is reflected in the outcomes, often up to 30% reduction in subjective distress over an hour.

Opening Conversations

In the opening of a text-based conversation, it’s important to be warm and genuine. Your opening message should give your name, because the visitor doesn’t have anything else to go on. You may want or need to identify your organization as well. Finally, you’ll want to ask the visitor what brought them to text in.

An example of an opening message I could use on the ONTX Project is “Welcome to the ONTX Project. My name is Dustin, what’s going on in your life?”

Sometimes a visitor will text in with a lethality statement, something like, “I want to die.” This doesn’t necessarily change your opening, but it doesn’t hurt to acknowledge the suicidal feeling. “Welcome to the ONTX Project. My name is Dustin, it sounds like you’re really struggling. Did you want to tell me what’s been going on?”

Some visitors though, may need a bit of encouragement. If you ask a visitor how they’re feeling, they may reply “idk” (I don’t know) or “bad”, and not elaborate. Other visitors may be much more articulate and be able to explain what’s going on in their life.

If someone says “idk” or “bad”, usually my next move is to ask them what’s on their mind tonight. This is a gentle way of rewording the question that helps them feel more comfortable. Usually at this point they’ll begin talking, but if not my final option is “What were you hoping to get out of texting in tonight?”

I’ve never had a visitor respond with “idk” or other messages after this much encouragement but I would likely empathize with how difficult it’s been for them to text in before ending the conversation and inviting them to try us again when they’re more able to speak.

Because of a 140 character limit, some of these messages may need to be sent as a pair of messages on text.

Exploring the Issue

Exploring the issue that the visitor is texting in about can be challenging. Unlike the helpline, where you may need to take a while to establish rapport, visitors on text tend to jump right to their primary concern rather quickly. They don’t have the luxury of many messages back and forth.

If you’ve used the above Opening the Conversation ideas, you should be well into exploring the issue. This section should proceed just the same way as an offline conversation does, using all elements of the active listening process (open ended questions, paraphrasing and summarizing.)

You may notice that you need to ask more clarifying questions than usual, because with text and a lack of tone it’s easier for things to be misunderstood or misconstrued.

Demonstrating Empathy

In an online environment, you have no voice tone to demonstrate empathy. For this reason it’s important to write out your empathy statements clearly in order to show that you have an idea what the visitor is going through. Clarifying and paraphrasing can help in rapport building as well, by demonstrating that you are paying attention. It’s important to recognize that clarifying, paraphrasing and other open and close-ended questions are not a replacement for pure empathy.

Empathy: You sound really alone.

Clarifying: You just lost your dog?

Paraphrasing: You’ve been having trouble since you lost your pet.

Note the difference, empathy highlights an emotion (alone) while clarifying and paraphrasing primarily on content without regard to an emotional undertone.

Suicide Risk Assessment and Intervention

Suicide risk assessment and intervention is a challenging topic over chat and text. The primary challenges in this environment include the difficulty collecting the amount of information required to perform a competent assessment in 140 characters and the lack of voice tone and body language.

Typically the first question asked on chat and text after confirming suicide thoughts are present is to determine if they’re at imminent risk. This is usually accomplished by asking something like “Have you done anything to kill yourself?” or “Have you taken any steps to end your life tonight?”

Chatters and texters will sometimes text in immediately after an overdose, and will readily reveal their level of danger but not until you ask. Sooner rather than later!

Next, I’ll ask the visitor what’s led them to feeling suicidal. This, when combined with an empathy statements, helps to begin exploring the visitor’s reasons for living or dying. For example, “You must be feeling so overwhelmed. Tell me what’s led you to feeling suicidal?”

After this, I move onto the elements of the DCIB Suicide Risk Assessment tool.

Winding Up Conversations

Because visitors are using their cell phones, they can put their phone in their pocket, and then pull it out without thinking about the time that passes in a few minutes. It’s not uncommon that at the end of your 45-60 minutes, when it comes to winding up, the visitor doesn’t even realize that amount of time has passed. They find themselves feeling better, however, which is great news!

Winding up has to be deliberate, otherwise the visitor is unlikely to wind up in a decent time. Past experience has shown that crisis chats can last 3 hours or longer lacking a proper wind up. In order to initiate a windup, you simply have to give the visitor an opportunity to express anything else on their mind and then let them know that you have to go. For example,

“We’ve been talking for about an hour so we’ll need to wrap our conversation up soon. I’m wondering if there’s anything else on your mind that you haven’t shared yet.”

Or, more succinctly,

“We’re just coming up on 45 minutes of chatting so we’ll need to wind up soon. Was there anything else you wanted to share before we do?”

This cues the visitor that the conversation needs to end and lets them focus on any outstanding issues. For instance, you may be convinced of their safety and they may not be – and by pointing that out by replying “I don’t know what to do to avoid attempting suicide tonight” then you can spend your remaining 15 minutes implementing a comprehensive safety plan for that visitor. In this way, the windup can be a tool for you and the visitor.

Cite this article as: MacDonald, D.K., (2016), "Providing Emotional Support Over Text and Chat," retrieved on February 17, 2018 from http://dustinkmacdonald.com/providing-emotional-support-text-chat/.
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Critical Incident Stress (CIS) Management

Introduction

Critical incident stress (CIS) management is the process of managing the response after a critical incident at work that causes employee stress. (Caine, & Ter-Bagdasarian, 2003) In a 911 communications environment this could be hearing a call where you’re not able to respond before someone dies of a medical injury, listening to a suicide or homicide in progress, or other events that have the potential to overwhelm an individual’s coping skills.

After an initial traumatic event or critical incident, an acute stress disorder may develop. If these symptoms (numbing, reduced awareness, derealization) continue for more than 4 weeks a client may meet the definition for PTSD. (Gibson, 2016) Approximately 20% of individuals who experience a trauma will go on to develop PTSD. (Norris, et. al., 2002)

The goal of CIS Maangement (CISM) is to short-circuit this process in people exposed to secondary trauma in order to ensure the best outcome for the individual. For primary victims of trauma CISM is ineffective. (Jacobs, Horne-Moyer & Jones, 2004)

CISM is generally broken into three categories (Guenthner, 2012):

  • Primary Interventions, which focus on promoting health and resilience in employees in the absence of any critical incident
  • Secondary Interventions, which focus on the immediate steps after the crisis
  • Tertiary Interventions, for individuals who are experiencing symptoms of PTSD

Critical Incident Stress Management (CISM) Process

Blacklock (2012) identified the steps of the CISM process. The first step of the CISM process is diffusing. Diffusing is limited to individuals who were directly involved in the trauma (e.g. the first responders at an accident scene) so that they can begin the process of ventilating emotion. Individuals are provided with a telephone line to call or other resource they can reach out to and make sure they will be okay for the remainder of their shift.

The second step in the CISM process is debriefing. This should be done within 72 hours with all staff directly or indirectly involved being allowed to attend. Mitchell (1983) identified seven steps to the CISM Debrief which are listed in the next section.

Critical Incident Stress Debriefing (CISD)

The following table comes from Blacklock (2012) who cited it from Mitchell (1983):

Critical Incident Stress Debriefing

 

 

 

 

 

 

 

 

 

 

 

 

 

Other CISM Interventions

Pulley (2005) identifies additional activities including:

  • Crisis management briefing, where large groups of individuals affected by a trauma are brief on the crisis
  • Family support – Providing the family of an emergency worker with practical supports to assist in the CISM process
  • Assessment/consultation – On an organizational level, additional support is provided by larger organizations (such as the Tema Conter Memorial Trust) to help identify appropriate referrals
  • Follow-up and referral – The organization follows up with affected individuals to identify any unmet needs and performs case management to help them access new supports.
  • Mutual aid – Finally, other individuals who have previously experienced trauma provide peer support to help everyone work through their symptoms.

CISM/CISD Training

The Canadian Critical Incident Stress Foundation provides individual and group training that meets the requirements of the International Critical Incident Stress Foundation (ICISF). Online CISM Training is also offered online through the ICISF.

Bibliography

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.

Blacklock, E. (2012) Interventions Following a Critical Incident: Developing a Critical Incident Stress Management Team. Archives of Psychiatric Nursing. 2-8.

Caine, R., & Ter-Bagdasarian, L. (2003). Advanced practice. Early identification and management of critical incident stress. Critical Care Nurse, 23(1), 59-65 7p.

Gibson, L.E. (2016) Acute Stress Disorder. U.S. Department of Veterans Affairs, National Center for PTSD. Accessed electronically on Sun May 22, 2016 from http://www.ptsd.va.gov/professional/treatment/early/acute-stress-disorder.asp

Guenthner, D. H. (2012). Emergency and crisis management: Critical incident stress management for first responders and business organisations. Journal Of Business Continuity & Emergency Planning, 5(4), 298-315.

Jacobs, J. Horne-Moyer, H.L., Jones, R. (2004) The effectiveness of critical incident stress debriefing with primary and secondary trauma victims. International Jounal of Emergency Mental Health. 6(1):5-14

Norris, F.H., Friedman, M.J., Watson, P.J., Byrne, C.M., Diaz, E. & Kaniasty, K (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65, 207–239.

Pulley, S.A. (2005) Critical Incident Stress Management. Accessed electronically on May 28, 2016 from http://web.archive.org/web/20060811232118/http://www.emedicine.com/emerg/topic826.htm

Cite this article as: MacDonald, D.K., (2016), "Critical Incident Stress (CIS) Management," retrieved on February 17, 2018 from http://dustinkmacdonald.com/critical-incident-stress-cis-management/.
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Involuntary Celibacy: Causes and Treatments

Introduction

I recently watched a documentary called “Shy Boys: IRL“, involving individuals who identify as experiencing involuntary celibacy (incel), also called forever alone (FA), true forced loneliness (TFL), love shy or a number of other terms. This describes an inability to get a romantic partner despite trying and over a certain age (usually by 18, when most individuals have experienced some romantic contact with their peers.) It is closely linked to overall loneliness, though it’s possible for people to have general life satisfaction outside of a lack of romantic relationships.

As an individual who once struggled with women (although no longer), I found the concept intriguing and decided to explore it further. While this article is written from the perspective of men pursuing women, but women can be FA/incel as well.

Understanding Loneliness

Loneliness is defined as a difference between an individual’s desired social relationships and their actual relationships (either in quantity or emotional quality.) Researchers have identified three dimensions of loneliness, intimate loneliness, relational loneliness, and collective loneliness. (Cacioppo, et. al., 2015)

Intimate loneliness refers to your romantic partners, relational loneliness to friends and acquaintances, while collective loneliness refers to loneliness in the context of being part of a larger community like students or professionals.

There is a direct link between between loneliness and depression (Bekhet & Zauszniewski, 2012) while Victor & Yang (2012) determined that before the age of 25 the quantity of friendships is most associated with loneliness while as individuals proceed into middle age fewer, deeper relationships become more important.

Luhmann, et. al. (2016) found that self report ratings were the best source of how lonely an individual actually feels, and that romantic partners (where they exist) were more accurate than friends or parents in predicting this in a sample of first year college students.

Involuntary celibates, then, can be theorized to have high levels of intimate loneliness, and many also struggle with depression.

Model and Causes of Loneliness

Roekel et. al. (2016) and Bangee et. al. (2014) identified that people with high levels of loneliness experienced hypersensitivity to social threat (they were extra sensitive to negative social environments and more likely to assume people around them were judging them) but also, contrary to their initial hypothesis hyposensitivity to social reward. This means that they responded well to positive social interaction when they could obtain it.

Yao & Zhong (2014) found that internet addiction was associated with increasing levels of loneliness, while online contacts did not reduce loneliness as was expected. Odaci & Kalkan (2010) found internet use over 5 hours a day was significantly related to both loneliness and dating anxiety.

Involuntary celibates are likely to interpret social situations as negatively as possible, which can impair their ability to befriend the opposite sex. They may interpret neutral stimuli as negative and therefore become hopeless, believing that they are being rejected when no such rejection has occurred.

Potential Interventions to Reduce Loneliness

Cacioppo, et. al., (2015) in their meta-review explored a number of potential targets of existing work to reduce loneliness. Providing social support to lonely people through programs like mentoring or one-to-one befriending led to a small improvement in loneliness, while increasing opportunities for social interaction by providing group therapy led to no improvement.

Therapy to correct distorted thinking was found to be the most effective, which was confirmed through a study by Masi et. al. in (2011) that used CBT. Involuntary celibacy frequently involved distorted thinking (either about themselves or about women.)

Autism Spectrum Disorder and Loneliness

Autism causes unique difficulties for individuals struggling with loneliness and involuntary celibacy. Their difficulty interpreting social cues means they can be unintentionally asocial and this can exacerbate their feelings of disconnection. Bishop-Fitzpatrick, Minshew & Eack (2013) in their metareview found that social skills training and Applied Behavior Analysis (ABA) were both effective in reducing loneliness.

A second study by Gantman et. al. (2012) looked at a 12-week social skills training called PEERS for Young Adults in particular led to sharply decreased loneliness and increased ratings of social skills by parents or other social supports around them.

Relationship Status and Loneliness

Adamczyk, & Segrin, C. (2015) found that, as expected, young adults in relationships were far likely to be lonely and to identify low social support.

Sexual Inexperience in Young Adults

Some young adults may not feel lonely, but may still be frustrated by their lack of sexual experience, and virginity in particular. By 12th grade, 62% of adolescents have engaged in vaginal intercourse, while about 5% of males and 3% of females 25-29 are virgins.

Interestingly, over 50% of 18 year old virgins went on to lose their virginity by 19-21. (Haydon et. al., 2014) This suggests that while involuntary celibacy or being “Forever Alone” (which is most commonly perceived by males 18-24) as a life-long problem, many of these same individuals will in fact have sex within a few years of their peers.

Donnelly, et. al. (2001) conducted a qualitative review of late-life virgins and discovered that differences began in adolescence, a failure to gain a first kiss and other formative sexual experiences led to a persistent feeling of being “behind” which exacerbated attempts to catch up.

Factors related to late-life virginity as summarized Boislard, van de Bongardt, & Blais (2016) include:

  • Being overweight
  • Perceived as physically unattractive
  • Having never been in a romantic relationship

Treatments for Involuntary Celibacy

Treatments for involuntary celibacy are few and far in between, because such a small portion of the population struggles in this way. Anecdotally it appears that a combination of a lack of risk-taking combined with shyness and maldadaptive cognitions lead lonely individuals to pre-emptively fear rejection and therefore not pursue romantic partners, leading to increased loneliness in a vicious cycle.

Those that do purse partners may find themselves unable to cope with the natural levels of rejection that everyone goes through and therefore give up before they find a willing partner.

As noted in previous sections, Cognitive Behavioural Therapy (CBT) is the most effective treatment to reduce loneliness and depression. CBT can help correct distorted thinking which is extremely common in individuals who are incel or ForeverAlone.

Social skills training for adults with autism has been shown to fix social skills deficits (and would likely assist adults not on the spectrum as well.) Additionally, improving physical attractiveness, particularly through weight loss for overweight individuals has been associated with an increase in sexual behaviour.

Finally, therapy can also be used to improve low self esteem and confidence.

Conclusion

There is a large internet community focusing on (mostly) young men who have been unable to crack the intimacy code. Do you have suggestions for how to improve your situation? Please write in the comments.

Bibliography

Adamczyk, K., & Segrin, C. (2015). Direct and Indirect Effects of Young Adults’ Relationship Status on Life Satisfaction through Loneliness and Perceived Social Support. Psychologica Belgica, 55(4), 196. doi:10.5334/pb.bn

Bangee, M., Harris, R. A., Bridges, N., Rotenberg, K. J., & Qualter, P. (2014). Loneliness and attention to social threat in young adults: Findings from an eye tracker study. Personality And Individual Differences, 6316-23. doi:10.1016/j.paid.2014.01.039

Bekhet, A.K., & Zauszniewski, J.A. (2012). Mental health of elders in retirement communities: Is loneliness a key factor? Archives of Psychiatric Nursing, 26(3), 214–224.

Bishop-Fitzpatrick, L., Minshew, N., & Eack, S. (2013). A Systematic Review of Psychosocial Interventions for Adults with Autism Spectrum Disorders. Journal Of Autism & Developmental Disorders,43(3), 687-694 8p. doi:10.1007/s10803-012-1615-8

Boislard, M., van de Bongardt, D., & Blais, M. (2016). Sexuality (and Lack Thereof) in Adolescence and Early Adulthood: A Review of the Literature. Behavioral Sciences (2076-328X), 6(1), 1-24. doi:10.3390/bs6010008

Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness: Clinical Import and Interventions.Perspectives On Psychological Science (Sage Publications Inc.), 10(2), 238-249 12p. doi:10.1177/1745691615570616

Donnelly, D., Burgess, E., Anderson, S., Davis, R., & Dillard, J. (2001). Involuntary Celibacy: A Life Course Analysis. Journal Of Sex Research, 38(2), 159.

Gantman, A., Kapp, S., Orenski, K., & Laugeson, E. (2012). Social Skills Training for Young Adults with High-Functioning Autism Spectrum Disorders: A Randomized Controlled Pilot Study. Journal Of Autism & Developmental Disorders, 42(6), 1094-1103 10p. doi:10.1007/s10803-011-1350-6

Hagan, R., Manktelow, R., Taylor, B. J., & Mallett, J. (2014). Reducing loneliness amongst older people: a systematic search and narrative review. Aging & Mental Health, 18(6), 683-693 11p. doi:10.1080/13607863.2013.875122

Haydon, A.A., Cheng, M.M., Herring, A.H., McRee, A-L., Halpern, C.T. (2014) Prevalence and Predictors of Sexual Inexperience in Adulthood. Archives of Sexual Behavior. 43:221-230. DOI 10.1007/s10508-013-0164-3

Luhmann, M., Bohn, J., Holtmann, J., Koch, T., & Eid, M. (2016). I’m lonely, can’t you tell? Convergent validity of self- and informant ratings of loneliness. Journal Of Research In Personality, 6150-60. doi:10.1016/j.jrp.2016.02.002

Mahmoud, J. R., Staten, R. ‘., Lennie, T. A., & Hall, L. A. (2015). The Relationships of Coping, Negative Thinking, Life Satisfaction, Social Support, and Selected Demographics With Anxiety of Young Adult College Students. Journal Of Child & Adolescent Psychiatric Nursing, 28(2), 97-108 12p. doi:10.1111/jcap.12109

Masi, C. M., Chen, H.-Y., Hawkley, L. C., & Cacioppo, J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15, 219– 266. doi:10.1177/1088868310377394

Odaci, H., Kalkan, M. (2010) Problematic Internet use, loneliness and dating anxiety among young adult university students. Computers & Education. 55, 1091-1097

Roekel, E., Ha, T., Scholte, R. J., Engels, R. E., & Verhagen, M. (2016). Loneliness in the Daily Lives of Young Adults: Testing a Socio-cognitive Model. European Journal Of Personality, 30(1), 19-30. doi:10.1002/per.2028

Victor, C. R., & Yang, K. (2012). The Prevalence of Loneliness Among Adults: A Case Study of the United Kingdom. Journal Of Psychology, 146(1/2), 85-104. doi:10.1080/00223980.2011.613875

Yao, M.Z., & Zhong, Z-j. (2014) Loneliness, social contacts and Internet addiction: A cross-lagged panel study. Computers in Human Behaviour, (30), 164-70

 



Cite this article as: MacDonald, D.K., (2016), "Involuntary Celibacy: Causes and Treatments," retrieved on February 17, 2018 from http://dustinkmacdonald.com/involuntary-celibacy-causes-treatments/.

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Interviewing on a Suicide Hotline

Crisis line reference checks and interviews are one part of the process for becoming a volunteer. A reference check usually involves the volunteer coordinator, distress line manager or other individual who is responsible for screening volunteers calling two or three individuals that you have written down (often an academic or employment reference, and then a personal reference.)

The purpose of the interviews are to determine your suitability for volunteering and to ensure that you won’t be negatively impacted by your helpline work. Below are some potential questions you might be asked on your interview

Common Interview Questions

What do you know about our service?
This question is important because a lot of people come into this field with an incorrect view of the day to day. For instance, some people believe that every call that they take will be someone who is highly suicidal. Certainly, on some lines there will be a bigger proportion of suicidal callers than others, but the majority of calls to most crisis lines (even suicide hotlines) are not imminent risk situations. Being aware of this is helpful.

Additionally, you may want to research how many calls the crisis line gets and how many volunteers they have. For example, some crisis lines get one call an hour, or even go stretches with no calls. (This is common for Samaritans branches where calling a single number gets a call bounced to the next available branch.) Other lines are much, much busier.

What made you interested in becoming a volunteer?
Sometimes people have visions of wanting to become a helpline, crisis line or suicide hotline volunteer because they want to save people. They imagine themselves as a counsellor who is able to fix people’s problems. Unfortunately, a lot of people’s problems can’t be fixed, and when we try to, we promote dependence.

On the other hand, there’s nothing wrong with wanting to become a volunteer to learn if social work or crisis intervention is right for you. Building skills, learning to network, and giving back to your community are all great reasons for joining a crisis line.

As well, it’s important to recognize if you’re interested in becoming a volunteer to fix your own problems. This will likely result in you being negatively affected by the work – and you should probably complete counselling or therapy first before approaching helpline work.

What relevant experience do you have, if any?
You may not have any experience as a peer counsellor or other kind of experience, and you may lack coursework in social work, but communication courses are helpful, as is customer service or call centre experience.

Remember that crisis lines will provide all the training you need, but anything that helps improve your ability to communicate helps. The most important thing is to be empathic, non-judgemental and to listen!

Have you ever dealt with stressful or crisis situations?
Obviously stressful situations can be common on crisis lines. The important thing is to consider whether you’ll be able to handle the pressure. Certainly, you may not have intervened in a suicidal crisis before, but any crisis experience can help.

Do you have personal experience with suicide?
It’s important that if you were suicidal yourself, or you lost someone to suicide, that you’ve taken time to work through your issues before beginning crisis line work. This can be triggering.

Are there any issues you may be uncomfortable talking about? For instance, some people have issues with intimate partner violence, abortion, or other issues that you may need to remain neutral in on the crisis line.

Finally you may have to perform a roleplay. For instance, you may be given a statement like, “Me and my husband got into a fight again. It’s the same thing all the time, he just never listens!” And you have to say how to respond. A good response that incorporates crisis line empathy statements would be something like “Wow, that sounds like it’s really frustrating for you.”

Important Definitions

There are some important definitions that may improve your interview performance.

Active Listening – Active listening is a form of listening that involves listening to really understand what the individual is saying. This involves elements of the active listening process, which includes voice tone and body language, pace, open and close-ended questions, and demonstrating empathy.

Empathy – Empathy is the ability to put yourself in someone else’s shoes and recognize the emotions they’re experiencing. This involves the use of empathy statements.

Your Interview

Hopefully these questions have given you a better idea what a helpline interview may contain. Were there any questions in your interview that I missed? Let me know in the comments section.
Cite this article as: MacDonald, D.K., (2015), "Interviewing on a Suicide Hotline," retrieved on February 17, 2018 from http://dustinkmacdonald.com/interviewing-suicide-hotline/.
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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 February 17, 2018 from http://dustinkmacdonald.com/declining-empathy-social-work-students/.

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