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Section 10
Telepsychology

Question 10 | Test | Table of Contents


THE REGULAR CLIENT
For the established client who is going through a situational life crisis where death becomes an immediate and pressing option, the counselor can give permission to call if there is a need. There are many ways in which to structure this permission. Saying "I am listed in the phone book and I want you to feel free to look up my number and call if you are in crisis" is much different from just handing a client a slip of paper with your name and number on it and explaining "It is OK to call if the need is great." The first option has undertones that suggest that the client has strength to make it without calling; the second option encourages more dependence. Another way to give permission, promote independence, and provide a boost of confidence is to say "It is perfectly all right to call me, but I don't think you will need to do that." It is important for the counselor to set limits when permission is given to call. The client must be told that he will not always be available when he calls. This shows the client that he cannot expect to get everything he needs from his counselor. He must be prepared to make use of the life line that has been worked out together.

Clients must also be told that the therapist is willing to spend time with them on the phone, but that there are limits. The counselor might say, "If I have five minutes, I will gladly talk with you, but then I will have to go." It is a good idea to be direct and honest with the client and to let him know of the time limits. For personal survival and comfort the counselor must be able to structure a call so that it does not go on and on.

It is essential to focus on the critical issues, find alternatives, and set a course of action. Only so much material can be adequately discussed on the phone and the client must realize this; the counselor has to tell the caller that a given topic will have to wait until the next session. Both parties must accept responsibility for finding the primary issues and setting priorities for discussion.

In each instance, a portion of the next regular counseling session must be used to debrief the previous crisis call. This helps show the client that he is responsible for his actions. It is also a way in which the client can learn new skills for dealing with emergencies. The educational aspects of counseling must always be kept in view. There is always a danger that responding to a crisis call can set a dangerous precedent; for the client, finding someone to rescue him can easily become a game. There is also a possibility that the counselor would be teaching clients to act helpless so they will get service.

GENERAL CONSIDERATIONS
For the unknown caller the phone has a number of distinct advantages. The caller is clearly placed in control and can remain anonymous if he chooses. The counselor is also anonymous and this sense of distance helps some people feel more at ease and able to talk freely. Self-esteem can be saved in the-eyes of some individuals if they are talking to a stranger who cannot see them. The dim figure in a confessional is somewhat similar. For the person in crisis, this type of help seeking may be a way in which to help him keep up the facade that he really has no problems. He rationalizes his call by thinking that his situation of upset is only temporary. The telephone also offers a very immediate source of support. There is not a long waiting period; immediate contact with a helping person can often be established.

A primary goal of any counseling intervention is to impact the client in a positive manner. The crisis caller is a likely candidate for change because of the high degree of emotionality. It is at these times that clients are the most emotionally accessible. In non-crisis situations the defenses are frequently up, and it is more difficult to get the client to work from his emotional base. Consequently, while the risk is high and there is high danger, there is opportunity for the client to come to some emotional understandings that might otherwise not be achieved if it were not for the emergency. Given this fact the counselor could well press on certain issues if it seemed that there was a good chance for therapeutic gain.

Because of the potential for crisis calls, it is important that all counselors develop good habits in regard to returning phone calls. Due to the press of time, many counselors have different systems for returning calls. It is our belief that calls should be returned within the hour, and messages should not be allowed to accumulate. Secretaries should be trained so that they can detect the real emergency and pass the message on to the counselor immediately.

Secretaries and receptionists are the first line of defense in handling initial contacts with clients. For both cases of face-to-face as well as telephone contact, it is critical for a positive impression be made. Office personnel must be warm and responsive to clients. It is their sensitivity, intuition, common sense, education, and special training that works in combination so they can separate the routine client from the emergency. After they have assessed the nature of the call, they must be able to make a smooth referral to the appropriate staff member. For instance, in the event of a counselor being tied up they could say, "Mr. Jones is seeing a client now, but he will be able to call you at the hour."

Answering services also should be selected with care. Some services answer a call by saying the phone number, "This is 385-4141." Others will give your name, "Dr. Jones' answering service, may I help you?" We believe that the personal approach is best. The counselor must be confident that the service will be able to judge how best to refer emergency calls.

The telephone can be used to the client's advantage or disadvantage. It is an important counseling tool; consequently, all counselors should review the systems that are used in their counseling office.
- Hipple, John, & Peter Cimbolic, The Counselor and Suicidal Crisis: Diagnosis and Intervention, Thomas Books, Inc.: Springfield, 1979.

Update
Blending Internet-Based and Tele Group Treatment:
Acceptability, Effects, and Mechanisms of Change
of Cognitive Behavioral Treatment for Depression

- Schuster, R., Fischer, E., Jansen, C., Napravnik, N., Rockinger, S., Steger, N., & Laireiter, A. R. (2022). Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression. Internet interventions, 29, 100551.

Depression in adolescence

- Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. Lancet (London, England), 379(9820), 1056–1067. doi:10.1016/S0140-6736(11)60871-4.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. Thus, space has been provided for you to make personal notes as you apply Course Concepts to your practice. Affix extra Journaling paper to the end of this Course Content Manual. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socioeconomic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 150 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress”. You will not be required to provide us with these Journaling Activities. Only the Test is to be returned to the Institute.

Personal Reflection Exercise #2
The preceding section contained information about the use of the telephone in treatment. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Peer-Reviewed Journal Article References:
Bermingham, L., Meehan, K. B., Wong, P. S., & Trub, L. (2021). Attachment anxiety and solitude in the age of smartphones. Psychoanalytic Psychology, 38(4), 311–318.

Hill, K., Schwarzer, R., Somerset, S., Chouinard, P. A., & Chan, C. (2021). Enhancing community suicide risk assessment and protective intervention action plans through a bystander intervention model-informed video: A randomized controlled trial. Crisis: The Journal of Crisis Intervention and Suicide Prevention.

Kuhn, E., Kanuri, N., Hoffman, J. E., Garvert, D. W., Ruzek, J. I., & Taylor, C. B. (2017). A randomized controlled trial of a smartphone app for posttraumatic stress disorder symptoms. Journal of Consulting and Clinical Psychology, 85(3), 267–273.

McClellan, M. J., Osbaldiston, R., Wu, R., Yeager, R., Monroe, A. D., McQueen, T., & Dunlap, M. H. (2021). The effectiveness of telepsychology with veterans: A meta-analysis of services delivered by videoconference and phone. Psychological Services. Advance online publication.

QUESTION 10
According to Hipple, what are three essentials to focus on with suicidal telephone contacts? Record the letter of the correct answer the Test.

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