Critically comment upon experiences in terms of my own counselling experience and experience working within the organisation
My practicum was undertaken at Lifeline Community Care Queensland, Fraser District in telephone counsellor role. To be eligible for a placement within the telephone counselling area, a Lifeline Telephone Counselling training course must first be completed. I was fortunate that I had completed the training a little over two years ago. Not only did I have the basic training, but I was also a current volunteer in other roles within the telephone counselling area. I benefited from being familiar with the organisation, the relevant policies and procedures, and a number of staff members. I did not have to go through ‘new person’ difficulties. I believe I have a good working relationship with my supervisors. New learning activities included undertaking computer supervision, sit-in supervision and support, and providing administrative support. Continuous reading, self assessment and reflection, along with the keeping of journal notes proved invaluable to my learning and skills development.
Discuss in light of relevant theoretical concepts and research
Without it being stated Lifeline telephone counselling uses a ‘client directed outcome informed’ approach (Duncan, Miller & Sparks, 2004). In training we are educated in the principles of ‘the caller’s story’ and of the need to explore with the caller their options, past coping and/or solutions to address their issue. The telephone counselling training details the Carl Rogers concept of ‘unconditional positive regard’ (Lifeline Training Manual, 2009), without which it may be impossible to build the rapport needed to establish a counselling relationship. There is no measure of the service provided or feedback requested from callers to the 13 11 14 crisis line service. The Outcome Rating Scale and Session Rating Scale (Duncan, Miller & Sparks, 2004) are perhaps not entirely suitable for this purpose, but might be adapted in order to provide a feedback mechanism. Some callers leave you with very clear indication of how they believe the call went and what was achieved. However in other cases I am left wondering about client satisfaction. As the service is a ‘crisis’ line, there is no opportunity to follow through with a client.
Scott Miller (1997), in his audio CD, ‘Working with mandated clients’, identifies three types of clients: the “Customer, 15% of clients”, the “Browser, 65% of clients” and the “Visitor, 20% of clients”. In telephone counselling terms I relate the “customer” callers to those who are in the preparation stage of change and ring to gain clarity, for support and/or someone to listen and guide them in their planned action. The “browser” callers can describe the problem in detail, but appear to be stuck, this category would include the “yes, but” callers. The last group, the “visitor” caller, does not identify as having any problem themselves, everyone has a problem with them. Some of the caller’s I have spoken to, for example, some callers with mental illness concerns, perpetrators of domestic violence, and callers who report their drug and alcohol issues, I would place in this group.
Reflect on own experience and learning in light of research and theory.
As the role of telephone counselling was known to me, I was in a position to begin extra reading from the commencement of the practicum placement. I chose material that I thought would provide relevant information to the provision of the 13 11 14 crisis telephone service and to improve my general knowledge. My supervisor suggested that as many as 85% of callers had a mental illness, not that all callers with an identified mental illness disclosed that as their reason for calling. In light of this high number I began my reading list with ‘The everything health guide to adult bipolar disorder’ (Bloch, 2006); and ‘A family intervention guide to mental illness’ (Morey & Muser, 2007). These two books coupled with the Clinician’s Thesaurus (Zuckerman, 2005) provided valuable information which helped to guide my questions to callers, in order to better understand their issues and expectations of their call.
Callers at risk of suicide require a very high level of attention, these calls are stressful and can be challenging. My initial training in dealing with suicide was comprehensive. I later completed the Applied Suicide Intervention Skills Training (LivingWorks, 2004). Ongoing reading into the issues of suicide, loss and grief have improved my knowledge and in turn helped me to gain a greater understanding of the pain and suffering experienced by the person at risk and their families. The need for empathic listening is clearly outlined in McKissock & McKissock (1995) ‘Coping with Grief” and Appleby (1992) ‘Surviving the Pain after Suicide’, both are small easy to read, and relevant books.
Reflect/examine journal entries as a whole. Go back over your supervision journal noting the main themes and patterns of thought as well and incidents and insights.
Reference material, for example, ‘Becoming a Helper’ (Corey & Corey, 2009) and the ‘Clinician’s Thesaurus’ (Zuckerman, 2005) outline informed consent, detailing what a client may expect regarding confidentiality, of their rights within the counselling relationship and the decision making process. Clients are also informed of the limitations of confidentially. This is not the case in telephone counselling, where confidentially is implied. In cases where police or medical interventions are required, this can present an ethical and/or moral dilemma. If the caller has disclosed such issues that it goes against the morals of the telephone counsellor, the supervisor on call, and/or society, would it be better not to report the suicide in progress? In telephone counselling there is no opportunity to pick your calls, you cannot be a specialist in any one area. It is necessary to have the skills to work with callers on a wide range of issues. The concept of ‘unconditional positive regard’ is questioned when I am faced with a caller who is drunk, abusive or is clearly sex caller (a caller who discloses unwanted explicit detail).
In some cases there is a clear breach of client confidentiality, such as the case when the telephone counsellor on shift, promised the caller that she would not contact the police (journal entry 17 October 2010), even after his disclosed that he had already taken a higher than recommended dose of medication and had a history of mental illness. After contacting ‘Poisons Information’ it was clear that the caller’s life was at risk and intervention was required. Perhaps this could be viewed as the telephone counsellor, not calling the Police, but as the action of contracting the police was undertaken by another. The client’s confidentiality was technically breached several times, in the TC providing me with details, in my providing the Police with the caller’s information and in consultation with the supervisor.
Two books which have proved very valuable as resources are the Clinician’s thesaurus (Zuckerman, 2005) as quick reference including “treatment for specific disorders and concerns” and a “Listing of common psychiatric and psychoactive drugs”. The other reference is People in Crisis (Hoskinson, 2000), which has proven to be extremely helpful. I use the book to ground me, when I am seeking reassurance that I am on track, when I am faced with a challenging issue or when I am exposed to issues where I am little or no experience.
Analyse your experiences and record any modifications of your views.
Overall I enjoyed the roles and activities undertaken in the practicum with Lifeline and I believe that the experience was a very valuable learning experience. Additional reading undertaken improved my general knowledge of many of the issues raised by callers. Although, only one counselling approach is used in telephone counselling, strengths based approach, this is similar to the solution focused approach that I believe will become my favoured counselling approach. This belief is based on my limited experience to date and on the feedback from callers when they find their own solutions. It is gratifying to hear the ‘light bulb moment’ when callers realise what they have or can achieve.
Ongoing training and development, such as at the Wide Bay Women’s Centre, which provides DVD viewing and networking opportunities, the Lifeline ‘In Service Training’ and the ‘GOSS’ nights are relevant and beneficial, as they present information that is generally immediately applicable in my role as a telephone counsellor. The Huntington’s Disease National Conference in September highlighted “the art of listening”. Of the problems associated with not listening with full attention, jumping ahead and interrupting the speaker and of the importance of “asking the right questions” and of avoiding “complex questions”. The National Lifeline National Conference in November provided a greater insight into suicide prevention strategies. It was inspiring to hear from some great speakers such as Professor Brian Mishara, who spoke about suicide prevention and help lines. The Lifeline Suicide Prevention Strategy was launched and a copy of the new booklet was supplied. The motivational speaker, Maggie Mackellar, the author of ‘When it rains’, spoke about her experiences. I was very fortunate to have the opportunity to speak privately with her and to purchase a signed copy of her book.
Review your experiences in light of any relevant research and theory that relates to the themes you have observed and highlight the implications and learning for your personal development.
In a client directed, outcome informed approach to counselling there is a focuses on the relationship with the client and the client’s additional “therapeutic factors” (Duncan, Miller Sparks, 2004). Corey & Corey (2009) suggest that when we engage with a client we are “not consciously thinking about what theory we are using”. Rather we adjust to fit the client taking into account their willingness to engage and the trust we establish together. In telephone counselling this is referred to as ‘building rapport and exploring caller options (Lifeline Training Manual, 2009), the telephone counsellor works with the client to understand the problem from the client’s point of view, and to explore with the client what they wish to achieve and to discuss the ways they can achieve their goal.
Boylan & Scott (2009) describe “brief therapies” a descriptive summary which could also be applied to define the functions of telephone counselling provided by the 13 11 14, Lifeline Crisis Line. The service provides short term, crisis support. There is not follow up contact or counselling and no client measurable feedback.
Essay should demonstrate learning that is based on both experience and theory/research.
In this placement with Lifeline, telephone counselling, I was able to tie together past life and work experiences, Lifeline training, academic study and general reading. In a crisis line telephone counselling service, you never know what the next call will bring, however the extra reading has provided a greater knowledge and understanding of the some topics, but it is only is in the practice of asking of better questions of the caller that any real benefit is gained.
In applying a client directed outcome informed approach (Duncan, Miller Sparks, 2004), the caller is recognised as the ‘expert’ on their problem. A relationship (rapport) with the caller cannot be established without first listening and seeking to understand the caller’s issues from perspective, while valuing and respecting their position. Change is driven by the caller and it is important that their ideas about options, management and change are explored. The need for empathy and caring and the ability to reduce the callers stress while providing an opportunity the caller to speak openly regarding their problems is paramount.
I have long been aware of the need of self reflection and self care, the importance of which has been reinforced during this placement, along with the essential requirement to keep reading, questioning and learning. I was very fortunate in having good support from my supervisors, I was able to debrief, question and discuss any topic or issue as it arose.
My conclusion at the competition of CDS3000 practicum is that I remain ‘a work in progress’. I believe that I am a competent telephone counsellor, but I wonder if this will translate to face-to-face counselling.