Caller: I've never called before . . . I'm not sure why I'm doing this.
Listener: It sounds like you're concerned about something.
Caller: I . . . I don't know what to do.
Listener: I hear sadness, uncertainty in your voice. Is something troubling you?
Caller: Yes. Ever since I lost my leg in an accident a few years ago, I haven't been able to cope. I was an athlete; now I'm nothing.
Listener: It sounds very difficult to live with this.
Caller: Yes, and I can't live with it any longer. I can't go on.
Listener: Have you talked to anyone about your feelings about losing your leg?
Caller: Of course. I've talked to everyone. I went through six months of rehabilitation and there's still no answer. Now I know what to do. Soon I'll be free.
Listener: When you say things like "I can't go on" and "soon I'll be free," I feel concerned because I'm not sure what you mean. Are you thinking of taking your life?
Caller: Yes, why not? I see no other way except these pills.
Listener: It sounds like you're really stuck right now -- what can you do besides taking those pills that might help?
Caller: Nothing. You don't understand . . . I think I've made up my mind! (click) As a volunteer for the D.C. Hotline, a crisis-intervention phone-referral service, I thought I had effectively followed the crisis model taught by the Hotline. Yet I had lost her. I tried to empathize, not sympathize, with her. I felt I was beginning to build a rapport through a patient, caring tone in my voice. After she hung up, I felt relieved that this was a simulated call. The caller was a supervisor role-playing a crisis call I might face on a weekly four-hour shift with the Hotline after training.
Now, one year later, I have taken part in similar calls. And, for the most part, by using the reflective listening skills and other communication techniques taught in training, I've been able to help callers vent their anger, frustration or sadness, to focus on their problem and decide how to deal with it.
Through Hotline training and experiences with callers, I have become a more helpful listener in daily conversations, as well. For example, I soon realized that in the past I had often been more judgmental than sensitive when someone had come to me with a problem.
Though I'm not exactly certain what my motive was for joining the Hotline, I wanted to do something "civic minded," I told friends, and when I scanned Anne's Reader Exchange, a column in The Washington Post listing local volunteer opportunities, a blurb on the Hotline sparked my interest. Hotline work also suited my experiences, since I had done some phone work in fund raising and political polling.
At the time, I was not certain what kind of people the Hotline was looking for as volunteers, and at my first night of training the some 40 volunteers were very different. A few had extensive experience in counseling and psychology; others had none. There were men and women of all ages, lawyers, managers, journalists, students and teachers. As far as I know, none of the volunteers was rejected, though some were asked to take another night or two of training before taking a shift, and some declined to complete training. As one departing volunteer told me, "It's just not for me right now." I wondered myself whether the Hotline was for me. With little educational background in psychology and no professional counseling experience, could I effectively guide a desperate caller overwhelmed by a crisis? Could I bear that responsibility?
Soon, however, I realized we would not be counselors so much as listeners. We would reflect and empathize, not diagnose and treat. We were assured that the only requirement to serve as a volunteer was to be a caring person.
The first thing we were taught was the crisis model, beginning with the need to display three essentials with every call: empathy, nonjudgmental acceptance and sensitivity. We were told not to confuse empathy with sympathy, which may sound judgmental and condescending to the caller.
"Using empathy helps establish an equal relationship with callers. It helps them to feel understood," said Heller An Shapiro, former director of volunteers for the Hotline.
Shapiro and Hotline trainers said many people call because they feel powerless to deal with a crisis themselves and don't know where to turn. Friends and families often find it difficult to listen effectively. As willing strangers with no personal interest in, or influence on, the caller, we could fill that void.
We were asked to be aware of our own values on issues and circumstances. How did we feel about bigotry, child abuse, suicide, rape, abortion, extramarital sex, incest? Would our feelings about these issues get in the way of hearing the caller?
We were also told that everything a caller says is significant. We would have to listen hard and not take for granted the caller's words or assume what the problems were. As one trainer said, "Everything they say to you is a piece of gold. Even if you know what their sentence is going to end with, let them finish it." :: :: ::
Since the D.C. Hotline promises confidentiality, I can describe only the types of calls, not specific calls and callers. Concerns ranged from alcohol and drug problems, unemployment or troubles at work, relationship problems, pregnancy, rape, child and spouse abuse to suicide.
The Hotline is also a referral service, and many callers requested resources to consult for problems and feelings and for emergency food and housing, medical care and legal help, as well as sexual problems.
Callers were as likely to be males as females, though they tended to be mostly young adults. My general impression after a year is that most callers called about relationship problems, particularly with lovers and spouses but also with family members and friends. Though I initially expected to be often dealing with traumatic, critical, sometimes life-threatening crises, I had only three suicide calls; one was very serious.
After 36 hours of training and one night observing an experienced volunteer handle calls, I began my first shift. Though I had expected a sterile office setting, the Hotline office was much like a comfortable den with a worn sofa, recliners and a large coffee table covered with magazines. Outlines of the crisis and suicide models, listening tips, and telephone numbers of emergency referrals like the Suicide Hotline covered two bulletin boards and the walls. A small metal filing cabinet listed general resources we might refer callers to.
Though training told me not to feel responsible, I immediately did as I sat down in front of the phone that first night, waiting for it to ring. Someone has come to you with a problem, and the strong implication is that you are there to provide the solution. I felt as though I would have to block that panicking thought to hear the caller. I knew that I would also have to focus on the caller's feelings to follow the crisis model -- not on my own feelings. But my first call didn't go that way at all.
Immediately, I started taking notes about the caller and his problem, much to the chagrin of my supervisor. I listened to the hesitant caller but couldn't seem to focus on the caller's feelings or needs.
"What is it about taking notes that you think is important?" my supervisor asked at the close of the call. "It's more important to hear the caller's tone, the emotion in his voice, which is hard to do when you're scribblihg away on that pad."
She was right. For the next call, I put the note pad down and listened for the caller's tone as a signal of emotion. Consequently, I could hear the words. Words and emotions were no longer separate, confusing. My own distracting reactions were pushed aside as I focused on the caller. :: :: ::
After discussing options and decisions, I can help a caller by summarizing those decisions and have the caller agree to try to take the needed action. I often neglected this vital part of the crisis model. I may have been distracted by my own satisfaction in hearing the caller come up with options against seemingly insurmountable odds and forgotten that the call wasn't over. Also, it felt awkward to say, "When do you think you might try that? Can we agree that you can try talking about this with her tomorrow? Would you feel comfortable about that?"
But we were told in training that such agreement phrases help firm up the caller's resolve to take action. And after I used these phrases more often, callers seemed to respond to them, perhaps surprised by this conclusion to the call. They called asking for help, and something was now being asked of them. The agreement seemed to stay with them at the close of the call.
By repeatedly following the crisis model of reflection, assessment, exploration and agreement, it became ingrained. There were, however, times when I found myself straying from what I had learned in training. Consequently, some callers seemed to stray as well. Periodic self-refresher courses with training notes helped get me, and the callers, back on track and reaffirmed that the crisis model is an effective way to help people hear themselves and sort out their problems.
I also received abusive calls. You name it, I've been called it. In training we were instructed to counter such abuse with messages like: "I'd like to hear what's troubling you, but it's difficult when you continuously place your anger on me. Do you think you can calm down and talk about this?" If that doesn't work and the abuse continues, we can close the call: "I'm going to end the call, but you might want to think about what you want to say and call back another time." (click) We were instructed that if we do nothing and let the abuse continue, it will not help us deal with the problem or crisis, and we'll feel bad about the abuse. :: :: ::
Suicide calls, particularly difficult to handle, would have to be treated differently from other crisis calls: We would immediately have to separate the caller from the potential means of suicide. We would not have the luxury of reflecting, assessing the underlying currents in this tense situation and playing the call out.
We would have to follow the SAL (specific-available-lethal) model: Is there a specific way in which the caller plans to take his life? Are the means available? How lethal are those means? When there are indications that the caller is considering suicide, we might ask, "Do you have a plan? What do you plan to do?" If the caller says, "I'm about to blow my brains out," we would have to try to separate the person from the gun.
We would also have to maintain rapport and balance it with the lethal means. "I'm trying to understand what you're saying, but I'm having difficulty doing that when you're sitting there with a gun. How would you feel about taking the bullets out and putting the gun in a drawer?" When we get past this point, we can begin to follow the crisis model of reflecting and assessing the feelings and problems, and exploring the options.
Agreement, however, would be particularly important to suicide calls. The caller has already considered suicide and that thinking may likely increase in the following few days. We should try to help the caller think about an option when he wakes up the next day. Even if he is skeptical about a plan, it will help build up his resolve to execute it. We might ask, "If you were willing to do something else, what would you do?"
Suicide calls can be frustrating battles. Volunteer listeners often face inflexible thinking and extreme reactions, such as, "If this person doesn't come back to me, I'm going to kill myself." Many callers dwell on the negative and can't imagine things getting better. They pour feelings of alienation, anger, depression, despair, fear, frustration, fatigue and hopelessness into the listener. We were told that it would hurt to hear their feelings, and that instinctively we would have to acknowledge the caller's pain, not deny it.
Also, suicide calls, regardless of whether or not we think they are serious, should be taken seriously. Even if we believe that a person has a right to take his life, we should do everything we can to encourage the caller to look at options to deal with the crisis. The fact that someone called the hotline implies that he wants an option. We were also warned not to fall into the "rescuer role" in suicide calls, which could lead us into feeling responsible for the caller's life.
"You can't talk someone into suicide," said Shapiro.
In the one serious suicide call I had -- serious in that the caller sounded determined to take his life, had the means and was planning to do it soon -- I initially panicked. I couldn't help feeling I was between the caller and suicide, and I could not easily push the thought aside. I felt that anything I said would be interpreted as a threat, not as support. How could trying to remove the caller from the means help?
But surprisingly, it worked. The caller agreed to remove the means. An hour later, after much venting and exploring of options, even an agreement he would call the referrals I gave him, we closed the call. :: :: ::
I often think about the voices while walking home afterward and feel a strange bond with these callers. I'm a stranger to them, but by trying to be empathetic and sensitive I sometimes touch lives in ways I might not be able to as a friend or a relative. I know so little about them, yet I know their most intimate feelings. And I wonder how their stories end.
Gary Logan is a Washington free-lance writer and an editor for TRIAL magazine. Resources
D.C. Hotline, P.O. Box 57194, Washington, D.C. 20037. Hotline, 223-2255; office, 223-0020. Montgomery County Hotline, 10920 Connecticut Ave., Kensington, MD 20895. Hotline, 949-6603; office, 949-1255. Northern Virginia Hotline, P.O. Box 187, Arlington, VA 22210. Office, 527-4077. Suicide Prevention Hotline, Washington, D.C. 561-7000. Baby Hotline, maternal and child health, Washington, D.C. 723-2229. Gay Hotline, Washington, D.C. 833-3234. Rape Crisis Center, Washington D.C. 333-7273.