Working With Difficult Interactions

The Difficult Dozen

1. 
   Abusive Callers are those who abuse, malign, or victimize us or our agencies through either their words or their behavior. Their contacts are not for Crisis Intervention but rather for the purpose of expressing a personal opinion. The abusive behavior is most likely triggered by the inability to cope with a past or present life situation but the Caller’s focus is on expressing their opinion not on problem resolution. It is important to recognize their behavior is directed at us not a life situation.
   

It is also important to differentiate the Abusive Caller from the Caller who contacts us dealing with issues of abuse. The abused or those who are abusers who are contacting us in an effort to change their situation can be stressful for us to interact with. By working with such Callers non-judgmentally it can help us to maintain our emotional integrity while providing them the level of service they require.

2. 
   Angry Callers are those who express anger at a specific situation or circumstance that affects them, as opposed to expressing it towards us. The situation addressed is generally the result of a life situation but the focus on the expression of the anger frequently interferes with the problem-solving process. Their method of expression and intensity of emotion frequently makes it difficult for us to not want to distance ourselves from interacting with them.
   

3. Sexuality Issue Callers contact us about issues regarding their sexuality and are seeking concrete methods to address those issues. Among the issues they contact us about are STD’s, pregnancy, sexual identity issues, and victimization. The difficulty in dealing with these Callers stems from the comfortability we have in addressing their issues and their manner of expression. It is import to make a differentiation here. Sexuality Issue Callers contact us to resolve an issue regarding their sexuality and as such deserve the full benefit of our talents and resources. However, given that each of us has our own perception and comfortability with our own sexuality the nature of the subject matter, the manner of presentation, or other intangibles may make the Specialist may feel uncomfortable during the interaction. As a result it is important that we be aware of any biases we may have and interact with these Callers in an accepting, non-judgmental manner. The danger here is that our biases may result in us misidentifying a Sexuality issue Caller as a Sexual gratification Caller. Sexual Gratification Callers contact us to derive personal pleasure from the interaction. As their contact is not focused at all on resolving a given issue it is important we tell them that ours is not an appropriate forum for their contact.

4. Sexual Gratification Callers (Sex-grat Callers) are those who engage us as unwilling partners in obtaining their own gratification. These Callers are usually male and are frequently overt in their behavior but will also present fantastical situations as actual in order to engage the us as unwilling participants in their quest for self-pleasure. While their behavior can be the result of a particular life issue, past or present, they are not interested in solving a problem. Interactions with this group of Callers are stressful for Specialists who can come to feel used, abused, and angry.

• 
  Type I who openly admits to wanting to masturbate or is already in the process of masturbating. They plead with the Specialist to stay on the line, talking until they have finished.
  
• 
  Type II who (a) tells a fantasy problem that is presented as being real. It is usually, but not always, of an overt sexual nature. While discussing this “problem” with the Specialist, they masturbate; or (b) also presents a fantasy problem, but rather than masturbating during the call, they use the call as a stimulus to masturbation after the call.
  

It is the position of this presenter that such interactions should be ended as soon as identified. In the case of the Type I Caller this should occur immediately at the first admission of masturbatory behavior. In the case of the Type II Caller the call should be ended as soon as an assessment reveals the Caller’s actual purpose for calling. This assessment is an important step as it ensures that a call with issues of sexuality is not misidentified.

However there are two schools of thought on the matter. The first postulates that sex-grat call be ended as soon as they are identified as such. The arguments for this practice are that:

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  Sex callers identify their behavior as a compulsion, or an addition. Talking to them serves to enable them, and demonstrates to them that there are no consequences for making sex calls. If there are no consequences the caller is just going to keep calling. An addict usually has to “hit bottom” - feel as bad as possible - before they take steps to recover.
  
• 
  Engaging sex callers sets up unrealistic expectations for them that other people will be able to see beyond their behavior and understand. Ending the call stresses that they need to take responsibility for their behavior, and for helping themselves. It shows them that, if they really want to stop, they have to ask directly.
  
• 
  Ending the call right then and there stresses that this behavior is not appropriate behavior and that it is abusive to others. That’s the reality, whether the caller likes it or not.
  
• 
  Sex-grat callers report that they actually want to be stopped. They feel compelled to call, but they know that it’s wrong, and want Specialists to help them stop themselves. Ending the call as soon as possible is a way of helping someone who can’t help themselves.
  
• 
  Ending the call once it is identified as a Sex-grat call serves to empower the Specialist who can feel abused and victimized by such interactions
  

The arguments for continuing to stay on the line and engaging sex-grat callers are:

• 
  Sex callers don’t tend to have insight into their behavior. They don’t know why they make these calls, but feel helpless to stop themselves. They need our help understanding that making sex calls is a sign of a problem that they would need outside help to recognize and fix.
  
• 
  Sex callers are so distrustful and afraid of being found out that they are very unlikely to seek outside counseling. Our being kind and respectful might help them to see that counselors can accept them, and might make them more likely to risk seeking outside support.
  
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  Staying on line with the sex caller will make it more possible to inform them that they are not the only ones who struggle with this compulsion. It’s not likely that they have friends in their lives to which they can confide, due to their shame and distrust of others. They might feel like the “only ones” otherwise. Also, if they find out that there are more people like them who struggle with this compulsion they might be more likely to seek outside help.
  
• 
  Low self-esteem is a primary issue for sex callers. Showing them that we value them enough to still try to work with them, even after recognizing that they were attempting to exploit us by making a sex call, can have tremendous healing potential.
  

As there are these two diametrically opposing views it is best if the agency decide which view they support and develop a written policy which explains their support of the view they chose. A written policy serves to delineate firm boundaries, establishes consistency in service provision, and empowers the workers to deal with these interactions in an assertive manner.

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  Use a lot of silence, and keep all statements brief. Put responsibility for the majority of the talking on the caller.
  
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  Focus on feelings not the details of the presented scenario.
  
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  Set limits as needed. Do not allow callers to share sexual details. Do not feel obligated to behave or do as the caller dictates.
  
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  Adjust your voice tone. Do not speak in a soft, “counselor” voice. Instead maintain a vocal “distance” by using a flat tone.
  
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  Do not give sexual information or advice.
  
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  Do not promise callers anything before you know what the promise will entail.
  
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  Do not engage a Type One sex caller (or an obscene caller).
  
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  Identify and address any possible indicators that the caller is a sex caller.
  
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  Wait for sufficient data (three indicators) before confronting the caller.
  
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  Be direct when confronting the caller, and tell the caller why you are hanging up.
  
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  Follow through with hanging up immediately after you have said you are going to do this. Do not debate with the caller after you have said you are hanging up.
  
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  Prior to actually ending the call, invite the caller to call back, should he (or she) want to discuss his compulsion to make sex calls.
  
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  If you are unsure as to whether a caller is a “sex caller”, treat them as a legitimate caller.
  

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  I’m getting the impression that you enjoy talking about this.
  
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  I get the impression that sharing this is stimulating to you.
  
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  I believe that this is a sex call.
  
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  I believe that you are masturbating right now. We are not here for that purpose.
  
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  Because your call is inappropriate I am going to end the call now.
  

Type II Sex-grat calls have certain characteristics that can identify them as such. While no single indicator is sufficient to definitively identify a sex-grat call as such groups of indicators occurring in the same interaction can lead to a confident identification. To prevent the possibility of someone calling about issues of sexuality being misidentified as a sex-grat Caller it is prudent to require a specific number of characteristics be identified before making the determination. Generally three or four indicators will be sufficient. A list of indicators appears below.

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  Will ask to speak to a person of the opposite gender
  
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  Voice is devoid of emotion or seems forced and melodramatic
  
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  Speaks haltingly, or is generally hesitant to speak
  
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  Gives first name immediately
  
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  Asks for the counselor’s first name immediately, and throughout the call if not provided
  
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  Asks personal questions about the counselor
  
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  Resists resolving the presented issue
  
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  Presents with innocence about sex
  
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  Uses the word “embarrassed” with frequency
  
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  Uses other key, sexual words with frequency (i.e., “diaper”, “spanking”)
  
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  Gives detailed sexual descriptions
  
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  Uses very formal or very childlike language to describe anatomy and sex acts
  
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  Resists resolving the presenting issue
  
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  Breathes heavily, or holds phone away from mouth so that breathing isn’t detected
  
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  Tries to get counselor to do all of the talking
  
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  Offers common sex caller themes: incest, sexual abuse, transgenderism, sadomasochism, exhibitionism, voyeurism, fetishism, concerns about size or functioning of anatomy
  
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  Uses common opening lines: “Will you talk to me?”, “Can I talk about anything?”, “Is there a man/woman I could speak to?”, “I’ve never called before”, “I have an embarrassing problem”, “I’m lonely”
  
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  Story grows and grows as the call progresses
  
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  Only wants to share details of the situation, not feelings
  
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  Caller is unable to identify and/or explore feelings
  
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  Provides inconsistent information
  
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  Affect doesn’t match the situation presented. Their motional tone doesn’t match the situation presented
  
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  Voice tone remains unchanged throughout the call
  
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  Obvious characteristics don’t seem to match the presented scenario (as when the caller sounds significantly older or younger than the stated)
  

There are Do’s and Don’ts for interacting with suspected Sex-grat Callers

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  Do treat all calls as real until shown to be otherwise.
  
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  Do reflect and focus on feelings.
  
• 
  Do use silence.
  
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  Do point out indicators and inappropriate behaviors as they occur.
  
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  Do allow the Caller to respond to the pointed out indicators and inappropriate behaviors.
  
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  Do maintain a neutral voice tone.
  
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  Do set firm limits.
  
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  Do keep your responses brief.
  
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  Do review indicators and behaviors when enough are discovered.
  
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  Do maintain your objectivity and composure.
  
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  Do end such contacts in a firm and respectful manner.
  
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  Don’t ask questions.
  
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  Don’t “search” for indicators or behaviors.
  
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  Don’t respond emotionally.
  
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  Don’t lecture.
  
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  Don’t continue the call once it is identified as being inappropriate.
  

5. 
   “Yes…, But…” Callers request solutions to their specific situation or condition but reject any constructive input. They are resistant to being an active participant in the Crisis Intervention Process as they have already “been there, done that, and it didn’t work.” Generally they seem hopeless of ever resolving their problem and want our company in their feeling of hopelessness.
   

6. Intoxicated Callers are those Callers who contact us under the influence of some substance(s) that impairs their ability to interact in a coherent or rational manner. The ability to interact with these Callers is dependent on the level of their intoxication and their tolerance of the substance ingested. While many agencies have policies regarding interactions with these Callers making a blanket statement that we cannot or will not interact with Inebriated Callers is not appropriate. We must assess the Callers ability to meaningfully communicate and proceed accordingly. It is important to remember that some psychotropic medications as well as physiological conditions can make Callers sound intoxicated. There is also the possibility the synergistic effect of some combinations of drugs may create a life-threatening situation. The following are thoughts to be considered in working with the inebriated caller:

1. Some medications people take can made them slur their words and sound inebriated. To end the interaction without assessing the reason for the person sounding the way they do sends a negative message regarding their medication compliance. An appropriate way to address this would be to point out the behavior and inquire about the reason for that behavior. In other words..."I am having a hard time understanding you because you are slurring your words (running your words together, jumping from topic to topic or whatever behavior you notice that is making them sound inebriated) can you tell me the reason for this?" The person reacting to their medication will tell you they had taken their meds. In this case the call should proceed as usual.

7. 
   Donor / Stakeholder Callers would seem not to present a difficulty to us so why include them in the Difficult Dozen? The reality is they usually aren’t problematic. That is, at least, until we remember they are the people who are paying the freight and we feel that we have to invent that non-existent magic solution that will solve all their woes. On a level we come to feel our performance is being judged and that the agency’s future lies in our hands. There are also those in this group who feel entitled to preferential treatment and will make demands we are not able to fulfill.
   

8. 
   Distracted Callers are those Callers who seem unable to focus on their situation because of reasons or circumstances outside their control. Their distraction can be the result of environment, emotional or psychological disabilities, medication, substance abuse, or a singular focus on the precipitating situation which blocks meaningful interaction.
   

9. 
   Silent Callers are those Callers who, at the time of their contact, are unable to verbalize what is going on that induced them to call or are unsure of how to initiate the Crisis Intervention Process. The difficulty lies in the fact it is hard to interact on the telephone with someone who will not speak.
   

10. 
    Prank Callers are those Callers who contact us to gain personal enjoyment or simply the fun or thrill of being able to manipulate or “put one over” on a perceived authority figure. While we might dismiss these contacts as “inappropriate” we must keep in mind that the call could be a test of our service, a cry for attention, or the emotional release of feelings which are the result of a some situation in the Callers life. We also should recognize that the making of prank calls, in the case of young people, could be considered normative behavior. If we keep some key perspectives in mind about Prank Calls we can mitigate the effect they will have on us over time.
    

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  Today’s Prank Caller is tomorrow’s Crisis Caller. Pranking may just be a way that young Callers test our service.
  
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  Every time we pick up the phone, we are representing the entire service. We should strive to maintain an appropriate, professional demeanor.
  
• 
  Some fantasies shared by Callers may be reflective of serious, emotional or psychiatric problems.
  
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  Sometimes calls fall into a “gray area” - the presented situation may be a fantasy, but the caller may still need some kind of help.
  
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  Making prank calls is normative adolescent behavior - most teens do it, and most people who were teens did it. It may be an expression of rebellion against authority, an acting out of depression or stress - issues that are commonly experienced by adolescents.
  

• 
  Employ an empathic tone, and point out that when Callers make calls as such to the Agency, it keeps people who really need help from getting through. Raising the tone of voice or expressing anger and frustration provides the prank callers desired effect and will ensue in additional calls
  
• 
  Specialists will then explain to the Caller that they are going to terminate the call, but invite the caller to call back if they are ever in need of assistance. This models the behaviors of respect and non-judgmentality to the caller and let’s them know we are there to help anyone calling in actual need
  
• 
  Specialists are then to immediately hang up. Staying on the line provides a tacit acceptance of the behavior which will encourage the Caller to continue.
  

There is a secondary type of prank call we will refer to as the In-obvious Prank Call. The In-obvious Prank reflects a desire to engage and trick the Specialist, and is more likely to be reflective of pathology. As with Sex-grat Calls it can be helpful to the workers if the agency has a written policy covering how they are to be handled. When confronted with this type of prank, the Specialist must point out potential indicators that the call is a prank to the Caller as they are observed, then explore them, all the while employing an empathic voice tone. The reason for collecting and pointing out the indicators is to preclude instances of misidentifying Callers in actual need as prank calls. After the Specialist has identified four indicators, explored them, and concluded that the call is a prank, the Specialist is to list the indicators again. Then, while employing an empathic voice tone, the Specialist is to explain that the indicators lead them to conclude that the call is a prank, and thereby an inappropriate use of the service. As this type of call could be either the result of some pathology or a testing of the service the Caller and should be offered an opportunity to explore their reasons for making such calls to the line. If the caller is amenable to such a discussion, and is willing to address legitimate issues, the worker is to take them through the Crisis Intervention process as usual. Otherwise, the Specialist is to end the call. Keep in mind that it is important to remain calm and resist any desire to scold or lecture the Caller as this will only serve to exacerbate the situation.

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  The Caller speaks haltingly, or is generally hesitant to speak.
  
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  The Caller’s tone remains unchanged throughout the call.
  
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  The Caller gives first name immediately.
  
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  The Caller asks for counselors name immediately.
  
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  The Caller asks personal questions about the counselor.
  
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  The Caller resists resolving the presenting issue
  
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  The Caller tries to get counselor to do all of the talking.
  
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  The Caller’s tone is devoid of emotion, doesn’t match the situation described, remains unchanged throughout the call, and/or seems forced or melodramatic.
  
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  The presented story seems to grow and grow as the call progresses.
  
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  The Caller only wants to share details of the situation, and no feelings.
  
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  The Caller is unable or unwilling to identify and/or explore feelings.
  
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  The Caller provides inconsistent information.
  
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  Observed or presented facts don’t seem to match the presented scenario, as when the Caller sounds significantly older or younger than their stated ages, or they claim to be calling from home, despite the sounds of a highway in the background.
  
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  The Caller is whispering to someone or laughing, or someone else is whispering to the caller, or laughing in the background.
  

To ameliorate the impact of prank calls the Specialist should:

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  Use a lot of silence. Prank Callers want the Specialist to do all the talking. They will find silence frustrating, and be dissuaded from continuing to call.
  
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  Focus on feelings. Prank Callers are ready with stories, but generally aren’t able to identify or explore feelings. Encouraging pranks to elaborate on feelings makes them have to do most of the talking, which, again, defeats their purpose.
  
• 
  Pace themselves. If the pranks are getting to you, take time between calls, take a break, or debrief with a supervisor - take steps to maintain objectivity and composure.
  
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  Come up with an appropriate but rote response to deliver to pranks, so that they can be rehearsed and prepared for the confrontation, and thereby be less reactive. Example: “When you make prank calls people needing help can’t get through, because you tie up the line. If you ever have a problem, feel free to call back, but right now, I’m going to hang up”.
  
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  Hang up immediately upon informing the Caller that they plan to do so.
  
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  Treat all calls, including suspected pranks, as legitimate crisis calls, unless four indicators have been identified and explored with the Caller.
  

11. 
    “Nobody Can Help” Callers are those who feel there is no way out of their life situation. This perception may or may not be reality but the helplessness they feel is and we find that we can get trapped in said feeling. With these Callers we have a tendency to don our SIRS (Super Information & Referral Specialist) cape and use our superhuman powers to make people better. This presents difficulty because we always do what we can to help our Callers. Trying to be superhuman only serves to build false hope and expectations creating more helplessness which not productive for either the Caller of ourselves.
    

12. 
    “It’s Not Over ‘Til I Say It’s Over” Callers are those Callers who can sometimes be confused with “Yes…, But…” Callers but the difference is that they are willing to engage in the shared responsibilities of the crisis intervention process. They are ready to move on to the next step but for some reason can’t bring themselves to say goodbye.
    

So this is my Difficult Dozen list. As with any list is by no means definitive (how did they leave Stevie Van Zandt off Rolling Stone’s 100 top guitarists list?) But our goal is not to have the perfect list. It is to develop a group of tools we can use to mitigate the “difficult” in Difficult Callers.

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  The Worker and Caller interact as equals
  
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  The Caller dictates the pace of the call while making their own choices and decisions
  
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  The Worker mirrors² the Caller by using the Active Listening Skills, which are:
  

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  Silence
  
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  Reflection
  
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  Paraphrasing
  
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  Summarizing
  
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  Clarification
  
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  Restatement
  
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  Encouraging statements
  

There are also four fundamentals governing Client Centered Interactions. They are:

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  Acceptance³ (being non-judgmental)
  
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  Respect⁴
  
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  Empathy⁵
  
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  Hope⁶
  

Through training, role-play, and actual use we learned to use these basics to help most of our Callers find help with their presenting problems. But when the same skills are applied to the Difficult Dozen the result is frustration. What is the reason for this? Part of the reason is derived from our definition. Their motivation for making contact is different than the majority of our Callers. Our basic training teaches us to deal with Callers requesting Crisis Intervention, not persons who call for other reasons. However, being aware of a few rules that supplement our basic training can help us develop a technique to interact with Difficult Callers without migraine pain. Some of those rues are listed below.

Be Aware of Your “Buttons”

It is ironic that we profess to abide by the rules of equality and acceptance yet we are discussing “Difficult Callers”. That we are differentiating these Callers form the bulk of the people to whom we provide Crisis Intervention indicates that we are assuming a superior (unequal) and judgmental stance. But, the reality is that we are just regular people and as regular people we have, and are entitled to, our own views regarding people, situations, and topics. Allowing that we must recognize that those feelings are our own and are not to be shared with the Caller. This can be easier said than done but with practice it becomes easier and easier to do. The process is much like trying to swim as far as you can underwater. At first you don’t get too far but perseverance enables you to eventually make it across the pool with breath to spare.
Another thing to remember is not to deny the effect certain Callers have on you. Doing so ensures that eventually the pent up feelings will explode and we all know that never happens at a good time. You will not be comfortable with every Caller and situation. But if you accept that fact and practice techniques to use with Callers that have a negative effect on you, you will be able to capably service all the Callers you deal with without frazzling yourself.

Remain In the Present

George Santayana wrote: “Those who do not remember their past are doomed to repeat it.” Yes, the Caller’s past is important to the Crisis Intervention Process, but Santayana says we need only to remember it, not relive it time and time and time again. When a Caller stays rooted in what has been it is difficult to progress to the “what can be”. Once a you have reached a consensus with the Caller about the events that have lead up to their current situation there is no reason to review them again. Should the Caller opt to go back to a rehashing of that which has been, it is appropriate to:

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  Remind them you understand what has happened in the past by summarizing what they have shared with you.
  
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  Re-reflect their feelings about it.
  
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  Remind them that changing the past is not something that is possible.
  
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  Point out that they can do something about the present if they stop focusing on the past.
  

Doing the above in a respectful manner usually will move the Caller along in the process but some Callers will need to be reminded several times. For those few that will insist on remaining in the past refer to Point Out Behaviors and Breaking the Unbroken Circle.

Assertive Confrontation

We have a tendency to feel that confrontation in a call is not appropriate. The reality is that it is when done in a firmly⁷, focused, concise manner. There are times when what the Caller says to us doesn’t “add up”. This can be attributable to the stress of the moment or it can be an indicator the Caller is calling for something other than Crisis Intervention.
When confronting a Caller we review the facts we are questioning, inform the Caller the facts don’t seem to add up and then state the confusion that represents for us and then explain the reason for the confrontation. For example take the Caller who seems well versed in the methods and capabilities of your agency and whose situation and voice sound vaguely familiar. Yet they claim to have never contacted you before. We might be tempted to “confront” them by asking, “Have you called us before?”. The “Yes” or “No” response elicited by this question does little to assist the flow of the call. Better, we might tell them we are confused by the fact they say they have never called before, yet they speak in a manner which indicates they know how your agency operates, and their situation and voice seem familiar. We would then explain that we need to know if they have called previously so that we don’t duplicate referrals that seemed to have not worked before. Confrontation in this manner lets the Caller know we are not judging them but we need the facts to serve their needs best.

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