Online Counseling and Telephone Counseling (eCounseling) with Clients in Crisis

Crisis situations are a common concern for eCounselors – and rightly so. To be ethical, counselors of all philosophies and practice settings need to handle these situations carefully. If you haven’t been concerned, consider that failures to make efforts to prevent client suicide account for 42% of the dollars paid in malpractice settlements.1 Thankfully, one can make prevention efforts and handle crisis situations successfully with online counseling (and telephone counseling).

Emphasis on Crisis

In contrast to in-person clients who visit a counseling center (which is a safe and neutral environment separate from their life-issues), online counseling clients receive help from within the settings where their problems take place. Hence, when a client says, “I hate my apartment, it reminds me of my ex-husband,” she is saying this from inside that apartment. This can increase the intensity of the counseling process.
In addition to the uncontrolled setting, online and telephone counseling clients seek help during a problem, not after it. They may seek help at odd hours of the night or morning when they feel the worst. eCounselors can be contacted by clients who just experienced violence, clients in fear of violence, or clients feeling guilty over committing violence. And, perhaps most unsettling, eCounselors are sometimes contacted by persons seriously considering suicide.

I’m not saying online Counselors are overwhelmed with emergency calls – that is a common misperception. In fact, emergency calls (such as the suicidal caller) are quite rare. One crisis hotline recently reported that out of more than 500 calls a month, only 10% of callers reported being suicidal. The majority of callers were not in an emergency, but simply felt they were having a personal crisis. The fact is, a client can be in “crisis” whether she is a stressed-out teen or a panic-stricken elderly woman calling because she can’t make her mortgage payment.2

Helping Suicidal Clients

Online counseling and telephone counseling are obviously not the gold standard treatment for clients in a life-threatening crisis. However, it is certainly better than no treatment at all, and could be a lifesaver for persons who refuse, or are unable to receive, help in another manner. This idea is not new. The Samaritans, a group in England, “provide emotional support to any person who is suicidal or despairing” through telephone and online care.3 Similarly, 1-800-SUICIDE is just one of several U.S.-based hotlines that has been providing crisis care for decades.

Responding to an Emergency

An important issue when dealing with suicidal, or homicidal/violent, clients is whether a counselor is able to respond effectively to an emergency situation. With some preparation, online and telephone counselors can be sufficiently equipped to respond.

Online counselors and telephone counselors, like in-person counselors, should have an official intake process where clients provide their address/location, multiple contact methods, and an emergency contact person. Electronic filing makes this information easy to retrieve, and electronic payment (i.e., credit card; a common eCounseling payment method) provides a verified client address. Hence, in a situation where there is a threat to a client’s self or others, eCounselors can be well equipped to contact relevant local agencies, and even warn parties in potential danger.

Preparing for the Unexpected

Here are some more specific preparation tips:

Before you begin taking clients…

• Have a reliable suicide assessment tool on hand
• Make public (by posting online) a policy explaining if or how you provide care to suicidal/violent clients
• Recommend (by posting online) alternative treatments for persons battling suicide (in-person care, hospitalization, etc.)
• Prepare a thorough informed consent processes that includes confidentiality limits

Before an Emergency occurs…

* Establish contact with a counselor local to the client in case in-person care is needed
* Obtain accurate client information including name, location, and permanent address
* Obtain back-up contact methods, including the contact information of several people the client knows and trusts
* Obtain the contact information of emergency services that are local to the client
* Create an agreed-upon emergency plan with at-risk clients