My Notes About Working at San Francisco's HIV/AIDS/HepC Nightline
- The goal: Help people cope in the moment.
- Ask: "Why tonight?"
- The most effective techniques are Socratic.
- If suicide is mentioned:
- Get right to the action e.g., "I wonder what you mean by that.
Are you thinking of suicide?"
It's ok to broach the subject, to break the ice.
- They may be using this merely as an attention-getter.
- They may need to face getting tested for STIs.
Might it be "rational suicide"?
- Assess. Here are questions to ask:
- Has means?
- Has plan?
- Prior attempt(s)?
- Traumatic event?
- Health condition
- Mental disorder
- Substance/drug use
- Answers to common questions; learn this repertory by heart:
- The only way to know if you're infected is to get tested.
No one can tell you on the phone.
- Is there a reason why you might be worried?
- What exactly happened?
- How comfortable are you with risk?
- (Caller just rec'd + HIV test result.)
How are you handling it?
- Give advice
- Attempt to diagnose
- List symptoms
- Be a rescuer
- Take responsibility for the caller's problems
- Pay attention to emotions;
callers are often unaccustomed to talking about them.
- Strategy for Fielding a Call:
- Get the facts.
- HIV status of partner
- Needle-cleaning practices
- Body fluids exchanged
- What behaviors have more/less risk
- Prevention methods for the future
- Assess risk
- Even if little HIV risk, there may still be STD risk,
e.g. from oral sex. Refer to STD hotline.
- Emotional issues: how do they sound?
- "Tell me more about what's going on."
- "Have you discussed this with your partner?"
- "Do you have someone you can talk to about this?"
- Give info as briefly as possible.
- Steer conversation to emotional issues.
- "You sound like you may be concerned that you are at risk..."
- The primary function of Nightline is emotional support.
- "I'm aware that this is difficult."
- "It can be hard to discuss these things with a stranger."
- Use their own words; may need to be less clinical or less personal.
- "Were body fluids transmitted? Were any of these involved:
semen, blood, mother's milk, vaginal fluid."
- Callers are often feeling hopeless, without options.
- Point out things they have done that were
courageous, significant, showed strength.
- If caller panics:
- "I'm here. Can you hear my voice?"
- "What are you thinking about right now?"
- "Are you at home right now?"
- Common caller condition is chronic depression.
- We may be their only outlet.
- Likely to reject suggestions of getting help.
- The toughest calls are from emotionally "flat-lined"
A strategy is to be tender;
"I notice this must be really hard to talk about but I'm glad you called."
- Reflecting the emotion is helpful.
"I hear you saying that you're feeling X; am I hearing you correctly?"
- Phases of a call:
- Create rapport
- Encourage caller to express feelings
- Esp. pent-up, hidden, misunderstood
- Achieve a feeling of release
- Pay attention to your own language and voice
- E.g. use street terms if they do
- Respond in a calm, personal voice
- May need to explain that we are an emotional support line
- "How are you feeling about (what they said) right now?"
- Can personalize (I had that, too) but don't shift focus
- If they ask, reply: "No I'm not HIV+.
Is it important for you to talk to someone who is?
We don't identify our nightline volunteers by HIV status.
I'd be happy to talk with you anyway."
- Reflect back to them
- Summary and clarification
- Content (facts) -- may need to clarify
- Reflect feelings in empathic way -- "It must be
difficult when it begins to impact your family."
"You sound concerned about how your boss might react."
- Use open-ended questions:
- "How do you feel about that?"
- "How are you handling it?"
- "Is that a decision you feel you must make right now?"
- "Why is this an issue tonight?"
- "I'm glad you called. How are you feeling now?"
- Paraphrase, condense
- Identify the problem; ask perceptive questions
- Especially when they ramble
- Focus on what's bothering them at this moment
- Most calls are driven by a main problem
- Guidance to self-discovery
- Discover and examine options for progress, mitigation
- Remind: "You've been in moments like this before;
how did you handle it then?" e.g. for anxiety
- Discover and examine resources he/she has to draw on
- Making decisions
- Be sure they're ready.
- Support them, validate the plan they make.
- "Call us back and let us know how it goes."
- Technical info
- Treatment providers
- Remind: We're here every night
- Common concerns:
- How can I (should I) tell my parents, my boss, my partner?
- "Have you thought about how you might present that to him?"
- "What if you flat-out told him?"
- "What problems might there be if you don't tell?"
- Engaging in risky activity:
- Make an informal contract, e.g. "Do you think you can make that
phone call tomorrow? Call us back and let us know."
- Evaluating the result of a risky activity:
Did I expose myself to disease?
The fear can be stressful, incapacitating.
- Loneliness, isolation:
- Sometimes the main thing they need is a listener.
- Make it clear that it's safe.
- Controlling the call
- Esp. with callers who are obsessed
- Keep the material fresh; draw the line on repetition
- Remind that they can call us back
- Substance users/callers
- Alcohol: by far the most common
- Need not dismiss if there's a possibility for productive dialog;
otherwise, explain why and terminate
- ...But without being judgemental, demeaning, angry
- Get them to identify the substance abuse behavior, e.g.
"I notice that your thoughts are jumping around a lot;
what could be causing this?"
- Make sure they take responsibility for the behavior,
without making excuses for them or justifying.
- They may be in a lot of denial;
it's not our job to confront them on it (nor to criticize nor to diagnose).
- Talk about harm reduction, esp. not sharing paraphernalia
- What kinds of changes do you think you could make tonight?
- Drug users' riskiest behavior
-- even more than sharing paraphernalia --
is unprotected sex when high.
- Often "triple-diagnosis": HIV, mental illness, and substance abuse
-- complex to manage medically
- HIV+ women:
- 25% of HIV+ population
- Mostly black
- Mostly from hetero sex
- Must have a good relationship with medical caregiver
- Encourage communication around condom use with partner
- Pregnant HIV+ women:
- Give the virus to their babies less than 10% of the time
- Pregnancy does not alter progression of HIV
- Difficult callers
- Mentally ill
- Broken record
- Story teller
- Sex caller