People in need send messages to the Crisis Text Line around the clock looking for help and support. The organization has responded to nearly six million chat calls since the nonprofit was founded in 2013. Some people find the line of text more accessible and convenient than face-to-face counseling, notes Ana Reyes, a licensed professional counselor and bilingual director of clinical supervision at the line of crisis.
In crisis counseling, clients need a safe and empathic environment in order to reveal deeply disturbing thoughts and emotions. But how can emergency responders create the same environment with text messages in which the clinician and client cannot see or hear each other?
Reyes admits that crisis counseling through text feels very different from personal counseling and requires a different approach from the responder. Words sent through text must be chosen very carefully to validate the writer's experience and build a relationship.
“During personal [counseling] church services, my face reacts to someone's sadness. In text messages, my words have to be this mirror, convey this empathy, ”says Reyes, who conducts group and individual counseling in a private practice in Denton, Texas.
Reyes is a member of Crisis Text Line, who are licensed psychologists who oversee the organization's volunteer crisis counselors, who are based in the United States and come from a variety of backgrounds. These volunteers undergo more than 30 hours of training, much of which is focused on ways to stay safe and bond through text messaging, notes Reyes.
Responders are encouraged to use "feeling words" often, Reyes says, because they reflect the emotions a copywriter is describing and help them feel heard, understood, and validated. “Maybe a copywriter describes being frustrated,” she explains. "We'd call that [in a text response]'It feels like you seem frustrated because your mom didn't react the way you hoped,' or 'It sounds like you're stuck, and it's normal to feel stuck when things don't go the way you hoped or planned. "Such statements not only confirm what the copywriter is saying, but also serve as a gentle way to deal with the crisis to de-escalate, she emphasizes.
Many aspects of the Crisis Text Line response model reflect the work of a crisis counselor in a traditional session with a client, either face-to-face or through telebehavioral health. Crisis Text Line responders begin by introducing themselves and sending the copywriter a confidentiality notice, Reyes says. You will use a warm tone throughout the conversation and use open-ended questions to fully understand the writer's situation and allow him to discuss the topic and the emotions that led him to contact the organization.
The responders also assess abuse, thoughts of murder and suicide as well as self-harm or non-suicidal self-harm. However, they do not begin to include risk assessment questions in the conversation until reporting and trust has been established. Letting the copywriter know that Crisis Text Line is asking everyone these questions also prevents them from feeling singled out, Reyes adds.
"We recognize their courage," says Reyes, and continues to use warm tones and statements that convey care and reassurance in determining risk. For example, a respondent might text: “Thank you for telling me about the stress you are facing. I just want to make sure you are safe and I want to ask you: Do you have thoughts about ending your life? If they answered in the affirmative, the responder would follow up other assessment questions, including whether the person has a plan, time frame, or means to implement their suicidal ideation.
Crisis SMS replyers do not know the location, name or phone number of the person they are texting, although some SMS workers do reveal their name, Reyes says. However, a supervisor has access to a copywriter's telephone number and can initiate external intervention if the copywriter is deemed to be a danger to himself or others, she adds.
Supervisors monitor between three and 20 calls that take place live on their computer screen and can intervene at any time if a crisis worker needs additional support. They also sort the incoming texts to immediately assign those who have the greatest need and queue other less urgent calls to wait for the next available responder.
In addition to risk assessment and validation, Crisis Text Line Responders help copywriters identify goals and next steps that could improve their situation in the short or long term, says Reyes. The responders then work with the copywriter to explore the resources available to them in their lives, from self-care to community and social support. If necessary, they can also suggest resources to help copywriters with a limited or inadequate support system. They share links to national organizations that they can refer to support in their area because they don't know where the copywriter is, explains Reyes.
At the end of the conversation, the responder checks in with the copywriter one last time to assess how he is feeling and to confirm the work that has been done. They also summarize the next steps and resource options that they discussed during the chat. Most importantly, the responder appreciates the courage it took for the copywriter to get in touch and reminds them that the Crisis Text Line is available 24/7 if they need to chat again, Reyes says.
Many of the people who turn to the organization in need are younger, simply because younger generations are usually better at text messaging. Reyes, who recently received her PhD in the University of North Texas Advisory Program, notes that common presentation problems include anxiety, stress, depression, and feelings of isolation and insecurity – many of which were exacerbated during the COVID-19 pandemic – as well as bullying or more academic or school pressure. There is also a subset of copywriters who struggle with sexual or gender identity issues, such as deciding to come out to family or friends, she says.
The organization hopes to reach more people with the upcoming introduction of Spanish language services, which Reyes is helping to plan.
Crisis Text Line is not a substitute for long-term advice, notes Reyes, but it can be of great help in times of desperation. In the evening hours, which are often in acute moments of desperation, the organization sees an increase in the volume of text, she says. It can also be a first step towards liaising with a local long-term care advisor.
“It's nice to see our volunteers learn and thrive through training and experience. This work is meaningful and difficult, but there is also the deep knowledge that you are helping someone who otherwise received no support that day, ”says Reyes. "The need at the center of this is to reduce the stigma of mental health services and improve access to services regardless of financial need or language."
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Crisis SMS in 2020
In 2020 the Crisis Text Line had 1.4 million conversations with 843,982 copywriters.
The organization received an above-average amount of text in March 2020 when the COVID-19 pandemic began to affect the daily lives of Americans. Perhaps unsurprisingly, the most common problems these copywriters identified were stress and anxiety. However, the Crisis Text Line reports that the volume of conversations in which copywriters revealed feelings of depression or sadness decreased 10% between 2019 and 2020.
In addition, conversations in which copywriters expressed suicidal thoughts fell by 20% compared to 2019. The Crisis Text Line supported 26,629 conversations in 2020 in which the copywriter was classified as "Immediate Suicidal" for mentioning that he thought to end their lives, they had a plan, the means, and wanted within 48 hours make an attempt. "
The Crisis Text Line made this data publicly available in a report: “Everybody Wehs 2020: What 48 million messages say about the state of mental health in America.” See the report, including the data breakdown by problem, demographics and state by state, at Crisistextline.org/everybody-hurts.
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Related reading
Look for Advice Today's August cover story: "Crisis Advice: A Mixture of Security and Compassion."
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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact them at [email protected].
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Opinions and statements in articles appearing on CT Online should not be construed as the opinions of the editors or guidelines of the American Counseling Association.
