|
Ethical and Legal Issues in Hotline Counseling
by Jackie Thomason
GI Rights Hotline counselors at in-service ion Oakland, January 22, 2005
I began volunteering on the GI Rights Hotline late in 2001. The many stories of personal change and transformation I hear every week give me hope in what often feels like a hopeless world.
A few years ago I began helping out in the training sessions for new volunteers, covering ethics, legal issues and counseling skills. I enjoy doing this because it gives me an opportunity to share with new volunteers some of the stories I hear and the inspiration that I get from them. I want to share some of those stories here in order to describe the skills we use and some of the ethical and legal issues that frame our work on the Hotline. The primary work that we do is of course to provide information, resources, and support to our callers. But in this article I’m going to focus on some of the ways that we do that work rather than on the information that we provide.
Confidentiality and Disclosure
The GI Rights Hotline card includes the slogan “The service is free. The call is confidential.” In the trainings and here I preserve the confidentiality of the caller by presenting a composite of different callers when telling a story.
A recent caller was reluctant to give a name or phone number. He immediately asked, in a rather angry voice, who I was and why I was volunteering on the Hotline. He wanted to know if I would tell the Army or the government that he had called. These are normal questions and I knew from experience that the anger in his voice was probably motivated by fear and was not directed at me personally.
Of course I could assure him that we were not in any way connected to the military or the government and would not provide them with any information about him or his call. I always give callers who ask this kind of question some information about myself and how I decided to volunteer with CCCO.
Usually this question is really a way for the caller to figure out whether she or he can trust me. I keep my answer brief, honest, and straightforward. It is very seldom that someone requests more information.
I also told him that I am not a lawyer and that I would not be able to provide legal counsel. At the same time I was able to assure him that he was not violating any laws by asking for information from the Hotline.
Besides building trust, this conversation also places us on a more equal footing. Simply asking the question and having it acknowledged as legitimate and answered respectfully is a way that the caller asserts her or his power and is validated for doing so.
After I answered his questions, the caller said that I could call him ‘Ernesto’ and admitted to being in the Marines, in boot camp. The assurances of confidentiality laid the foundation of safety and trust that he needed to proceed with his call. He said that he was “getting crazy”; that his recruiter had “lied about everything”; that he had made a “big mistake” joining the Marines; and that he wanted out. We continued our conversation, discussing possibilities of separation and discharge. Because he had told me he was depressed, I also gave him the number for the Suicide Hotline (1-800-SUICIDE) for additional support. He told me that he was not actively suicidal and promised that if he became so, he would use that number.
(Not) Giving Advice
While not all callers are in crisis, many do feel vulnerable, disempowered, and sometimes desperate when they first call the Hotline. When presented with a variety of options, a person can also feel overwhelmed and have difficulty making a decision. According to one writer who describes himself as a Master Trainer in the military, “The Army wants to break you down and build you up in their image” during basic training (silentwarriors.net). Callers who are or have recently been in basic training may therefore be especially vulnerable.
Alicia called us after having gone AWOL from the Army five days previously. She had finished basic training and was in Advanced Individual Training (AIT). Her parents had told her not to join the Army and now were equally adamant that she must return immediately. They were very fearful about her situation. She reported that two weeks before she went AWOL she had attended a meeting in which she was told that she could be shot if she went AWOL and became a deserter. She was terrified, and yet she felt that she could not go back.
Because of a medical condition, Alicia had the option of returning to her unit within 30 days of having gone AWOL and attempting to get a discharge for her medical condition. She had heard that she could stay away for more than 30 days (at which time she would be classified as a deserter) and then return to Fort Sill to obtain an Other Than Honorable (OTH) discharge. She asked if this was true and, when I told her that it was correct, wanted more information about this option.
Alicia was relieved to learn that the administrative classification as a deserter was not the same as being charged with desertion. She had a lot of questions about the processing at Fort Sill. Having more facts about what would happen if she chose to do this seemed to be calming for her.
On the other hand, simply having several options was difficult for her. “What is the best thing for me to do?” she asked. I told her that I could give her information but that this was her decision. I said that it seemed as if the Army was telling her what she had to do and her parents were telling her what she had to do but that I was confident that she could make the best decision for herself. This was also a good opportunity to remind her that I am not an attorney.
I asked her what it would be like for her to return and seek the medical discharge. She said she’d had a bad experience when she went to the hospital and believed that the doctor would never recommend a discharge. She described how her command had humiliated her when she talked about her condition and told her to stop being such a girl and “just suck it up.” She did not feel very hopeful about this option.
She was thinking of staying AWOL until she was declared a deserter and requesting a discharge in lieu of court martial. Alicia wanted assurances that if she chose the option of being categorized administratively as a deserter the Other Than Honorable discharge would have no negative effect on her civilian life. And of course I could not give her those assurances. She continued to ask, in different ways, “What should I do?”
A central tenet of the empowerment model of counseling that we use at CCCO is that we do not give advice or encourage any particular course of action. We believe that the caller has the responsibility — and the ability — to maker her or his own decisions. We believe that it is unethical for a counselor to tell a caller what they ought to do. Our work is to provide information, support, and resources and to listen and ask clarifying questions to help the caller make the best decision for her or himself. We help the caller to develop a plan, or at least a next step, toward implementing their decision.
In Alicia’s case, there are also legal issues that make it imperative that we not give advice. According to the Military Law Task force of the National Lawyer’s Guild, “Counseling soldiers and sailors is legal. We don’t violate any laws by giving them info about their rights and options,” including those related to being AWOL. It is illegal, however, to encourage or advise that someone go AWOL or stay AWOL or that they do anything else that is illegal. Besides being poor counseling, giving advice in this case could put both the counselor and CCCO at risk.
It is, however, legal, to help someone who is AWOL to make preparations to return. With more discussion of the options and her feelings about them, Alicia decided to stay AWOL until she was declared a deserter. She would then turn herself in at Fort Sill and request a discharge in lieu of court martial. She had already sought civilian care for her medical problem. Information about her medical condition might serve as mitigating evidence when she returned. I e-mailed her information about the kinds of information her doctor could include in a letter about her condition, such as how long he had been treating her and what her prognosis was. She decided to bring her medical records and a letter from her doctor with her when she turned herself in, in the hope that her medical condition might help her to obtain a more favorable discharge.
Alicia did turn herself in at Fort Sill, after verifying that she had been dropped from the rolls. She called us to let us know that she arrived at Fort Sill on a Monday afternoon and left with her processing complete on Friday. Her discharge papers would be mailed to her. She was still concerned about the impact of the OTH but felt that she had made an informed decision and was ready to move forward with her civilian life.
Crisis Intervention: Helping a Caller to Manage Emotions
Occasionally a caller is in extreme emotional distress when she or he calls the Hotline. In these situations, the counselor’s first task is to help the caller to stabilize their emotions so that they are able to take in the sometimes complex information about options and make a plan of action.
John is a 29-year-old in the Army Reserves who had recently returned from six months in Iraq. He was married and had two children. A third pregnancy had resulted in miscarriage four months ago while John was deployed. Two of his best friends had been killed in Iraq and another had committed suicide when they returned to the United States. John was being redeployed. He did not want to go. He said that if he did go he would probably be killed and that he was going to “take someone out” with him. In addition, the military had “messed up” his pay and they were not fixing the problems. This was causing additional financial problems for John and his family.
All of this information came tumbling out in a rush. His speech was very pressured and he seemed not even to be breathing as he talked about all of these things that were going on.
While John’s case is quite dramatic, we have probably all dealt with friends and relatives who are overwhelmed by their situation and perhaps have developed some ways of being helpful to them. With this type of call, the counselor needs to make a judgment about how and when to intercede. We know that many of our callers have no one else to talk and that for others the call to us will be the first time they talk about these issues. We are also aware that it can be stressful for some people to make the decision to call us and that they may have a lot of anxiety and fear about doing so. These callers have a lot of pent up emotion. Often the most helpful thing to do initially is simply to listen and let the caller release the emotions and thoughts that have been building up. Sometimes just that opportunity to vent emotions and express ideas is enough to calm the person so that they can proceed to the next steps of gathering information and resources and identifying options.
At other times, a person is so “wound up” that they are unable to move forward. There comes a point when the mere expression is no longer helpful. Usually this is when the caller repeats him or herself and the voice takes on an obsessive quality. At that point an intervention is needed to help the caller manage their emotions. It can be difficult to decide when to do this, and difficult to interrupt someone that is expressing so much distress. However, in order to help the caller that is what we need to do.
This was the case with John. He had focused on the financial problems and his expression had taken on a more pressured and obsessive character. I took a deep breath. “John, I need to interrupt you.” I said. At first, he simply continued to talk over my statement. I repeated it and, when he stopped briefly, I suggested that we step back a moment. I acknowledged the extreme difficulty of his situation and said that any one of the problems he was experiencing would be challenging for most people. I asked him if I could summarize what I had heard, and he agreed. I did that. Knowing that he had been listened to and understood was calming to John. I asked him which of all this issues felt most important right now to deal with. Together we began to prioritize the issues and figure out which ones the Hotline could help with.
Whatever our training, when we are on the Hotline we are not functioning as doctors, psychologists or lawyers. However we can identify psychological issues that we observe and provide resources to our callers.
The Department of Veteran Affairs estimates that 30% of Vietnam veterans had experienced PTSD at some time after returning from Vietnam(http://www.ncptsd.va.gov/facts/general/fs_what_is_ptsd.html). I hypothesized that John was experiencing Post Traumatic Stress Disorder (PTSD) as a result of his experiences in Iraq aggravated by the other issues he identified. In his statements about his situation, he was describing a high level of depression. I told John that I am not a doctor but that some of the experiences he had recounted — sleeplessness, angry outbursts, a lack of pleasure in any aspect of his life — might indicate depression. I asked John if he was suicidal. He said “not right now.” He gave me permission to provide the number for the suicide hotline and promised me he would use it if he became suicidal. As part of our discussion of his options I also told provided the PTSD information and asked if any of those symptoms fit his experience. They did, so I provided him with some resources related to PTSD. This was also a possible avenue for discharge for him.
At the end of the call I asked John to summarize the steps he planned to take this week. He was able to do that. I reminded him that he could call our Hotline at any time and that CCCO would return his call if a counselor was not available. He agreed to call during my next Hotline time so that he could let me know how things were going and we could continue to identify next steps. I reminded him about the Suicide Hotline number and his promise, as well as about the PTSD resources.
Sometimes people are reluctant to ask about suicide or to name psychological problems such as depression or PTSD. We are not functioning as psychologists or doctors and cannot and should not provide diagnoses. However, we can let a caller know that they sound depressed to us and ask them about it. We can also state that many people in their situation do suffer from depression or PTSD. Giving a name to these issues can be very helpful. Research indicates that, contrary to what people may fear, asking someone if they are thinking of committing suicide actually reduces the likelihood that they will commit suicide. Summarizing the issues and naming the problems that we observe demonstrates that we have heard and understood the seriousness of their distress so that the caller is validated in their experience. This in turn is empowering as they face the challenges of dealing with discharge and other processes.
I continue to be inspired by the courage of the people who seek to resolve what may seem like overwhelming problems in relationship to their experience in the military. At the same time that I am very saddened by the damage that we are doing to people in the military — physical, psychological, financial, and spiritual damage — I am made hopeful by the brave responses to this damage. I am proud to be part of an organization that helps people to heal themselves from these assaults on their being.
____________
Jackie Thomason lives in Oakland, CA. She has been a GI Rights counselor with CCCO since November, 2001. Jackie holds a masters degree in feminist psychology from New College of California. She recently joined the Board of CCCO.
|