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The characteristics of chronic callers to telephone crisis centres Kramer, Richard Frank 1994

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THE CHARACTERISTICS OF CHRONIC CALLERS TO TELEPHONE C R I S I S CENTRES by RICHARD FRANK KRAMER A., The U n i v e r s i t y o f B r i t i s h C o l u m b i a , 198 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department o f C o u n s e l l i n g  Psychology)  We a c c e p t t h e t h e s i s a s c o n f o r m i n g xT"thie^required s t a n d a r d  THE UNIVERSITY OF B R I T I S H COLUMBIA December 1994 © R i c h a r d F r a n k K r a m e r , 1994  In  presenting  degree at the  this  thesis  in  University of  partial  fulfilment  of  of  department  this thesis for or  by  his  or  requirements  British Columbia, I agree that the  freely available for reference and study. I further copying  the  representatives.  an advanced  Library shall make  it  agree that permission for extensive  scholarly purposes may be her  for  It  is  granted  by the  understood  that  head of copying  my or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department The University of British Columbia Vancouver, Canada  DE-6 (2/88)  11  Abstract The c h a r a c t e r i s t i c s t h a t i d e n t i f y c h r o n i c c a l l e r s t o crisis  c e n t r e s were i n v e s t i g a t e d .  four c r i s i s  The t e l e p h o n e  telephone  workers  l i n e s i d e n t i f i e d and r e c r u i t e d s u b j e c t s .  c h r o n i c c a l l e r s were i n t e r v i e w e d b y t e l e p h o n e .  lines,  Eight  Subjects  p a r t i c i p a t e d i n a s t r u c t u r e d interview, responding on t h e i r experiences w i t h c r i s i s  from  t o questions  contacts with  other  community s e r v i c e s , t h e i r support network o f f r i e n d s and f a m i l y , t h e i r mental h e a l t h and substance family history.  use, and major events  Subjects telephoned  month t o f o u r t i m e s a day.  from three t o f i v e times  They had been t e l e p h o n i n g  l i n e s f r o m 6 m o n t h s t o o v e r 13 y e a r s . two o r t h r e e d i f f e r e n t c r i s i s  conclusions.  a  crisis  They u s u a l l y t e l e p h o n e d  lines regularly.  Qualitative  analysis of the interview data consisted of three activities:  i n their  concurrent  data r e d u c t i o n , data d i s p l a y , and d r a w i n g / v e r i f y i n g A n a l y s i s i d e n t i f i e d 17 c h r o n i c  caller  c h a r a c t e r i s t i c s common t o m o s t s u b j e c t s : 5 p e r s o n a l characteristics,  5 i n v o l v i n g r e l a t i o n s h i p s and t h e i r  support  network, 3 r e l a t i n g t o t h e i r f a m i l y background, and 4 t h e i r experience w i t h counselling, therapy o r other Support,  contact, esteem-building,  concerning  treatment.  f r i e n d l i n e s s and the  telephone  v o l u n t e e r s emerged a s p o s i t i v e c h a r a c t e r i s t i c s f r o m t h e s u b j e c t s ' experiences w i t h c r i s i s  lines.  Poor "business" p r a c t i c e ,  call  management a n d " l a b e l l e d " c a l l e r s e m e r g e d a s n e g a t i v e c h a r a c t e r i s t i c s from the s u b j e c t s ' experiences o f c r i s i s  lines.  Callers also displayed eight characteristics distinguishing  lower  I l l  frequency from higher  f r e q u e n c y c h r o n i c c a l l e r s b a s e d on  frequency of telephoning. callers'  others. and  l i n e s ; one  connection  - emerged a c r o s s The  therapeutic h i s t o r i e s feeding lines.  The  esteem,  a l l c a l l e r s f o r the  r e s u l t s p o i n t t o the  contact with c r i s i s  intervention.  the c r i s i s  Telephone c r i s i s  i n t o a dynamic o f  callers'  lines'  crisis  isolation, information  goal of  centres  are  family  ongoing  i n c r e a s e d use  of  crisis  caller crisis  l e f t to  d i f f e r e n t methods o f managing c h r o n i c c a l l e r s and work w i t h t h o s e h i g h e r  their  subjects' personal,  l i n e s a c c e n t u a t e s the mismatch between c h r o n i c c h a r a c t e r i s t i c s and  regarded  the  four concerned f a m i l y h i s t o r y or s p e c i a l  F o u r g l o b a l themes - v i c t i m i z a t i o n ,  they shared. and  Three c h a r a c t e r i s t i c s i n v o l v e d  r e l a t i o n s h i p to the c r i s i s  t h e r a p e u t i c h i s t o r y ; and  the  how  consider to  better  frequency chronic c a l l e r s t u r n i n g to  l i n e s as a t h e r a p e u t i c  resource.  the  iv Table of  Contents  Abstract  i i  Table of Contents  iv  L i s t of Tables  xiv  L i s t of Figures  xv  Acknowledgements  Chapter  xvi  One  Introduction  1  Chronic C a l l e r s  1  Declaration of Biases  4  Significance  5  Chapter  Two  L i t e r a t u r e Review  8  C h a r a c t e r i s t i c s of Chronic C a l l e r s  8  Frequency of C a l l s  8  M e n t a l H e a l t h and Substance  Misuse  Suicide  9 11  Past or Present Experience w i t h  Counselling,  Therapy o r Treatment Contact w i t h Other  Community S e r v i c e s  12 12  Relationship Status  13  Support  14  The  Network  Caller-Worker Relationship  Research Methods  15 16  V  Log Sheets Telephone  16 Follow-up  18  Research Interviews w i t h C r i s i s Line C a l l e r s Telephone  ...  Interviews  D e l i m i t a t i o n s : Other Chronic  Callers  19 21 24  Assumptions and L i m i t a t i o n s  25  Definitions  28  . .  Questions  Chapter  28  Three  Method  32  Procedure  32  Sampling  32  Caller Participation  36  Data C o l l e c t i o n  37  V a l i d a t i o n of Interview Data  39  Data /Analysis  40  Data Reduction  43  V a l i d a t i o n of Data Coding  45  Data D i s p l a y : M a t r i c e s  46  Data D i s p l a y : Causal Networks  54  Conclusion Drawing/Verification  56  Conclusion Drawing  57  Conclusion V e r i f i c a t i o n  59  V a l i d a t i o n Procedure f o r the Results w i t h C a l l e r s .  61  vi Chapter Four Results The  63 C a l l e r s and  t h e i r C r i s i s Line Contact  63  Chronic C a l l e r C h a r a c t e r i s t i c s Personal No  66  Characteristics  66  Substance Misuse  66  Prolonged Health Personal  and  Concerns  66  Physical Limitations  from  Health  69  L i m i t e d Employment, t h e n L i m i t e d F i n a n c e s  . .  69  Suicide History  70  Mental I l l n e s s  70  Relational  70  D e f i n i t e l y Friends  70  L i t t l e Family  71  Few  Contact  w i t h S p e c i a l Others  Challenging  Relationship History  L i m i t e d A b i l i t y t o Engage and  Family  71  Use  71 Support  Systems  72  Background  74  A l c o h o l o r Other Drug A d d i c t e d  Families  ...  74  Severe Abuse o r N e g l e c t  74  Two  76  Parent Families  Counselling, Previous  Therapy o r Treatment or Current Counselling,  Treatment  76 Therapy  or 76  V I 1  E a r l y L i f e S t a r t t o C o u n s e l l i n g , Therapy o r Treatment  76  Mental Health Contact  76  More Y e a r s w i t h H e l p i n g S e r v i c e s t h a n w i t h Crisis Lines  77  V a l i d a t i o n of Chronic C a l l e r C h a r a c t e r i s t i c s  with  Callers  77  V a r i a t i o n s on Chronic C a l l e r by Telephoning  Characteristics  Frequency  78  Relationship with C r i s i s Lines  78  T h e r a p e u t i c Use v e r s u s P r a c t i c a l Use  78  Complaints  82  versus Appreciations  C r i s i s L i n e D e p e n d e n t v e r s u s Many M o r e H e l p i n g Resources  84  Therapeutic H i s t o r y  85  Negative Therapeutic H i s t o r y versus  Mostly  Positive Therapeutic H i s t o r y  85  F a m i l y H i s t o r y and S p e c i a l Others Severe Abuse v e r s u s Severe None o r One S p e c i a l O t h e r  86  Neglect  86  t o Two o r M o r e  S p e c i a l Others' Traumatic  89  Parental Connection versus  No  Parental Contact Blamed f o r t h e F a m i l i e s '  89 I l l s versus  Ignored  b y t h e Family--. V a l i d a t i o n o f H i g h e r and Lower Frequency C h r o n i c  92  viii Caller Characteristicswith Callers  92  C r i s i s Line Characteristics  93  C r i s i s Line Positives  93  Support and  Comfort  93  Contact  Conversation  95  and  Esteem B u i l d i n g Volunteers  95  Create  a P o s i t i v e Experience  ...  Like Friends  96 98  C r i s i s Line Negatives Poor "Business"  98 Practice  98  C a l l Management  99  Labelled  100  V a l i d a t i o n of C r i s i s Line C h a r a c t e r i s t i c s w i t h Callers Leitmotifs  101  .  102  Isolation  102  Limitations Creating Loneliness  102  Sexual  103  Orientation  Families  103  B e t t e r Health Creates Few  Some L o n e l i n e s s  S p e c i a l Others  Connection  ....  104 104 105  C r i s i s Lines  105  Other Helping Resources  106  Families  106  F r i e n d s and  S p e c i a l Others  106  ix Victimization  1 0 7  C r i s i s Lines Counselling,  1° T h e r a p y and  Other Treatment  . . .  Family  1 1 0  C r i s i s Lines  I l l  Other Helping Resources  112  Family  113  Friends  113  V a l i d a t i o n of L e i t m o t i f s w i t h  Callers  114  C h r o n i c C a l l e r R e l a t i o n a l Network  114  Common C h a r a c t e r i s t i c s  115  Lower Frequency C h r o n i c C a l l e r C h a r a c t e r i s t i c s  . .  Higher.Frequency Chronic C a l l e r C h a r a c t e r i s t i c s  .  V a l i d a t i o n of the  Chronic C a l l e r  118 .120  Relational  Network  Chapter  108 109  Esteem  The  7  122  Five  Discussion  .  123  F a m i l y B a c k g r o u n d and  Victimization  123  Isolation  124  Limited  126  A  Support Challenging Relationship  History  Prolonged H e a l t h Concerns, then L i m i t a t i o n s Limited Connection  A b i l i t y t o Use  and  127 . . .  Engage S u p p o r t Network .  .128 129 129  X  Therapy, Treatment and t h e C a l l e r s '  Personal  Background  130  Previous or Current Counselling, Therapy o r Treatment  130  Mental Health Contact  132  Suicide  132  No  Substance  Positive  Misuse  133  Therapeutic History versus  Negative  Therapeutic History  134  Contradictions i n Helping Experience Telephone C r i s i s Centres I n c r e a s i n g C r i s i s L i n e Contact and  135 135  Mismatched  Needs  136  Building Self-Esteem  138  C r i s i s L i n e s as a T h e r a p e u t i c Resource  139  Positive The  Chapter  a n d N e g a t i v e s o f T h e r a p e u t i c Use  C h r o n i c C a l l e r s ' Negative Responses  140 140  Complaints  141  C a l l Management  142  Contradictions  142  Application  142  Six  I m p l i c a t i o n s and C o n c l u s i o n  144  Chronic C a l l e r I d e n t i f i c a t i o n  144  Previous D e f i n i t i o n  144  xi The New C r i t e r i a a n d T h e i r A p p l i c a t i o n  150  The F i r s t T e l e p h o n e C a l l : O b t a i n i n g  a  Helping  History  151  The F i r s t T e l e p h o n e C a l l : E x p l o r i n g t h e C a l l e r ' s Support System Further A Continued Cycle Previous A Cycle  153  Telephone C a l l s  154  of Telephoning  154  Research  155  o f Abuse  155  Therapeutic Trap  '  156  A Repeated P a t t e r n o f V i c t i m i z a t i o n F r i e n d l i n e s s i n the Caller-Worker  157  Relationship  Working w i t h Chronic C a l l e r s Contradictions  157 159  i n Service  160  C a l l Management  160  Crisis  161  I n t e r v e n t i o n o r Therapy?  Recommendations  162  F l e x i b l e C a l l Management Repeat t h e L i m i t s o f C r i s i s  162 Intervention Service  B e t t e r U n d e r s t a n d How C r i s i s L i n e s H e l p Callers  Chronic 164  C l a r i f y i n g the Helping Reduce C h i t - C h a t  . 164  Relationship  on C r i s i s L i n e s  165 166  T h e r a p e u t i c Management  167  L i m i t a t i o n s o f the Research  168  Implications  168  f o r Future Research  xii Summary  170  References  174  Footnotes  180  Appendix  A  Sex C a l l e r s  Appendix  181  B  Protocol f o r Requesting P a r t i c i p a t i o n  of  R e t u r n C a l l e r s by Telephone Workers  Appendix  C  Protocol f o r Requesting P a r t i c i p a t i o n of Return C a l l e r s Telephone Workers,  Appendix  Workers  of 193  E  Interview Protocol  Initial  .189  D  Return C a l l e r by I n t e r v i e w e r  Appendix  by  not S c h e d u l i n g I n t e r v i e w Times .  Protocol Confirming Participation  Appendix  183  195  F Codes  204  Appendix G P a t t e r n Codes  xiv L i s t of Tables T a b l e 1. D e s c r i p t i v e C h a r a c t e r i s t i c s o f C a l l e r s a n d Line  Crisis  Contact  64  T a b l e 2. C h r o n i c C a l l e r C h a r a c t e r i s t i c s  67  T a b l e 3. C a l l e r s ' C h r o n i c i t y b y Use o f C r i s i s L i n e s , D i s l i k e s about  C r i s i s Lines,  Callers'  and Other H e l p i n g  Resources  80  T a b l e 4. C a l l e r s ' C h r o n i c i t y b y F i r s t E x p e r i e n c e s w i t h Treatment,  and E x p e r i e n c e s w i t h  Therapy/  Therapy/Treatment/  Counselling  87  T a b l e 5. C a l l e r s ' C h r o n i c i t y b y F a m i l y H i s t o r y , and S p e c i a l Others T a b l e 6. C r i s i s L i n e  Characteristics  Other  Abuses, 90 94  XV  L i s t of  Figures  F i g u r e 1. D a t a R e d u c t i o n : I l l u s t r a t i o n o f T e c h n i q u e s F i g u r e 2.  44  C a l l e r by Conceptual C l u s t e r M a t r i x : An  Illustration  F i g u r e 3.  C a l l e r - O r d e r e d D e s c r i p t i v e M a t r i x : An  F i g u r e 4.  The  C h r o n i c C a l l e r R e l a t i o n a l Network  48 Illustration  . 51 116  xvi Acknowledgement s I am v e r y g r a t e f u l  t o those regular c a l l e r s that took  t i m e t o s h a r e t h e i r l i v e s a n d a n s w e r my c l e a r l y s u r v i v o r s and t h r i v e r s  questions.  They a r e  w i t h much v a l u a b l e l i f e  experience  to e n r i c h others' l i v e s should people take the time t o Many t h a n k s t o t h e c r i s i s for their participation e n c o u r a g i n g and  the  listen.  l i n e s and t h e t e l e p h o n e v o l u n t e e r s  i n the research.  Your i n t e r e s t  was  very  gratifying.  An e x t r e m e l y s p e c i a l  thanks t o Joan and J e e t f o r your  c o n t i n u e d s u p p o r t and i n p u t throughout t h e r e s e a r c h . both substantial  contributors to the process.  You  were  We've d o n e i t  Joan! Dr. Tolsma, thanks f o r y o u r s u p p o r t , guidance, a n d humour i n c o m p l e t i n g t h i s t h e s i s .  suggestions  You were e n c o u r a g i n g .  /And  D r s . Y o u n g a n d Westwood, t h a n k y o u f o r y o u r s u g g e s t i o n s t o t h e improvement o f t h e r e s e a r c h .  A l l o f you have h e l p e d b r i n g  t o g e t h e r i n f o r m a t i o n t h a t b o t h t h e r e g u l a r c a l l e r s and t h e lines appreciate.  crisis  1 Introduction I n C a n a d a a n d t h e U n i t e d S t a t e s t h e r e e x i s t s o v e r 500 telephone s u i c i d e p r e v e n t i o n and c r i s i s Many o f t h e s e s e r v i c e s intervention communities  a r e s t a f f e d 24 h o u r s a d a y  and support t o i n d i v i d u a l s (Slaikeu,  1990).  i n d i v i d u a l s who a r e l o n e l y , (Lester  Brockopp  providing  i n crisis within  depressed, o r i n a  relationship  & B r o c k o p p , 1970/ L e s t e r & B r o c k o p p ,  regularly.  their  Many c a l l s come f r o m  Frequently these telephone services who c a l l q u i t e  centres.  Some c a l l s t o t h e s e c e n t r e s a r e  from people i n c r i s i s o r s u i c i d a l .  conflict  intervention  encounter  1973).  individuals  F a r b e r o w e t a l . (1966) a n d L e s t e r a n d  (1970) l o n g a g o i d e n t i f i e d t h e s e " c h r o n i c "  callers.  They p r e s e n t u n i q u e c h a l l e n g e s t o t e l e p h o n e w o r k e r s a n d c r i s i s intervention of  centres a l i k e .  immediate need o f c r i s i s  numerous c a l l s t h a t  R a r e l y thought as h i g h r i s k i n terms intervention,  interfere with service  i n more u r g e n t c r i s i s o r d i s t r e s s Brockopp, 1970).  (Lester,  c h r o n i c c a l l e r s make a v a i l a b i l i t y t o those 1971; L e s t e r  &  T h e y r e m a i n d i f f i c u l t t o manage b e c a u s e o f  t h e i r p e r s o n a l c h a r a c t e r i s t i c s and h i s t o r y and t h e i n t e r a c t i o n patterns they i n i t i a t e workers  between themselves and t h e telephone  (Rudestam, 1 9 7 8 ) .  F o r a l l t h e i r challenge and contact,  chronic c a l l e r s a r e l i t t l e understood and vaguely i d e n t i f i e d . Though no c o n s i s t e n t exists,  n o r complete d e f i n i t i o n o f a c h r o n i c c a l l e r  some common c h a r a c t e r i s t i c s h a v e b e e n i d e n t i f i e d . Chronic  Callers  Over 75% o f c h r o n i c c a l l e r s have r e c e i v e d p r i o r  psychiatric  2 treatment concern  f o r a m e n t a l i l l n e s s o r some o t h e r p s y c h o l o g i c a l ( F a r b e r o w e t a l . , 1966;  Jameton, 1979).  L e s t e r & B r o c k o p p , 1970;  Over h a l f have a t t e m p t e d s u i c i d e and  s u f f e r from substance abuse Jameton, 1979).  ( F a b e r o w e t a l . , 1966;  agencies  and  resources  intervention services 1973;  Sawyer & Jameton, 1979).  have had p r e v i o u s  experience  p s y c h i a t r i c treatment McClure,  L e s t e r & Brockopp,  Murphy, W e t z e l ,  t o be m a r r i e d ,  Sawyer & Jameton, 1979). support  Chronic  separated  &  c a l l e r s maintain  frequent  They r e p r e s e n t  numbers o f c a l l s t o a c r i s i s  and  and  1979).  ongoing contact  M u r p h y e t a l . , 1969;  1978;  1981;  Sawyer & Jameton,  with  total  1978;  Lester,  Speer,  d e f i n e d i n terms of  or d u r a t i o n of ongoing telephone  (Johnson & B a r r y ,  Their frequent  as  1976;  f a m i l y (Haywood,  (Johnson & B a r r y ,  However, when a c h r o n i c c a l l e r c a n be frequency  (Greer,  large p o r t i o n s of the  line  L e s t e r & B r o c k o p p , 1970;  remains vague  appear  A l s o , c h r o n i c c a l l e r s appear t o have a  L e u t h e & O'Connor, 1981;  centres.  specific  Swallow  other c a l l e r s  o r widowed  network o f f r i e n d s and  Imdoden, 1 9 8 1 ;  1971;  or  s i g n i f i c a n t l y more c h r o n i c c a l l e r s a r e r e p o r t e d  unmarried: s i n g l e , divorced,  crisis  callers  1969).  W h i l e e q u i v a l e n t numbers o f c h r o n i c and  limited  crisis  E a s i l y 75% o f c h r o n i c  1976;  &  community  with counselling, therapy  (Greer,  half  challenges,  i n a d d i t i o n t o the telephone ( F a b e r o w e t a l . , 1966;  nearly  Sawyer  P o s s i b l y because of these p e r s o n a l  chronic c a l l e r s often are i n contact w i t h other  Sawyer &  1971). a  contact  Sawyer & Jameton,  ongoing contact w i t h the c r i s i s  1979). centres  3 c o n t i n u a l l y wears at the telephone workers' a b i l i t y t o understand and  e f f e c t i v e l y d e a l w i t h t h e m ( L e u t h e & O'Connor, 1981) .  C h r o n i c c a l l e r s seem t o i n i t i a t e  i n t e r a c t i o n a l dynamics  telephone workers that s e r i o u s l y impair the a b i l i t y of prevention and  and  c a l l e r contact,  (Rudestam, 1 9 7 8 ) .  t h e q u a l i t y o f i n t e r a c t i o n and  of the telephone worker decreases  (Greer,  has  c a l l e r s , more i n f o r m a t i o n  the  1976;  increasing effectiveness  Leuthe  &  o u t l i n e d some c h a r a c t e r i s t i c s o f  c h a r a c t e r i s t i c s a r e a s s o c i a t e d w i t h one r e s e a r c h e d and  chronic  i s needed t o u n d e r s t a n d b e t t e r and  manage e f f e c t i v e l y t h e s e c h a l l e n g i n g c a l l e r s .  The  With  1981).  Though r e s e a r c h  chronic  suicide  c r i s i s i n t e r v e n t i o n workers t o d e l i v e r adequate  needed s e r v i c e s t o them  O'Connor,  with  r a r e l y speculated  on.  A l s o , how  a n o t h e r has  A gap  not  to  these been  i n the research  on  c a l l e r s e x i s t s here. p r i n c i p a l i n v e s t i g a t o r studied the c h a r a c t e r i s t i c s that  identify chronic  callers to suicide prevention  intervention centres. s t u d i e d t o expand and the research  develop the chronic  caller profile.  some p o s s i b l e  t h a t e x i s t b e t w e e n t h e s e c h a r a c t e r i s t i c s . The  g r e a t e r and  discovered  i d e n t i f i c a t i o n of chronic  t h e d e v e l o p m e n t o f more e f f e c t i v e a n d callers.  Also,  associations  t h e a s s o c i a t i o n s between them w i l l  more c o n s i s t e n t  strategies f o r these  crisis  C h r o n i c c a l l e r c h a r a c t e r i s t i c s were  attempted to discover  c h a r a c t e r i s t i c s and  and  lead  to  callers  c o m p r e h e n s i v e management  and  4 Declaration of I b r i n g b o t h my telephone  crisis  with c r i s i s  Biases  e x p e r i e n c e and v i e w p o i n t s o f w o r k i n g  intervention f o r eight years.  lines,  T h o u g h no  immediate c r i s i s  a s h a v i n g some l i f e crisis  longer  I remain i n t e r e s t e d i n the challenge of  chronicity, p a r t i c u l a r l y that of chronic c a l l e r s . short-term,  in  intervention,  " s t u c k n e s s " and  Trained i n  I view chronic  long-term  i n t e r v e n t i o n models cannot address.  client  callers  difficulties  which  These  " c h a r a c t e r i s t i c s " o f c h r o n i c c a l l e r s make i t v e r y p r o b l e m a t i c them t o i n i t i a t e  s u b s t a n t i a l and q u i c k change i n t h e i r l i v e s .  have e x p e r i e n c e d t h e f r u s t r a t i o n o f w o r k i n g w i t h i n d i v i d u a l s d i r e c t l y and supervisor of a c r i s i s  l i m i t e d success.  to  them.  worker  I have s t r i v e d t o a p p l y o r  i n t e r v e n t i o n to these  I b e l i e v e now  initiate  individuals  with  effective assistance  I f p o s s i b l e , I h o p e t h i s a s s i s t a n c e c a n be crisis  and  t h e s e c a l l e r s n e e d t o be b e t t e r  t o p r o v i d e more a p p r o p r i a t e a n d  w i t h i n the telephone  I  these  i n d i r e c t l y as a t e l e p h o n e  line.  o t h e r forms o f telephone  understood  for  provided  c e n t r e s ' programs and s e r v i c e  o b j e c t i v e s , m o v i n g away f r o m s t r i c t a d h e r e n c e t o a  crisis  i n t e r v e n t i o n model. I have e x p e r i e n c e d  i n my  years with c r i s i s  c a l l e r s t r e a t e d as i n d i v i d u a l s w i t h unique needs s p e c i f i c a t t e n t i o n and  treatment.  callers being disparagingly called to  t h e w o r k e r s and  constant problems.  chronic  requiring  A l s o , I have heard  these  "chronic c a l l e r s , "  frustrating  centres, burdening The  lines  t h e phone l i n e s w i t h  i n d i v i d u a l c a l l e r s disappear behind  their their  5 chronicity,  a n d t h e y seem t o b e deemed a s l e s s w o r t h y o f  telephone c r i s i s  intervention  services.  I now v i e w t h e name " c h r o n i c c a l l e r " a s a n o f t e n p e j o r a t i v e label.  (I use t h e term c h r o n i c c a l l e r o n l y t o capture t h e  ongoing nature o f these c a l l e r s  telephone contact and t o conform  1  w i t h g e n e r a l usage i n t h e r e s e a r c h l i t e r a t u r e . ) for  While  uniform c h a r a c t e r i s t i c s across a l l these c a l l e r s ,  looking I hope t o  give a b e t t e r understanding o f chronic c a l l e r s so t h a t  crisis  l i n e s c a n b e t t e r i d e n t i f y a n d meet t h e n e e d s o f t h i s c h a l l e n g i n g and unique group o f i n d i v i d u a l s .  I b e l i e v e i t i s important and  n e c e s s a r y t o move b e y o n d t h e s e c a l l e r s '  c h r o n i c i t y t o understand  the d i f f e r e n t c h a r a c t e r i s t i c s that a r e p a r t o f these  individuals.  Besides t h e e x i s t i n g research l i t e r a t u r e and speculation,  my  views have i n f l u e n c e d t h e focus and d i r e c t i o n o f t h e r e s e a r c h questions.  Similarly,  the c o l l e c t i v e experience o f both  Langley  C r i s i s L i n e ' s a n d Richmond C r i s i s C e n t r e ' s a d m i n i s t r a t i v e have i n f l u e n c e d t h e importance  t o which they attached t o  p a r t i c u l a r r e s e a r c h q u e s t i o n s a n d how t h e y w o u l d a p p r o a c h c a l l e r s through t h e i r telephone  staff  chronic  lines.  Significance T h i s s t u d y i s designed t o expand on t h e u n d e r s t a n d i n g and information a v a i l a b l e on c h r o n i c c a l l e r s t o telephone  crisis  i n t e r v e n t i o n c e n t r e s . The d e r i v e d p r o f i l e o f c h r o n i c c a l l e r c h a r a c t e r i s t i c s w i l l a i d i n the easier i d e n t i f i c a t i o n o f these callers,  a l l o w i n g f o r t h e more r e a d y engagement o f management  strategies t o these c h a l l e n g i n g i n d i v i d u a l s .  This p r o f i l e  also  6 would a l l o w f o r f a s t e r i d e n t i f i c a t i o n o f p o t e n t i a l c a l l e r s before  they e s t a b l i s h frequent  chronic  and long term telephone  contact. Greater identifying  understanding o f t h e a s s o c i a t i o n s between t h e c h a r a c t e r i s t i c s and t h e c a l l e r s '  c h r o n i c i t y would  a l l o w f o r more e f f e c t i v e a n d c o m p r e h e n s i v e management a n d i n t e r v e n t i o n w i t h these i n d i v i d u a l s . and  Also,  thec h a r a c t e r i s t i c s  t h e i r a s s o c i a t i o n s t o c a l l e r c h r o n i c i t y would provide  starting point callers'  f o rapplying  need f o r frequent  would increase  and ongoing  contact.  t o reduce t h e These  actions  telephone counsellor effectiveness, depleted  ongoing chronic The  s e r v i c e s and resources  a  caller  by  contact.  i d e n t i f i e d c h a r a c t e r i s t i c s would a s s i s t i nt h e  development o f g e n e r a l  management s t r a t e g i e s f o r c h r o n i c  H i s t o r i c a l l y , management p l a n s  callers.  f o r c h r o n i c c a l l e r s have been  d i f f i c u l t t o c a r r y o u t b e c a u s e o f t h e l a r g e number o f t e l e p h o n e counsellors that a c r i s i s Brockopp, 1973).  centre  Management p l a n s  unique t o a s p e c i f i c chronic ongoing contact 1980/  employs  T a p p & M u r r a y , 1973) .  developed were  caller,  with a designated  ( L e s t e r , 1971/ L e s t e r  &  generally  o f t e n i n v o l v i n g one-to-one  telephone counsellor  T h e s e u n i q u e management  (Barmann,  plans  f r e q u e n t l y were a p p l i e d i n c o n s i s t e n t l y because t h e t e l e p h o n e counsellors at the c r i s i s  centre  o f t e n had v a r y i n g degrees o f  f a m i l i a r i t y w i t h t h e management p l a n . characteristics of chronic a standard  callers,  With general i d e n t i f y i n g  a crisis  centre  could  develop  s e t o f management s t r a t e g i e s t o a p p l y when t a l k i n g  7 w i t h any c h r o n i c  caller.  Other p u b l i c s e r v i c e agencies, such as t r a n s i t i o n houses and mental h e a l t h services, a l s o receive consistent,  repeat basis  14,  1991 ) . 2  This research  personal  handling  communication,  communication,  a l s o would b e n e f i t these  a g e n c i e s , g i v i n g them s t a r t i n g p o i n t s consistent  from i n d i v i d u a l s on a  (K. J o h n s o n , p e r s o n a l  J a n u a r y 2 6 , 1 9 9 4 ; D. M a r s h a l l , 1  calls  of t h e i r repeat  service  f o r e f f e c t i v e and  callers.  October  8 Literature  Review  C h a r a c t e r i s t i c s o f Chronic  Callers  Frequency o f C a l l s Research has provided repeat  callers.  d a t a o n t h e f r e q u e n c y o f c a l l s made b y  L e s t e r and Brockopp  (1970) r e p o r t e d  t h a t t h e 24  i d e n t i f i e d c h r o n i c c a l l e r s t o t h e E r i e County S u i c i d e and  Prevention  C r i s i s S e r v i c e made 649 (16.6%) o f t h e t o t a l c a l l s  months.  L a t e r , Speer  i n eight  (1971) r e p o r t e d t h a t i n d i v i d u a l s who h a d  t e l e p h o n e d p r e v i o u s l y made 4 2 % o f c a l l s t o t h e same c e n t r e . Murphy, W e t z e l ,  Swallow, and McClure  (1969) r e p o r t e d  c a l l s t o St. Louis Suicide Prevention, callers.  L a s t l y , Johnson and Barry  34% o f t h e  I n c . were f r o m 21  (1978) r e p o r t e d  repeat  i n their  s t u d y t h a t 2 3 % o f t h e s a m p l e made m u l t i p l e c a l l s b e y o n d o n e week r e p r e s e n t i n g 20.6% o f t h e incoming c a l l s t o t h e c e n t r e . repeat  c a l l e r s t o suicide prevention  centres it  represent  and c r i s i s  Clearly  intervention  a substantial proportion of the calls.  However,  r e m a i n s u n c l e a r what p o r t i o n o f t h e s e c a l l e r s a r e " c h r o n i c  c a l l e r s " as opposed t o c a l l e r s i n " r e a l " c r i s i s r e q u i r i n g ongoing support and i n t e r v e n t i o n . Other research has attempted a d e f i n i t i o n o f chronic b a s e d o n t h e number o f c a l l s t o t h e c r i s i s Brockopp  service.  callers  L e s t e r and  (1970) d e f i n e d c h r o n i c c a l l e r s t o t h e E r i e C o u n t y  Suicide Prevention  a n d C r i s i s S e r v i c e a s t h o s e c a l l e r s m a k i n g 10  o r more c a l l s o v e r a n 8-month p e r i o d .  Lester  (1971)  later  d e f i n e d c h r o n i c c a l l e r s a s t h o s e i n d i v i d u a l s who c a l l r e g u l a r l y to the centre,  sometimes a s o f t e n a s f i v e t i m e s a day.  Still  9 o t h e r s t u d i e s have d e f i n e d c h r o n i c c a l l e r s i n terms "repeaters"  ( F a r b e r o w e t a l . , 1966)  v i e w e d as c h r o n i c c a l l e r s Barry  of  or c a l l e r s administratively  (Sawyer & J a m e t o n , 1 9 7 9 ) .  Johnson  (1978) h a v e r i g h t l y r e p o r t e d t h a t c h r o n i c c a l l e r s  typically  h a v e b e e n d e f i n e d i n t e r m s o f a n a r b i t r a r y number o f c a l l s the c a l l e r over a given period. u s i n g L e s t e r and  Brockopp's  i n e i g h t m o n t h s , o n l y one whose h u s b a n d was c a l l s alone  F u r t h e r , they p o i n t out  from  that  (1970) d e f i n i t i o n o f 10 o r more c a l l s  o f t h e i r c a l l e r s was  suicidal.  to the c r i s i s  and  c h r o n i c - a woman  From t h e i r r e s e a r c h ,  t h e number o f  i n t e r v e n t i o n c e n t r e c a n n o t be  the  c r i t e r i o n t o decide whether or not a c a l l e r i s c h r o n i c . Identified  c h r o n i c c a l l e r s a l s o use  long periods of time. t h a t o f t h e 67  Sawyer and  Jameton  years.  A  services over  (1979) h a v e i n d i c a t e d  i d e n t i f i e d chronic c a l l e r s t o the  S u i c i d e P r e v e n t i o n C e n t e r n i n e had m o n t h s , 58  crisis  been c a l l i n g l e s s than s i x  l o n g e r t h a n s i x months, and few had  s t a r t e d i n 1967.  Cleveland  29  longer than  been c a l l i n g over the nine years C o n s e q u e n t l y , i t c a n be  chronic c a l l e r s telephone  f r e q u e n t l y and  three  s i n c e agency  s t a t e d t h a t not o n l y i n g r e a t numbers,  they  also c a l l over long periods. M e n t a l H e a l t h and  Substance Misuse  S e v e r a l s t u d i e s have i n v e s t i g a t e d c h r o n i c p s y c h i a t r i c b a c k g r o u n d and  substance misuse.  (1966) i n t h e i r c a l l e r s u r v e y  Farberow et a l .  f o r the S u i c i d e Prevention  o f L o s A n g e l e s e x a m i n e d 55 r e p e a t p e o p l e "were more t e n u o u s l y  callers'  c a l l e r s and  reported  structured i n their  Center  these  personalities,  do  10 and  were f r e q u e n t l y  556).  borderline,  M o r e t h a n 85%  treatment. Brockopp  of the  (1970) i n d i c a t e d  c a l l e r s had  18  been former p a t i e n t s .  the  67  of the  Sawyer and  c h r o n i c c a l l e r s t o the  were d i a g n o s e d as  schizophrenic.  Some c a l l e r s  substance abuse. i n the  Many h a d  Sawyer and  characterized  and  six  problem.  been seeking  and  time of the  Jameton  (9%)  the  nine  (1979) i n d i c a t e d  (21%)  34  of  (51%)  had  a  were d i a g n o s e d  as  were g i v e n a s e c o n d a r y d i a g n o s i s  transient Jameton  depressive  of  symptoms.  (1979) s t u d y , s u b s t a n c e m i s u s e  chronic callers.  Jose Suicide  drugs at the  and  chronic c a l l e r s to  d e p e n d e n t , 14  Greer  f r e q u e n t c a l l e r s v e r s u s 35.3%  San  24  Lester  suicide prevention centre,  drug or alcohol  definite affective disorder,  the  out  (p.  psychiatric  t r e a t m e n t , s i x were s e e i n g a p s y c h i a t r i s t , and  had  of the  been i n p r i o r  a p s y c h i a t r i c background: t h r e e had  psychiatric  has  outrightly psychotic"  O f t e n t h e y were c h r o n i c a l l y s u i c i d a l .  c e n t r e had  As  i f not  (1976) r e p o r t e d  of the  C r i s i s C e n t e r had c a l l o r had  63.6%  infrequent c a l l e r s used alcohol  or  other  r e v e a l e d a substance use  F a r b e r o w , e t a l . (1966) p o i n t e d o u t  r e a s o n s f o r c a l l i n g f o r r e p e a t e r s was  the  most  to  .  frequent  m a r i t a l problems  or  alcoholism. Psychiatric  treatment does not  r e p e a t o r c h r o n i c c a l l e r has involved  in psychiatric  necessarily  a mental i l l n e s s .  accuracy of  above s t u d i e s ,  the  the  Callers could  treatment f o r other d i f f i c u l t i e s ,  s e x u a l abuse, w i t h o u t a c o n c u r r e n t p s y c h i a t r i c the  indicate  psychiatric  d i a g n o s e s may  especially i f suicide  indicates  illness. be a  such Also,  argued i n further  the  be as  11 p s y c h i a t r i c impairment.  Additionally, contacting a c r i s i s  line  a f t e r u s i n g a l c o h o l o r other drugs i s not a d e f i n i t e i n d i c a t o r o f a substance misuse problem o r a d d i c t i o n . the c a l l e r s t h e "courage" t o telephone,  S u b s t a n c e u s e may  o r make t h e c a l l e r s '  c o n c e r n s more b u r d e n s o m e , l e a d i n g t o t h e t e l e p h o n e s u b s t a n c e m i s u s e p r o b l e m o r d e p e n d e n c y may  call.  No  exist.  Between 75% and 85% o f c h r o n i c o r repeat r e c e i v e d p r i o r p s y c h i a t r i c treatment  give  callers  have  f o ra diagnosed mental  i l l n e s s o r some o t h e r p s y c h o l o g i c a l c o n c e r n .  Also, a  primary  d i a g n o s i s o f s u b s t a n c e a b u s e was g i v e n t o u p w a r d s 5 0 % o f t h e s e callers.  Both a p s y c h i a t r i c background and a h i s t o r y o f  substance abuse appear t o d i s t i n g u i s h c h r o n i c  callers.  Suicide Whether s u i c i d e i s a d i s t i n g u i s h i n g c h a r a c t e r i s t i c o f a chronic c a l l e r i s unclear.  Sawyer a n d Jameton  (1979) r e p o r t e d 4  o u t o f 67 c h r o n i c c a l l e r s h a d c o m m i t t e d s u i c i d e o v e r t h e 9 - y e a r p e r i o d o f t h e study,  a n d 37 (55%) h a d a t t e m p t e d s u i c i d e .  t h e y h a d no c o m p a r i s o n group o f i n f r e q u e n t o r o t h e r Using a comparison group, Greer c a l l e r s disclosed a previous o n l y 36.4% o f t h e i n f r e q u e n t  But  callers.  (1976) r e p o r t e d 8 3 . 3 % o f  h i s t o r y o f s u i c i d e attempts  frequent versus  callers.  Other s t u d i e s comparing infrequent c a l l e r s and repeat c a l l e r s r e p o r t e d no d i f f e r e n c e s between t h e two g r o u p s . and  Brockopp  Lester  (1970) n o t e d n o d i f f e r e n c e s i n s u i c i d a l h i s t o r y a n d  r e l a t e d s u i c i d e r i s k on t h e f i r s t  call  one-time c a l l e r s t o a s u i c i d e l i n e .  between repeat  c a l l e r s and  M u r p h y e t a l . (1969)  12 reported 9  (52.9%) o f t h e i n t e r v i e w e d r e p e a t  history of previous  s u i c i d e attempts.  s e l f - c a l l e r s had  a  They r e p o r t e d a l s o t h a t  o v e r h a l f o f a l l s e l f c a l l e r s h a d made p r e v i o u s  suicide  attempts.  R e s e a r c h shows o v e r h a l f o f c h r o n i c c a l l e r s h a v e made previous  s u i c i d e attempts.  However, w h e t h e r t h i s i s u n i q u e  to  chronic c a l l e r s i s uncertain. Past or Present  Experience  w i t h Counselling, Therapy or  High percentages of a l l c a l l e r s  ( r e p e a t o r one  Treatment  time  seem t o h a v e b e e n i n v o l v e d i n some t y p e o f c o u n s e l l i n g , or mental h e a l t h treatment. o f t h e 17 r e p e a t previous  M u r p h y e t a l . (1969) r e p o r t e d  self c a l l e r s interviewed,  13  that  (76.5%) h a d  And  of the t o t a l s e l f c a l l e r s ,  repeaters  a  Greer  i n d i c a t e d 95.8%  of  of frequent  c a l l e r s had p a s t o r p r e s e n t or hospitalization.  c a l l e r s versus experience  Previous  c o u n s e l l i n g or treatment  92.3%  (1976)  infrequent  with counselling,  or current experience  i s not unique t o c h r o n i c  of  included,  f o u r f i f t h s had p r e v i o u s p s y c h i a t r i c a t t e n t i o n .  with  therapy therapy,  callers.  w i t h O t h e r Community S e r v i c e s  Having experienced  a past or current p s y c h i a t r i c challenge,  c h r o n i c c a l l e r s o f t e n have had community s e r v i c e s . t h a n 85%  therapy  o r c u r r e n t p s y c h i a t r i c h i s t o r y i n v o l v i n g some d e g r e e  treatment.  Contact  callers)  they  i t s agencies,  exhausted the f a c i l i t i e s . . . " (1973) r e v i e w e d  contact with  other  F a r b e r o w e t a l . (1966) s t a t e d " w i t h more  i n p r i o r treatment,  the community and  frequent  [chronic c a l l e r s ]  a r e known t o  h a v i n g made t h e r o u n d s a n d  (p. 5 5 6 ) .  L e s t e r and  often  Brockopp  the chronic c a l l e r s t o the S u i c i d e Prevention  and  13 C r i s i s S e r v i c e o f E r i e County.  They s t a t e d t h a t  " i n most  instances, the chronic c a l l e r i sbeing heard not only by the [crisis]  c e n t e r b u t b y many o t h e r a g e n c i e s  t h e community"  and organizations i n  ( p . 1 8 2 ) . S a w y e r a n d J a m e t o n (1979) s a i d t h a t o f  t h e 67 c h r o n i c c a l l e r s t o t h e s u i c i d e p r e v e n t i o n c e n t r e , a t follow-up,  31 (47%) w e r e r e f e r r e d f o r o n g o i n g t r e a t m e n t  community m e n t a l h e a l t h Relationship  a t other  resources.  Status  Considering  the unmarried  widowed), s i g n i f i c a n t c a l l e r s appear.  divorced,  separated and  d i f f e r e n c e s between c h r o n i c and o t h e r  Greer  as u n m a r r i e d v e r s u s  (single,  (1976) r e p o r t e d 7 7 . 4 % o f f r e q u e n t  56.0% o f i n f r e q u e n t c a l l e r s .  callers  Sawyer a n d  J a m e t o n (1979) r e p o r t e d 6 7 % o f t h e c h r o n i c c a l l e r s w e r e u n m a r r i e d or separated  compared w i t h 47.2% o f t h e t o t a l p o p u l a t i o n o f  callers. However,  considering only married  callers, the differences  between c h r o n i c and u s u a l c a l l e r s disappear.  Sawyer a n d Jameton  (1979) r e p o r t e d s i m i l a r p e r c e n t a g e s o f m a r r i e d chronic callers (32.8%).  callers f o r  (31%) a n d t h e t o t a l p o p u l a t i o n o f c a l l e r s  Approximately  20% o f t h e t o t a l p o p u l a t i o n o f t h e i r  s t u d y h a d a n d unknown m a r i t a l s t a t u s , p o s s i b l y p a r t n e r e d , law,  etc.  Unfortunately,  percentages f o r married  Greer  callers  common-  (1976) d i d n o t r e p o r t a n y f o r frequent  or infrequent  c a l l e r s , p r o v i d i n g no a d d i t i o n a l i n f o r m a t i o n t o t h e m a r i t a l status o f chronic c a l l e r s other than c i t e d Chronic  above.  c a l l e r s seem t o b e more l i k e l y u n m a r r i e d - d i v o r c e d ,  14 separated,  s i n g l e o r widowed - t h a n o t h e r c a l l e r s .  However,  c h r o n i c c a l l e r s a l s o appear u n d i s t i n g u i s h a b l e by marriage other c a l l e r s .  from  B e c a u s e t h e m a r i t a l s t a t u s o f some c a l l e r s  r e m a i n e d unknown i n t h e above s t u d i e s , f i r m s t a t e m e n t s f o r d i f f e r e n c e s o r s i m i l a r i t i e s between c h r o n i c and c a n n o t be  other  callers  made.  Support Network Studies n o t i n g the chronic c a l l e r s ' limited  support  network o f f a m i l y and  support  friends.  network report Haywood  stated chronic c a l l e r s are i s o l a t e d  individuals, having  social  l i n e s to chat.  supports,  telephoning  crisis  (1981) r e p o r t e d c h r o n i c c a l l e r s a s l a c k i n g s u p p o r t s o c i a l networks.  (1981) few  Imboden systems  and  s t a t e d these  callers  inappropriately f i l l  t h e i r need f o r s o c i a l c o n t a c t and  support  through the  crisis  O'Connor (1981) a c k n o w l e d g e d  repeat  lines.  He  A l s o , Leuthe and  c a l l e r s as  l a c k i n g support  systems and  resources.  These s t u d i e s r e l i e d on the r e s e a r c h e r s ' c h r o n i c c a l l e r s and other telephone nature.  workers.  Sawyer and  chronic c a l l e r s past year.  anecdotal  experiences  i n f o r m a t i o n on these  O n l y one  s t u d y was  callers  (76%)  from  of the  67  contact with peers during  the  T h i s f i n d i n g remains c o n s i s t e n t w i t h above s t u d i e s .  T h i s r e s e a r c h o n l y a d d r e s s e s t h e s i z e o r amount o f w i t h the c a l l e r s ' callers'  with  quantitative i n  J a m e t o n (1979) r e p o r t e d 51  i n v e s t i g a t e d h a d no  a  ability  support  network.  None a d d r e s s e s t h e  t o engage and u t i l i z e t h e i r  family or friends.  F u r t h e r , no  support  contact chronic  network  r e s e a r c h compares c h r o n i c  of  callers  15 with other c r i s i s  l i n e c a l l e r s on t h i s dimension.  c o n s i d e r i n g s i z e and  amount o f c o n t a c t ,  appears t o c h a r a c t e r i z e c h r o n i c The  Caller-Worker  a l i m i t e d support network  callers.  Relationship  Some r e s e a r c h h a s  a l s o i n v e s t i g a t e d the  c a l l e r s on t h e t e l e p h o n e w o r k e r s and relationship.  However,  L e u t h e and  l a c k o f movement a n d  the  impact of  chronic  worker-caller  O'Connor (1981) h a v e s a i d  continued  change by c h r o n i c c a l l e r s l e a d t o  e f f e c t i v e n e s s , t o l e r a n c e , and  less  s e n s i t i v i t y t o c a l l e r needs.  This  then produces poor therapeutic r e l a t i o n s h i p s , c a r e g i v e r s e l f - d o u b t , and and  burnout.  They s t a t e the mismatch between  w o r k e r n e e d s makes n e g a t i v e  Further,  contact  f o r e a c h most  caller  likely.  they point to chronic c a l l e r s being a major f a c t o r i n  the premature t e r m i n a t i o n of v o l u n t e e r i n g f o r telephone workers. Also, Greer  (1976) h a s  stated the q u a l i t y of  i n t e r a c t i o n s d e c r e a s e s as the  frequency of c a l l e r s '  the s e r v i c e i n c r e a s e , as i s t r u e w i t h c h r o n i c Rudestam  (1978) h a s  volunteer  conceptualized  contact  callers.  chronic  caller  c h a r a c t e r i s t i c s i n terms of the i n t e r a c t i o n a l dynamics set between t h e c a l l e r and  the telephone worker.  p e r s i s t e n t c a l l e r s are often profoundly Telephone workers t r y t o p r o v i d e  fail  t o improve.  Chronic  i n the r e l a t i o n s h i p .  He  d e p r e s s e d and  h o s t i l e as the  u n c e r t a i n t y , t h e y a r e u n w i l l i n g t o g i v e up  one  1  needs  callers  and  of the  that  suicidal.  c a l l e r s cannot understand t h i s  In s p i t e of t h e i r confusion  up  speculates  f o r the chronic c a l l e r s  a n d become i n c r e a s i n g l y f r u s t r a t e d a n d  with  few  change  16 remaining  relationships  distinguish  t h e y have.  between t h e c h r o n i c c a l l e r s ' c o n f u s i o n over t h e  change i n t h e r e l a t i o n s h i p However, t h e y w i l l  and t h e i r previous  An  t othe  interactional  results.  Rudestam  (1978) i s o n l y s p e c u l a t i n g o n t h e d y n a m i c s t h a t  e x i s t between t h e telephone Previous research suggests crisis  the callers'  out o f g u i l t and r e s p o n s i b i l i t y  and s u i c i d a l chronic c a l l e r .  stalemate  behaviour.  c o n t i n u e t o deny and r e j e c t  demanding b e h a v i o u r s depressed  Telephone workers cannot  worker and t h e c h r o n i c c a l l e r . t h a t t h o u g h many c h r o n i c c a l l e r s t o  services are suffering  f r o m d e p r e s s i v e symptoms, n o t a l l  p e r s i s t e n t c a l l e r s t o the centres a r e depressed T h o u g h many t e l e p h o n e  w o r k e r s may g e t c a u g h t u p i n a  w i t h t h e c h r o n i c c a l l e r , some r e a d i l y frustration  or suicidal.  address  deadlock  their feelings  and annoyance w i t h c a l l e r b e h a v i o u r s .  of  Further  r e s e a r c h and i n f o r m a t i o n i s r e q u i r e d t o expand and support Rudestam's  view. Research  Log  Methods  Sheets Most r e s e a r c h w i t h c h r o n i c c a l l e r s t o c r i s i s  involved review of c r i s i s et a l . , 1966; G r e e r ,  centre telephone  centres has  l o g sheets  (Farberow  1976; J o h n s o n & B a r r y , 1978; L e s t e r &  Brockopp, 1971; Sawyer & Jameton, 1979; Speer, 1976). inadequate  a n d i n c o n s i s t e n t r e c o r d s k e p t b y most c r i s i s  o f t e n has l i m i t e d t h i s r e s e a r c h Many c r i s i s  The  (Rosenbaum & C a l h o u n ,  lines  1977).  l i n e s maintain t h e c a l l e r s ' anonymity b y o p e r a t i n g on  17 a f i r s t name o n l y b a s i s , m a k i n g t h e t a s k o f k e e p i n g f i l e s very d i f f i c u l t . f i l e s on c a l l e r s , not maintained  Even a t those c e n t r e s t h a t keep  usually chronic callers,  the f i l e s  (Greer,  lines  communication, February chronic callers,  Greer  Often on the  between what i s h e a r d  a n d what i s r e c o r d e d  p e r s o n a l communication, February  on paper 3  Specifically  4  personal  related to  (1976) r e p o r t e d t h a t o u t o f a t o t a l o f t e n  i n f o r m a t i o n a l spots on t h e "Follow-Up Sheet," t h e frequent g r o u p s h o w e d a m e d i a n o f 4.8 v a c a n c i e s o f 2.4  (jtx = 4.6) v e r s u s  (fx = 3.1) f o r t h e i n f r e q u e n t c a l l e r g r o u p .  h a l f t h e time t h e r e i s o n l y 50% o f t h e l o gsheet the frequent Greer  reasonable  caller  a median  He n o t e s  that  f i l l e d out f o r  caller.  (1976) a n d L e u t h e a n d O'Connor  decrease i n t h e q u a l i t y o f telephone frequency  over  (M. Chand,  4, 1 9 9 4 ; J . R a w l y n s ,  5, 1994 ) .  data  time o f c a l l , e t  1 9 7 6 ; Rosenbaum & C a l h o u n , 1 9 7 7 ) .  sheets there e x i s t s a divergence  the telephone  often are  c e n t r e s keep o n l y g e n e r a l s t a t i s t i c a l  c o n s i s t i n g o f age, gender, problem, d i s p o s i t i o n ,  log  individual  (Rosenbaum & C a l h o u n , 1977) .  Most c r i s i s  cetera  individual  of callers'  (1981) r e p o r t e d a  worker i n t e r a c t i o n s as t h e  contact with the service increases.  A  a s s u m p t i o n c o u l d b e made h e r e t h a t f r u s t r a t e d a n d l e s s  e f f e c t i v e telephone  w o r k e r s may n o t r e p o r t a s much o r a s  accurately the content  and context o f t h e c a l l .  i n c r e a s i n g contact, t h e telephone  Also,  with  worker could perceive both t h e  c a l l a n d c a l l e r a s " r o u t i n e , " e x p e c t i n g n o new i n f o r m a t i o n a n d requiring l i t t l e  l o g sheet write-up.  Therefore,  both the routine  18 nature  o f t h e c o n t a c t and  the decreased q u a l i t y of caller-worker  i n t e r a c t i o n s c o u l d i n f l u e n c e the completeness and sheet data  for chronic  accuracy  of  log  callers.  Telephone Follow-up Little crisis  l i n e r e s e a r c h has  follow-up with c a l l e r s .  employed d i r e c t  That w h i c h has  involved brief  i n v e s t i g a t i n g the e f f e c t i v e n e s s of telephone (Auerbach & Kilman, 1984).  1977;  In the research,  successfully, although  telephone  crisis intervention  Hornblow, 1986a; S t e i n & Lambert, d i r e c t telephone  f o l l o w - u p has  r i g o r o u s f o l l o w - u p was  assumed  g i v e n t h e d e s i r e o f many c a l l e r s t o r e m a i n anonymous 1986b; S l a i k e u & L e f f - S i m o n ,  (1988) d e s i g n e d  evaluate the e f f e c t i v e n e s s of a c r i s i s  telephone  follow-up.  been used difficult  (Hornblow,  1990).  G i n g e r i c h , Gurney and W i r t z to  surveys  their  line to  research  include  They r e p o r t e d t h a t a p p r o x i m a t e l y  25 t o  30%  o f t h e c a l l e r s d e c l i n e d t o p a r t i c i p a t e when a p p r o a c h e d .  At  time of the telephone  those  c a l l e r s who  had  follow-up,  a f u r t h e r 10 t o 1 5 % o f  a g r e e d t o p a r t i c i p a t e c o u l d n o t be  declined to participate.  Overall approximately  approached c a l l e r s p a r t i c i p a t e d i n the s t u d y and telephone  the  contacted  60 t o 6 5 %  or  of  completed  the  follow-up.  S l a i k e u , T u l k i n and  Speer  (1975) d e m o n s t r a t e d t h a t  s e l f - r e p o r t f o l l o w - u p d a t a c o u l d be o b t a i n e d o n m o s t c a l l e r s t o crisis  line.  T h e y r e p o r t e d 9 5 % o f t h e shows f o r a  face-to-face  appointment booked d u r i n g a c r i s i s c a l l responded t o follow-up questionnaire.  A l s o , 70%  the  o f t h e no-shows and  93%  of  a  19 t h e c a n c e l s who c o u l d b e r e a c h e d questionnaire.  by telephone  returned the  The r e s e a r c h e r s e f f e c t i v e l y u s e d a  telephone  f o l l o w - u p t o o b t a i n outcome d a t a . Slaikeu and Leff-Simon workers c o u l d e l i c i t  (1990) r e p o r t e d t h a t  from t h e c a l l e r a t l e a s t  telephone  a name a n d  telephone  number t o a l l o w f o r a s u b s e q u e n t c a l l b a c k .  The most  important  c o n s i d e r a t i o n s f o r t h e w o r k e r s a r e t o (a) e x p l a i n t o  t h e c a l l e r s t h e r e a s o n s f o r t h e f o l l o w - u p , a n d (b) e n s u r e t h e confidentiality  o f those  telephone  contacts.  They suggest t h a t  t h e c a l l e r s a r e p r e s e n t e d w i t h t h e o p t i o n t o g i v e a name a n d telephone  number f o r f o l l o w - u p o r t o c a l l b a c k t h e c e n t r e o n  t h e i r own, b o t h w i t h i n a s p e c i f i e d whether o r n o t t o m a i n t a i n t h e i r  period.  Callers  choose  anonymity.  Telephone f o l l o w - u p c a n be used e f f e c t i v e l y t o o b t a i n outcome d a t a f r o m a l a r g e p e r c e n t a g e o f c a l l e r s t o a crisis  line.  Procedures  confidentiality,  c a n be employed t o ensure  such as t h e telephone  telephone  caller  follow-up scheduled  t h a t t h e c a l l e r w i l l be alone t o r e c e i v e t h e c a l l .  so  Also, the  c a l l e r s always a r e g i v e n t h e choice whether o r n o t t o m a i n t a i n t h e i r anonymity. effective  Therefore,  telephone  f o l l o w - u p c a n be b o t h an  a n d a p p r o p r i a t e method f o r r e s e a r c h w i t h  Research Interviews w i t h C r i s i s Line O n l y one s t u d y  callers.  Callers  (Murphy e t a l . , 1969) was l o c a t e d t h a t  completed in-depth i n t e r v i e w s w i t h c a l l e r s t o a telephone intervention service. the circumstances  The r e s e a r c h e r s a s k e d t h e c a l l e r s  around t h e i r c a l l ,  crisis about  the effectiveness ofthe  20 suicide prevention  service, suicidal  a l i f e h i s t o r y seeking m a r i t a l and  and  psychiatric history,  i n f o r m a t i o n on e d u c a t i o n ,  f a m i l y b a c k g r o u n d and  job,  economic s t a t u s .  study d i d not  s p e c i f i c a l l y use  s u b j e c t s , but  a t t e m p t e d t o sample a l l s e l f - c a l l e r s  prevention Of  the  73  of St. Louis, callers was  was  self-callers 55  (75%)  chronic or repeat c a l l e r s  were i n t e r v i e w e d .  any,  pass t h i s  on  s u i c i d e and  today.  The  1967. Inc.  Contact of  At  f o r S.P.I, then.  confidentiality  s e l f - c a l l e r s were c o n t a c t e d The  researchers  the m a i l i n g address of subjects  There were e i g h t r e f u s a l s . was  call,  d i s t r e s s l i n e s would operate i n t h i s  obligation to a caller's  as  a n a l c o h o l i c man  i n t e r v i e w e r when t h e  who  One  threatened  by  F o r t y - s i x of the T h i r t y - s i x took place  the caller  (Few,  manner and  People  s p e c i f y how  f o r the  study.  c a l l e r l i s t e d as a r e f u s a l t o shoot h i m s e l f  and  interviews.  the  Ten  located. i n t e r v i e w s were  i n the c a l l e r s '  r i s k f o r b o t h c a l l e r and  face-to-face.  home, a p o t e n t i a l s a f e t y  i n t e r v i e w e r , as  shown b y  the  an  they  i n t e r v i e w e r a r r i v e d f o r the agreed upon  55  i f  l e t t e r requesting  d i d not  appointment - a c l e a r danger of f a c e - t o - f a c e s e l f - c a l l e r s were not  S.P.I,  t e l e p h o n e number o f t h e  t o the p e r s o n on c a l l  i n t e r v i e w appointment. obtained  (S.P.I.)  these  the time of the  a n o n y m i t y w o u l d make t h i s p r o c e d u r e u n a c c e p t a b l e . ) identified  suicide  made p o s s i b l e b e c a u s e t h e t e l e p h o n e number o f  a telephone answering s e r v i c e .  this  as  t o the  to Suicide Prevention,  s e r v i c e w o u l d r e q u e s t t h e name a n d and  military,  However,  s e r v i c e b e t w e e n J a n u a r y 1 a n d M a r c h 31,  and  above  21 suicide/homicide researchers  threat.  Five interviews occurred  o f f i c e , p o t e n t i a l l y both f r i g h t e n i n g and  f o r a p e r s o n whose u s u a l means o f c o n t a c t took place  i n the inconvenient  i s a telephone.  Four  i n h o s p i t a l s where t h e c a l l e r s were t h e n p a t i e n t s , and  one i n a n i n t e r v i e w e r ' s a u t o m o b i l e .  The a p p r o p r i a t e n e s s  of both  t h e s e s e t t i n g s c a n be argued. N i n e i n t e r v i e w s were c o n d u c t e d o v e r t h e t e l e p h o n e because t h i s was t h e o n l y o t h e r o p t i o n t o t h e c a l l e r ' s o u t r i g h t r e f u s a l t o be i n t e r v i e w e d  face-to-face.  No w r i t t e n c o n s e n t i s p o s s i b l e  h e r e , though i n f o r m e d consent c a n s t i l l be o b t a i n e d appropriate  through  verbal protocols.  M u r p h y e t a l . (1969) shows t h e p o t e n t i a l p e r s o n a l  danger f o r  c a l l e r s and i n t e r v i e w e r s o f face-to-face i n t e r v i e w s w i t h s u i c i d e and  d i s t r e s s l i n e users.  interviewed callers) face-to-face.  Sixteen percent  (9 o f t h e 55  o u t r i g h t l y r e f u s e d t o be  Some r e m a i n i n g  interviewed  i n t e r v i e w s were c o n d u c t e d i n l e s s  than i d e a l environments, i e . , the h o s p i t a l and t h e i n t e r v i e w e r ' s vehicle. researcher  A telephone i n t e r v i e w format would a l l o w t h e c a l l e r and t h e s a f e t y and s e c u r i t y o f t h e i r  "home" e n v i r o n m e n t .  T h i s method a l s o would ease t h e h e s i t a n c y and r e l u c t a n c e o f t h e c a l l e r t o b e i n t e r v i e w e d , p r o v i d i n g a medium (a t e l e p h o n e already quite natural t o the chronic Telephone  line)  caller.  Interviews  The t e l e p h o n e i n t e r v i e w c a n b r i n g i n t o q u e s t i o n of the obtained  interview data.  However, r e s e a r c h  the accuracy  comparing  i n - p e r s o n w i t h t e l e p h o n e i n t e r v i e w m e t h o d s h a v e shown t h a t t h e  22 q u a l i t y o f data obtained by telephone superior to that obtained (Aneshensel,  through face-to-face  R o g e r s , 1976;  Pless & M i l l e r ,  S i e m i a t y c h i , 1979;  Weeks, K u l k a ,  Leake & Robins,  1979;  1988).  Colombotos,  Reich & Earls,  Simon, F l e i s s ,  L e s s l e r & W h i t m o r e , 1983;  status,  reports of h o s p i t a l i z a t i o n .  f o u r months,  They a t t r i b u t e d the  t h e i n t e r v i e w methods.  R e i c h and  and  25 y o u t h s i n - p e r s o n .  health or  one interview  Earls  (1990),  u s i n g a s t r u c t u r e d p s y c h i a t r i c i n t e r v i e w , i n t e r v i e w e d 25 by telephone  no  telephone  s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e reported to the not  Burnam,  i n t e r v i e w s f o r the assessment of  i l l n e s s e s reported f o r the previous  i t e m and  Gurland,  A n e s h e n s e l e t a l . (1982) r e p o r t e d  in-person  1969;  1990;  Fisher &  Wells,  s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between i n t e r v i e w s and  or  interviews  F r e r i c h s , C l a r k & Y o k o p e n i c , 1982;  H o c h s t i m , 1967;  1974;  i n t e r v i e w s i s comparable  They o b t a i n e d  youths  no  s i g n i f i c a n t d i f f e r e n c e s i n the r e p o r t i n g of d i a g n o s t i c categories for  t h e two  groups.  Rogers  (1976) a s k e d s u b j e c t s i n f o r m a t i o n o n t h e i r  personal  income, v o t i n g p a t t e r n s , e d u c a t i o n a l b a c k g r o u n d and a t t i t u d e s about l o c a l s e r v i c e s . 98  She  subjects in-person.  telephone  was  i n t e r v i e w e d 85 p e o p l e b y t e l e p h o n e  She  as a c c u r a t e  concluded  that the data obtained  as i n - p e r s o n data..  psychiatric patients. u s e d w i t h t h e 85  A  by  S i m o n e t a l . (1974)  compared f a c e - t o - f a c e i n t e r v i e w s w i t h t e l e p h o n e i n v e s t i g a t i n g the information obtained  interviews  from informants  of  semistructured psychiatric interview  s u b j e c t s , 50  and  i n t e r v i e w e d f a c e - t o - f a c e and  35  was  23 over the telephone.  Their r e s u l t s i n d i c a t e d the q u a l i t y  h i s t o r i c a l p s y c h i a t r i c data c o l l e c t e d from informants r e l a t e to the  i n t e r v i e w method used.  reported that telephone accurate  The  r e s p o n d e n t s a p p e a r e d t o be  researchers  r e s p o n s e s b e t w e e n t h e two a t t r i b u t e d these  versus and  somewhat more  providers than  in-person  n o t e d some m i n o r d i f f e r e n c e s i n  methods o f i n t e r v i e w i n g , b u t  they  and  in-person  i n t e r v i e w respondents.  r e s e a r c h on the q u a n t i t y o f d a t a o b t a i n e d w i t h  face-to-face interviews i s less conclusive.  in-person  However, R e i c h a n d  Earls  (1976)  obtained  i n t e r v i e w s as complete as t h a t o b t a i n e d  interviews.  telephone  Rogers  S i m o n e t a l . (1974) r e p o r t e d t h a t t h e i n f o r m a t i o n  from telephone  not  d i f f e r e n c e s to sociodemographic d i f f e r e n c e s  between the telephone The  did  Weeks e t a l . (1983)  i n reporting v i s i t s to medical  respondents.  of  from  (1990)  recorded  f e w e r p s y c h i a t r i c symptoms r e p o r t e d b y t h o s e y o u t h i n t e r v i e w e d telephone  as compared w i t h those  speculated the lower  r e p o r t i n g was  the youth w i t h t h e i r parents telephone  interview.  due  They  to the l a c k of p r i v a c y f o r  possibly listening i n to  the  A l s o , Weeks e t a l . (1983) r e p o r t e d  g r e a t e r e f f o r t by those reporting medical  interviewed in-person.  a  subjects interviewed face-to-face  c o n d i t i o n s than those  by  i n t e r v i e w e d by  in  telephone.  However, w i t h t h e g r e a t e r r e p o r t i n g o f r e s p o n d e n t s p e r s o n a l l y i n t e r v i e w e d , more d i s a g r e e m e n t s b e t w e e n t h e i r r e p o r t s o f c o n d i t i o n s and concluded  h o s p i t a l r e c o r d s w e r e shown.  t h a t though telephone  t e n d e d t o be more a c c u r a t e  The  researchers  respondents reported l e s s ,  than in-person  medical  respondents.  they  24 Lastly,  t h e l i t e r a t u r e comparing in-person versus  telephone  i n t e r v i e w s h a s shown t h e r e c a n b e more t r u t h f u l n e s s i n r e s p o n s e , ie.,  l e s s s o c i a l d e s i r a b i l i t y , with telephone interviews  with face-to-face 1976).  interviews  (Pless & M i l l e r ,  However, o t h e r r e s e a r c h e r s  1979; Rogers,  have r e p o r t e d t h a t  and  in-person  interviews are equivalent  i n social  for  responses, w i t h t h e advantage going  to mailed  questionnaires  ( S i e m i a t y c k i , 1 9 7 9 ; Wiseman,  interviews concerning  social  telephone  desirability out  1972).  No c l e a r  s t a t e m e n t c a n b e made o n t h e a d v a n t a g e o f t e l e p h o n e over in-person  than  interviews  desirability.  Telephone i n t e r v i e w s can o b t a i n a comparable q u a l i t y o f i n f o r m a t i o n from s u b j e c t s as t h a t obtained  by  in-person  i n t e r v i e w s u s i n g a v a r i e t y o f i n t e r v i e w schedules and o u t l i n e s . However, t h e c o m p l e t e n e s s o f d a t a a n d a c c u r a c y o f with regard  information  t o s o c i a l d e s i r a b i l i t y remain t o be e s t a b l i s h e d  f i r m l y i n favour  of e i t h e r telephone o r  face-to-face  interviewing. D e l i m i t a t i o n s : Other Chronic Sex for  c a l l e r s were e x c l u d e d  Callers  from t h i s study  (see Appendix A  the d e f i n i t i o n and c h a r a c t e r i s t i c s used f o r i d e n t i f y i n g sex  callers).  Though c h r o n i c i n n a t u r e ,  intervention centres 1973;  Wark, 1 9 8 4 ) .  these c a l l e r s use  f o r sexual g r a t i f i c a t i o n  crisis  (Lester & Brockopp,  The c h r o n i c i t y o f t h e i r c a l l i n g r e s u l t s f r o m  a s e x u a l a d d i c t i o n (Carnes, The t e l e p h o n e c r i s i s  1 9 8 3 ; E a r l e & Crow,  centres  1989).  d i d not r e c r u i t those  c a l l e r s t h e y deemed t o o p s y c h i a t r i c a l l y c h a l l e n g e d  to  chronic  25 participate.  They were concerned o v e r the v u l n e r a b i l i t y o f  particular callers.  The  c e n t r e s were concerned a l s o about  p o t e n t i a l f o r v e r b a l abuse and telephone  the  the  workers should the chronic c a l l e r s respond n e g a t i v e l y  to the request excluded  aggression directed at  these  to participate.  from the  Therefore,  these  callers  were  study.  Those i n d i v i d u a l s w i t h an extreme p s y c h i a t r i c c h a l l e n g e c o u l d be  d e f i n e d as a d i s c r e t e group o f c h r o n i c c a l l e r s  long term mentally c h a r a c t e r i z e d as:  ill.  T h i s group o f c a l l e r s has  -  the  been  (a) l o w - f u n c t i o n i n g , . w i t h a n o n g o i n g ,  often  a c u t e , p s y c h i a t r i c c o n d i t i o n ; (b) o f t e n i s o l a t e d i n d i v i d u a l s w i t h l i m i t e d s o c i a l supports; rapport with others; u n d e r s t r e s s ; and  (c) h a v i n g  (d) o f t e n e x h i b i t i n g a n g e r a n d  C h r z a n o w s k i , 1980;  & G o l d f i n g e r , 1981).  1988;  Langley  personal  (Bachrach,  Crisis Clinic,  1980;  t r e a t these  (chronic) c a l l e r s  February,  1988;  (Crisis Clinic,  c o m m u n i c a t i o n , J u n e 10,  T.  Schwartz  crisis  i n d i v i d u a l s as a  F a m i l y S e r v i c e s A s s o c i a t i o n , 1993;  and  Bassuk & Gerson,  C o n s e q u e n t l y , some t e l e p h o n e  i n t e r v e n t i o n c e n t r e s do group of r e g u l a r  hostility  (e) r e q u i r i n g p a r t i c u l a r t e c h n i q u e s  s t r a t e g i e s f o r t h e i r management 1980;  difficulty establishing  distinct February, Lohnes,  1994 ) . 5  Assumptions and L i m i t a t i o n s A p o s s i b l e l i m i t a t i o n of the study c o u l d have been e x c l u s i o n of those  c h r o n i c c a l l e r s deemed t o o  c h a l l e n g e d by the telephone research.  the  psychiatrically  c r i s i s centres t o p a r t i c i p a t e i n the  R a t h e r t h a n b e i n g a d i s c r e t e group as o u t l i n e d above,  26 t h i s g r o u p o f c h r o n i c c a l l e r s c o u l d be  j u s t a segment t o w a r d  extreme of the c h r o n i c c a l l e r continuum.  As  c o u l d h a v e r e d u c e d t h e number o f p o t e n t i a l a limited  set of i d e n t i f y i n g  such, t h i s  c a l l e r s who  c o u l d not g i v e informed  produced  characteristics.  (However, t h i s l i m i t a t i o n d i d b e n e f i t t h e s t u d y b y those  exclusion  s u b j e c t s and  chronic c a l l e r  the  excluding  consent  to  participate.) The  researcher  c a l l e r s t o be those  assumed t h e r e m a i n i n g  A f u r t h e r a s s u m p t i o n was  and  of sex c a l l e r telephone  contact relates  with  lines.  1983/  workers f o r r e c r u i t i n g  the  the incomplete  need  participation  chronic c a l l e r s . felt  Not a l l  comfortable  Those t h a t d i d h e l p m i s s e d o p p o r t u n i t i e s t o  with  the  request  because the w o r k e r s f o r g o t o r were  on a t r a i n i n g  s h i f t w i t h another telephone  Additionally,  sometimes the c i r c u m s t a n c e s  volunteer. around r e c r u i t i n g  c a l l e r were not a p p r o p r i a t e , the c a l l e r d i s t r e s s e d o r a b u s i v e the time of the c a l l .  to  Wark, 1 9 8 4 ) .  counsellors asked to a s s i s t  chronic c a l l e r s ' participation  that  uniquely  o f s e x u a l a d d i c t i o n and  /Another r e s e a r c h l i m i t a t i o n was  study.  uniquely  i n concept t o the understanding  f o r s e x u a l s t i m u l a t i o n (Carnes,  telephone  a set of  participate.  duration of t h e i r contact w i t h c r i s i s  the i d e n t i f i e d c h a r a c t e r i s t i c s  of telephone  to  and  of chronic c a l l e r s associated  This assumption i s i d e n t i c a l the frequency  impaired  that there exists  characteristics  the frequency  chronic  a homogeneous g r o u p , e x c l u d i n g s e x c a l l e r s  c a l l e r s deemed t o o p s y c h i a t r i c a l l y  identifying  population of  (M. Chand, p e r s o n a l  communication,  the at  October  27 4,  1994;  D.  Knight,  Rawlyns, p e r s o n a l  personal  comrnunication,  O c t o b e r 17,  c o m m u n i c a t i o n , O c t o b e r 18,  voluntary participation  of the telephone  1994) .  1994 ; J . 6  However,  workers remained  most a p p r o p r i a t e t o r e d u c e w o r k e r unease and  the  the  resistance to  the  research. An  a d d i t i o n a l l i m i t a t i o n was  the time of year.  c a l l s o f t e n d r o p o f f o v e r t h e summer m o n t h s . warm, s u n n y w e a t h e r , c a l l s a l s o d e c l i n e c o m m u n i c a t i o n , O c t o b e r 4,  1994;  c o m m u n i c a t i o n , O c t o b e r 18, recruitment  1994).  personal  personal  With these  influences,  the small population of  Valley region.  Previous  studies of chronic c a l l e r s  c o n s i s t e n t l y experienced  small subject pools.  (1970) i d e n t i f i e d 24  P r e v e n t i o n and  1969.  callers telephoning Crisis Service.  two  Greer  chronic c a l l e r s t o the  (1976) i d e n t i f i e d 37  o r more y e a r s  Sawyer and  t o t h e San  For t h i s study,  and Suicide  Jose Suicide  telephone  c r i s i s centres.  number o f c h r o n i c c a l l e r s  9-year  identified  four  Therefore,  this  l o c a l l y c o u l d have y i e l d e d a  set of i d e n t i f i e d c h a r a c t e r i s t i c s f o r chronic c a l l e r s  and  chronic  over a  c h r o n i c c a l l e r s were  as p o t e n t i a l p a r t i c i p a n t s i n t h e r e s e a r c h by t h e  31,  chronic  J a m e t o n (1979) i d e n t i f i e d 67  o n l y 38  Fraser  have  Lester  c a l l e r s t o the Cleveland Suicide Prevention Centers  participating  the  C r i s i s S e r v i c e of E r i e County from October  t o J u n e 30,  period.  the  chronic  c a l l e r s t h a t e x i s t e d w i t h i n m e t r o p o l i t a n Vancouver and  1968,  the  opportunities for chronic callers also declined.  A l i m i t a t i o n a l s o was  Brockopp  line  Further, with  (M. Chand,  J . Rawlyns,  Crisis  small limited  to  28 telephone  crisis  intervention centres.  Also, the results of the  s t u d y may n o t g e n e r a l i z e t o o t h e r c h r o n i c c a l l e r p o p u l a t i o n s i n r e g i o n s o u t s i d e t h e Lower M a i n l a n d  and F r a s e r V a l l e y .  Definitions The  researcher  s t u d i e d those  c a l l e r s i d e n t i f i e d as chronic  c a l l e r s by t h e a d m i n i s t r a t i o n s o f t h e d i s t r e s s and c r i s i s intervention services. through a l i s t sufficient  These c e n t r e s i d e n t i f y c h r o n i c  of criteria.  No s i n g l e c h a r a c t e r i s t i c i s  foridentification.  Rather,  chronic c a l l e r s requires a combination the c r i t e r i a  callers  the identification of of factors.  Commonly,  used i n the i d e n t i f i c a t i o n o f chronic c a l l e r s are:  (1) f r e q u e n c y  of contact,  three times d a i l y ,  r a n g i n g anywhere from once w e e k l y , t o  t o three times p e r s h i f t ;  o n g o i n g c o n t a c t , u s u a l l y o v e r s e v e r a l months;  (2) d u r a t i o n o f (3) t h e r e i s a n  absence o f a c r i s i s o r emergency;  (4) t h e e v e n t o r s t r e s s o r  precipitating the c a l l i s unclear;  (5) i m m e d i a t e a c t i o n o r  d e c i s i o n making by t h e c a l l e r r a r e l y occurs; unreceptive  and r e l u c t a n t t o accept  (6) t h e p e r s o n i s  i n t e r v e n t i o n s , encouragement,  or develop a c t i o n plans; t h e r e f o r e , a s s i s t a n c e u s u a l l y i s "yes, but..."  a n d r e j e c t e d ; (7) o f t e n t h e p e r s o n c a l l s  support  a n d t o meet h i s o r h e r n e e d f o r c o n t a c t ; a n d (8) t h e  c a l l e r i s very d i f f i c u l t t o terminate  (Chimo P e r s o n a l  I n t e r v e n t i o n S e r v i c e s i n Richmond, 1993; L a n g l e y Association,  for social  Distress  Family  Services  1993). Questions  The  researcher  chose a q u a l i t a t i v e method t o i n v e s t i g a t e t h e  29  c h a r a c t e r i s t i c s of chronic c a l l e r s . q u a l i t a t i v e methodology.  On one  T h e r e a r e two  side, the  approaches t o  researchers  i n v e s t i g a t e t h e phenomenon o f i n t e r e s t w i t h a m o r e  loosely  s t r u c t u r e d , emergent, i n d u c t i v e l y "grounded" a p p r o a c h t o gathering data. conceptual  The  most i m p o r t a n t  r e s e a r c h q u e s t i o n s and  the  framework t h a t r e l a t e the v a r i o u s f a c t o r s o r v a r i a b l e s  o f t h e r e s e a r c h a r e a emerge a s t h e i n v e s t i g a t i o n p r o c e e d s . the o t h e r s i d e , r e s e a r c h e r s l o o k t o c o n f i r m and n e a r l y complete theory o r set of hypotheses.  q u e s t i o n n a i r e o r s e t i n t e r v i e w format,  expand on  They would  the i n v e s t i g a t i o n w i t h a s t r u c t u r e d instrument,  like  t o address  research questions a r i s i n g from the conceptual  start  the  specific  framework. middle  ground between the extremes of q u a l i t a t i v e methodology.  known a n d  researched.  phenomenon. Others  administrators. dated,  and  l i n e workers  on  and  that which i s current deals w i t h chronic Therefore,  caller  the research  t o "confirm" those a l r e a d y i d e n t i f i e d c h r o n i c  characteristics,  well  U n f o r t u n a t e l y , most o f t h i s i n f o r m a t i o n i s  management, n o t c h a r a c t e r i s t i c s . designed  Chronic  Some c h a r a c t e r i s t i c s a r e  are s p e c u l a t i v e , based  e x p e r i e n c e and anecdote o f c r i s i s  a  a  For t h i s study the p r i n c i p a l i n v e s t i g a t o r took the  c a l l e r s a r e n o t a new  On  was  caller  t o b u i l d on t h e e x i s t i n g r e s e a r c h , and  to  d i s c o v e r p o s s i b l e a s s o c i a t i o n s between i d e n t i f i e d c h r o n i c  caller  characteristics. From t h e o u t s e t a b a s i c c o n c e p t u a l b a s e o n c h r o n i c c a l l e r s was  framework and  information  u s e d t o draw out r e s e a r c h q u e s t i o n s .  30 The  r e s e a r c h q u e s t i o n s were framed t o seek s p e c i f i c d a t a t o  support to  and expand on t h e c h a r a c t e r i s t i c s  i n v e s t i g a t e a s s o c i a t i o n s among t h e s e  o f c h r o n i c c a l l e r s , and characteristics.  Further, because t h e research i n v o l v e d o b t a i n i n g i n f o r m a t i o n from multiple subjects, the principal questions t o c o l l e c t across subjects.  selective  i n v e s t i g a t o r wanted r e s e a r c h  and s i m i l a r data f o r comparison  H o w e v e r , o t h e r d a t a was n o t i g n o r e d t h a t w e n t  beyond t h e o r i g i n a l r e s e a r c h q u e s t i o n s , c o n t r a d i c t e d t h e o r i g i n a l c o n c e p t u a l framework, o r c h a l l e n g e d e x i s t i n g For t h e study, r e s e a r c h were:  information.  the major g l o b a l questions g u i d i n g t h e  (a) What a r e t h e i d e n t i f y i n g  chronic c a l l e r s t o telephone  crisis  characteristics  i n t e r v e n t i o n c e n t r e s ? a n d (b)  What a r e t h e p o s s i b l e a s s o c i a t i o n s b e t w e e n t h e s e characteristics  crisis  the following l i s t  questions f o rthe s p e c i f i c  intervention centres?  More  represents the basic research  i n t e r v i e w questions used i n t h e study:  1. What i s t h e r e g u l a r i t y chronic  identified  and t h e frequency and d u r a t i o n o f contact by  chronic c a l l e r s t o telephone specifically,  of  of contact with c r i s i s  lines of  callers?  2. What i s t h a t c o n t a c t l i k e f o r t h e c h r o n i c 3. What i s t h e c r i s i s  lines  1  callers?  impact on t h e c h r o n i c c a l l e r s '  lives? 4. What p u r p o s e d o e s t h e c r i s i s  l i n e serve f o rthe chronic  callers? 5. What i s t h e c h r o n i c c a l l e r s ' c o n t a c t w i t h o t h e r c o m m u n i t y services?  31 6. What h a s b e e n t h e c a l l e r s ' therapy o r other  experiences w i t h counselling,  treatment?  7. What i s t h e c h r o n i c c a l l e r s '  support network l i k e ,  both  past and present, i n v o l v i n g f a m i l y and f r i e n d s ? 8. What w e r e some m a j o r f a m i l y c h a n g e s t h a t i n f l u e n c e d t h e callers'  lives?  9. What w e r e t h e a l c o h o l a n d o t h e r d r u g h i s t o r y a n d m e n t a l health history of the callers'  families?  10. What i s t h e c h r o n i c c a l l e r s ' 1 1 . What a r e t h e c a l l e r s ' their  own m e n t a l  history?  c u r r e n t and past experiences  health?  12. What a r e t h e c a l l e r s ' around t h e i r  suicide  own s u b s t a n c e  current and past  use?  V  experiences  with  32  Method T h i s r e s e a r c h was a d e s c r i p t i v e s t u d y t h a t e x p e c t e d t o l e n d support  t o p r e v i o u s l y i d e n t i f i e d c h a r a c t e r i s t i c s and t o i d e n t i f y  further chronic c a l l e r characteristics. designed  Also, the study  t o d i s c o v e r some p o s s i b l e a s s o c i a t i o n s t h a t  between t h e i d e n t i f y i n g c h a r a c t e r i s t i c s o f c h r o n i c  was  exist  callers.  Procedure A q u a l i t a t i v e r e s e a r c h a p p r o a c h was c h o s e n t o p r o v i d e d e s c r i p t i v e depth and d e t a i l t h a t would f a c i l i t a t e t h e i d e n t i f i c a t i o n o f chronic c a l l e r c h a r a c t e r i s t i c s and t h e p o s s i b l e a s s o c i a t i o n s between these  characteristics.  Also, a qualitative  m e t h o d was u s e d t o h e l p move b e y o n d t h e u s u a l c r i s i s sheet review  line log  f o r chronic c a l l e r s and i n v e s t i g a t e these  with a r a r e l y used in-depth  callers  interview.  Telephone i n t e r v i e w s were conducted.  T h i s m e t h o d was  s e l e c t e d t o help a v o i d t h e h e s i t a n c y and r e l u c t a n c e o f c a l l e r s w i t h f a c e - t o - f a c e communication the telephone  (Murphy e t a l . , 1 9 6 9 ) .  Second,  i s t h e u s u a l a n d " n a t u r a l " c o m m u n i c a t i o n medium f o r  the chronic c a l l e r s .  The t e l e p h o n e  appropriate and comfortable interviewer over previous (Murphy e t a l . , 1 9 6 9 ) .  interview allowed  f o r a more  environment f o r t h e c a l l e r and t h e  research with in-person  Lastly,  the telephone  interviews  interview provided  f o r t h e s e c u r i t y o f t h e c a l l e r a n d t h e i n t e r v i e w e r (Murphy e t al.,  1969) .  Sampling The  first  s t e p was t o e n l i s t t h e c o o p e r a t i o n  of four  telephone region.  crisis  c e n t r e s i n t h e Lower M a i n l a n d  The p r i n c i p a l  and F r a s e r Valley-  i n v e s t i g a t o r obtained t h e i r consent  addressing t h e i r concerns  around p a r t i c i p a t i o n  i n the research.  The a d m i n i s t r a t i v e s t a f f a t t w o c e n t r e s n e g o t i a t e d conditions f o r their participation  workers.  particular  around the procedures f o r  s c h e d u l i n g s u b j e c t i n t e r v i e w s and t h e p a r t i c i p a t i o n telephone  after  of their  These c o n d i t i o n s a r e d e l i n e a t e d b e l o w where  appropriate. The n e x t  s t e p was t o o b t a i n e t h i c a l a p p r o v a l f r o m t h e  U n i v e r s i t y o f B r i t i s h Columbia. participating principal programs.  crisis  The a d m i n i s t r a t i v e s t a f f o f t h e  l i n e s p r o v i d e d consent  l e t t e r s f o r the  i n v e s t i g a t o r t o conduct the r e s e a r c h through These consent  their  l e t t e r s and t h e "Request f o r E t h i c a l  Review," i n c l u d i n g proposed p r o t o c o l s f o r r e q u e s t i n g t h e participation  o f c a l l e r s and t h e i n t e r v i e w , were sent t o t h e  B e h a v i o u r i a l S c i e n c e s S c r e e n i n g Committee f o r Research  Involving  Human S u b j e c t s a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a O f f i c e o f Research  Services.  Once t h e e t h i c a l a p p r o v a l was r e c e i v e d , t h e  " C e r t i f i c a t e o f A p p r o v a l " was p r e s e n t e d telephone  crisis  centres.  t o the  participating  The a d m i n i s t r a t i v e s t a f f a t t h e c r i s i s  l i n e s then began t o request t h e p a r t i c i p a t i o n  of their  telephone  workers. The t h i r d s t e p was t o e n l i s t t h e c o o p e r a t i o n o f t h e telephone study.  workers,  The c r i s i s  who w e r e a s k e d t o r e c r u i t  subjects f o r the  l i n e workers a t the p a r t i c i p a t i n g  c e n t r e s were a p p r o a c h e d i n two ways:  (1) b y g e n e r a l  telephone announcement  34  to a l l telephone recruiting request  workers requesting t h e i r a s s i s t a n c e i n  c h r o n i c c a l l e r s t o the study,  t o those  telephone  enough b y t h e c r i s i s callers'  1  its  p a r t i c i p a t e i n the research.  The a d m i n i s t r a t i v e  workers'  was v o l u n t a r y a t a l l c e n t r e s .  lines).  subjects  (chronic c a l l e r s t o  Those c a l l e r s i d e n t i f i e d as c h r o n i c  by t h e c r i s i s  lines' administrations' c r i t e r i a  "Definitions"  section earlier),.  sampling  The c r i s i s  i d e n t i f i e d sex c a l l e r s and those  too p s y c h i a t r i c a l l y Participating prepared  callers  were sampled (see  centres  excluded  chronic callers  telephone  workers read verbatim  Because anonymity i s an important  caller  aspect  a p r o c e d u r e was p r o v i d e d  that allowed  v i o l a t i n g the telephone  callers'  t o anonymity.  worker f i r s t  participation). provided  intervention services,  follow-up access  c a l l e r s without  (see  of the service  s u i c i d e p r e v e n t i o n and c r i s i s  rights  deemed  from a  p r o t o c o l t o introduce the study t o the c a l l e r s  by telephone  from  impaired t o p a r t i c i p a t e i n the research.  Appendix B f o r the p r o t o c o l t o request  telephone  approached  s p e c i f i c workers t o  The t e l e p h o n e  The l a s t s t e p was t o r e c r u i t the c r i s i s  the  workers f o r t h e i r  v o l u n t e e r s u s i n g b o t h methods.  s t a f f at the other centre requested  participation  skilled  A d m i n i s t r a t i v e s t a f f a t t w o c e n t r e s made  The a d m i n i s t r a t i v e s t a f f a t one c e n t r e  telephone  specific  administrations t o request  a g e n e r a l announcement t o t h e i r t e l e p h o n e assistance.  by  workers b e l i e v e d c o n f i d e n t and  centres  participation.  (2)  and  to the  v o l u n t e e r s ' and t h e  At the conclusion of the c a l l ,  a s k e d t h e c a l l e r i f he o r she h a d  the  called  35  the c r i s i s  l i n e before.  I f the c a l l e r s e l f - i d e n t i f i e d as a  r e t u r n c a l l e r , t h e worker e x p l a i n e d t h e purpose  o f the study - t o  understand b e t t e r repeat and frequent c a l l e r s and t h e i r t o t h e s e r v i c e p r o v i d e d t o them.  The t e l e p h o n e w o r k e r  t h e c a l l e r s i f t h e y were w i l l i n g t o p a r t i c i p a t e interview later outside the c r i s i s  centre  When c a l l e r s a g r e e d t o p a r t i c i p a t e ,  response then  asked  i na telephone  environment. they negotiated an  a v a i l a b l e i n t e r v i e w t i m e , g a v e a name f o r t h e i n t e r v i e w , a n d a r r a n g e d who w o u l d t e l e p h o n e whom a t t h e t i m e o f t h e i n t e r v i e w . When n o i n t e r v i e w t i m e c o u l d b e s c h e d u l e d f r o m t h o s e  available,  t h e t e l e p h o n e worker gave t h e c a l l e r s t h e p r i n c i p a l i n v e s t i g a t o r ' s t e l e p h o n e number a n d a s k e d t h e m t o a r r a n g e a n interview directly.  I f t h e c a l l e r s agreed t o be c o n t a c t e d f o r  the interview, t h e c r i s i s  l i n e worker  t o o k a t e l e p h o n e number  where t h e c a l l e r c o u l d be r e a c h e d f o r t h e i n t e r v i e w .  I f callers  agreed t o contact t h e research i n t e r v i e w e r themselves a t t h e i n t e r v i e w t i m e , t h e w o r k e r g a v e t h e m t h e t e l e p h o n e number f o r t h e contact.  The t e l e p h o n e w o r k e r r e c o r d e d a l l t h i s i n f o r m a t i o n o n  the i n t e r v i e w schedule sheet. One  crisis  l i n e ' s a d m i n i s t r a t i o n was u n c o m f o r t a b l e w i t h  scheduling interview times f o r subjects.  /Another c r i s i s  a d m i n i s t r a t i o n c o u l d n o t communicate t h e c h r o n i c c a l l e r schedule t o a l l t h e i r p a r t i c i p a t i n g  interview  telephone workers and  d e c l i n e d booking interview times f o r t h e c a l l e r s . crisis  centre's  F o r these  lines, theprotocol for requesting the callers'  participation  was a l t e r e d  (see A p p e n d i x  C for the revised  36 p r o t o c o l t o request  caller participation  workers scheduling i n t e r v i e w s ) .  without  the  telephone  The p r o t o c o l e x c l u d e d t h e  scheduling o f i n t e r v i e w s and i n c l u d e d g i v i n g out t h e p r i n c i p a l i n v e s t i g a t o r ' s telephone  number s o t h a t t h e c a l l e r s c o u l d  arrange  the i n t e r v i e w d i r e c t l y . Caller  Participation  The f o u r p a r t i c i p a t i n g 38 p o t e n t i a l l y Mainland  different  telephone  centres  identified  c h r o n i c c a l l e r s w i t h i n t h e Lower  and Fraser V a l l e y area.  t h a n one c r i s i s  crisis  Those c a l l e r s  l i s t e d b y more  l i n e were c o u n t e d o n l y once, assuming t h a t t h e  c a l l e r s u s e d t h e same name t o i d e n t i f y t h e m s e l v e s a t t h e v a r i o u s centres. crisis  A l l these  individuals  were c u r r e n t c a l l e r s t o t h e s e  lines.  Sixteen participate telephone  (42%) o f t h e 38 c a l l e r s w e r e n o t r e q u e s t e d i n the research.  the participating  subject recruitment, telephone  participate  d i d not  lines during the period of  o r t h e y were m i s s e d b y  participating  recruitment.  (58%) o f t h e 38 c a l l e r s w e r e r e q u e s t e d  i n the research.  participate.  Three o f these  to  callers declined to  Three o t h e r c a l l e r s were u n c e r t a i n whether  would p a r t i c i p a t e .  The r e m a i n i n g  to participate  Nine o f these principal  crisis  workers f o r subject  Twenty-two  requested  These c a l l e r s e i t h e r  to  sixteen callers  they  (42%) t h a t w e r e  a g r e e d t o be. i n t e r v i e w e d f o r t h e s t u d y .  16 c a l l e r s c o m p l e t e d t h e c o n t a c t w i t h t h e  i n v e s t i g a t o r f o r an i n t e r v i e w .  was n o t a p p r o p r i a t e .  One o f t h e s e  This c a l l e r i n d i c a t e d a severe  callers psychiatric  37 impairment  and s u f f i c i e n t sex c a l l e r c h a r a c t e r i s t i c s  excluded from t h e study.  Eight callers  t o be  (21%) o f t h e 38  potential  c a l l e r s were i n t e r v i e w e d and i n c l u d e d i n t h e r e s e a r c h d a t a Data  base.  Collection I n i t i a l l y d a t a c o l l e c t i o n began by n e g o t i a t i n g access t o  four telephone in recruiting  crisis callers  centres.  The t e l e p h o n e w o r k e r s  interested  f o r the study had the purpose o f the study  e x p l a i n e d t o them i n - p e r s o n and t h r o u g h i n f o r m a t i o n s h e e t s . telephone  c o u n s e l l o r s , who a g r e e d t o p a r t i c i p a t e ,  received the  protocol f o r presenting the request f o r p a r t i c i p a t i o n callers.  of return  They t h e n reviewed and p r a c t i c e d t h e p r o t o c o l .  t h e i r telephone  shift,  The  Once o n  the worker read the p r o t o c o l verbatim t o  their centre's i d e n t i f i e d chronic c a l l e r s , asking the callers f o r their participation.  I f c a l l e r s agreed t o p a r t i c i p a t e ,  the  telephone worker scheduled an i n t e r v i e w time o r gave t h e c a l l e r s a t e l e p h o n e number t o b o o k a n i n t e r v i e w t i m e t h e m s e l v e s . c a l l e r s d i d not wish t o participate, c a l l e r ' s desire not to participate  I f the  the worker recorded the so other workers  d i d not ask  the c a l l e r again. The p r i n c i p a l  i n v e s t i g a t o r conducted  contacted, the p a r t i c i p a t i n g  the interviews.  Once  c a l l e r s again had the purpose o f the  s t u d y e x p l a i n e d t o them a n d t h e i r d e s i r e t o p a r t i c i p a t e  confirmed  (see A p p e n d i x D f o r t h e p r o t o c o l t o c o n f i r m c a l l e r participation). The c a l l e r s w e r e a s k e d t o r e s p o n d s t a n d a r d i z e d i n t e r v i e w format.  t o questions from  a  The i n t e r v i e w q u e s t i o n s w e r e  38  d e r i v e d i n i t i a l l y from g e n e r a l assessment i n t e r v i e w previous personnel  chronic c a l l e r research, of the crisis  lines.  formats,  and t h e a d m i n i s t r a t i o n  From a d i a l o g u e w i t h t h e c r i s i s  l i n e s ' administrations and information on q u a l i t a t i v e interviewing  (Patton, 1990), a n i n i t i a l  standardized  interview  format r e s u l t e d . The r e s e a r c h e r  role-played the protocols and i n t e r v i e w  format t o p r e t e s t t h e items  a n d t r y t o a n t i c i p a t e how a c t u a l  c a l l e r s might r e a c t t o t h e procedure.  C h a n g e s w e r e made a s a  r e s u l t o f t h e p r e t e s t i n t h e i n t e r v i e w p r o t o c o l s and standardized i n t e r v i e w format.  Some q u e s t i o n s  were reworded f o r c l a r i t y .  i n t e r v i e w p r o t o c o l a l s o was s h o r t e n e d  The  t o reduce t h e p o s s i b i l i t y  of subject fatigue during interviewing. A one-subject the questions  pilot  s t u d y was t h e n c o n d u c t e d t o t e s t f u r t h e r  and t h e i n t e r v i e w p r o t o c o l length w i t h an a c t u a l  caller.  A s a r e s u l t o f t h e t e s t i n t e r v i e w , o n e q u e s t i o n was  modified  f o r g r e a t e r ease o f understanding  by c a l l e r s and t o ask  more c l e a r l y t h e i r r e a s o n s f o r c o n t a c t i n g c r i s i s other follow-ups  o r sub-questions  lines.  Three  were e l i m i n a t e d w h i c h y i e l d e d  n o i n f o r m a t i o n o r seemed t o o c o n f u s i n g .  Lastly,  t h e scheduled  i n t e r i m summaries were dropped from t h e i n t e r v i e w p r o t o c o l t o reduce t h e i n t e r v i e w time. Questions on the f i n a l F i r s t was t h e c a l l e r s ' frequency  and nature  i n t e r v i e w format a d d r e s s e d two a r e a s .  experiences  with crisis  line services: the  o f t h e i r contacts, and t h e i r experience and  c o n t a c t s w i t h o t h e r community s e r v i c e s .  S e c o n d was t h e i r  life  39  experience:  mental h e a l t h and substance use, t h e i r  support  network o f f a m i l y and f r i e n d s , and a b r i e f h i s t o r y o f major family events  (see Appendix E f o r s t a n d a r d i z e d  interview  format). A request callers.  was made t o t a p e r e c o r d t h e i n t e r v i e w s w i t h t h e  Notes a l s o were t a k e n w i t h t h e s t a n d a r d i z e d  format as guide.  B e c a u s e some c a l l e r s d e c l i n e d t o b e  t h e s e n o t e d were " f l e s h e d o u t " a t t h e c o m p l e t i o n and  t r a n s c r i b e d f o r data a n a l y s i s .  interview taped,  of the interview  I f the c a l l e r agreed t o tape  r e c o r d i n g , t h e i n t e r v i e w was t r a n s c r i b e d f o r l a t e r d a t a a n a l y s i s . V a l i d a t i o n o f Interview Data The v a l i d i t y a n d q u a l i t y o f t h e i n t e r v i e w d a t a w e r e c h e c k e d with the callers. to  A l l 8 subjects agreed t o a follow-up  check t h e accuracy  the researcher scheduled  of the information provided.  telephoning  them.  The o t h e r t w o  a p h o n e b a c k t i m e when t h e y c o n t a c t e d  The r e s e a r c h e r o n l y o b t a i n e d  follow-up  interview information with 5 subjects.  S i x agreed t o  subjects the researcher.  confirmation of the  One s u b j e c t c o u l d n o t b e  reached; another d i d not complete the scheduled remaining  contact  c a l l back.  The  s u b j e c t c o m p l e t e d t h e c a l l b a c k , b u t was i n t h e m i d s t  of dealing w i t h a personal  crisis,  and c h o s e n o t t o do t h e  follow-up check o f the i n t e r v i e w data. The r e s e a r c h e r r e a d t o t h e s u b j e c t s a d e t a i l e d summary a t t h e f o l l o w - u p .  interview  The s u b j e c t s w e r e a s k e d t o a d d o r  c o r r e c t a n y i n f o r m a t i o n f r o m t h e summary. All  c a l l e r s were v e r y d i r e c t and e x a c t i n g t o c l a r i f y and  40 c o r r e c t a n y i n f o r m a t i o n t h a t was n o t p r e c i s e t o t h e i r All  experience.  c a l l e r s p r o v i d e d a d d i t i o n a l i n f o r m a t i o n t o e n l a r g e o n some  p o i n t s i n t h e i r summaries.  No more t h a n t h r e e p o i n t s i n a n y one  summary n e e d e d c o r r e c t i o n s o r c l a r i f i c a t i o n .  Overall, a l l  s u b j e c t s s a i d t h e summaries were a c c u r a t e a n d r e f l e c t e d what had  they  said. Data A n a l y s i s Because t h e i n v e s t i g a t i o n o f c h r o n i c c a l l e r  started with the previous research findings,  characteristics  the q u a l i t a t i v e  r e s e a r c h method needed had t o p r o v i d e f o r t h e c o n f i r m a t i o n o f p r e v i o u s a s w e l l a s t h e d i s c o v e r y o f new c h r o n i c characteristics.  caller  The q u a l i t a t i v e m e t h o d w a n t e d a l s o h a d t o b e g i n  data a n a l y s i s w i t h the standardized i n t e r v i e w questions. F u r t h e r , t h e method o f d a t a a n a l y s i s w o u l d need t o p r o v i d e structured,  systematic approach t o f i n d r e g u l a r i t i e s  a  across  m u l t i p l e s u b j e c t s f r o m t h e l a r g e amount o f i n t e r v i e w d a t a . Lastly,  t h e d a t a a n a l y s i s m e t h o d u s e d n e e d e d t o p r o v i d e a means  t o compare t h e e m e r g i n g r e g u l a r i t i e s w i t h one a n o t h e r  to discover  p o s s i b l e a s s o c i a t i o n s among them, a l l o w i n g f o r t h e d i s p l a y o f these r e l a t i o n s h i p s .  M i l e s a n d Huberman's  (1984) m e t h o d o f  q u a l i t a t i v e a n a l y s i s b e s t f i t t h e needs o f d a t a  analysis.  M i l e s a n d Huberman (1984) b e g i n t h e i r r e s e a r c h w i t h a g e n e r a l c o n c e p t u a l framework developed of the research area.  from t h e c u r r e n t knowledge  From t h e framework t h e y d r a f t a s e t o f  research questions t o guide the i n v e s t i g a t i o n .  Using both the  framework and r e s e a r c h q u e s t i o n s , t h e y t h e n d e v e l o p  a  41 p r e s t r u c t u r e d format questions.  f o r data c o l l e c t i o n ,  They t h e n use  such as i n t e r v i e w  the p r e s t r u c t u r e d format  s e r i e s o f s t a r t - u p codes f o r a n a l y z i n g d a t a as the collection  t o develop data  proceeds.  M i l e s a n d Huberman (1984) e n g a g e i n d a t a a n a l y s i s three simultaneous  currents of a c t i v i t y :  through  data reduction, data  d i s p l a y , and c o n c l u s i o n d r a w i n g / v e r i f i c a t i o n .  F o r them d a t a  reduction begins w i t h the coding of the data t o i d e n t i f y themes.  a  The  emerging  purpose i s t o b r i n g t o g e t h e r the volume o f d a t a i n  a n e f f i c i e n t a n d more m a n a g e a b l e way,  s y n t h e s i z i n g and  drawing  t o g e t h e r t h e most r e l e v a n t a s p e c t s o f t h e i n f o r m a t i o n .  While  c o d i n g , t h e y u s e m a r g i n a l comments t o r e c o r d t h e i r r e a c t i o n s a n d thoughts  about the data.  L a t e r memos a r e w r i t t e n t o s t a r t  to  c o m b i n e t h e i n f o r m a t i o n b i t s i n t o l a r g e r a n d more e n c o m p a s s i n g concepts, p a t t e r n s and  associations.  Data d i s p l a y takes the reduced  chunks o f i n f o r m a t i o n and  shows t h e m b y c o d e , theme o r p a t t e r n a c r o s s a l l s u b j e c t s . data i n t h i s stream of a n a l y s i s i s f u r t h e r reduced i n t o d i s p l a y f o r m a t s w h e r e new  and  The  rendered  p a t t e r n s , themes o r a s s o c i a t i o n s  b e t w e e n t h e d i f f e r e n t v a r i a b l e s c a n be v i e w e d  at a glance.  The  r e s e a r c h e r s use m a t r i c e s t o o r d e r the i n f o r m a t i o n b i t s  into  grids.  display  all  They would s t a r t w i t h unordered  the reduced  information.  meta-matrix  to  d a t a and b e g i n a d e s c r i p t i v e a n a l y s i s o f  the  T h e y w o u l d move t h r o u g h v a r i o u s l e v e l s o f o r d e r  analysis, eventually to a subject-ordered  and  predictor-outcome  m a t r i x t o b e g i n an i n f e r e n t i a l l e v e l of a n a l y s i s .  At t h i s point  42 t h e y w o u l d d i s c o v e r what f a c t o r s / v a r i a b l e s c o v a r y w i t h  other  factors/variables. Data d i s p l a y a l s o would i n c l u d e causal networks.  Causal  networks l i n k together the d i f f e r e n t v a r i a b l e s i n t o a c h a i n events,  a c t i v i t i e s and p r o c e s s e s  of  influencing or i n i t i a t i n g  one  another. In the remaining  data a n a l y s i s stream of  conclusion  d r a w i n g / v e r i f i c a t i o n , M i l e s a n d Huberman (1984) g e n e r a t e from t h e d a t a and  t e s t or confirm the f i n d i n g s .  meaning  They employ  several s t r a t e g i e s f o r generating conclusions from  the  i n f o r m a t i o n , moving the a n a l y s i s from d e s c r i p t i o n t o e x p l a n a t i o n , and  from the concrete  abstraction. and  t o h i g h e r l e v e l s c o n c e p t u a l i z a t i o n and  N o t i n g p a t t e r n s and  plausibility,  c l u s t e r i n g helps the researchers d i s c o v e r which i n f o r m a t i o n  groups w i t h o t h e r data. general category, and  themes, s e e i n g  Subsuming p a r t i c u l a r d a t a chunks i n t o  a  f a c t o r i n g , n o t i n g r e l a t i o n s between v a r i a b l e s ,  finding intervening variables f a c i l i t a t e s i n generating  h i g h e r l e v e l s o f a b s t r a c t i o n and i n the data.  the discovery of r e l a t i o n s h i p s  L a s t l y , b u i l d i n g a l o g i c a l chain of evidence  the r e s e a r c h e r assemble a coherent The  r e s e a r c h e r s use  understanding  Drawing c o n t r a s t s  comparisons, c h e c k i n g the meaning o f e x c e p t i o n s  confirm  and  i n the data,  and  t e s t s t h e c o n c l u s i o n a b o u t a p a t t e r n o r theme  by d e s c r i b i n g what t h e c o n c l u s i o n i s n o t spurious r e l a t i o n s ,  data.  s p e c i f i c s t r a t e g i e s t o t e s t and  the v e r a c i t y of the conclusions.  u s i n g extreme cases  of the  helps  like.  Ruling  out  c h e c k i n g out r i v a l e x p l a n a t i o n s , and  looking  43 for negative  evidence allows the researchers  to confirm findings  a g a i n s t o p p o s i n g f a c t s and v i e w s from t h e d a t a .  Finally,  Miles  a n d Huberman (1984) e n c o u r a g e t h e c y c l i n g b a c k o f t h e f i n d i n g s t o the s u b j e c t s t o check the v a l i d i t y of the Data  results.  Reduction The  content  s u b j e c t e d t o an  from the chronic c a l l e r s ' initial  emerging p a t t e r n s and directly  interviews  coding procedure t h a t sought t o  themes.  codes used).  (see A p p e n d i x F f o r  final  initial  A few  s t a r t - u p c o d e s w e r e c h a n g e d , s u c h a s CALL-PUR  E a c h c o d e was  purpose i n phoning the c r i s i s l i n e ) . CALL-GETS t o b e t t e r r e f l e c t  not  identify  These s t a r t - u p codes were d e r i v e d  from the i n t e r v i e w questions  what t h e c a l l e r s  was  the  operationally defined.  T h i s c o d e was  t h e f a c t t h e c o d e was  (the  callers'  changed t o  u s e d t o mark  r e c e i v e d from c o n t a c t i n g the c r i s i s l i n e s ,  the concerns the c a l l e r s  Other codes were d i s c a r d e d ,  telephoned  the c r i s i s l i n e s  s u c h a s CLR-AP  (callers'  and  over.  appreciation  o f c r i s i s l i n e s ) , because t h e y were i n f r e q u e n t l y u s e d o r were subsumed i n t o o t h e r c o d e s . POS:  what t h e c a l l e r s  line.)  (CLR-AP was  l a t e r encompassed by  found h e l p f u l o r p o s i t i v e about c r i s i s  Some c o d e s w e r e a d d e d , s u c h a s THPY-ABU  experiences  o f abuse i n therapy,  (callers'  counselling or treatment),  t h e p a t t e r n s o r themes emerged f r o m t h e i n t e r v i e w d a t a . Figure 1 f o r i l l u s t r a t i o n s of i n i t i a l Marginal proceeded  codes and  as  (See  coding.)  remarks n o t e d p o s s i b l e themes o r p a t t e r n s as  (see F i g u r e 1 f o r an i l l u s t r a t i o n ) .  word " i s o l a t i o n "  was  LN-  w r i t t e n beside  coding  F o r example,  a subject's statement  the  "...and  44 Figure  1  Data Reduction:  Illustration  of Techniques  Marginal  I n i t i a l Codes  Remarks  p h y s i c a l l y o r f i n a n c i a l l y do an a w f u l l o t ; so t h a t my r e g u l a r c o n t a c t I have w i t h p e o p l e e v e r y day i s on c r i s i s l i n e s . . S '^e/ ° s i n c e y o u c a n , t 9 ' y° aontaot w i t h people ' / ' i s b a s i c a l l y on t h e c r i s i s l i n e s ? Yeah. e t  o  u  t  a  l  o  t  u r  Callers Reactions - Likee and Dislikes - about Crisis Lines 3. Now t h a t we t a l k e d about y o u r u s u a l c a l l t o t h e c r i s i s l i n e , overall... a. What do y o u l i k e about c r i s i s l i n e s ? I l e a r n e d i t was okay t o be m y s e l f . When I f i r s t s t a r t e d c a l l i n g them, I was anonymous. And j u s t I had a l o t o f problems i n l i f e because I had been abused a l l l i f e . And I had always rays been t o l d i f anybody e v e r knew t h e r e a l me, t h e y wouldn't me. But I was i n s u c h b a d shape when I f i r s t s t a r t e d c a l l i n g , " and I t h i n k I was t a k i n g o f f everybody's head when I phoned and -fi"6^ e v e r y t h i n g , and t h e y were a l l j u s t so n i c e about i t . L i k e nobody \'\V\^^ took i t p e r s o n a l l y . And once t h e y was t h a t s i d e o f me, I j u s t d i d n ' t have t o h i d e anymore. I j u s t l e a r n e d i t was okay t o be myself. Once I calmed down and wasn't s u i c i d a l anymore, i t wasn't l i k e I had t o p r e t e n d I was somebody I wasn't because t h e s e were p e o p l e I was n e v e r g o i n g t o meet. t  So t h a t anonymous n a t u r e a l l o w e d y o u t o | t h e y a c c e p t e d y o u f o r who y o u were, and i t t h a t was l i f t e d . Yeah. I guess you mentioned t h e abuse and c r i s i s l i n e t r e a t you, "Hey, I'm n o t s t i g m myself." Yeah.  P a t t e r n Codes  Memoing  r  45  I c a n ' t p h y s i c a l l y o r f i n a n c i a l l y do regular contact  an a w f u l  I have w i t h p e o p l e e v e r y day  l o t ; so t h a t i s on  crisis  Some m a r g i n a l comments w e r e l a t e r u s e d a s a g u i d e t o d a t a t h a t was researcher like and  elaborated  f u r t h e r i n memos.  l a t e r explored  " l a b e l l e d and "family outcast  my lines."  interview  For example,  the  i n t e r v i e w d a t a w i t h m a r g i n a l comments  d i s c r e d i t e d : v i c t i m i z a t i o n , " "powerlessness," and  v i c t i m " i n a l a r g e r theme o f  "Caller  victimization." Memoing  (memos) b r o u g h t t o g e t h e r  b i t s of information  c a l l e r s t h a t a l l u d e d t o a p o s s i b l e theme o r p a t t e r n f o r an  illustration).  self-acceptance  mentions esteem b u i l d i n g t h r u acceptance t h r u c r i s i s  [sic] c r i s i s  line.  [sic] v a l i d a t i o n &  f o r r i c h e x p l o r a t i o n of the  Person T  also  [sic] s e l f -  O t h e r memos w e r e t h o r o u g h f a r e s  interview data.  " C a l l e r s f e e l i n g p o w e r l e s s t o move on,  For  f e e l have  c o n t r o l / i n f l u e n c e o v e r t h e i r environments and  they b u i l d c a l l e r s '  [sic]  lines."  Some memos w e r e d e a d e n d s .  lines for direction.  (see F i g u r e  F o r example, "Esteem b u i l d i n g t h r u  of c a l l e r thru  across  When c r i s i s  example, no  contact  l i n e s empower a n d  esteem so t h e y t a k e p e r s o n a l  crisis  encourage,  action."  This  memo l e d t o t h e d e v e l o p m e n t o f t h e p a t t e r n c o d e " C a l l e r empowerment a n d codes used.  esteem b u i l d i n g . "  Also,  see  Figure  (See A p p e n d i x G f o r  1 f o r an  i l l u s t r a t i o n of  pattern pattern  coding.) V a l i d a t i o n of Data Coding The  p r i n c i p a l i n v e s t i g a t o r u s e d two  other  data coders  to  1  46 check the v a l i d i t y of d a t a coding. previous c r i s i s  l i n e experience.  Data coders were chosen w i t h However, b o t h d a t a c o d e r s  not v o l u n t e e r e d f o r a telephone c r i s i s c e n t r e f o r over  had  three  years. The  principal  i n v e s t i g a t o r and d a t a c o d e r s compared coded  segments o f c a l l e r s ' i n t e r v i e w s .  The p r i n c i p a l  investigator  and  data coders began w i t h the f i r s t s u b j e c t ' s i n t e r v i e w d a t a .  A  d i a l o g u e was  and  e s t a b l i s h e d between the p r i n c i p a l  investigator  the d a t a coders t o r e v i e w and c l a r i f y the d a t a codes Working through t o the l a s t s u b j e c t ' s i n t e r v i e w , a u n d e r s t a n d i n g o f t h e d a t a c o d e s was Initial first  similar  c r e a t e d and t h e n m a i n t a i n e d .  intercoder r e l i a b i l i t i e s  i n t e r v i e w s coded.  used.  were d e t e r m i n e d  f o r the  Final intercoder r e l i a b i l i t i e s  were  determined w i t h the l a s t i n t e r v i e w s coded. The initial  principal  intercoder r e l i a b i l i t y  reliability The initial  i n v e s t i g a t o r and t h e f i r s t d a t a coder had o f 68% t o 7 3 % .  e v e n t u a l l y r a n g e d f r o m 82% t o  reliability  ranged  from 85% t o  fall  M i l e s a n d Huberman  i n v e s t i g a t o r had  o f 7 7 % t o 80%.  an  Final intercoder  87%.  T h o u g h w i t h i n t h e 80 p e r c e n t r a n g e , reliabilities  Intercoder  86%.  second d a t a coder and the p r i n c i p a l intercoder r e l i a b i l i t y  an  the i n t e r c o d e r  s h o r t o f t h e 90 p e r c e n t r a n g e  recommended b y  (1984).  Data D i s p l a y : M a t r i c e s O v e r a l l d a t a d i s p l a y began w i t h an unordered m a t r i x d i s p l a y i n g reduced data i n each c e l l  (massive)  meta-  of a "caller-by-coded  47 question" grid.  Data a n a l y s i s proceeded from here b y s o r t i n g a l l  the i n f o r m a t i o n b i t s w i t h i n a code a c r o s s a l l s u b j e c t s on f l i p chart paper on a w a l l .  Where a p p r o p r i a t e , b r o a d e r c a t e g o r i e s ,  s u c h a s " C r i s i s L i n e : P o s i t i v e a s p e c t s " w e r e u s e d t o subsume s m a l l e r , more l i m i t e d c a t e g o r i e s , s u c h a s " C r i s i s  line  recognition of caller:  P o s i t i v e aspects" and " C r i s i s l i n e non-  recognition of caller:  Positive aspects."  i n t e r v i e w d a t a was f u r t h e r r e d u c e d  I n t h i s manner t h e  and displayed.  Once t h e i n t e r v i e w d a t a was d i s p l a y e d , i n f o r m a t i o n b i t s connected  a n d combined a s e m e r g i n g p a t t e r n s a n d themes a p p e a r e d  i n t h edata. used.  " C a l l e r - b y - c o n c e p t u a l c l u s t e r " m a t r i c e s now w e r e  F o r example, "Mental h e a l t h : N e g a t i v e , "  Negative"  were  "Physical health:  a n d "Therapy: N e g a t i v e " were combined i n t o a c a t e g o r y  of "Helping: Negative."  "Mental h e a l t h : P o s i t i v e , " " P h y s i c a l  h e a l t h : P o s i t i v e " a n d "Therapy: P o s i t i v e " were combined i n t o a category o f "Helping: P o s i t i v e . " experience"  The c a t e g o r i e s o f " H e l p i n g  t h e n were brought t o g e t h e r i n a c o n c e p t u a l l y  clustered matrix o f "caller-by-helping p r o f e s s i o n experience" t o juxtapose those data r e f l e c t i n g t h e c a l l e r s ' helping professions.  experiences  with  (See F i g u r e 2 f o r a n i l l u s t r a t i o n o f a  c a l l e r by conceptual c l u s t e r  matrix.)  D a t a d i s p l a y c o n t i n u e d u s i n g e a r l i e r memos f r o m t h e d a t a r e d u c t i o n stream.  T h e s e memos w e r e f u r t h e r d e v e l o p e d a n d  investigated f o r possible patterns across a l l subjects. I n f o r m a t i o n b i t s were combined i n t o f u r t h e r c o n c e p t u a l  clusters,  such as " V i c t i m i z a t i o n : Neglect" and " V i c t i m i z a t i o n : A c t i v e  48 Figure 2 C a l l e r by Conceptual Cluster Matrix: An I l l u s t r a t i o n  Caller  Mental Health Positive  Physical Health Positive  Therapy Positive  Helping - Positive  Mental Health Negative  Physical Health Negative  Therapy Negative  Helping - Negative  -doctor believed not mentally i l l ; wouldn't commit to hospital -challenged doctor i n manicdepression support group  -uneasy with helping professionals; can't t e l l them what wants t o -committed 3 times by family -doctors say follow my instructions o r won't get better -health professional just treat symptoms; don't look at background  L  - w i l l t e l l nurses they're doing too much -too much mental health, but helpful -stand ground with doctor to get what wants  -mental health treats c a l l e r like child -nurses do too much f o r c a l l e r - y e l l e d at by mental health worker -doctor refuses t o address medical needs  N  -support groups very h e l p f u l : can express emotions t o people who know what c a l l e r going through  - p s y c h i a t r i s t not h e l p f u l -support groups l i m i t e d support; c a l l e r not ready to change yet  Y  -mental health teams not supportive; only p i l l s given  - p s y c h i a t r i s t most supportive; treats c a l l e r l i k e a queen  R  -doing a l o t of good work with counsellor on emotions, etc  -counsellor didn't l i s t e n : burnt out -counsellor uncomfortable with c a l l e r ' s issues -expensive; l i m i t e d low cost service a v a i l a b l e  S  -reported abusive therapists to r e f e r r a l sources; therapists removed from l i s t s -some therapy empowering; found safety & understanding of abusive family h i s t o r y - v a l i d a t i o n & reassurance through therapists -treated as equal by therapist  - c o n f i d e n t i a l i t y breached by mental health -history of 5 abusive & inappropriate therapists -trusted & worked well with one therapist, who turned on c a l l e r with severe abuse -mental health t r i e s to keep c a l l e r i n t h e i r system of care -professionals t r y to cover up for one another -too much power i n the medical & mental health systems  T  continued  49 Figure  2  C a l l e r by  Caller  Conceptual Mental Health Positive  C l u s t e r M a t r i x : An Physical Health Positive  Helping  Therapy Positive  - Positive •  Illustration  Mental Health Negative  (continued)  Physical Health Negative  Helping  -  Therapy Negative  Negative  M  -support group good to t a l k with others i n s i m i l a r situation  -mental health very busy -lousy counselling from psychiatrist - r e l i g i o u s groups l i m i t e d help  P  -learned to take on own pass on others  -some counsellors not approachable; they can't r e l a t e or communicate -counsellor says lack of connection r e s p o n s i b i l i t y of caller  stuff &  Example m a t r i x : " C a l l e r by H e l p i n g P r o f e s s i o n E x p e r i e n c e . " " H e l p i n g - p o s i t i v e " and " h e l p i n g - n e g a t i v e " c o n c e p t u a l c l u s t e r s .  50 /Abuse." across  These c l u s t e r s , o r  emerging p a t t e r n s , were a p p l i e d  t h e i n i t i a l b r o a d c a t e g o r i e s t o combine the d i s c r e t e b i t s  o f i n f o r m a t i o n i n t o l a r g e r emerging, g l o b a l themes, s u c h "Victimization." connection,  Eventually, four leitmotifs  i s o l a t i o n and  o u t l i n e d i n the The  - victimization,  esteem - emerged f r o m t h e  c l u s t e r i n g of the c a l l e r s '  i n t e r v i e w data.  "Results"  (The  f u r t h e r r e d u c e d and  using caller-ordered descriptive matrices.  leitmotifs  displayed  "Callers'  as d e f i n e d by t h e c u r r e n t f r e q u e n c y l i n e s , was  " C h r o n i c i t y and  Callers'  of  telephone  Callers'  t h e n were b u i l t .  o t h e r drug use  illness i n callers'  callers'  b i r t h order  in callers'  family of o r i g i n ,  abuse i n t h e i r f a m i l i e s ,  callers'  For  Family Background" m a t r i x  constructed u s i n g the c a l l e r v a r i a b l e s of telephoning a l c o h o l and  by  the major c a l l e r v a r i a b l e used.  c h r o n i c i t y by...." m a t r i c e s  example, a  are  C a l l e r c h r o n i c i t y was  the main v a r i a b l e of i n t e r e s t f o r data a n a l y s i s .  contact with c r i s i s  continued  section.)  i n t e r v i e w d a t a was  chronicity,  as  frequency,  f a m i l y of o r i g i n , callers'  mental  experience  of  role(s) i n their families,  i n t h e i r family of o r i g i n .  was  (See F i g u r e  and 3  f o r an i l l u s t r a t i o n o f a c a l l e r - o r d e r e d d e s c r i p t i v e m a t r i x . ) Some o f t h e s e  comparisons y i e l d e d nothing,  c h r o n i c i t y by mental i l l n e s s p a t t e r n s were d i s c o v e r e d . or interesting patterns. a l c o h o l and all  o t h e r drug use  i n callers'  such as  "callers'  f a m i l y of o r i g i n "  Other comparisons produced F o r example, " c a l l e r s ' i n callers'  -  no  significant  c h r o n i c i t y by  family of o r i g i n "  c a l l e r s coming from an a l c o h o l i c o r o t h e r drug  showed  addicted  51 Figure 3 Caller-Ordered Descriptive Matrix: An I l l u s t r a t i o n Family  - A & D  Family - Mental Health  Caller  Frequency  S  4/day  -mother drank too much - c a l l e r sent t o p s y c h i a t r i s t t o get p i l l s f o r mother  -mother sent c a l l e r to p s y c h i a t r i s t as the i d e n t i f i e d patient  T  2/day  -alcoholic father; personality varied by l e v e l of i n t o x i c a t i o n -scary incidents  - c a l l e r was the i d e n t i f i e d patient; committed by family several times -does say family dysf unct ional  P  4-5/week  R  d a i l y or 12/week  -mother never drank, but into tranquilizers f o r awhile - s i b l i n g has drinking problem  -mother may have had nervous breakdown when c a l l e r born -grandmother kind of out of i t when l i v i n g with family  N  3-4/week  -father a l c o h o l i c & mother caught up i n it - c a l l e r believes parents never r e a l l y cared because into alcohol  -nothing mentioned  Y  3/week  -father had drinking problem i n past; abusive - s i b l i n g also drinking problem i n past  -nothing mentioned  L  8-12/month  - t o l d by others that father had a alcohol problem - s i b l i n g s took a l o t of drugs at home  -parents sick mentally; put a l l c h i l d r e n into mental health i t seems -dysfunctional family: too many secrets  - i d e n t i f i e d patient -father's drinking and blame game i n the and mother wanted c a l l e r committed family -victimized by father's drinking  continued  52 Figure 3 Caller-Ordered  D e s c r i p t i v e M a t r i x : /An I l l u s t r a t i o n  Caller  Frequency  M  3-5/month  (continued)  - A & D  Family - Mental Health  -whole family with drinking problems & h i d i t from one another  -father "psychotic" -mother emotional wreck; very emotionally l a b i l e  Family  Example m a t r i x : " C a l l e r s ' C h r o n i c i t y b y C a l l e r s ' F a m i l y Background." Caller-ordered by " c a l l e r s ' telephoning frequency." "Family-alcohol and other drug h i s t o r y " and "family-mental h e a l t h history" descriptive variables.  53 f a m i l y background.  Also,  "callers'  c h r o n i c i t y by  callers'  o v e r a l l experience with therapy or treatment" suggested tendency f o r higher frequency c a l l e r s experiences with  the h e l p i n g  professions.  comparisons showing emerging p a t t e r n s data analysis Not  t o have had  a  more n e g a t i v e  A l l variable  o r themes were e x p l o r e d  as  proceeded.  a l l c a l l e r - o r d e r e d d e s c r i p t i v e m a t r i c e s were u s e f u l .  When c a l l e r s ' contact with  c h r o n i c i t y was crisis  m a t r i c e s y i e l d e d no variables.  No  lines,  defined  by  the years of  these caller-ordered  ongoing  descriptive  c l a r i f y i n g o r b e n e f i c i a l comparisons between  f u r t h e r understanding of the  information  was  produced. O t h e r c a l l e r - o r d e r e d d e s c r i p t i v e m a t r i c e s became c e n t r a l further data analysis. the  current  When c a l l e r s '  c h r o n i c i t y , as  frequency of telephone contact with  t h e m a i n v a r i a b l e , many v a l u a b l e were produced. themes i n t h e e x p l o r e d and  The data.  crisis  comparisons between  researcher discovered These p a t t e r n s  and  defined  to by  lines,  was  variables  additional patterns  and  themes t h e n were  further  expanded i n the next l e v e l of a n a l y s i s w i t h  display  matrices. D a t a d i s p l a y now matrices. be  A s k i n g the p r e d i c t i o n question,  associated  lines?,"  moved t o c a l l e r - o r d e r e d  "What f a c t o r s seem t o  w i t h more o r l e s s c o n t a c t w i t h  data a n a l y s i s proceeded with  i n t e r e s t from e a r l i e r s u p p o r t n e t w o r k was  analysis.  s c a l e d on  two  For  predictor-outcome  telephone  scaled variables example, the  dimensions.  crisis of  callers'  First,  the  54 researcher s c a l e d the support network from none/small t h e number o f p e o p l e m e n t i o n e d callers'  by every c a l l e r .  to large  Second,  a b i l i t y t o engage o r u s e t h e i r s u p p o r t n e t w o r k  the was  s c a l e d from none/low t o h i g h by c o u n t i n g t h e f r e q u e n c y and o f c o n t a c t s w i t h o t h e r s , a n d b y how themselves  when e n g a g i n g  much t h e c a l l e r s '  t h e i r support  by  number  share  of  network.  V a r i o u s c a l l e r - o r d e r e d p r e d i c t o r - o u t c o m e m a t r i c e s were constructed.  (See T a b l e s 4 t h r o u g h 6 i n t h e " R e s u l t s " f o r  examples u s i n g t h e f i n a l c a l l e r - o r d e r e d matrices.)  predicator-outcome  F o r example, u s i n g t h e p r e v i o u s l y d e f i n e d c a l l e r s '  c h r o n i c i t y as c u r r e n t t e l e p h o n i n g frequency, a C h r o n i c i t y and t h e C a l l e r s ' R e l a t i o n s h i p s " - m a t r i x was  Support Network and  constructed.  d i s p l a y e d no r e l a t i o n s h i p w i t h c a l l e r s ' callers'  support network.  "Callers' Special  Some p r e d i c t o r chronicity,  Neither the s i z e of the  variables  such  as  callers'  support network,  nor the c a l l e r s '  a b i l i t y t o engage o r use  support network,  showed a n y r e l a t i o n s h i p t o i n c r e a s i n g  their  or  decreasing frequency or telephone contact.  Other v a r i a b l e s d i d  show a n a s s o c i a t i o n t o c a l l e r s '  F o r example,  chronicity.  s p e c i a l o t h e r s / r e l a t i o n s h i p s d i d appear t o i n c r e a s e as frequency of telephone contact w i t h the c r i s i s  lines  the  the  decreased.  Data D i s p l a y : Causal Networks The  researcher analyzed i n d i v i d u a l subjects f o r important  events and a c t i v i t i e s  i n their lives.  These e v e n t s  a c t i v i t i e s were combined v i s u a l l y i n a d e s c r i p t i v e  and network,  l i n k i n g t o g e t h e r the i n f o r m a t i o n b i t s t o form a chronology  and  55 process  f o rthe callers'  lives.  As suggested  by the data,  p o s s i b l e e x p l a n a t o r y v a r i a b l e s were p e n c i l l e d i n t o t h e networks t o connect  and b e t t e r understand  d i s c r e t e events The Matching  and a c t i v i t i e s .  i n t e r v i e w data from a l l events  and p r o c e s s  t h e r e l a t i o n s h i p between t h e  and a c t i v i t i e s ,  streams,  s u b j e c t s was c o n s i d e r e d  next.  as w e l l as s i m i l a r c h r o n o l o g i c a l  were r e n d e r e d  a c r o s s a l l c a l l e r s i n t o more  g e n e r a l v a r i a b l e s p r o d u c i n g a s i n g l e c a u s a l meta-network.  For  example, two c a l l e r s were d i s a b l e d , and f o u r c a l l e r s h a d a c u r r e n t o r c h r o n i c i l l n e s s o r i n j u r y t h a t h a d e x i s t e d o v e r many years.  These events were r e n d e r e d  into the general variable of  "Prolonged H e a l t h Concerns" and e n t e r e d i n t o t h e meta-network. As d a t a a n a l y s i s proceeded, o t h e r d e s c r i p t i v e and e x p l a n a t o r y v a r i a b l e s were added t o i n d i v i d u a l c a u s a l networks and t h e s i n g l e meta-network. Some e a r l i e r h y p o t h e s i z e d i n t e r v e n i n g v a r i a b l e s o n i n d i v i d u a l c a u s a l networks were c o n f i r m e d b y i n t e r v i e w d a t a i n other c a l l e r s '  c a u s a l networks.  These were t h e n i n c o r p o r a t e d  i n t o t h e meta-network.  F o r example, o t h e r i n t e r v i e w e d s u b j e c t s  discussed and confirmed  the hypothesized  intervening variables of  " L i m i t e d Employment" a n d " L i m i t e d F i n a n c e s , " of "Prolonged  linking the variable  H e a l t h Concerns" t o t h e v a r i a b l e o f " L i m i t e d  Support Network." C h r o n i c c a l l e r s became d i s t i n g u i s h a b l e b a s e d o n t h e i r t e l e p h o n i n g f r e q u e n c y w i t h c r i s i s c e n t r e s when t h e r e s e a r c h e r u s e d a c a l l e r - o r d e r e d d e s c r i p t i v e m a t r i x as mentioned above.  56 Where e v e n t ,  activities,  distinguished higher frequency  and  c h r o n o l o g i c a l and p r o c e s s  frequency  chronic callers,  chronic c a l l e r s from  these  F o r example, h i g h e r  h a d more n e g a t i v e  experience  T h i s c h a r a c t e r i s t i c was callers'  frequency  lower  therapy or  i n t o the higher  treatment.  frequency  c a u s a l network as a d e s c r i p t i v e v a r i a b l e .  v a r i a b l e s a l s o were e n t e r e d  frequency  c a l l e r s tended t o have  with previous  entered  lower  d e s c r i p t i v e v a r i a b l e s were added  t o the emerging c a u s a l network f o r h i g h e r and callers.  streams  Explanatory  i n t o the emerging c a u s a l network  as  data a n a l y s i s proceeded from the c a l l e r - o r d e r e d d e s c r i p t i v e matrices  t o the c a l l e r - o r d e r e d predictor-outcome  E v e n t u a l l y s i m i l a r event, d e s c r i p t i v e and  matrices.  a c t i v i t y and p r o c e s s  streams,  explanatory v a r i a b l e s from across a l l subjects  were combined f o r the f i n a l c h r o n i c c a l l e r c a u s a l network.  The  common c h r o n i c c a l l e r c h a r a c t e r i s t i c s w e r e u s e d t o l i n k t h e  two  d i f f e r e n t c a u s a l pathways f o r lower and h i g h e r  frequency  c a l l e r s i n t o the l a r g e r c h r o n i c c a l l e r c a u s a l network. M i l e s and  Huberman (1984) u s e  somewhat m i s l e a d i n g a n d  has  (Though  the term "causal network," t h i s i s  been r e p l a c e d by the term  network" throughout the remainder o f the study. t h i s word change i s g i v e n i n t h e i n the  chronic  "Results".  "relational  Explanation  A l s o , see  Figure  " R e s u l t s " f o r an i l l u s t r a t i o n o f the f i n a l c h r o n i c  relational  for  caller  network.)  Conclusion Drawing/Verification Data r e d u c t i o n t h r o u g h c o d i n g and  4  data d i s p l a y through  unordered meta-matrices t o c a l l e r - o r d e r e d d e s c r i p t i v e matrices  57 f a c i l i t a t e d the discovery of the general chronic c a l l e r s . matrices,  characteristics of  Moving through c a l l e r - o r d e r e d d e s c r i p t i v e  t o c a l l e r - o r d e r e d predictor-outcome  f i n a l l y t o causal networks, helped  matrices,  and  reveal the possible  a s s o c i a t i o n s between c h r o n i c c a l l e r c h a r a c t e r i s t i c s .  Concurrent  w i t h t h i s d a t a r e d u c t i o n a n d d i s p l a y , c o n c l u s i o n s w e r e made a b o u t c h r o n i c c a l l e r c h a r a c t e r i s t i c s a n d t h e a s s o c i a t i o n s b e t w e e n them. They were t h e n t e s t e d and c o n f i r m e d  f o rtheir veracity.  C o n c l u s i o n Drawing. S e v e r a l s t r a t e g i e s were u s e d f o r generating  conclusions  from t h e i n f o r m a t i o n .  e m p l o y e d moved d a t a a n a l y s i s f r o m c o n c r e t e explanatory  The s t r a t e g i e s  description to  concepts and h i g h e r l e v e l s o f a b s t r a c t i o n .  Counting,  n o t i n g patterns/themes, seeing p l a u s i b i l i t y and c l u s t e r i n g the researcher data. times  Counting  helped  d i s c o v e r which information b i t s grouped w i t h  other  j u s t t a l l i e d s o m e t h i n g t h a t h a p p e n e d a number o f  a n d t h a t h a p p e n e d i n a c o n s i s t e n t way.  With  identifying  p a t t e r n s / t h e m e s , t h e f i n d i n g t h a t a l l c h r o n i c c a l l e r s come  from  a l c o h o l i c o r o t h e r d r u g a d d i c t e d f a m i l y b a c k g r o u n d s emerged from noting this recurring pattern i n their families of origin. p l a u s i b l e c o n c l u s i o n r e a c h e d f r o m t h e d a t a was t h a t  A  "limited  employment" a n d " l i m i t e d f i n a n c e s " l i n k e d t h e v a r i a b l e o f "personal and p h y s i c a l l i m i t a t i o n s from h e a l t h " w i t h t h e c a l l e r v a r i a b l e o f " l i m i t e d a b i l i t y t o u s e a n d engage s u p p o r t  network."  T h i s c o n c l u s i o n was l a t e r s u p p o r t e d  interview  data.  Lastly,  by other subjects'  c l u s t e r i n g was u s e d t o u n d e r s t a n d b e t t e r a n d  conceptualize data with s i m i l a r c h a r a c t e r i s t i c s ,  i . e . , data  on  58 the c a l l e r s ' illness,  chronic i l l n e s s o r d i s a b i l i t y ,  and past  current injury o r  i n j u r y o r i l l n e s s was c o n c e p t u a l l y c l u s t e r e d  under t h e c a l l e r c h a r a c t e r i s t i c o f "prolonged  health  Subsuming p a r t i c u l a r d a t a chunks i n t o a g e n e r a l  concerns." category,  f a c t o r i n g , n o t i n g r e l a t i o n s between v a r i a b l e s and f i n d i n g intervening v a r i a b l e s helped and  higher  the c a l l e r s '  i nthe information. experiences  t h e i r occasions  h e a l t h treatments, category  explanation  l e v e l s o f a b s t r a c t i o n from t h e data and d i s c o v e r  relationships  and  the researcher generate  S p e c i f i c data chunks,  o f abuse and n e g l e c t  i ntheir families  o f powerlessness against p h y s i c a l and mental w e r e subsumed i n t o t h e l a r g e r , more  of "callers' victimization."  general  With f a c t o r i n g conclusions  w e r e g e n e r a t e d b y p u l l i n g a common t h r e a d f r o m d i s p a r a t e bits.  F o r example, t h e c r i s i s  resources  like  data  line activities of giving callers  and r e f e r r a l s , problem-solving  w i t h them, e x p l o r i n g new  p e r s p e c t i v e s a n d o p t i o n s w i t h them, a n d g i v i n g t h e c a l l e r s v a l i d a t i o n a l l h a v e t h e common t h r e a d o f e m p o w e r i n g t h e c a l l e r . O f t e n r e l a t i o n s between v a r i a b l e s were n o t e d , a f r e q u e n t of generated f i n d i n g s .  The l a s t s t r a t e g y h e r e ,  source  finding  i n t e r v e n i n g v a r i a b l e s , b u i l d s t h e r e l a t i o n s h i p between two v a r i a b l e s t h a t were n o t e x p e c t e d t o be a s s o c i a t e d , o r were e x p e c t e d t o go t o g e t h e r a n d do s o o n l y w e a k l y . using the c r i s i s  l i n e f o r comfort and support  F o r example, was e x p e c t e d t o  associate strongly with increased c a l l s t o the c r i s i s centre. did not.  When t h e i n t e r v e n i n g v a r i a b l e o f " u s i n g c r i s i s  a therapeutic resource"  was d i s c o v e r e d ,  It  l i n e s as  t h e r e l a t i o n s h i p between  59 t h e above v a r i a b l e s  strengthened.  B u i l d i n g a l o g i c a l c h a i n o f evidence helped assemble a coherent understanding o f t h e i n f o r m a t i o n . s e v e r a l s u b j e c t s emphasized t h e s p e c i f i c  When t h i s o c c u r r e d ,  factors  independently  and i n d i c a t e d c a u s a l l i n k s , d i r e c t l y o r i n d i r e c t l y , between t h e factors.  F o r example, s e v e r a l c a l l e r s  l i n e s w i t h a very h i g h frequency. they used t h e c r i s i s  said they use the c r i s i s  Some o f t h e s e c a l l e r s  stated  l i n e s a s a f i l l - i n when t h e y h a v e n o  c o u n s e l l i n g o r t h e r a p y a v a i l a b l e t o them.  Other c a l l e r s r e v e a l e d  crisis  l i n e p e r s o n n e l h a d t o l d them t h a t i f t h e y were u s i n g t h e  crisis  l i n e s a s t h e r a p y , t h i s was n o t a n a p p r o p r i a t e u s e o f t h e  service.  Additionally,  f o r most c a l l e r s , i n r e s p o n s e  increased telephoning, c r i s i s time l i m i t s .  to their  c e n t r e s t a f f had imposed c a l l and  F r o m t h i s i n f o r m a t i o n , a c h a i n o f e v e n t s was b u i l t :  inconsistent counselling o r therapy l e d t o the c a l l e r s using the crisis  l i n e s t h e r a p e u t i c a l l y , and increased c a l l i n g r e s u l t s .  crisis  l i n e s n o t e d t h e i n c r e a s e and t h e change i n t h e n a t u r e o f  the c r i s i s  line calls.  The t e l e p h o n e w o r k e r s  The  confronted the  c a l l e r s on t h e i r t h e r a p e u t i c u s e o f t h e phone l i n e s a n d i n i t i a t e d c a l l management t e c h n i q u e s t o r e d u c e  t h e amount o f c o n t a c t t h e  c a l l e r s have w i t h t h e c r i s i s c e n t r e . Conclusion Verification.  The above t e c h n i q u e s  generated  f i n d i n g s from t h e c a l l e r s ' i n t e r v i e w s t h a t r e q u i r e d v e r i f i c a t i o n . A g a i n s e v e r a l s t r a t e g i e s were used t o c o n f i r m a n d t e s t t h e c o n c l u s i o n s drawn.  Drawing c o n t r a s t s and comparisons,  checking  the meaning o f e x c e p t i o n s i n t h e d a t a , and u s i n g extreme  cases  60 helped  t e s t the conclusions  a b o u t a p a t t e r n o r theme by-  d e s c r i b i n g what t h e c o n c l u s i o n s and  comparisons f o rhigher  were n o t l i k e .  Drawing  and lower frequency c h r o n i c  were o f t e n u s e d t o t e s t t h e c o n c l u s i o n s  contrasts callers  about these groups.  For  example, c o n t r a s t i n g t h e s e two groups t e s t e d t h e f i n d i n g t h a t t h e s e i n d i v i d u a l s were t r e a t e d d i f f e r e n t l y i n t h e i r origin.  Specifically,  lower frequency chronic c a l l e r s tended t o  be i n f a m i l y r o l e s l i k e  the i n v i s i b l e c h i l d o r the outcast,  unwanted b y t h e i r p a r e n t s , higher like  families of  and g e n e r a l l y ignored b y t h e f a m i l y ;  f r e q u e n c y c h r o n i c c a l l e r s tended t o be i n f a m i l y r o l e s  t h e scapegoat o r i d e n t i f i e d p a t i e n t , where t h e f a m i l y  g e n e r a l l y b l a m e d them f o r f a m i l y p r o b l e m s . meaning o f e x c e p t i o n s  t o the conclusions,  I n checking the f i n d i n g s were  strengthened,  i . e . , c a l l e r s d i s l i k e d t h e u s e o f c a l l management  by t h e c r i s i s  lines.  considered  to this  f i n d i n g were  - those c a l l e r s not mentioning c a l l l i m i t s - they a l l  disliked crisis experienced  When t h e e x c e p t i o n s  i t .  l i n e c a l l management a s w e l l i f t h e y h a d The e x c e p t i o n s  confirmed  Lastly,  extreme cases were used, l i k e  caller,  t o test the conclusions  information from t h e lowest  the conclusion.  t h e lowest  from t h e data.  frequency F o r example, t h e  frequency chronic c a l l e r  confirmed  the c o n c l u s i o n that lower frequency chronic c a l l e r s a r e not u s i n g the c r i s i s  lines therapeutically.  therapeutic use of c r i s i s my t h e r a p y  T h i s c a l l e r d i s c l o s e d non-  l i n e s and s a i d d u r i n g  follow-up,  a n d c o u n s e l l i n g e l s e w h e r e " when a s k e d a b o u t  therapeutic use o f c r i s i s  lines.  "Iget  61 O t h e r s t r a t e g i e s a l s o were u s e d t o c o n f i r m t h e f i n d i n g s against opposing f a c t s and views from t h e data. r e l a t i o n s were r u l e d o u t between v a r i a b l e s . experience  with therapy  the c a l l e r s ' l i n e use. treatment  l i n e s and increased  Many c a l l e r s h a d a r i c h e x p e r i e n c e  frequently.  d i dnot telephone  Rival explanations,  like  being r e l a t e d t o a l i m i t e d support  large support  day  w i t h therapy and  the c r i s i s  centres  increased c r i s i s  crisis  l i n e use  l i n e use had both a  Other evidence i n the i n t e r v i e w data  f o rt o counter  conclusions,  was  i . e . , no c a l l e r  r e p o r t i n g a c u r r e n t substance misuse problem. difficulties  crisis  network and engaged i t w i t h ease, n o t s u p p o r t i n g  explanation.  a l s o searched  greater  network, were checked o u t .  Some c a l l e r s w i t h t h e h i g h f r e q u e n c y  the r i v a l  F o r example,  o r c o u n s e l l i n g was n o t v a r i a b l e l i n k i n g  therapeutic use o f c r i s i s  and s t i l l  Spurious  Present  i n f a m i l y o r other r e l a t i o n s h i p s and challenges i n  t o d a y l i v i n g were reviewed  substance misuse.  f o r t h e c a l l e r s w i t h an eye t o  The r e s e a r c h e r  e n c o u n t e r e d no  negative  evidence t o t h e f i n d i n g . Finally, to  t h e p r i n c i p a l i n v e s t i g a t o r c y c l e d back t h e f i n d i n g s  the c a l l e r s agreeable  t o t h i s further contact.  V a l i d a t i o n Procedure f o rthe Results w i t h C a l l e r s The  v a l i d i t y o f t h e r e s u l t s was c h e c k e d w i t h f i v e  callers.  One s u b j e c t c o u l d n o t b e r e a c h e d f o r v a l i d a t i o n o f t h e i n t e r v i e w data o r v a l i d a t i o n o f the r e s u l t s . o r i g i n a l l y scheduled  The t w o s u b j e c t s  a phone back t i m e ,  that  when t h e y c o n t a c t e d t h e  p r i n c i p a l i n v e s t i g a t o r t o v a l i d a t e the interview data,  d i d not  62 complete t h e phone back.  W i t h o u t t h e o r i g i n a l phone back, a  f u r t h e r phone back t o v a l i d a t e  t h e r e s u l t s c o u l d n o t be  scheduled. C r i s i s l i n e c h a r a c t e r i s t i c s emerging from t h e i n t e r v i e w data were v a l i d a t e d  by confirmation w i t h the c a l l e r s .  The c a l l e r s  also validated  the four l e i t m o t i f s through t h e i r confirmation of  t h e themes. Chronic those  c a l l e r c h a r a c t e r i s t i c s and t h e r e l a t i o n a l network o f  c h a r a c t e r i s t i c s a l s o were v a l i d a t e d  with the c a l l e r s . A l l  five c a l l e r s provided validation f o r chronic c a l l e r c h a r a c t e r i s t i c s common t o a l l t h e s u b j e c t s . c h r o n i c c a l l e r c h a r a c t e r i s t i c s were v a l i d a t e d c o n f i r m a t i o n w i t h lower disagreement w i t h higher frequency  frequency frequency  Lower  frequency  through  c h r o n i c c a l l e r s and chronic c a l l e r s .  Higher  c h r o n i c c a l l e r c h a r a c t e r i s t i c s were v a l i d a t e d  confirmation with higher disagreement w i t h lower  frequency frequency  c h r o n i c c a l l e r s and chronic c a l l e r s .  through  63 Results The  callers' confidentiality  research concerns.  Because c r i s i s  their chronic callers well, callers'  and  anonymity remain  l i n e personnel  characteristics, results.  f r e q u e n t l y know  steps have been t a k e n  i d e n t i t i e s remain concealed.  primary  t o ensure  the  Detailed descriptive  such as gender, have been o m i t t e d  A l s o , where p o s s i b l e , r e s u l t s  and  i n the  d a t a t a b l e s have been  w r i t t e n to minimize c a l l e r i d e n t i f i c a t i o n through a s s o c i a t i n g characteristics. telephone  Similarly,  t o ensure the anonymity of  c r i s i s centres, references  have been  to specific c r i s i s  lines  omitted.  The  f i n d i n g s are presented  their crisis  i n s i x p a r t s : the c a l l e r s  l i n e contact, chronic c a l l e r  frequency,  crisis  line characteristics,  chronic c a l l e r relational The  callers.  telephoning  l e i t m o t i f s , and  their C r i s i s Line  t o 49,  the  Contact  investigator interviewed eight  F i v e c a l l e r s were female and  r a n g e d f r o m 26  by  network.  C a l l e r s and  principal  and  characteristics,  v a r i a t i o n s on c h r o n i c c a l l e r c h a r a c t e r i s t i c s  The  the  t h r e e male.  w i t h a n a v e r a g e age  chronic Callers'  o f 37 y e a r s  (see  ages Table  1) . Four c a l l e r s l i v e d i n an u r b a n c e n t r e density part of a c i t y . away f r o m t h e c i t y c o r e . No  callers The  Two Two  lived i n a rural  - an o l d e r ,  higher  l i v e d i n suburban o u t l a y i n g areas, callers  lived i n valley  suburbs.  area.  c a l l e r s reported years  of contact ranging  f r o m 6 months  64 Table 1 D e s c r i p t i v e C h a r a c t e r i s t i c s o f C a l l e r s and C r i s i s L i n e Contact  Subject  Age  Years o f Contact  Frequency of Contact  Crisis Lines Contacted  s  43  7  4/day  2-4  T  38  6  2/day  3-5  P  33  10  R  31  N  4-5/week  2-4  10-11  daily or 1-2/week  1-4  33  M  3-4/week  •2-3  Y  43  7-8  3/week  3-5  L  49  13  8-12/ month  1  M  26  5  3-5/ month  1-2  V  65 t h r o u g h t o 13 y e a r s The a v e r a g e years.  (see Table 1 ) .  l e n g t h o f o n g o i n g c o n t a c t was a p p r o x i m a t e l y 7%  T h i s average  was o b t a i n e d b y a d d i n g t h e y e a r s o f c o n t a c t  f o r a l l s u b j e c t s a n d d i v i d i n g b y t h e t o t a l number o f s u b j e c t s . (When a c a l l e r  s t a t e d a range  f o r y e a r s o f c o n t a c t , midway i n t h e  r a n g e o f y e a r s was t a k e n a s t h e y e a r s o f c o n t a c t . 10 t o 11 y e a r s o f c o n t a c t was t a k e n a s 10%  F o r example,  years.)  C a l l e r s a l s o r e p o r t e d a wide range o f t e l e p h o n i n g frequency. The g r e a t e s t was f o u r c a l l s a d a y .  The l o w e s t f r e q u e n c y was  t h r e e t o f i v e t i m e s a month, a b o u t o n c e a week The a v e r a g e t h i s average,  (see Table 1 ) .  c a l l e r phoned about once a day.  t h e f o l l o w i n g p r o c e d u r e was u s e d .  In obtaining F i r s t , the  f r e q u e n c y o f c o n t a c t f o r a l l s u b j e c t s was c h a n g e d t o t h e number of  c a l l s p e r week.  Next,  t h e number o f c a l l s p e r week f o r a l l  s u b j e c t s was a d d e d a n d d i v i d e d b y t h e t o t a l number o f s u b j e c t s t o o b t a i n t h e average Lastly,  number o f c a l l s p e r week f o r a c a l l e r .  t h e average  number o f c a l l s p e r week was d i v i d e d b y  to o b t a i n t h e average The c a l l e r s  number o f c a l l s p e r d a y f o r a c a l l e r .  r e p o r t e d t h e y t e l e p h o n e d r e g u l a r l y f r o m one t o  five different crisis one  crisis  extreme,  two c a l l e r s  On a v e r a g e lines. of  lines.  lines  telephoning  To t h e o t h e r  stated they telephoned three t o f i v e  lines  regularly  the callers  In obtaining this  crisis  One c a l l e r m e n t i o n e d  l i n e c o n s i s t e n t l y and no o t h e r s .  different crisis  seven  (see Table 1 ) .  phoned two o r t h r e e d i f f e r e n t  average,  crisis  t h e l o w number f r o m t h e r a n g e  r e g u l a r l y c o n t a c t e d f o r a l l s u b j e c t s was a d d e d  66 a n d d i v i d e d b y t h e t o t a l number o f s u b j e c t s . number f r o m t h e r a n g e o f c r i s i s s u b j e c t s was (For  those  crisis  Next, the  high  lines regularly contacted f o r a l l  a d d e d a n d d i v i d e d b y t h e t o t a l number o f s u b j e c t s .  s u b j e c t s w i t h a s p e c i f i c number o f r e g u l a r l y  lines,  t h i s number was  number o f c r i s i s  u s e d f o r b o t h t h e low and  l i n e s r e g u l a r l y contacted.)  t h e n gave t h e range o f c r i s i s  contacted high  T h e s e two  numbers  l i n e s r e g u l a r l y c o n t a c t e d by  the  callers. Chronic C a l l e r The  Characteristics  c h r o n i c c a l l e r c h a r a c t e r i s t i c s are grouped i n t o  categories: personal characteristics; relational; background; and  family  c o u n s e l l i n g , therapy or treatment.  The  reported r e f l e c t those chronic c a l l e r c h a r a c t e r i s t i c s from p r e v i o u s r e s e a r c h and (see T a b l e Personal No  results indicated  those c h a r a c t e r i s t i c s newly  identified  2).  Characteristics Substance Misuse.  None o f t h e c a l l e r s i n t h e  r e v e a l e d a c u r r e n t substance c a l l e r s mentioning  misuse concern.  forward:  Of t h e  study three  an a l c o h o l o r o t h e r drug problem, a l l were  i n recovery f o r t h e i r substance put  four  misuse.  The  remaining  now  callers  " I t ' s not an i s s u e . "  Prolonged H e a l t h Concerns. A l l c a l l e r s d i s c l o s e d prolonged h e a l t h problems, e i t h e r p h y s i c a l , mental o r emotional, concurrently. The  Two  c a l l e r s s a i d t h e y were d i s a b l e d from  other c a l l e r s r e p o r t e d p h y s i c a l h e a l t h concerns  several years,  sometimes birth.  lasting  sometimes as a d u l t s , sometimes as c h i l d r e n .  Four  67 Table  2  Chronic C a l l e r n  Characteristics  Chronic C a l l e r  Characteristic  Personal  Characteristics  8  no  substance misuse  8  prolonged health  6  p e r s o n a l and  6  l i m i t e d employment, t h e n l i m i t e d f i n a n c e s  5  suicide  3  mental  concerns  physical  l i m i t a t i o n s from  health  history illness Relational  6  d e f i n i t e l y friends  6  little  6  few  6  challenging  5  l i m i t e d a b i l i t y t o engage and  family  with  contact  special  others  relationship  history use  support  systems  Family Background 8  alcohol  or other drug addicted  8  severe abuse o r  7  two  parent  families  neglect  families continued  68 Table  2  Chronic C a l l e r C h a r a c t e r i s t i c s n  Chronic C a l l e r  (Continued)  Characteristic  C o u n s e l l i n g , Therapy o r Treatment 8  previous or current counselling,  therapy or  treatment  8  early l i f e  therapy or  treatment  8  mental h e a l t h contact  8  more y e a r s w i t h h e l p i n g s e r v i c e s t h a n w i t h c r i s i s  start to counselling,  lines  69 c a l l e r s t a l k e d about o n g o i n g p h y s i c a l h e a l t h p r o b l e m s , two o f these c a l l e r s w i t h concurrent mental  illnesses.  Three c a l l e r s d i s c l o s e d a p s y c h i a t r i c d i a g n o s i s . c a l l e r shared a severe emotional d i f f i c u l t y around identity,  Another  personal  s t r e s s i n g t o the point o f attempted s u i c i d e .  these c a l l e r s they reported  t h e i r p s y c h i a t r i c o r emotional  c o n c e r n s l a s t e d many y e a r s .  A d d i t i o n a l l y , f o rthe three  that d i s c l o s e d a diagnosed mental i l l n e s s , concurrent p h y s i c a l health Personal  concern.  Three c a l l e r s  l i m i t e d a b i l i t y t o get out i n the world  s a i d they had a  because h e a l t h  had  p h y s i c a l l y d i s a b l e d them.  and  emotional l i m i t a t i o n s a r i s i n g from t h e i r h e a l t h  them l a t e r .  The o t h e r  A s one c a l l e r s t a t e d , r e p r e s e n t a t i v e  experience f o r a l l :  " I had epilepsy u n t i l  I had a very d i f f i c u l t  I was b e i n g  of the  The o t h e r  o f f work c u r r e n t l y due t o a b a c k i n j u r y . financial  I was p u t  c a l l e d stupid"(N) . 7  O n l y two c a l l e r s  One o f t h e t w o m e n t i o n e d  from p a y cheque t o p a y cheque.  indicated current  stigmatized  I was t h e a g e o f s e v e n .  L i m i t e d Employment, t h e n L i m i t e d F i n a n c e s . m e n t i o n e d r e g u l a r employment.  personal  challenges.  time l e a r n i n g through school.  I always f e l t  problems  three mentioned  f e e l i n g t h e i r h e a l t h p r o b l e m somehow  back i n c l a s s .  S i xof the  t h e i r h e a l t h concerns as p h y s i c a l l y hampering  t h e m o r p e r s o n a l l y l i m i t i n g them.  They r e p o r t e d  callers  they a l s o mentioned a  and P h y s i c a l L i m i t a t i o n s from Health.  callers discussed  For a l l  living  c a l l e r mentioned Only t h i s  caller  success.  The r e m a i n i n g s i x c a l l e r s s h a r e d a h i s t o r y o f l i m i t e d  being  70 employment o r unemployment. limited  Unable t o g e t a j o b o r having o n l y  employment, t h e s e c a l l e r s r e p o r t e d r e d u c e d  resources.  financial  W i t h l i m i t e d money, t h e y s t a t e d t h e y w e r e  i n o t h e r r e s o u r c e s t h e y c o u l d engage f o r t h e m s e l v e s , counselling or recreational  restricted like  services.  S u i c i d e H i s t o r y . Four c a l l e r s d i s c l o s e d a p r e v i o u s attempt. effort  suicide  F o r o n e t h e " s u i c i d e a t t e m p t " was d e s c r i b e d a s a n  t o g a i n some c o n t r o l a n d p o w e r b a c k f r o m m e n t a l h e a l t h  over enforced i n s t i t u t i o n a l i z a t i o n .  For the other three the  r e p o r t e d s u i c i d e attempts were t o end t h e i r c a l l e r mentioned  a drug overdose  lives.  One o t h e r  - not a s u i c i d e attempt  - trying  t o engage h e l p f r o m m e n t a l h e a l t h s e r v i c e s . Three c a l l e r s with suicidal  stated they i n i t i a l l y contacted c r i s i s  feelings.  might telephone c r i s i s one,  t h i s was r a r e .  s u i c i d a l tendency,  C u r r e n t l y , o n l y two c a l l e r s l i n e s w i t h some s u i c i d a l  lines  said  they  feelings.  For  F o r t h e o t h e r , t h i s was a c h r o n i c , p a s s i v e eg., s u i c i d e b y n e g l e c t i n g one's h e a l t h ,  a s d r i n k i n g t o o much, l i k e t h e c a l l e r d i d i n t h e p a s t . f i v e c a l l e r s mentioned  feeling  suicidal or previous  such  In a l l  suicide  attempts. Mental  I l l n e s s . Three c a l l e r s had a p s y c h i a t r i c d i a g n o s i s  that they disclosed. mentioned  A l l were d i a g n o s e d m a n i c - d e p r e s s i v e .  r e c e i v i n g ongoing treatment.  The o t h e r c a l l e r  i n d i c a t e d t h a t t r e a t m e n t was n o l o n g e r n e e d e d . Relational Definitely  F r i e n d s . Two c a l l e r s m e n t i o n e d  they got out  Two  71 s o c i a l l y w i t h others but c a l l e d these people o n l y The  acquaintances.  o t h e r s i x c a l l e r s r e p o r t e d t w o o r more f r i e n d s t h a t  e n g a g e d w i t h s o c i a l l y a t l e a s t o n c e o r more t i m e s of these  callers reported a social  support  they  a month.  Three  network o f f i v e o r  more p e o p l e t h a t t h e y saw a t l e a s t o n c e e v e r y t w o w e e k s t o d a i l y . L i t t l e Family Contact. significant  O n l y two c a l l e r s m e n t i o n e d r e g u l a r ,  a n d m e a n i n g f u l c o n t a c t w i t h f a m i l y members.  However,  t h e y s t a t e d t h i s c o n t a c t was l i m i t e d o n l y t o some o f t h e i r members.  F o r b o t h c a l l e r s , t h e y i n d i c a t e d one p a r e n t  part of their The  f a m i l y support  family  was n o t  network.  o t h e r c a l l e r s r e v e a l e d more l i m i t e d  relationships with their family.  Four c a l l e r s  contact and s a i d they had  r e g u l a r b u t d i s t a n c e r e l a t i o n s h i p s w i t h t h e i r f a m i l y members. They d e s c r i b e d t h e i r f a m i l y r e l a t i o n s h i p s as s a t i s f a c t o r y , a l l f a m i l y members g e n e r a l l y l i v i n g t h e i r own l i v e s . two  The  c a l l e r s m e n t i o n e d r a r e o r no c o n t a c t w i t h t h e i r  members, p a r t i c u l a r l y  family  parents.  Few w i t h S p e c i a l O t h e r s .  The c a l l e r s t e n d e d t o b e more o f t e n  u n m a r r i e d / u n p a r t n e r e d : s i n g l e , d i v o r c e d , widowed o r O n l y two c a l l e r s m e n t i o n e d a c u r r e n t r e l a t i o n s h i p . callers The  remaining  separated. Two  other  i n d i c a t e d a r e l a t i o n s h i p had ended w i t h i n t h e l a s t  remaining  c a l l e r s r e p o r t e d e i t h e r no p r e v i o u s  year.  significant  r e l a t i o n s h i p s o r being out of a s p e c i a l r e l a t i o n s h i p w e l l over a year. C h a l l e n g i n g R e l a t i o n s h i p H i s t o r y . One c a l l e r m e n t i o n e d n o current o r previous  r e l a t i o n s h i p s . Another c a l l e r s t i l l  was  72 m a i n t a i n i n g the m e n t i o n e d one  f i r s t relationship.  remaining s i x c a l l e r s  o r more s i g n i f i c a n t r e l a t i o n s h i p s .  callers disclosed  one  previous relationship,  i n a second r e l a t i o n s h i p . relationships. significant  The  Two  Three of  one  of  o t h e r s m e n t i o n e d two  Another c a l l e r discussed three  three  now  previous  previous  relationships.  Four c a l l e r s reported previous r e l a t i o n s h i p s abusive.  the  these  For  one  c a l l e r , the  a b u s e r e v e a l e d was  s e v e r e e m o t i o n a l and  verbal  e m o t i o n a l and  abuse d i s c l o s e d  verbal  abuse.  For  the  was  that  were  limited  other three,  compounded b y  to the  physical  abuse. For  the  o t h e r two  callers reporting  both described t h e i r relationships l e f t the stated  relationships  to better  they f e l t a sense of  and  friends.  other giving  s u p p o r t as w e l l .  l i m i t e d o r no and  no  n e t w o r k and  no  Use  they  needs.  They  Support Systems. Only  one  meaningful support from both  Two  from t h e i r family,  friends.  substantial  f i v e c a l l e r s that  special others also  special  other c a l l e r s mentioned  The  and  support from f a m i l y  indicated relayed  the  remaining f i v e c a l l e r s  s p e c i a l o t h e r s t o draw s u p p o r t  Three of the  said  w a n t e d t o make  This c a l l e r mentioned a current  other from t h e i r network of  friends,  and  instead.  e n g a g i n g s u p p o r t f r o m o t h e r s : one  indicated  relationships,  d e a l w i t h t h e i r own  A b i l i t y t o Engage and  c a l l e r r e p o r t e d s i g n i f i c a n t and family  as u n s a t i s f y i n g  i n c o m p a t i b i l i t y and  t h e i r l i v e s what t h e y d e s i r e d Limited  previous  an  or  from. a limited  support  i n a b i l i t y to  share  73 themselves others. social  more i n t i m a t e l y w i t h  T h e y s h a r e d a h e s i t a n c y o r i n a b i l i t y t o move b e y o n d t h e surface.  callers but  more d e e p l y a n d t o c o n n e c t  One c a l l e r r e p r e s e n t e d t h i s f o r a l l t h r e e  i n t h e statement:  "We t a l k a b o u t e a c h o t h e r s ' p r o b l e m s ,  I n e v e r r e a l l y go i n t o d e t a i l about t h i n g s o t h e r t h a n  surface.  B u t t h a t ' s t h e b e s t I c a n do.  a b o u t m y s e l f " (M) . intimacy.  U s u a l l y I don't  like talk  One c a l l e r e v e n m e n t i o n e d a f e a r t o b u i l d  A l s o , f o r two o f t h e s e c a l l e r s t h e i r  more  reported  f r e q u e n c y o f c o n t a c t w i t h o t h e r s was n o i n d i c a t o r o f d e p t h o f contact.  They r e p o r t e d s e e i n g f r i e n d s o r acquaintances  even weekly and s t i l l  mentioned d i f f i c u l t i e s connecting  daily or with  others with greater intimacy. O n l y two c a l l e r s m e n t i o n e d any s u p p o r t n e t w o r k , t h o u g h t h i s s u p p o r t was r e s t r i c t e d The r e m a i n i n g  from t h e i r  i n the callers'  view.  s i x c a l l e r s r e p o r t e d l i m i t e d o r no c o n t a c t w i t h  f a m i l y members.  They i n d i c a t e d i f any f a m i l y c o n t a c t  i t was n o t s u p p o r t i v e f o r them.  occurred,  Four o f these c a l l e r s even  t h e i r p a r e n t s a n d o t h e r f a m i l y members w e r e n o t r e a l l y in  family  said  interested  them. While  people,  a l l c a l l e r s r e p o r t e d a s o c i a l n e t w o r k o f t w o o r more  o n l y two c a l l e r s  showed a n a b i l i t y t o u s e t h e i r  n e t w o r k f o r more s i g n i f i c a n t and m e a n i n g f u l  support  personal losses. these f r i e n d s h i p s , disagreements.  support.  from these  They r e p o r t e d  friends,  l i k e help  They a l s o r e p o r t e d t h e i r e f f o r t s such as working  Both  significant through  t o maintain  t o g e t h e r t o work  i n d i c a t e d the f r i e n d s h i p s as  social  through  satisfying.  74 The  three g a y / l e s b i a n i d e n t i f i e d c a l l e r s tended t o report  l a r g e r , more b e n e f i c i a l ,  a n d more m e a n i n g f u l  support networks  of  friends than d i d those c a l l e r s heterosexual i d e n t i f i e d . Family Background A l c o h o l o r Other Drug A d d i c t e d F a m i l i e s . Without all  c a l l e r s r e p o r t e d an a l c o h o l o r o t h e r drug a d d i c t e d f a m i l y  background. Two  exception  F i v e c a l l e r s mentioned  mentioned  a substance a b u s i n g mother.  b o t h p a r e n t s as substance abusers. misusing a substance other than Two  callers  The  Two  One  father.  c a l l e r reported  callers revealed a  parent  alcohol.  s h a r e d t h e i n f o r m a t i o n came t o t h e m  s e c o n d h a n d news - t h e y n e v e r themselves.  a substance abusing  through  saw t h e s u b s t a n c e a b u s i n g  other s i x callers reported direct  w i t h the substance abusing parent.  parent  experiences  They mentioned  family  c o n f l i c t s , p h y s i c a l a b u s e i n t h e home, a n d n e g l e c t f u l p a r e n t i n g as p a r t o f t h e i r e x p e r i e n c e s .  For a l l , representing the general  i m p a c t o f t h e s u b s t a n c e a b u s e , one t h a t ' s why my  I had a d i f f i c u l t time...because  f a t h e r was  one way  c a l l e r stated:  into alcohol, they  o r a n o t h e r w h a t I was  "And  I think  I f e e l t h a t maybe i f  [my p a r e n t s ] r e a l l y d i d n ' t c a r e  going  through"(N).  S e v e r e A b u s e o r N e g l e c t . A t a minimum a l l c a l l e r s r e p o r t e d e x p e r i e n c i n g v e r b a l and e m o t i o n a l abuse i n t h e i r of  the c a l l e r s  families.  s a i d t h e i r substance abusing parents c o n t r i b u t e d  t o t h e e m o t i o n a l abuse and n e g l e c t endured  b y them.  For the  c a l l e r s r e p o r t i n g o n l y v e r b a l and e m o t i o n a l abuse, even t h e y mentioned  Four  l o n g t e r m c h a l l e n g e s , r e p r e s e n t e d i n one  caller's  two  75 statement: it's  "I s t i l l  a l o t better.  sometimes i t j u s t  n a v e a l o t o f p r o b l e m s w i t h my I d o n ' t know i f y o u  takes a long  Five c a l l e r s reported personally violating.  get  over i t , but  f a m i l y a b u s e was  you,  physical  and  Four of these c a l l e r s a l s o reported A l l five c a l l e r s reported  impact from the abuse t h a t t h e y s t i l l were w o r k i n g Four c a l l e r s revealed  the abuse t h e y r e p o r t e d  a b u s e , t h e a b u s e was  long  was  the  For  entire  other  less influential from  family.  F i v e c a l l e r s mentioned severe neglect They s a i d t h e i r p a r e n t s d i d not as c h i l d r e n o r y o u t h . unavailable  term  most  the  them t h a n t h e n e g l e c t i n g p a r e n t s o r o u t r i g h t o s t r a c i s m  the  sexual  through.  i n f l u e n c e from t h e i r f a m i l y of o r i g i n .  four, even i f t h e y reported on  but  time"(P).  the  a b u s e t h a t h a p p e n e d t o them.  significant  esteem,  from t h e i r  parents.  n o t i c e o r show i n t e r e s t  Four c a l l e r s  i n them  i n d i c a t e d t h e i r p a r e n t s were  t o them t o a d d r e s s t h e i r needs and  concerns,  often  because o f a l c o h o l o r o t h e r drug abuse. Four c a l l e r s the r e s t of the t h e home. by  their One  Two  s t a t e d t h e y were a c t i v e l y  family,  e i t h e r i n s t i t u t i o n a l i z e d o r f o r c e d out  of  of t h e s e c a l l e r s s t a t e d t h e y were c l e a r l y unwanted  parents. c a l l e r revealed  parents s h e l t e r e d the This  s h u f f l e d away f r o m  a more s u b t l e f o r m o f n e g l e c t  c a l l e r as a c h i l d because o f a  c a l l e r said this led to d i f f i c u l t i e s  choosing f r i e n d s , because the s k i l l s needed i n the  sheltered  develop the  situation.  the  disability.  later in life,  c a l l e r d i d not family  -  such life  as  76 Two P a r e n t F a m i l i e s . S i x c a l l e r s c o n s i s t e n t l y i n a two p a r e n t f a m i l y .  i n d i c a t e d t h e y were r a i s e d One c a l l e r m e n t i o n e d  growing up i n a s i n g l e p a r e n t f a m i l y f o rt h r e e father remarried.  years u n t i l the  The r e m a i n i n g c a l l e r r e v e a l e d  i n a single parent family, the family's  father  usually  living  sporadically  l i v i n g w i t h t h e mother and c h i l d r e n . Counselling,  Therapy o r Treatment  Previous o r Current Counselling, c a l l e r s reported  involvement w i t h  therapy o r treatment.  Therapy o r Treatment. A l l  some t y p e o f c o u n s e l l i n g ,  Two o f t h e c a l l e r s  therapy and/or c o u n s e l l i n g f o rthree  s t a t e d t h e y h a d ended  o r more y e a r s .  m e n t i o n e d l o o k i n g f o r a new c o u n s e l l i n g r e s o u r c e . about s t a r t i n g  therapy again.  One c a l l e r Another  The r e m a i n i n g f o u r c a l l e r s  talked stated  t h e y were i n o n g o i n g t h e r a p y , t r e a t m e n t o r c o u n s e l l i n g . Early L i f e Start t o Counselling, callers  interviewed  Therapy o r Treatment. A l l  stated t h e i r experiences with  therapy o r treatment - medical o r mental h e a l t h their lives.  Five callers  counselling,  - began e a r l y i n  s a i d t h e y were i n v o l v e d  i n some t y p e  o f m e d i c a l o r m e n t a l h e a l t h t r e a t m e n t b e f o r e age 10; t h e o t h e r three  c a l l e r s stated by t h e i r l a t e Mental Health  teens.  Contact. A l l c a l l e r s mentioned contact  m e n t a l h e a l t h s e r v i c e s a t sometime i n t h e i r l i v e s . said they had received  a psychiatric diagnosis:  r e c e i v i n g t r e a t m e n t ; one o u t o f t r e a t m e n t .  two  Three  with callers  still  Two o t h e r  callers  s t a t e d t h e y were i n v o l v e d w i t h p s y c h i a t r i c s e r v i c e s a s y o u t h without a mental i l l n e s s , pushed i n t o treatment b y t h e i r  parents.  77 The  remaining  three c a l l e r s reported contact w i t h mental h e a l t h  services, a l l with non-psychiatric  concerns.  More Y e a r s w i t h H e l p i n g S e r v i c e s t h a n w i t h C r i s i s L i n e s . A l l the c a l l e r s mentioned contact w i t h other h e l p i n g s e r v i c e s their initial  contact w i t h telephone  crisis  centres.  r e p o r t i n g t h e g r e a t e s t amount o f c o n t a c t w i t h o t h e r  before  The c a l l e r helping  s e r v i c e s h a d b e e n i n c o n t a c t w i t h them f o r o v e r t w e n t y y e a r s , probably crisis  c l o s e r t o 30 y e a r s ,  and mentioned o n l y  l i n e s f o r about t h i r t e e n years.  telephoning  The c a l l e r  mentioning  l e a s t contact w i t h other h e l p i n g p r o f e s s i o n s had o n l y been r e c e i v i n g s e r v i c e s f o r about e i g h t months. only contacting c r i s i s  This c a l l e r  reported  l i n e s f o r a f e w weeks l e s s t h a n  other  O n l y two c a l l e r s s a i d t h e y found o u t about c r i s i s  lines  helping services.  another h e l p i n g s e r v i c e . crisis  Four c a l l e r s s a i d they  l i n e s from t h e telephone  book.  found o u t about  lines.  V a l i d a t i o n o f Chronic The  Caller Characteristics with Callers  f i v e c a l l e r s contacted a t follow-up confirmed,  sometimes c l a r i f i e d , all  found o u t about  The o t h e r t w o c a l l e r s  s t a t e d t h e y d i d n o t remember w h e r e t h e y f i r s t crisis  from  subjects.  t h e c h r o n i c c a l l e r c h a r a c t e r i s t i c s common t o  F o r e x a m p l e , t h e common c h r o n i c  caller  c h a r a c t e r i s t i c o f " a t l e a s t some f r i e n d s " was c l a r i f i e d at follow-up. callers,  and  Though s t i l l  a c h a r a c t e r i s t i c common m o s t l y  a s l i g h t trend f o r the highest  i d e n t i f y i n g acquaintances,  further  frequency  chronic  to a l l callers  n o t f r i e n d s , was s t a r t i n g t o emerge.  78 V a r i a t i o n s on Chronic C a l l e r by Telephoning  Characteristics  Frequency  The f o u r c a l l e r s t e l e p h o n i n g w i t h t h e g r e a t e s t f r e q u e n c y were r e g a r d e d as h i g h e r f r e q u e n c y c h r o n i c c a l l e r s .  The f o u r  c a l l e r s t e l e p h o n i n g w i t h t h e l e a s t f r e q u e n c y were r e g a r d e d as lower frequency chronic c a l l e r s .  With t h i s d i s t i n c t i o n , the  c h r o n i c c a l l e r s d i s p l a y e d d i f f e r e n c e s depending on whether they were h i g h e r o r l o w e r f r e q u e n c y  callers.  The f o u r h i g h e r f r e q u e n c y c h r o n i c c a l l e r s t e n d e d t o telephone c r i s i s  l i n e s w i t h a g r e a t e r a n d more c o n s i s t e n t  frequency than the f o u r lower frequency c h r o n i c c a l l e r s . lower frequency c h r o n i c c a l l e r s  s t a t e d i n t h e p a s t t h e y were a  f r e q u e n t , d a i l y o r more u s e r o f c r i s i s lower frequency chronic c a l l e r s  Two  lines.  However,  these  i n d i c a t e d they had maintained  t h e i r c u r r e n t c o n s i s t e n t l e v e l o f c o n t a c t f o r s e v e r a l months, even y e a r s .  Two  lower frequency c h r o n i c c a l l e r s mentioned even  g o i n g a m o n t h o r more w i t h o u t a n y c r i s i s  l i n e contact.  The d i s c r i m i n a t i n g c h a r a c t e r i s t i c s b e t w e e n t h e f o u r h i g h e r frequency and t h e f o u r lower frequency c h r o n i c c a l l e r s across three broad categories: the c a l l e r s crisis  1  relationship with the  lines, the callers' therapeutic history,  f a m i l y h i s t o r y and s p e c i a l  occur  and the c a l l e r s '  relationships.  Relationship with C r i s i s Lines T h e r a p e u t i c U s e v e r s u s P r a c t i c a l U s e . The f o u r h i g h e r f r e q u e n c y c h r o n i c c a l l e r s t e n d e d t o r e p o r t more t h e r a p e u t i c u s e of  crisis  l i n e s than d i d the four lower frequency chronic  79 callers. crisis  The h i g h e r f r e q u e n c y c a l l e r s r e v e a l e d t e l e p h o n i n g  centres f o r support, f r i e n d s h i p , contact, and f o r  therapeutic reasons, skills.  l i k e v a l i d a t i o n and r e l a t i o n s h i p  The f o u r l o w e r f r e q u e n c y c h r o n i c c a l l e r s  telephoning c r i s i s  building  mentioned  l i n e s f o r support, f r i e n d s h i p and contact,  s i m i l a r t o higher frequency c a l l e r s .  The l o w e r f r e q u e n c y c h r o n i c  c a l l e r s a l s o t e n d e d t o r e p o r t more p r a c t i c a l u s e o f c r i s i s  lines,  s u c h a s f o r r e f e r r a l s o r p r o b l e m - s o l v i n g , t h e s e s e r v i c e s more a v a i l a b l e from c r i s i s callers' All  l i n e s than therapy.  (See T a b l e 3 f o r  c h r o n i c i t y by the c a l l e r s use o f c r i s i s  four higher frequency chronic c a l l e r s revealed a  relationship with the c r i s i s therapeutic.  l i n e s t h a t was f r e q u e n t l y  They tended t o r e p o r t u s i n g t h e c r i s i s  between c o u n s e l l i n g appointments  the replacement  lines  f o r therapeutic support.  three o f these c a l l e r s they stated the c r i s i s  The  lines.)  f o r inconsistent o r abusive  For  l i n e e v e n became  therapy.  four higher frequency chronic c a l l e r s reported f i n d i n g  telephone workers  and c r i s i s  l i n e s where t h e y c o u l d g e t  v a l i d a t i o n , p r a c t i c e and b u i l d r e l a t i o n s h i p s k i l l s , reconnect w i t h others. conflict with the c r i s i s  For a l lthese c a l l e r s they  and l e a r n t o indicated  l i n e s d i d d e v e l o p when t h e c a l l e r s  t h e p h o n e l i n e s f o r more t h a n c r i s i s  intervention.  stated a s i m i l a r experience f o ra l lthe c a l l e r s :  One  used  caller  "And t h e n i t was  l i k e they're t e l l i n g you that you can't c a l l a l l the time...they s a y t o y o u : 'We're n o t t h e r a p i s t s . We're n o t p s y c h i a t r i s t s .  We a r e n o t p s y c h o l o g i s t s .  We're n o t c o u n s e l l o r s . '  And i f you're  80  Table 3 C a l l e r s ' C h r o n i c i t y b y Use o f C r i s i s L i n e s , C a l l e r s ' about C r i s i s L i n e s , and Other H e l p i n g Resources  Dislikes  Use o f Lines  Dislikes about C r i s i s Lines  Other Helping Resources  4/day  -regular contact with people, l i k e friends -disclose secrets of abuse so can focus on relationships face-to-face -practice & b u i l d r e l a t ionships - l i f e information - f i l l i n between counselling  -labelled chronic -time Sc c a l l limits -different treatment because chronic -complaints ignored -problemsolving when want t o vent -business-like - r i g i d to procedures  -one private therapist -recently started again  T  2/day  - v a l i d a t i o n on what accomplishing -mirroring of esteem to b u i l d health -help since refuses therapy ever again -contact t o overcome loneliness  -time & c a l l limits -focusing/ directing c a l l -rigid to procedures -rushed o f f phone when recognized  -none f o r 4 years  P  4-5/week  -emotional support & venting -maintenance now -get perspectives on concerns -connecting with others, l i k e friends or family  -labelled caller -time & c a l l limits -focusing/ directing c a l l -complaints ignored -worker unease with sexuality -rushed o f f phone -workers assuming what saying -business-like, cold -responses scripted  -none f o r about a year  Caller  Frequency  S  Callers Crisis  continued  81  Table 3 C a l l e r s ' C h r o n i c i t y b y Use o f C r i s i s L i n e s , C a l l e r s ' D i s l i k e s about C r i s i s L i n e s , and Other H e l p i n g Resources (continued) Caller  Frequency  C a l l e r s Use o f C r i s i s Lines  Dislikes about C r i s i s Lines  Other Helping Resources  Y  3 /week  -break loneliness -support -friendliness  -sometimes workers f r u s t r a t e d with calls  -7 years same psychiatrist -doctors -employment services  L  8-12/month  -talk through & input on problems -encourage workers -chat -resources & referrals - l i f e information  -call limits  -doctor -two mental health workers -with mental health services many years  M  3-5/month  -talk about problems can't t a l k to others about -chat, l i k e friends -resources & referrals -new perspectives & advice  -worker unease with sexuality -forced opinions  -reconnected with counsellor -ongoing support group  R  d a i l y or 1-2/week  -support & contact when alone -get sense of security -problem-solve - f i l l gaps i n between therapy  -worker unease with sexuality -busy signals  -none f o r 4 months -incons i stent counselling -therapists keepleaving  N  3-4/week  -support through difficulties -emotional release & comfort -to t a l k with someone -resources & referrals -new perspectives  -time l i m i t s -focusing/ directing c a l l -"Oh! You've c a l l e d today. Now what?" -busy signals  -psychiatrist -support group -consistent since f i r s t contact  82 u s i n g i t f o r t h a t p u r p o s e , t h e n t h e y t r y t o wean y o u away f r o m it.  Now, p r o c e d u r e a n d p o l i c y w i s e ,  you're h u r t i n g so bad t h a t you can't lousy"(P). frequency fill-in  Further,  f o rc o u n s e l l i n g o r other therapy.  telephoning  and  crisis  frequency  callers  frequency  chronic callers  chronic c a l l e r s : support, They d i f f e r e d  The l o w e r  telephoning  frequency  problem-solving,  these  frequency  f o r more p r a c t i c a l  chronic c a l l e r s mentioned o f t e n new p e r s p e c t i v e s o n problems.  c a l l e r s reported they received the the c r i s i s  lines  Appreciations frequency  chronic c a l l e r s tended t o report  more c o m p l a i n t s  and a g r e a t e r v a r i e t y  line services.  A l l expressed  of crisis  contact  available.  The f o u r h i g h e r  telephone  centres  i n f o r m a t i o n , and r e f e r r a l s  Complaints versus  use  friendship,  and a c t i o n plans t o deal w i t h t h e i r  Rather than therapy,  had  reported  from t h e higher  f o r information and r e f e r r a l s ,  t h e i r concerns,  They j u s t were unaware  l i n e worker's c o n f r o n t a t i o n .  i n t h e i r stated use o f c r i s i s  reasons.  l i n e s as a  l i n e s f o r many o f t h e same r e a s o n s a s t h e  conversation.  readily  see i t , t h e i r approach i s  c a l l e r s acknowledged t h e i r use o f c r i s i s  The f o u r l o w e r  But i f  l i k e t h e above q u o t a t i o n , a l l t h e h i g h e r  o f i t a t t h e moment o f t h e c r i s i s  higher  I can see t h a t .  of complaints  a recognition of their  l i n e s and appreciated the f a c t  a l l t h e time.  d i s l i k e and negative manage t h e i r c a l l s ,  about  However, t h e s e  increased  that they  callers  shared  crisis  cannot their  responses t o t h e c r i s i s centres' attempts t o especially  when t h e c a l l e r s w e r e p h o n i n g i n  83 pain or distress.  They r e p o r t e d t h e i r most a d v e r s e r e s p o n s e s t o  the c r i s i s centres  1  efforts  t o l i m i t and t o focus t h e i r  when t h e y f e l t t h e t e l e p h o n e w o r k e r s w e r e n o t t r e a t i n g  them a s a n  individual  but o n l y as another  mentioned:  " I g u e s s f o r me I f i n d t h a t s o m e t i m e s y o u ' r e n o t  getting...a personal touch. them a r e j u s t  "chronic" c a l l e r .  calls  One c a l l e r  I g u e s s I f e e l t h a t t h e r e ' s some o f  t o o p o l i c y based and t o o p r o c e d u r e - l i k e , and i t  r e a l l y w o u l d b e n i c e i f t h e y c o u l d c u t some o f t h a t b . s . o u t o f t h e i r m a n d a t e " (P) . stated:  "Then y o u r c a l l i s o v e r a t t e n m i n u t e s .  mid-sentence if  /Another h i g h e r f r e q u e n c y c h r o n i c c a l l e r  o r something,  and they, a l o t o f times, t r e a t  t h e y ' r e j u s t p u t t i n g up w i t h you.  1  you as  You're a c h r o n i c c a l l e r and  y o u ' r e n o t one o f t h e i m p o r t a n t o n e s " ( S ) . typify the callers  You c o u l d be  negative responses.  These  statements  The h i g h e r f r e q u e n c y  chronic c a l l e r s uniformly stated their d i s l i k e of c a l l restrictions,  the efforts  the chronic c a l l e r l a b e l .  to direct  (See T a b l e 3 f o r c a l l e r s '  by t h e c a l l e r s ' d i s l i k e s about The any,  and focus t h e i r c a l l s ,  the c r i s i s  chronicity  lines.)  f o u r lower frequency c h r o n i c c a l l e r s mentioned  c o m p l a i n t s about  dislikes of crisis  crisis  fewer, i f  l i n e s , e v e n when a s k e d a b o u t  l i n e s by the p r i n c i p a l  and  investigator.  their They  more o f t e n e x p r e s s e d a p p r e c i a t i o n o f t h e s e r v i c e t h e y r e c e i v e d from c r i s i s  lines.  F o r example,  "I'm j u s t  so v e r y g r a t e f u l  that  t h e y ' r e o u t t h e r e . . . . I don't t a k e them f o r g r a n t e d . . . . t h e y ' v e h e l p e d me o u t s o m u c h " ( L ) .  Rather than complaints, the lower  f r e q u e n c y c h r o n i c c a l l e r s r e p o r t e d much more e a s i l y t h e p o s i t i v e s  84 and  their appreciations of c r i s i s  lines.  C r i s i s L i n e D e p e n d e n t v e r s u s Many M o r e H e l p i n g The f o u r h i g h e r f r e q u e n c y crisis  Resources  chronic c a l l e r s o f t e n mentioned  l i n e s a s t h e o n l y h e l p i n g r e s o u r c e a v a i l a b l e t o them.  Because t h e y were o u t o f c o u n s e l l i n g o r t r e a t m e n t , using c r i s i s support  they  reported  l i n e s e x t e n s i v e l y as a replacement f o r t h e m i s s i n g  and therapy.  They a l s o r e p o r t e d d i f f i c u l t y  finding  consistent, appropriate counselling or other helping when l o o k i n g f o r t h e r a p y o r t r e a t m e n t . the d i f f i c u l t y  for a l l callers,  One c a l l e r ,  s t a t e d : "I've been  f i f t e e n c o u n s e l l o r s i n t h e l a s t 12 t o 15 y e a r s . f i n d s e r v i c e s I can a f f o r d . doesn't s t a y long before  resources indicating  through  I t ' s hard t o  When I do f i n d o n e , t h e c o u n s e l l o r  finding a better paying  c a l l e r s revealed the telephone  crisis  job"(R).  These  centres as the o n l y  r e l i a b l e h e l p i n g r e s o u r c e a v a i l a b l e t o them. The f o u r l o w e r involvement resources  frequency  c h r o n i c c a l l e r s r e p o r t e d much more  a n d more c o n s i s t e n t i n v o l v e m e n t  other than c r i s i s  lines,  with helping  o f t e n over  several years.  T h e s e c a l l e r s a l s o r e p o r t e d more p o s i t i v e e x p e r i e n c e s helping resources. caller said: resource  of these experiences,  "The...support group...that  one  has been t h e best  I've found out o f a l l i t because t h e y have been  supportive. people  Representative  with the  I feel  I'm n o t o u t t h e r e a l o n e  o u t t h e r e t h a t have gone t h r o u g h  - there're  similar  other  situations"(N).  These c a l l e r s r e p o r t e d c r i s i s  l i n e s a s j u s t one h e l p i n g  a v a i l a b l e t o them.  3 for callers'  (See T a b l e  really  resource  c h r o n i c i t y by the  85 callers  1  contact w i t h other h e l p i n g resources.)  Therapeutic  History-  Negative Therapeutic H i s t o r y versus Mostly T h e r a p e u t i c H i s t o r y . The  Positive  four higher frequency chronic c a l l e r s  t e n d e d t o r e p o r t more n e g a t i v e a n d more s e v e r e l y n e g a t i v e experiences w i t h counselling, therapy or treatment frequency chronic c a l l e r s .  than  lower  Often the experiences they  shared  i n v o l v e d h a v i n g t h e power and c o n t r o l o v e r t h e i r l i v e s removed a diagnosis of p h y s i c a l or mental i l l n e s s . s t a t e d t h e y were f o r c e d i n t o t r e a t m e n t  Three of the  or therapy.  callers  (One  caller  even r e v e a l e d b e i n g f o r c e d i n t o a p s y c h i a t r i c i n s t i t u t i o n family.)  F u r t h e r , two o f t h e c a l l e r s m e n t i o n e d y e a r s  t h e r a p e u t i c o r p s y c h i a t r i c abuse.  by  by  of  Overall, these four c a l l e r s  s h a r e d m o s t l y n e g a t i v e v i e w s and e x p e r i e n c e s o f t h e r a p y  and  counselling. A few p o s i t i v e e x p e r i e n c e s were m e n t i o n e d b y t h e frequency chronic c a l l e r s , for  e x a m p l e , " I was  and a h a l f ,  she  often part of a negative  w i t h her f o r three years.  [ t h e t h e r a p i s t ] was  higher  experience,  For the f i r s t  so k i n d and w o n d e r f u l ,  year and  she made i t s a f e e n o u g h f o r t h e f i r s t p e r s o n f a c e - t o - f a c e t h a t I could trust with everything. overnight.  She  And  she t u r n e d o n me  d i d n ' t e v e n a n s w e r t o why  viciously  s h e d o n e i t " (S) .  For  the higher frequency chronic c a l l e r s they always e x p l a i n e d the negative therapeutic experiences f i r s t . e x p e r i e n c e s , i f any, interview.  The  positive,  beneficial  they acknowledged always l a t e r i n the  (See T a b l e 4 f o r c a l l e r s '  c h r o n i c i t y by the  callers'  86 therapeutic The  history.)  f o u r lower frequency c h r o n i c c a l l e r s a l s o mentioned  n e g a t i v e t h e r a p e u t i c e x p e r i e n c e s , though r a r e l y as severe e x t e n s i v e as h i g h e r frequency c a l l e r s . much m e n t a l h e a l t h .  A n d y e t , why  am  F o r example,  I complaining?  or  " I t ' s too Maybe  c o m p l a i n i n g b e c a u s e I f e e l t h a t I wasn't s t r o n g enough. know, b e c a u s e ,  some  I'm  You  i f i t wasn't f o r m e n t a l h e a l t h p e o p l e , where w o u l d  I be t o d a y ? " ( L ) .  Typically,  l i k e t h e p r e v i o u s example, t h e  f r e q u e n c y c a l l e r s wove t h e n e g a t i v e e x p e r i e n c e i n t o a n p o s i t i v e c o n t e x t o r outcome.  lower  overall  H o w e v e r , t h e y s h a r e d more p o s i t i v e  e x p e r i e n c e s w i t h t h e r a p y and treatment t h a n n e g a t i v e ones.  Also,  t h e y more r e a d i l y s h a r e d t h e s e p o s i t i v e e x p e r i e n c e s w i t h c o u n s e l l i n g and  therapy.  F a m i l y H i s t o r y and S p e c i a l  Others  S e v e r e A b u s e v e r s u s S e v e r e N e g l e c t . The  four higher  f r e q u e n c y c h r o n i c c a l l e r s t e n d e d t o r e p o r t more a c t i v e (physical, (family,  s e x u a l , a n d v e r b a l ) a n d a b u s e f r o m more  f r i e n d s , and therapy)  chronic c a l l e r s .  The  than the four lower  b y t h e s e c a l l e r s was  a c t i v e abuse mentioned  c h r o n i c c a l l e r s a l w a y s was process.  frequency  s e x u a l and v e r b a l abuse; however,  most s i g n i f i c a n t abuse m e n t i o n e d The  sources  f o u r lower frequency c a l l e r s a l s o r e p o r t e d  a c t i v e abuse: p h y s i c a l ,  their parents.  abuse  n e g l e c t by  by the lower  discussed l a t e r i n the  experienced.  They mentioned  frequency  interview  For the higher frequency chronic c a l l e r s they  t h e m o s t i n f l u e n t i a l a b u s e was  the  indicated  the a c t i v e abuse t h a t t h e y  t h i s abuse f i r s t and most  often.  87  Table 4 C a l l e r s ' C h r o n i c i t y b y F i r s t E x p e r i e n c e s w i t h Therapy/Treatment, and E x p e r i e n c e s w i t h T h e r a p y / T r e a t m e n t / C o u n s e l l i n g Experiences with Therapy, Treatment or Counselling  Caller  Frequency  F i r s t Experiences w i t h Therapy o r Treatment  S  4/day  - p s y c h i a t r i s t forced on c a l l e r by mother -seen as family problem  -4 therapists abusive or inappropriate -trusted one therapist deeply, then abused & betrayed a f t e r few years of good therapy -one counsellor consistently appropriate & h e l p f u l -mental health system labelling & overpowering; don't want c l i e n t s to leave system  T  2/day  -forced medical treatment f o r health problems by parents; experimental treatments used -institutionalized for mental i l l n e s s by family  - i n s t i t u t i o n a l i z e d by family 3 times; a l l power & r i g h t s removed -experiences medical & mental health people as controlling  P  4-5/week  -family forced into counselling -mother wanted c a l l e r inst itut ionalized  -difficulties connecting with some therapists -some counsellors unapproachable; they put out c a l l e r responsible f o r resistance  R  daily or 1-2/week  -support group through women's centre on own i n i t i a t i v e ; tended to be p o s i t i v e  - d i f f i c u l t y f i n d i n g low cost & consistent therapy -some therapists uncomfortable with sexuality -some therapy h e l p f u l with issues and emotions  N  3-4/week  -started within l a s t year  - p s y c h i a t r i s t useless -support groups very helpful;others with s i m i l a r experiences continued  88  Table 4 C a l l e r s ' C h r o n i c i t Y b y F i r s t E x p e r i e n c e s w i t h 'Therapy/Treatment, and E x p e r i e n c e s w i t h Therapy/Treatment/Counselling (continued) F i r s t Experiences w i t h Therapy o r Treatment  Experiences with Therapy, Treatment or Counselling  Caller  Frequency  Y  3/week  L  8-12/month  -started with mental health i n youth -institutions & p s y c h i a t r i c treatments  -wouldn't be a l i v e today without mental health -much mental health support J -coping well & appreciative -current d i s l i k e of workers (  M  3-5/month  -started i n l a t e teens  -support groups mostly beneficial \ -one poor p s y c h i a t r i c -mostly appreciated of help; finds i t h e l p f u l  -not  disclosed  -previous i n s t i t u t i o n a l treatment - r e a l l y connected with psychiatrist -current medical problems concerning  . \  89 (See T a b l e 5 f o r c a l l e r s '  c h r o n i c i t y by the c a l l e r s '  family  h i s t o r y and o t h e r abuse experiences.) None o r One  S p e c i a l O t h e r t o Two  o r More S p e c i a l  Others.  Going from the h i g h e s t frequency c h r o n i c c a l l e r t o the frequency chronic c a l l e r ,  lowest  t h e number o f r e l a t i o n s h i p s r e p o r t e d  w i t h s p e c i a l others tended t o i n c r e a s e .  The  c h r o n i c c a l l e r s t e n d e d t o m e n t i o n no o r one  higher  frequency  special other.  The  l o w e r f r e q u e n c y c h r o n i c c a l l e r s t e n d e d t o m e n t i o n two o r t h r e e s p e c i a l others throughout  their lives.  c h r o n i c i t y by the c a l l e r s ' One  special  (See T a b l e 5  others.)  c a l l e r s a i d telephoning the c r i s i s  by a s p e c i a l o t h e r .  callers'  l i n e s was  influenced  T h i s c a l l e r s a i d w i t h o u t someone t o t a l k t o ,  increased support from the c r i s i s  l i n e s was  needed.  The  caller  t h e n t e l e p h o n e d more o f t e n . Traumatic The  P a r e n t a l C o n n e c t i o n v e r s u s No  P a r e n t a l Contact.  four higher frequency chronic c a l l e r s revealed a traumatic  connection w i t h a parent t h a t r e s u l t e d from the o t h e r parent's d e a t h , a b u s e o r abandonment.  They i n d i c a t e d t h e i r  w i t h t h e r e m a i n i n g p a r e n t a l s o became t r a u m a t i c .  relationship They mentioned  t h i s p a r e n t l a t e r abused o r abandoned them p h y s i c a l l y  or  emotionally.  the  callers' The  (See T a b l e 5 f o r c a l l e r s '  family  c h r o n i c i t y by  history.)  four lower frequency chronic c a l l e r s reported being  n e g l e c t e d o r unwanted by t h e i r p a r e n t s and f a m i l y . t h e y were i g n o r e d by t h e i r p a r e n t s and e x c l u d e d from activities.  They r e p o r t e d family  These c a l l e r s i n d i c a t e d t h e i r p a r e n t s r a r e l y were  90 Table 5 Callers' Others  Chronicity by Family History,  Family  Other Abuses, and S p e c i a l  History  Other Abuse  Special Others  Caller  Frequency  S  4/day  -severe emotional & sexual abuse -mother drug addicted - i s o l a t e d from s i b l i n g s and others through father's t r a i n i n g i n s o c i a l s k i l l s ; extreme loyalty, -forced into therapy -scapegoat & i d e n t i f i e d patient f o r family  -mental health -medical -therapy -crisis lines  none  T  2/day  -father a l c o h o l i c -severe physical & emotional abuse -severe dependency with mother -forced into treatment -became i d e n t i f i e d patient f o r family  -mental health -medical -partner abuse  one  P  4-5/week  -father a l c o h o l i c & c a l l e r victimized -mother's death, then dependency on father -severe emotional & verbal abuse from parents -almost institutionalized -family blacksheep, scapegoat & i d e n t i f i e d patient  -therapy -crisis lines  one  R  d a i l y or 1-2/week  -mother drug addicted -physical & emotional abuse -over protected as child -father abandoned family -family rebel  -therapy -partner abuse  two  N  3-4/week  -alcoholic father -ignored by parents because of alcoholism -severe neglect -sexual abuse i n home  one  continued  91  Table  5  C a l l e r s ' C h r o n i c i t y by Family H i s t o r y , Others (cont inued) Family  O t h e r /Abuse, a n d  History  Caller  Frequency  Y  3/week  L  8-12/month  -parents never there for caller -father drinking problem - l o t s of family secrets -physical & sexual abuse as well -parents okay with mentally i l l children; they're the patients, not them -parents sick mentally  M  3-5/month  -unwanted c h i l d -parents a l c o h o l i c -father psychotic -mother emotional wreck -the family outcast & blacksheep -abandoned & kicked out of family -sexual & physical abuse as well  Other Abuse  -partner -not wanted by parents -physical abuse i n home abuse -outcast Sc. neglected by family -excluded from family events -father drinking problem -partner abuse  Special  Special Others -two  -three  two  92 t h e r e f o r them a s t h e y grew up.  Further, they stated  their  p a r e n t s r e m a i n e d u n a v a i l a b l e t o s u p p o r t them a s a d u l t s w i t h p e r s o n a l d i f f i c u l t i e s t h e y may b e u n d e r g o i n g . Blamed f o r t h e F a m i l i e s ' The  I l l s versus Ignored by the Family.  f o u r h i g h e r frequency c h r o n i c c a l l e r s s t a t e d t h e scapegoat,  b l a c k s h e e p , o r r e b e l l a b e l o f t e n accompanied them i n t h e i r families.  They s t a t e d t h e y were blamed f o r t h e f a m i l i e s '  a n d t h e y o f t e n became t h e f a m i l i e s '  identified patient.  f a m i l y e x p e r i e n c e i s summed u p i n t h i s c a l l e r s '  ills, Their  statement:  " I can  remember when I was y o u n g e r , my f a m i l y s e n t me t o a p s y c h i a t r i s t when I was a b o u t f i f t e e n .  I was s e n t a s t h e s c a p e g o a t .  I t was  l i k e e v e r y t h i n g t h a t was w r o n g w i t h o u r f a m i l y was my f a u l t . . . . I was t h e i d e n t i f i e d p a t i e n t i n a s i c k f a m i l y " ( S ) . for callers' The  c h r o n i c i t y by the c a l l e r s '  family  (See T a b l e 5  history.)  f o u r lower frequency c h r o n i c c a l l e r s mentioned  r e c e i v e d no a t t e n t i o n from t h e f a m i l y g e n e r a l l y . t h e y were i g n o r e d whatever t h e y d i d . these c a l l e r s '  They  they stated  One c a l l e r r e p r e s e n t e d a l l  experiences i n t h e statement:  "Nobody e v e r  really  f e l t a n y t h i n g f o r me, l i k e t h e y d i d n ' t a p p r e c i a t e me when I d i d s o much f o r t h e m a l l  t h e time"(M).  The c a l l e r s i n d i c a t e d  they  a l l w e r e a b a n d o n e d t o t h e i r own r e s o u r c e s , a n d t h e y s u r v i v e d o n t h e i r own. V a l i d a t i o n o f H i g h e r and Lower Frequency C h r o n i c  Caller  Characteristics with Callers All  f i v e c a l l e r s contacted f o rthe v a l i d i t y follow-up  confirmed both t h e h i g h e r frequency and lower frequency c h r o n i c  93 caller characteristics. them a c h a r a c t e r i s t i c  O n l y two s u b j e c t s d i s c u s s e d t h a t f o r  was somewhat i n c o n g r u e n t w i t h t h e i r  or higher frequency c a l l i n g i d e n t i f i c a t i o n .  Some l o w e r  c h r o n i c c a l l e r s even p r o v i d e d c o n f i r m a t i o n f o r h i g h e r chronic c a l l e r characteristics characteristic  by i d e n t i f y i n g  lower  frequency  frequency  with the  f r o m t h e t i m e t h e y t e l e p h o n e d more f r e q u e n t l y .  F o r e x a m p l e , t w o c a l l e r s , now t e l e p h o n i n g w i t h l e s s both reported c r i s i s  frequency,  l i n e c a l l management was u s e d o n t h e m when  t h e y were t e l e p h o n i n g w i t h g r e a t e r f r e q u e n c y . Crisis Line Characteristics The r e s u l t s positive  r e p o r t e d here a r e those c h a r a c t e r i s t i c s  -  o r negative - that the chronic c a l l e r s revealed as  themes i n t h e i r  i n t e r a c t i o n s w i t h the telephone c r i s i s  (see T a b l e 6 ) .  The c r i s i s  line characteristics  centres  are the callers'  view. Crisis Line Support  Positives and Comfort.  A l l the callers reported the c r i s i s  l i n e s a s s u p p o r t i v e when t h e y w e r e c a u g h t u p i n t h e e m o t i o n s a n d challenges of t h e i r  lives.  More s p e c i f i c a l l y , t h r e e  callers  shared sometimes t h e y j u s t needed t o v e n t , and t h e c r i s i s workers  line  s u p p o r t e d them t h r o u g h b e i n g a v a i l a b l e t o t a l k a n d v e n t  t h e i r emotions and a n x i e t y .  Four c a l l e r s  shared the telephone  w o r k e r s p r o v i d e d t h e m s u p p o r t b y c o m f o r t i n g t h e m when t h e y w e r e lonely, depressed o r vulnerable. r e c e i v e d , one c a l l e r s t a t e d : it,  Representative o f t h e comfort  "And, o f c o u r s e , t h e h e l p I g e t f r o m  t h e b e n e f i t I g e t o u t o f i t , b e c a u s e when I p h o n e when I'm  94 Table  6  Crisis Line n  Characteristics  C r i s i s Line  Characteristic Crisis Line  and  Positives  8  support  comfort  8  c o n t a c t and  8  esteem b u i l d i n g  8  volunteers create a positive  6  like  conversation  experience  friends C r i s i s Line  6  poor "business"  6  call  5  labelled  management  practice  Negatives  95 d e p r e s s e d , i t u p l i f t s me"(M).  F o r two c a l l e r s , t h e w o r k e r s '  v o i c e s a l s o were v e r y c o m f o r t i n g . workers' v o i c e s soothing,  They s t a t e d t h e y  found the  a l l o w i n g t h e e m o t i o n s and a n x i e t y t o be  released. Contact  and Conversation.  used the c r i s i s  lines  The c a l l e r s a l l r e v e a l e d t h a t  f o r contact.  Five callers  s t a t e d some o f  t h e i r c o n t a c t was n o more t h a n a n o p p o r t u n i t y t o s o c i a l i z e chat.  F i v e c a l l e r s a l s o mentioned they telephoned  f r o m t h e l o n e l i n e s s o r i s o l a t i o n t h e y may regular contact with However,  they  or  t o b r e a k away  f e e l and t o have  others.  a l l t h e c a l l e r s r e p o r t e d t h a t some c r i s i s  line  w o r k e r s a l l o w e d them t o s h a r e t h e i r day, l i k e w i t h a f r i e n d  or  f a m i l y member, a n d j u s t t o c h e c k i n w i t h someone e l s e . I n d i c a t i v e o f the contact the c a l l e r s had developed w i t h the crisis  l i n e s , one c a l l e r s t a t e d : " U s u a l l y . . . [ I t e l e p h o n e ] . . . j u s t  t o t r y t o v o i c e t o someone w h a t ' s h a p p e n i n g , b u t l a t e l y i t ' s b e e n more o f a m a i n t e n a n c e . . . . T h i s i s w h a t ' s h a p p e n i n g presently....but and  i t ' s almost l i k e a f a m i l y r e l a t i o n s h i p w i t h  them" (P) . Esteem B u i l d i n g .  the c r i s i s  lines.  A l l callers  showed e s t e e m b u i l d i n g t h r o u g h  They i n d i c a t e d t h e i r esteem had grown t h r o u g h  (a) t h e a c k n o w l e d g e m e n t a n d e n c o u r a g e m e n t f r o m t e l e p h o n e and  me  (b) t h e a c t i o n p l a n s d e v e l o p e d b e t w e e n t h e c r i s i s  workers and t h e c a l l e r s t o address t h e c a l l e r s ' All  workers,  line  concerns.  t h e c a l l e r s r e p o r t e d a t l e a s t some v a l i d a t i o n a n d  acknowledgement o f them and t h e i r l i f e e x p e r i e n c e s  from the  96 telephone workers. telephone workers  1  T h e y i n d i c a t e d t h i s came t o t h e m t h r o u g h t h e u s e o f l i s t e n i n g s k i l l s and empathy t o  u n d e r s t a n d what t h e c a l l e r s were s a y i n g . i n d i c a t e d non-judgemental f e e l b e t t e r about The  Also, three  telephone workers helped t h e c a l l e r s  themselves.  c a l l e r s r e p o r t e d t h a t t h e y l e a r n e d i t was o k a y t o b e  themselves.  S i m i l a r f o r a l l c a l l e r s , one c a l l e r d i r e c t l y  " I l e a r n e d i t was o k a y t o b e m y s e l f . . . . A n d  was i n s u c h b a d s h a p e when I f i r s t t h e y saw t h a t s i d e o f me,  uniqueness,  But I  I j u s t d i d n ' t h a v e t o h i d e me a n y m o r e .  l i n e workers  As w e l l ,  acknowledged  three  their  p u t t i n g f o r w a r d t h a t t h e c a l l e r s were s p e c i a l  F o r example, one c a l l e r s a i d : a kind.  l i k e me.  "They t o l d me:  l o v i n g person.  people.  'Well, you're  Y o u ' v e g o t a l o t o f , y o u know, q u a l i t i e s  you're a v e r y c a r i n g ,  told  s t a r t e d c a l l i n g . . . A n d once  l e a r n e d i t was o k a y t o b e m y s e l f " ( S ) .  callers stated the c r i s i s  stated:  I had always been  i f a n y b o d y e v e r knew t h e r e a l me, t h e y w o u l d n ' t  I just  callers  i nlife,  one o f and  I t ' s v e r y great o f you"(N).  C a l l e r s a l s o r e v e a l e d t h e telephone workers  encouraged  their  esteem through h e l p i n g t h e c a l l e r s w i t h t h e i r problems and concerns.  Five callers  stated c r i s i s  l i n e workers  h e l p e d them  expand t h e i r p e r s p e c t i v e s on t h e i r concerns and d e v e l o p p l a n s t o a l l e v i a t e t h e problems.  Further, f o rthree c a l l e r s , the  help they r e p o r t e d r e c e i v i n g from t h e c r i s i s life  action  i n f o r m a t i o n they never received.  lines also included  They s t a t e d  i n f o r m a t i o n b e t t e r h e l p e d them w i t h t h e i r d a y - t o - d a y  this living.  Volunteers Create a P o s i t i v e Experience. A l l c a l l e r s  shared  97 that telephone the c r i s i s  w o r k e r s made a p o s i t i v e  lines.  experiences,  Representative  one c a l l e r s a i d :  of a l l the callers'  "I feel like, well,  r e a l l y d o e s n ' t know me, b u t c a r e s . world  i s a better place after  somebody o u t t h e r e a c t u a l l y you  can't  volunteers lines.  d i f f e r e n c e f o r them w i t h  A n d i t makes me t h i n k t h e  a l l . . . . I t makes me f e e l g o o d t h a t  cares, and you can t a l k about  r e a l l y t a l k about t o anybody"(M).  Two c a l l e r s  things said the  c l e a r l y made t h e d i f f e r e n c e f o r t h e m b e t w e e n c r i s i s  They p e r c e i v e d  some p e o p l e a t o n e c r i s i s  considerate and b e t t e r able t o deal w i t h t h e i r c a l l e r s a l s o expressed used t h e i r d i s c r e t i o n crisis  that person  line policies  believed these  l i n e a s more  situations.  Two  t h e i r a p p r e c i a t i o n f o r those workers and acted independently,  and procedures.  telephone  crisis  that  when n e e d e d , f r o m  For these  callers,  they  c e n t r e s were b e t t e r phone  lines  because o f t h e v o l u n t e e r s . Four c a l l e r s mentioned t h e telephone experience  as important.  l i f e experience understanding  These c a l l e r s  workers'  life  stated the volunteers'  was a p l a c e w h e r e t h e w o r k e r s c o u l d d r a w more  a n d c o m p a s s i o n t o c o n n e c t w i t h them.  The c a l l e r s  reported f e e l i n g b e t t e r connected w i t h those volunteers similar  life  experiences  having  t o t h e i r own a n d t h a t w e r e s h a r e d  at a  p r o f e s s i o n a l l e v e l w i t h them. The y e a r s  o f c o n t a c t b e t w e e n some t e l e p h o n e  c a l l e r s a l s o appeared t o b u i l d a p o s i t i v e callers.  Two c a l l e r s r e v e a l e d a s p e c i a l  t h e y e a r s w i t h some v o l u n t e e r s .  w o r k e r s a n d some  experience  f o r a few  long term contact  As s a i d b y one o f t h e s e  over  callers:  98 " 1 ve been phoning 1  i n many y e a r s .  same p e o p l e o n t h e l i n e .  /And a l o t o f p e o p l e a r e  A f e w anyway, y o u know.  v e r y g r a t e f u l t h a t they're out t h e r e " ( L ) .  I'm  just  a p o s i t i v e e x p e r i e n c e and c o n n e c t i o n w i t h t h e c r i s i s  the c r i s i s  lines.  so  For these c a l l e r s  i n d i c a t e d the c o n s i s t e n c y o f knowing another p e r s o n h e l p e d  L i k e F r i e n d s . S i x c a l l e r s mentioned  the  they  build  lines.  f r i e n d l i n e s s coming  from  A l l s a i d t h e i r c o n n e c t i o n and r a p p o r t w i t h  some w o r k e r s  was  like a friendship.  t h e m know me  so w e l l t h r o u g h t h e t e l e p h o n e t h a t t h e y f e e l l i k e  f r i e n d , which i s a k i n d of unique concerned"(P). callers'  a  the  a c t e d much  t h e c a l l e r s were d o i n g .  c a l l e r even d e s c r i b e d the workers joked around w i t h the c a l l e r .  "A l o t o f  I'm  reflected a l l  They r e p o r t e d t h e workers  f r i e n d s b e c a u s e t h e y a s k e d how  friendship.  c a l l e r stated:  r a p p o r t as f a r as  T h i s c a l l e r ' s statement  experiences.  friendliness,  One  like  One  as v e r y p e r s o n a b l e because  they  However, e v e n w i t h t h e p e r c e i v e d  f o u r c a l l e r s s a i d c l e a r l y i t was  not t r u e  T h e y s t a t e d t h e y d i d n o t know t h e  workers  p e r s o n a l l y , a n d t h e r e l a t i o n s h i p o n l y was  somewhat l i k e  a  friendship. C r i s i s Line Negatives Poor  " B u s i n e s s " P r a c t i c e . S i x c a l l e r s made d i r e c t  r e l a t i n g t o the c r i s i s  lines' handling of c a l l s .  Three  comments callers  s t a t e d t h e i r c a l l s were h a n d l e d t o o b u s i n e s s l i k e , w i t h o u t warmth, w i t h the workers  too r i g i d to c r i s i s  l i n e procedures.  r e v e a l e d what t h e s e c a l l e r s e x p e r i e n c e d i n s t a t i n g : sometimes t h e i r c l i c h e ,  t r i t e responses  that they  One  caller  "I find  give...it's  99 very robotic. receiving  I t ' s very impersonal"(P).  busy signals,  Three c a l l e r s  sometimes o v e r an hour.  And  mentioned  two  callers  s h a r e d t h a t t h e t e l e p h o n e w o r k e r s p u t them on h o l d as o t h e r c a l l s came i n . C a l l Management. S i x c a l l e r s  shared t h a t c r i s i s c e n t r e s have  r e s t r i c t e d a n d managed t h e i r c a l l s . c a l l management m e t h o d s : f o c u s i n g and d i r e c t i n g  (a) c a l l a n d t i m e l i m i t s , a n d  the content of t h e i r c a l l s .  e x c e p t i o n a l l c a l l e r s mentioned methods.  O n l y one  These c a l l e r s mentioned  d i s l i k i n g these c a l l  c a l l e r mentioned  two  (b)  Without management  anything positive  about  call  management: " I c a n r e s p e c t c r i s i s l i n e s t h a t h a v e t i m e l i m i t s s t i c k b y them. The  I t shows t h e y h a v e b o u n d a r i e s " ( T ) .  c a l l e r s e x p r e s s e d t h a t c a l l and t i m e l i m i t s r e s u l t e d  them b e i n g c u t o f f following  and  mid-sentence  the r e s t r i c t i o n .  when t h e t e l e p h o n e w o r k e r s  in  rigidly  They r e p o r t e d t h e y were o f t e n n e i t h e r  given the o p p o r t u n i t y nor control  t o d e c i d e t h a t t h e y n e e d e d more  time t h i s c a l l t o t a l k through t h e i r concerns.  They shared t h a t  t h e y o f t e n were rushed, t r e a t e d l i k e a case, and not r e s p e c t e d . One  c a l l e r explained the experience of c a l l r e s t r i c t i o n s  " I t makes me  f e e l l i k e I'm  rid of....It's  j u s t a number t h e y ' r e t r y i n g  T h i s statement  experience f o r a l l c a l l e r s .  Two  reflected  limited  o f u p s e t s me  to a certain  a n d makes me  a  you  similar  c a l l e r s even noted  c o n t r a d i c t i o n i n t h e t i m e l i m i t s , one  sort  t o get  l i k e they're doing you a favour by t o l e r a t i n g  f o r 10 m i n u t e s " ( S ) .  t h a t when I am  like:  a  stating:  "Sometimes I  find  t i m e i n my  phone c a l l s ,  this  f e e l t h a t nobody c a r e s about  how  100 I'm f e e l i n g a n y m o r e . .. . B u t t h e c r i s i s l i n e h a s t o l d me t h a t i t ' s b e t t e r t o p h o n e somebody a n d t a l k t o t h e m a b o u t y o u r e m o t i o n s y o u r f e e l i n g s t h a n t o h o l d them One c a l l e r m e n t i o n e d  and  inside"(N).  t h a t some t e l e p h o n e w o r k e r s  imposed o r n e g o t i a t e d time l i m i t s .  This c a l l e r said  gently that  after  i t h a d b e e n d e t e r m i n e d n o c r i s i s e x i s t e d f o r t h e c a l l e r , a n d when the c r i s i s  l i n e was b u s y , some t e l e p h o n e v o l u n t e e r s w o u l d s a y :  " I t ' s been k i n d o f busy t o n i g h t . short."  The c a l l e r s a i d  I would l i k e t o keep t h i s  t h i s approach  call  seemed much m o r e  appropriate. Four c a l l e r s mentioned  that they f e l t the telephone  were sometimes i g n o r i n g t h e i r emotions v e n t when t h e w o r k e r s caller,  indicating  workers  a n d n o t a l l o w i n g them t o  focused and d i r e c t e d t h e c a l l s .  the d i f f i c u l t y f o r a l l , stated:  One  "I'm g o i n g  t h r o u g h a v e r y e m o t i o n a l p e r i o d where I j u s t n e e d t h e i r  support  a n d t o b e t h e r e t o h e a r me o u t a n d t o h e l p g i v e me t h e s u p p o r t I need.  And o t h e r s a r e v e r y up f r o n t a n d a l l t h e y want t o do i s  sort of direct  me i n a d i r e c t i o n  m y s e l f t o d a y " (N). directing  These c a l l e r s  a s t o w h a t am I g o i n g t o d o f o r shared that t h e f o c u s i n g and  o f t h e i r c a l l s l e f t them f e e l i n g h u r t a n d r e j e c t e d  because t h e telephone worker  d i dnot address t h e i r  They r e p o r t e d t h e y were l e f t  feeling not f u l l y  L a b e l l e d . F i v e c a l l e r s mentioned treatment  from c r i s i s  receiving  emotions.  understood. different  l i n e s because t h e y were l a b e l l e d  "chronic"  or gay/lesbian i d e n t i f i e d . Three c a l l e r s  s t a t e d t h e y were l a b e l l e d  "chronic" c a l l e r s by  101 crisis  lines.  They mentioned t h e y e x p e r i e n c e d a  substandard  s e r v i c e as c h r o n i c c a l l e r s because t h e y were n o t c r i s i s  callers.  R e p r e s e n t a t i v e o f a l l t h e s e c a l l e r s , o n e c a l l e r s t a t e d : "They c a l l e d me  'chronic c a l l e r , ' w i t h c h r o n i c has a negative  connotation t o it....they,  a l o t o f times, treat  t h e y ' r e p u t t i n g up w i t h you. n o t one o f t h e i m p o r t a n t complained lines'  you asi f  You're a c h r o n i c c a l l e r and you're  ones"(S).  F o r two c a l l e r s  that  about t h e s e r v i c e they r e c e i v e d , t h e y s a i d  the c r i s i s  a d m i n i s t r a t i o n s disregarded t h e i r complaints and  attributed  the complaints t o the "chronic" l a b e l .  r e p u t a t i o n f o l l o w e d them, e v e n i f t h e y d i d c h a n g e . indicated  t h e o n l y way t h e t r e a t m e n t  they stopped  They s t a t e d a They  o r l a b e l d i s a p p e a r e d was i f  telephoning f o ra while.  Three c a l l e r s a l s o r e p o r t e d telephone  workers as seeming  awkward o r n o t a c c e p t i n g o f t h e i r g a y o r l e s b i a n l i f e s t y l e . one  c a l l e r said,  r e f l e c t i n g a l l three c a l l e r s '  " C e r t a i n f e l l o w s make me u n e a s y . times i n a l l t h e years  I've been phoning.  The  uncomfortable  One c a l l e r e v e n s t a t e d t h e  and acted on t h e i r  of C r i s i s Line Characteristics f i v e c a l l e r s reached  line characteristics Callers  They're  w o r k e r s r e a d t h i n g s i n t o what t h e c a l l e r s a i d  the c a l l e r ' s s e x u a l i t y Validation  experiences:  I t ' s o n l y happened two o r t h r e e  when I t a l k a b o u t my l i f e s t y l e " ( R ) . telephone  regarding  assumptions. with  Callers  f o r follow-up confirmed  the c r i s i s  t h a t emerged f r o m t h e i n t e r v i e w d a t a .  that o r i g i n a l l y provided limited  line characteristics  As  provided additional  evidence  f o r some  information that  crisis  102 strengthened the i d e n t i f i e d c h a r a c t e r i s t i c s . for the i d e n t i f i e d c r i s i s the  No c o u n t e r e v i d e n c e  line characteristics  was p r o v i d e d b y  c a l l e r s at follow-up. Leitmotifs F o u r g l o b a l themes, o r l e i t m o t i f s ,  analysis. and  The l e i t m o t i f s  emerged f r o m t h e d a t a  of i s o l a t i o n , connection,  victimization  e s t e e m c a p t u r e d g r e a t e r , more m e a n i n g f u l p a t t e r n s a r i s i n g o u t  o f what t h e c a l l e r s d i r e c t l y s a i d o r i m p l i e d .  These g l o b a l  themes c u t a c r o s s a l l a s p e c t s o f t h e c a l l e r s ' l i v e s : interaction services, others. their  their  w i t h the c r i s i s l i n e s , t h e i r use o f other  and t h e i r experiences w i t h family, The l e i t m o t i f s p u t t h e c a l l e r s  friends  into a larger  helping and  special  context f o r  lives.  Isolation The i s o l a t i o n l e i t m o t i f e m e r g e d f r o m i n t e r v i e w indicating  c a l l e r i s o l a t i o n and l o n e l i n e s s .  arose from the c a l l e r s  1  data  The g l o b a l  theme  i n f o r m a t i o n on t h e i r p h y s i c a l and  psychological health, their families,  and t h e i r  intimate  relationships. L i m i t a t i o n s Creating Loneliness. Four c a l l e r s c l e a r l y one o f t h e i r r e a s o n s f o r c o n t a c t i n g c r i s i s loneliness.  stated  l i n e s as i s o l a t i o n o r  For these c a l l e r s , they said the c r i s i s  lines  became  a r e g u l a r c o n t a c t f o r them because t h e y c o u l d n o t c o n n e c t w i t h others.  Further,  s i x c a l l e r s mentioned l i m i t e d  hampered t h e i r a b i l i t y t o c o n n e c t s o c i a l l y . callers,  finances  that  For three o f these  they also stated t h e i r physical health limited  their  103 a b i l i t y t o get out. Sexual O r i e n t a t i o n . Three c a l l e r s isolated  from t h e i r  families  not accept t h e c a l l e r s ' mentioned  i n d i c a t e d t h e y were  and o t h e r s because these people d i d  sexual orientation.  t h e nonacceptance  These  callers  came a c r o s s a s u n e a s i n e s s t o o u t r i g h t  h o s t i l i t y t o w a r d them from f a m i l y , h e l p i n g p r o f e s s i o n a l s a n d others.  One c a l l e r d i s c l o s e d a s o l i d r e l u c t a n c e t o t a l k  sexuality  out o f f e a r o f being not accepted and judged by others.  F a m i l i e s . A l l c a l l e r s mentioned members.  O n l y two c a l l e r s mentioned  f a m i l y members; t h e y s a i d members.  some i s o l a t i o n f r o m  t h e y d i dn o t speak w i t h o t h e r  The r e m a i n i n g t w o c a l l e r s  contacted their  family  a c o n n e c t i o n w i t h some  Four o t h e r c a l l e r s r e v e a l e d a tenuous  their families. rarely  about  family  connection with  s a i d they never o r  families.  H a l f t h e c a l l e r s i n d i c a t e d i s o l a t i o n from t h e i r  families  t h a t arose from n e g l e c t by t h e i r parents - t h e i r p a r e n t s  just  were n o t t h e r e f o r them because o f s u b s t a n c e abuse o r i l l n e s s . Two o f t h e s e c a l l e r s n o t w a n t them. both c a l l e r s  s t a t e d t h e i r parents and f a m i l y c l e a r l y d i d  One c a l l e r e x p r e s s e d t h e s i m i l a r  i n t h e statement:  " B o t h my p a r e n t s w a n t e d a b o y , b u t  when t h e y h a d h i m , t h e y w e r e h a p p y . ignored"(M).  experience f o r  B u t I was c o m p l e t e l y  F o r t h e s e two c a l l e r s , t h e y r e p o r t e d l a t e r i n t h e i r  l i v e s t h e y even were e x c l u d e d from f a m i l y a c t i v i t i e s , parties,  like  a n d b e i n g t a u g h t how t o r u n a home, s u c h a s c o o k i n g .  For t h e other h a l f  of the c a l l e r s , they revealed a parental  c o n n e c t i o n through t h e trauma o f t h e o t h e r p a r e n t s '  death,  104 p a r e n t a l a b u s e o r abandonment. connection  developed at the e x c l u s i o n of other  Once t h e p a r e n t a l c o n n e c t i o n one  They i n d i c a t e d t h e i r  i n the  was  parental  f a m i l y members.  broken, they mentioned that  f a m i l y i n i t i a l l y remained t o provide  support.  no  Three  c a l l e r s even s t a t e d t h e y were blamed f o r t h e i r e x c l u s i o n f r o m  the  family. Four c a l l e r s i n d i c a t e d t h e y were the the  f a m i l y and  i n t h e home.  forced i n t o therapy f o r the c o n f l i c t they F o u r c a l l e r s m e n t i o n e d t h e y became t h e  rebel, outcast of the  identified patient  o r scapegoat, and  family.  were cut o f f from t h e  C r e a t e s Some L o n e l i n e s s .  A l l the  m e n t i o n e d t h a t when t h e y i m p r o v e d t h e i r e m o t i o n a l p s y c h o l o g i c a l h e a l t h , t h e y l o s t some f a m i l y a n d Representing the a lot  experience f o r a l l c a l l e r s , [of f r i e n d s ] .  When I was  l o t of f r i e n d s , a l o t of f r i e n d s . [now  But,  w i t h b e t t e r e s t e e m ] " (L) .  broke o f f contact  to maintain  the  f a m i l y c a s t them out  and  b e l i e f s when t h e y g o t Few  family remainder  actions.  Better Health  anybody  created  A l l i n d i c a t e d t h e i r f a m i l i e s d i s o w n e d them  because o f t h e i r  u s e d t o see  in  and  you  callers and  friends.  one  caller said:  a doormat, I had know, I h a r d l y  They shared t h a t  family  a see  they  to b u i l d t h e i r health, or  because t h e y challenged  that  loyalties  better.  S p e c i a l Others. H a l f the c a l l e r s mentioned t h e y had  o r o n l y one  s p e c i a l other two  "I  in their lives.  revealed  t h e y had  or three  O n l y two  c a l l e r s mentioned a current  The  s p e c i a l others  other  no  half  in their  lives.  special relationship.  Six  105 callers stated they l i v e d  alone.  Connection C a l l e r s d i s c l o s e d i n f o r m a t i o n on t h e i r i n t e r a c t i o n s w i t h crisis  l i n e s and o t h e r h e l p i n g s e r v i c e s , and on t h e i r  r e l a t i o n s h i p s w i t h f a m i l y and f r i e n d s .  From t h i s i n t e r v i e w  data  e m e r g e d t h e g l o b a l theme o f c o n n e c t i o n . C r i s i s L i n e s . C a l l e r s s t a t e d they connected w i t h l i n e s i n many w a y s .  F i v e c a l l e r s mentioned  crisis  telephoning c r i s i s  l i n e s t o h a v e someone l i s t e n t o them, t o t a l k w i t h , a n d t h e i r day and f e e l i n g s .  Three c a l l e r s s p e c i f i c a l l y mentioned  they appreciated they could telephone the c r i s i s chat.  share  They s a i d t h e telephone workers  a s k t h e c a l l e r s how t h i n g s w e r e g o i n g . connected w i t h the c r i s i s  lines like  how  lines just to  a l s o would chat and even Five callers stated  family or friends.  c a l l e r s t a t e d a s i m i l a r e x p e r i e n c e f o r a l l : "There's  they  One  one  crisis  l i n e I'm v e r y i n t o u c h w i t h more t h a n t h e o t h e r s , a n d t h e s e people,  I almost  by t h i s  - but i t ' s almost  them.  feel like  - I d o n ' t know i f y o u ' l l  shocked  l i k e a f a m i l y r e l a t i o n s h i p w i t h me  and  A n d a l o t o f t h e m know me s o w e l l t h r o u g h t h e t e l e p h o n e  that they f e e l l i k e a  friend"(P).  Four c a l l e r s mentioned life  sound  the telephone workers  with  e x p e r i e n c e s t o them h e l p e d b u i l d t h e t e l e p h o n e  through the sharing of that experience. shared e x p e r i e n c e between t h e worker  relationship  They i n d i c a t e d t h e  and t h e c a l l e r h e l p e d  and b u i l d g r e a t e r r a p p o r t and c o n n e c t i o n . s a i d they found telephone workers  similar  A l s o , these  foster  callers  were b e t t e r a b l e t o u n d e r s t a n d  106 and  h e l p them i f t h e w o r k e r s h a d been t h r o u g h  experience  a similar  life  t o them.  Two c a l l e r s  indicated t h e i r contact with c r i s i s  l i n e s was  therapeutic and allowed b e t t e r i n t e r a c t i o n w i t h others. shared  t h e i r contact with the c r i s i s  l i n e s had f o s t e r e d  changes t h a t a l l o w e d them t o c o n n e c t w i t h o t h e r s .  They life  They s t a t e d  they learned t o take t h e focus o f f themselves and focus on t h e other person. with others  They i n d i c a t e d t h e y were b e t t e r a b l e t o connect then.  Other Helping Resources. C a l l e r s a l s o r e v e a l e d t h e i r need for  connection  through  their therapeutic relationships.  Six  c a l l e r s s t a t e d they had poor therapeutic r e l a t i o n s h i p sa t sometime.  They i n d i c a t e d they wanted t o connect b u t t h e y  perceived they had counsellors o r t h e r a p i s t s that could not r e l a t e t o them o r s u p p o r t  them.  However, f i v e o f t h e e i g h t  c a l l e r s a l s o mentioned a c l e a r connection w i t h t h e i r resource  through  having  v a l i d a t e d and assured. callers, alone  t h e i r experiences, Representative  therapeutic  f e e l i n g s and b e l i e f s  of the experience  for a l l  one c a l l e r s t a t e d : "The...support g r o u p . . . I f e e l  - t h e r e ' r e o t h e r p e o p l e o u t t h e r e t h a t have gone  I'm n o t  through  similar situations"(N). Families. S i xc a l l e r s revealed contact with t h e i r t h a t was n o n e x i s t e n t  o r tenuous a t best.  families  O n l y two c a l l e r s  r e p o r t e d t h e y had connected o r enhanced t h e i r c o n t a c t w i t h families or, at least,  some f a m i l y members.  Friends and S p e c i a l Others.  A l l c a l l e r s m e n t i o n e d some  their  107 contact w i t h others, a b o u t a t l e a s t one Six  excluding  family.  Seven c a l l e r s  talked  intimate r e l a t i o n s h i p with a s p e c i a l other.  o f t h e c a l l e r s m e n t i o n e d t h e i r f r i e n d s ; t h e o t h e r two  about acquaintances.  Still,  s o c i a l l y a t l e a s t e v e r y few  talked  a l l eight s a i d they connected weeks.  Victimization The from the  g l o b a l theme o f v i c t i m i z a t i o n e m e r g e d a c r o s s  a l l callers  i n f o r m a t i o n t h e y shared about t h e i r f a m i l i e s ,  i n t e r a c t i o n s w i t h the c r i s i s other helping  lines,  and  their  t h e i r experiences  with  resources.  C r i s i s Lines. Five c a l l e r s reported they received d i f f e r e n t t r e a t m e n t because t h e y were not lines. said: list  Representative  the usual c a l l e r s t o the  of t h i s d i f f e r e n t treatment,  you  caller  "They a c t u a l l y p u t y o u r name o n a b o a r d a s w a r n i n g a s o f p e o p l e t o w a t c h on.  /And  I a c t u a l l y had  l i n e s u p e r v i s o r s p h o n e , t a l k i n g t o me 'You  one  crisis  know, we'd t h a t you  do  l i k e t o t e l l you c a l l often'"(P).  we  one  a  of the  about t h a t , and  crisis  saying,  r e a l l y need t o s o r t of warn  Two  c a l l e r s s a i d the  label  " c h r o n i c " c a l l e r seemed a s t h e y w e r e l e s s w o r t h y o f s e r v i c e  and  open t o v i o l a t i o n s o f t h e i r anonymity and  confidentiality.  One  c a l l e r represented  "It's like...it's  acceptable  both i n the statement:  t o abuse... [chronic]  callers.... It's just like  o f f i c e o r s o m e t h i n g i f somebody t r a n s f e r s i n t o t h e o f f i c e t h e y have a bad there,  reputation.  F o r two  callers that  inappropriate service they  an  and  They're abused from t h e i r f i r s t  so t h e y can n e v e r l o s e i t " ( S ) .  they complained about the  in  day said  received,  108 t h e y s t a t e d t h e c r i s i s c e n t r e s ' a d m i n i s t r a t i o n s d i s c r e d i t e d them because t h e y were " c h r o n i c " c a l l e r s . crisis  The c a l l e r s p e r c e i v e d  l i n e s ' a d m i n i s t r a t i o n s a s d i s r e g a r d i n g them b e c a u s e  they  were " c h r o n i c . " Six  c a l l e r s mentioned  t h a t t h e i r c r i s i s l i n e c a l l s had been  managed t h r o u g h t i m e r e s t r i c t i o n s their calls.  and focusing t h e content o f  Three c a l l e r s r e p o r t e d t h e c r i s i s l i n e  workers  m a i n t a i n e d t h e t i m e l i m i t s e v e n when t h e c a l l e r s n e e d e d more t h a n t h e 10 o r 15 m i n u t e s were u n d e r g o i n g . or  t o vent t h e p a i n and emotional d i s t r e s s  Also, three callers  two i s s u e s i n a c a l l  s a i d f o c u s i n g them t o one  i g n o r e d what t h e y c o n s i d e r e d i m p o r t a n t t o  understanding the t o t a l s i t u a t i o n  a n d them.  Showing t h e  d i f f i c u l t y a l l these c a l l e r s experienced w i t h c a l l one  c a l l e r stated:  minutes.  they  "When t h e w o r k e r  says,  management,  'We o n l y h a v e 15  L e t ' s f o c u s on t h i s f o r t h e next two minutes,' i t  s o u n d s l i k e a r e p r i m a n d t o me. interviewed by a doctor"(T). c a l l management a s h u r t f u l  I t s o u n d s l i k e I'm b e i n g F o r these c a l l e r s , they  indicated  a n d p u n i t i v e f o r them.  C o u n s e l l i n g , Therapy and Other Treatment.  Three  callers  i n d i c a t e d t h e y f e l t caught up i n t h e h e a l t h c a r e system t o t r e a t t h e i r mental  or physical illness.  of powerlessness  Five callers revealed a  a g a i n s t t h e p r o f e s s i o n a l s h e l p i n g them.  sense They  stated t h e medical and p s y c h i a t r i c p r o f e s s i o n a l s b e l i e v e d they knew w h a t was b e s t f o r t h e c a l l e r s ' t r e a t m e n t a n d w o u l d n o t l i s t e n t o t h e c a l l e r s ' concerns.  Three c a l l e r s shared t h a t they  were i n s t i t u t i o n a l i z e d a n d t h e i r r i g h t s removed.  When t w o  109 c a l l e r s s a i d t h e y d i d speak out a g a i n s t t h e treatment t h e y  had  received, they s a i d others used the l a b e l of m e n t a l l y i l l t o c o n f i n e them and  l i m i t t h e i r c o n t r o l over t h e i r treatment.  s a i d t h e i r c u r r e n t a c t i o n s were seen as p a r t o f t h e F i v e c a l l e r s mentioned therapy.  him a second  inappropriate helpers i n later  these c a l l e r s ,  time...he  a sheet o f paper. b e e n r e v i e w i n g my said,  illness.  Representative of the type of i n a p p r o p r i a t e helpers  experienced by a l l to  They  was  one  c a l l e r stated:  " I went back  s i t t i n g b e h i n d h i s desk,  looking at  A n d he g l a n c e d u p o v e r t h e t o p o f i t , notes  '1 ve 1  I made a f t e r y o u r l a s t s e s s i o n , ' a n d  ' I w a n t y o u t o know I d o n ' t  treat losers'"(S).  Two  he  callers  r e p o r t e d t h e y were even blamed f o r t h e a b u s i v e o r i n a p p r o p r i a t e treatment because o f t h e i r behaviour.  They s a i d t h e y were  told  b y o t h e r h e l p e r s t h e r e must have b e e n g o o d r e a s o n f o r t h e therapists'  a c t i o n s : t h e t h e r a p i s t s were p r o b a b l y r e s p o n d i n g  the c a l l e r s ' One  behaviour.  c a l l e r mentioned  feeling like a child.  being o v e r l y sheltered i n treatment  took over f o r the c a l l e r .  f e e l i n g scared by the worker's learning l i f e  and  This c a l l e r indicated that i n situations  where o p p o r t u n i t i e s e x i s t e d t o l e a r n and p r a c t i c e l i f e the workers  to  s k i l l s the c a l l e r  The  caller  skills,  mentioned  a c t i o n s and p r e v e n t e d  from  needed.  F a m i l y . Three c a l l e r s c l e a r l y s t a t e d t h e y were v i c t i m i z e d i n their families.  These c a l l e r s i n d i c a t e d a p a t t e r n o f  v i c t i m i z a t i o n t h a t repeated through out t h e i r l i v e s  in  f r i e n d s h i p s , work, t h e r a p y , t r e a t m e n t , and r e l a t i o n s h i p s w i t h  110 special others.  Three o t h e r c a l l e r s s a i d they w i t n e s s e d  and  e x p e r i e n c e d p h y s i c a l abuse i n t h e i r f a m i l y and mentioned  they  went on t o have s i g n i f i c a n t r e l a t i o n s h i p s w i t h p h y s i c a l l y partners.  Two  c a l l e r s , who  mentioned  a dependent  abusive  controlling  relationship w i t h a parent, indicated they repeated t h i s p a t t e r n w i t h those f r i e n d s and s i g n i f i c a n t o t h e r s l a t e r i n t h e i r One  c a l l e r made a s t a t e m e n t  codependent t o o q u i c k l y .  representative f o r both:  lives.  "I get  I get e m o t i o n a l l y i n v o l v e d and  lose  myself i n the person"(T). F o u r c a l l e r s r e p o r t e d s e v e r e n e g l e c t , two o f t h e m t h e y were unwanted by t h e i r p a r e n t s .  stating  A l l these c a l l e r s  t h e i r p a r e n t s were u n a v a i l a b l e t o them f o r s u p p o r t e v e n the c a l l e r s '  most d i f f i c u l t  times.  A s one  raped...And I had a baby from i t . w i t h me  And  indicated through  c a l l e r stated:  everybody  "I got  disassociated  because I had the baby"(M).  For the other four c a l l e r s , betrayal.  A l l mentioned  t h e y r e p o r t e d p a r e n t a l abuse  a s i m i l a r h i s t o r y w h e r e one  became u n a v a i l a b l e e i t h e r t h r o u g h d e a t h , abandonment.  and  parent  substance abuse o r  They i n d i c a t e d t h e y then b u i l t a c o n n e c t i o n w i t h  t h e r e m a i n i n g p a r e n t , w h i c h was parent's substance misuse,  l a t e r betrayed through  abuse o f the c a l l e r ,  t o p r o t e c t the c a l l e r a g a i n s t o t h e r abuse. they m i s t r u s t e d t h e i r parent ever  or  this  unavailability  They a l l  indicated  since.  Esteem The  esteem l e i t m o t i f emerged f r o m i n t e r v i e w d a t a  e s t e e m b u i l d i n g a n d c a l l e r empowerment.  The  indicating  g l o b a l theme a r o s e  from t h e c a l l e r s '  shared i n f o r m a t i o n on t h e i r i n t e r a c t i o n s w i t h  the c r i s i s  their therapeutic relationship with other  lines,  h e l p i n g resources, and t h e i r changing r e l a t i o n s h i p s w i t h and  family  friends. C r i s i s L i n e s . The c a l l e r s i n d i c a t e d a d e v e l o p i n g e s t e e m a s  t h e y t a l k e d a b o u t how t h e c r i s i s concerns workers  and d i f f i c u l t i e s .  their  Three c a l l e r s s t a t e d t h e telephone  h e l p e d them t h r o u g h b r a i n - s t o r m i n g a n d p r o b l e m - s o l v i n g  activities, callers'  moving t h e c a l l e r s t o a c t i o n and b u i l d i n g t h e  self-reliance.  caller said: call  l i n e s h e l p e d them t h r o u g h  Indicative o f a l l these c a l l e r s ,  "At one t i m e I w o u l d be v e r y f r u s t r a t e d t h a t o n one  I c o u l d n ' t come t o a c o n c l u s i o n o n a p r o b l e m .  a l o n g t i m e ago.  A n d now I u n d e r s t a n d  o n i t a m o n t h . . . .And maybe t h e y  B u t t h a t was  i t m i g h t t a k e me  [the c r i s i s  line]  be i n s t r u m e n t a l i n me f i n d i n g a s o l u t i o n " ( L ) . mentioned  one  working  wouldn't  Four  even  callers  they developed a c t i o n plans w i t h t h e telephone  workers  and were g i v e n t h e r e s o u r c e s a n d r e f e r r a l s t o c a r r y o u t t h e plans.  Five callers reported the c r i s i s  t h e m new p e r s p e c t i v e s o n t h e i r c o n c e r n s c a l l e r s t o view t h e i r problems  l i n e workers  a l s o gave  t h a t encouraged t h e  differently.  Four c a l l e r s s t a t e d they r e c e i v e d v a l i d a t i o n and acknowledgement o f t h e i r l i f e telephone workers. themselves, bad.  experiences and f e e l i n g s  T h e y i n d i c a t e d t h e y l e a r n e d i t was o k a y t o b e  a n d t h e y w o u l d be a c c e p t e d whether t h e y were good o r  Two c a l l e r s a l s o m e n t i o n e d  themselves  from  t h e y were t o l d t o l o o k a f t e r  because t h e y were unique.  A l l indicated they  felt  112 b e t t e r about all  themselves.  the callers  One c a l l e r r e p r e s e n t e d t h e a t t i t u d e s o f  i n t h e statement:  " I t took a long time before I  c o u l d d o i t [ f e e l g o o d a b o u t m y s e l f ] . Now,  I d o n ' t know how I  l i v e i t any other way"(L). Other H e l p i n g Resources.  Five callers  stated  their  e x p e r i e n c e s were v a l i d a t e d b y t h e i r support group, other helping professional. t h e r a p y was b e n e f i c i a l  Further, four callers reported their  i n h e l p i n g them b u i l d  s t a n d up f o r themselves.  therapist or  One c a l l e r s t a t e d :  t h e i r esteem and "Where I g o t t h e  s t r e n g t h f r o m - my f i r s t y e a r a n d a h a l f w i t h t h a t t h e r a p i s t . felt  I  so empowered....because o f t h e good work I d i d w i t h  h e r . . . t h a t g a v e me t h e s t r e n g t h t o s p e a k u p . . . " ( S ) . statement t y p i f i e s a l l t h e c a l l e r s ' experiences.  This  With  helpful  t h e r a p y , t h e y i n d i c a t e d t h e y were l e t t i n g go o f p e r s o n a l r e l a t i o n s h i p s t h a t were h i n d e r i n g o r p a i n f u l . to  They a l s o  started  speak up about p r e v i o u s t r e a t m e n t t h e y p e r c e i v e d as  inappropriate. Four c a l l e r s mentioned  they took a c t i o n f o r themselves t o  counter t h e mistreatment t h e y had undergone t h r o u g h abuse o r involvement i n t h e h e a l t h c a r e system.  They spoke up a g a i n s t  h e a l t h care treatment they had received, confronting the h e a l t h care p r o f e s s i o n a l i n front of others.  They i n d i c a t e d t h e y were  t a k i n g c o n t r o l back t o care f o r themselves and t h e i r  own  interests. Five c a l l e r s also stated they l e f t helping  relationships  when t h e h e l p e r was i n a p p r o p r i a t e , a n d t w o s a i d t h e y t o o k  action  113  against the inappropriate therapy they received. callers  These two  said they reported the therapists t o r e f e r r a l  agencies.  These a g e n c i e s t h e n w o u l d ensure o t h e r s w o u l d be i n f o r m e d o f t h e poor and i n a p p r o p r i a t e p r o f e s s i o n a l behaviours. Family. Four c a l l e r s  i n d i c a t e d they had b u i l t t h e i r  esteem  a n d m a i n t a i n e d i t b y e s t a b l i s h i n g b o u n d a r i e s a n d new r e l a t i o n s h i p s w i t h f a m i l y members.  They r e v e a l e d t h e y no l o n g e r  g o t s t u c k i n o l d f a m i l y games a n d p a t t e r n s a n d o n l y t o o k o n w h a t was t h e i r r e s p o n s i b i l i t y . one  c a l l e r gave:  T h i s i s represented by t h e statement  " I don't w o r r y anymore.  I'm n o t a s v i c t i m i z e d  by h i s b e h a v i o u r a s . I used t o be.... I used t o t a k e i t v e r y p e r s o n a l l y . . . . I t ' s h i s c h o i c e , h i s problem. The  four other callers  L e t h i m own  indicated they s t i l l  it"(P).  struggled to  move f u r t h e r b e y o n d t h e i r a w a r e n e s s o f t h e i r f a m i l y d y n a m i c s t o c o n c r e t e a c t i o n s t h a t h e l p them m a i n t a i n t h e m s e l v e s  against  family patterns.  dysfunctional  They mentioned  freedom from t h e i r  f a m i l y l o y a l t i e s a n d r e s p o n s i b i l i t i e s when t h e y w e r e o n t h e i r own, away f r o m f a m i l y members.  However, t h e y r e v e a l e d a s t r u g g l e  t o m a i n t a i n t h e i r .esteem when f a m i l y members e n t e r e d t h e i r F r i e n d s . Two c a l l e r s  shared they befriended people  could r e l y on and share themselves  equally.  lives.  they  They i n d i c a t e d  these  f r i e n d s h i p s enhanced t h e i r esteem through t h e mutual understanding, support and c a r i n g . revealed they s t i l l  The r e m a i n i n g s i x c a l l e r s  s t r u g g l e d t o overcome t h e i r f e e l i n g s o f s e l f -  doubt t o r e a c h o u t and connect w i t h o t h e r s . s t r u g g l e f o r a l l , one c a l l e r s a i d :  Indicative of this  " I am f i n d i n g  i t easier  114 because o f c r i s i s  l i n e s who h a v e l e t me know I'm o k a y t o make t h e  - t o n o t be a f r a i d t o r e a c h o u t t o o t h e r p e o p l e " ( S ) .  As these  c a l l e r s found b e t t e r p s y c h o l o g i c a l h e a l t h , they i n d i c a t e d  they  were s l o w l y b u i l d i n g t h e i r esteem t h r o u g h b e t t e r c a r e i n c h o o s i n g their  friends.  Validation of Leitmotifs with All and  four leitmotifs  Callers  - isolation,  connection,  victimization  esteem - were c o n f i r m e d b y a l l f i v e c a l l e r s c o n t a c t e d f o r t h e  v a l i d i t y check. their lives,  The c a l l e r s i d e n t i f i e d t h e t h e m e s a s p r e s e n t i n  f o r a t l e a s t a p e r i o d o f time.  F o r example, one  c a l l e r c o u l d see v i c t i m i z a t i o n a s once b e i n g a p a r t o f l i f e . Now, t h e c a l l e r c o u l d b e s t i d e n t i f y o n l y w i t h t h e theme o f esteem. The The  term  Chronic C a l l e r R e l a t i o n a l Network  " c a u s a l n e t w o r k " i s u s e d b y M i l e s a n d Huberman  (1984) t o d e s c r i b e how d i f f e r e n t v a r i a b l e s a r e l i n k e d i n t o a chain o f events,  a c t i v i t i e s and processes  i n i t i a t e one a n o t h e r .  However, t h i s t e r m  f o r t h i s study and i s r e p l a c e d by t h e term  which influence o r i s somewhat m i s l e a d i n g "relational  network."  T h o u g h many v a r i a b l e s a p p e a r e d t o i n f l u e n c e o r i n i t i a t e  other  f a c t o r s i n t h e network, t o s t a t e a l l v a r i a b l e s were c a u s a l l y l i n k e d would be i n a c c u r a t e .  Some v a r i a b l e s w e r e o n l y  c h r o n o l o g i c a l l y l i n k e d , one f a c t o r p r e c e d i n g t h e o t h e r . v a r i a b l e s appeared t o i n f l u e n c e a d d i t i o n a l v a r i a b l e s , d e f i n i t e support  f o r these v a r i a b l e s '  i n the interview data.  Therefore,  Other  though  i n f l u e n c e s was n o t p r e s e n t  the relational  network  115 a t t e m p t s b e s t t o show t h e p o s s i b l e identified chronic c a l l e r  relationships  between  characteristics.  The i d e n t i f i e d c h r o n i c c a l l e r c h a r a c t e r i s t i c s produce t h e r e l a t i o n a l network. as  were u s e d t o  The c h a r a c t e r i s t i c s  were t a k e n  r e p r e s e n t a t i v e o f a l l chronic c a l l e r s , though c a l l e r  exceptions f o r a few i d e n t i f i e d c h a r a c t e r i s t i c s  existed.  Rather  than look a t exceptions, t h e c h r o n i c c a l l e r r e l a t i o n a l network a t t e m p t s t o show t h e p o s s i b l e  connections between i d e n t i f i e d  chronic c a l l e r characteristics. different  factors  that lead  frequency o f c r i s i s  I t p r o v i d e s paths between t h e  t o a chronic c a l l e r s higher o r lower 1  l i n e contact.  The c h r o n i c c a l l e r r e l a t i o n a l n e t w o r k c o n t a i n s t h r e e (see and  Figure 4).  Characteristics  centre of the figure,  1 t h r o u g h 11, a p p r o x i m a t e l y  are those c h a r a c t e r i s t i c s  to higher and lower frequency chronic  callers.  12 t h r o u g h 2 1 , r o u g h l y a l o n g t h e b o t t o m p o r t i o n are  characteristics  callers. portion the  of the figure,  left  common b o t h  Characteristics of the figure,  unique t o the lower frequency  Characteristics  parts  chronic  22 t h r o u g h 3 2 , c o n t a i n e d i n t h e t o p  are those c h a r a c t e r i s t i c s  identifying to  higher frequency chronic c a l l e r s .  Common All  Characteristics c a l l e r s r e p o r t e d coming from an a l c o h o l  addicted family  (1).  (The number i n p a r e n t h e s e s r e f e r s  c h r o n i c c a l l e r c h a r a c t e r i s t i c o n F i g u r e 4.) characteristic  or other  influenced  the early  life  drug  t o the  How t h i s c a l l e r  start to  counselling,  116  11 CQ  > -Hto  CQ  CQ  014J u11 rt rt 0 •H a re ii —, rl -rl D CN ft 1 1 I1) u  CD  .i  D g) -rl rt 1 H HM 11001 r  th  ICS  nd  rt  jJIS•H U Ol u 0 1 a 3 0) s -H m <«  01  JJ  •rt  01 c •H 01  P, rt ii -H  g p<-HC n • — 0 rT  rrH r< CO H rt rt 0 U •JJrH JJ0> H .—. O rt CD H — rl r« 11-H  u_-Id-  11 C 0  0  4H in i0 -i CQ 0 co 11 ft 4 0 ft g-1  Si c  JJ  JJ  •rl  .—. •rl  Ol o  •rt  rt  >1  0  rH •H— rrt 01•rlU u 1 0 0 s ft CO 01 u u J1 o g :1 CN 0 JJ — 01 9  -U  rt -H  -H U CQ u H rft CQ ft rt -H !H u r*—* H <NM-l  •rl  .—,  MH  T) 3 rt 0  J oi rt u  4J CN CN CN rH  oi H  -H  CQ -H !H CQ  0 c1  u  IH  •rl  0  JJ  •rl  rt C  -rl  g  JJ  n  D > -JJH -H'J D « 43J U 011) mrt oi ft •H 1M .—. rt U 1) CN 0 1 .a ft E- rl  rH rt 01 Pi  1) a rt > •3C rQ t JJ01-H O iJ0ft -9 C >1 rt C O u ft rt .—, fl u 0 ft ft in 0 rt 01 a CN Hrt M J5 IT -H  1  H | 01 JJ  Si  ng or  o -H  JJ  0 a rH u H )rt JJJJ rrH H ft JJg 0 1 rt W C Q .—. H lft! 3a H lu rt 0 U) CN JJ01O0 J5 ir ~  1  u (0  rJD C  1) rJJ-UH -H  rt •rlC Q 0  ><  JJ  0  J rH JJrt  .—,  —  •rl  g a rt u0  o  u  01  --H C Q U U u -H rt CJ Ot  c  >•. « fi  o 6 6 o u  rt Oi s a  lH  CQ 0 rt1 C O0 ) -H rH CQ  .—.  i-C HC O >1 U c CD D C D !H 1  U  u d CD ^ D3 CD SH 1  fa  1 C S-i ^ CD d) CD si Cn S tn CD o -H  rH rt -rt JJ rt 0 rH rt C > H QrH rt 01 O0 t1 0 a -H C Qi gu0 > Si — CM4H  rl  U rJJH a; -H CQ > 1) s0 — , -HJJ ft rt JJ0 Q 01 CO 0 i-H OC t n >.  rt r•H rt g H « rt b. I-I rH CN 0 — Ai.±rH d  D  U  TJ  U g  0  rH  g  CQ  JJ JJ  >,  rt  rJ (0  Ut  <?  •JJH  cn  -rl iaH>  i-l CD — •1 rJ r 1 rH (0 — CO  it  n1 1 11iO1 0 a rt 0 0 rH 0 u si 13  rt CNrH  -rrH -3  ft ft  r- JJ0 oi3  rt 0  o; C  rt rt u  -H C0Q1 u0  CQ  U u  01 t«  •rl  u U ed (0 S-i (0  0 1 !H C 01 0 > >. 011) 4H 0 ) r-H C Q H 3 g rlC — NJ3 3 ft!  ^1  -H  o  rl  4-)  •rl  r5  S'  JJ  fl  u  -H  JJ  rt e rt 3 0 rt !H JJ • r rt U-t JJ ,—, rt 0 CN U D a0rt1 CN — rt o  1 Jj0 CQ -rt CQ JJ 01 H a rJJ rt >, CQ •H 0  o  -H JJ  fd i-H  u s0 ti ft o rt ^  in  <u  !H  D ft FhSi H rt rfft  rl  "«  (U  rH rH fC  U  !H  11 -H  MH  01 JJ  Si  0 •H  o  ng or  0. rH 1) K 0 1 -U 1 ) C -H JJfiD •H -H rt -H !H 0  cn u  u  JJ  JJ  of  -•rH HH 0 01 1SH n ! J5 Oi C 0 rt WJJ3 Tj JJ 01 1)  -rt CQ g 01 0 c  m-  u  -rl JJ  rl  >,  U  rH  •rt -U •rl -U 4c -n J cn H -rl -rl U<D rJ 4-1 to <U O  u> CQ 3 0  O JJ  O  CQ  rt  n  CM  01  0 rt1 0 rt si 0 Q4H X uI uJJ C O 0 0 Pt C C Q 0 1 ft , rt 3ft 0e -rlr •H — 01XL rn ri  CN  H  •rH  Tl rH  EQ (D  •rl  JJ >i ~ rlU JJ0 •rl rl >, a 01 rt JJ rl01 ft JJ6 w rt > H u C Q c rt rt 3 u CN -U 0 .a01 r  cn u ir Ir 1  1  U -H  1  ^1 A  117 therapy o r other treatment  (2) r e m a i n e d  r e v e a l i n g e a r l y c h i l d h o o d involvement  unclear.  Those c a l l e r s  i n helping services  r e p o r t e d t h e e a r l y t r e a t m e n t s t a r t t o be t h e r e s u l t  of their  p h y s i c a l o r mental health, not a parent's a l c o h o l o r other problem.  When t h e c a l l e r s ' r e p o r t e d i n v o l v e m e n t  starting  i n therapy  i n t h e i r youth, they stated the family viewed  them a s  the "problem, " r a t h e r t h a n t h e substance a b u s i n g p a r e n t . c a l l e r s mentioned  drug  The  t h e y were t h e n f o r c e d i n t o c o u n s e l l i n g o r  treatment by t h e i r parents. All Callers  c h r o n i c c a l l e r s reported prolonged h e a l t h concerns (3). also  mentioned  t h e i r h e a l t h concerns and t h e l i m i t a t i o n s  personal or physical limitations  from  (4). Both the prolonged h e a l t h concerns  e x p e r i e n c e d because o f them c o n t r i b u t e d t o  c a l l e r s h a v i n g l i m i t e d employment o p p o r t u n i t i e s ( 5 ) , a n d t h e n l i m i t e d f i n a n c e s (6) . The c a l l e r s ' p e r s o n a l o r p h y s i c a l l i m i t a t i o n s health  from  their  (4) a n d t h e c a l l e r s ' l i m i t e d f i n a n c e s (6) c o n t r i b u t e d t o  t h e c h r o n i c c a l l e r s l i m i t e d a b i l i t y t o u s e a n d engage support network  (7). A l s o , severe f a m i l y neglect  their  (13) f o r l o w e r  f r e q u e n c y c h r o n i c c a l l e r s a n d s e v e r e f a m i l y a b u s e (23) f o r h i g h e r frequency chronic c a l l e r s c o n t r i b u t e d t o the c a l l e r s a b i l i t y t o u s e a n d engage t h e i r s u p p o r t network.  limited  Both the severe  n e g l e c t and t h e severe abuse r e p o r t e d by t h e c a l l e r s i n t h e i r families  appeared  to affect  t h e i r s o c i a l and r e l a t i o n s h i p  The c a l l e r s l i m i t e d a b i l i t y t o u s e a n d e n g a g e t h e i r network  (7), as w e l l as t h e c a l l e r s ' f a m i l y h i s t o r y ,  skills. support  encouraged  118 little  family contact  specifically,  (8) f o r c h r o n i c c a l l e r s .  f o r the lower frequency chronic c a l l e r s ,  h i s t o r y of severe family neglect  (13) a n d b e i n g  family  (14), c o n t r i b u t e d t o l i t t l e  higher  frequency chronic c a l l e r s ,  abuse  More  ignored by the  family contact.  family contact  For the  t h e i r h i s t o r y of severe  (23) a n d b e i n g b l a m e d f o r t h e f a m i l y ' s i l l s  little  their  family  (24) e n c o u r a g e d  f o r them.  The c h r o n i c c a l l e r s l i m i t e d a b i l i t y t o u s e a n d e n g a g e support network and  (7) c o n t r i b u t e d t o c a l l e r s n e e d i n g c r i s i s  their lines  c o n t i n u i n g t o t e l e p h o n e them f o r s u p p o r t a n d c o n t a c t ( 9 ) .  The i m p a i r m e n t a n d l a c k o f i n t e r p e r s o n a l s k i l l s ,  implied i n the  c a l l e r s l i m i t e d a b i l i t y t o u s e a n d engage t h e i r s u p p o r t network, also contributed the callers challenging relationship h i s t o r y (10).  H o w e v e r , c a l l e r s a l s o r e p o r t e d a t l e a s t some f r i e n d s (11)  that they maintain  regular contact with.  How t h i s  characteristic  exactly r e l a t e d t o the other chronic c a l l e r c h a r a c t e r i s t i c s remained u n c l e a r . callers' for  F r i e n d s d i d n o t seem t o a d d o r r e d u c e t h e  frequency of telephoning.  the highest  acquaintances,  However, a s l i g h t  frequency chronic c a l l e r s t o report n o t f r i e n d s , was b e g i n n i n g  Lower F r e q u e n c y C h r o n i c The r e p o r t e d  t o emerge.  Caller Characteristics  common c h a r a c t e r i s t i c o f a n a l c o h o l i c o r o t h e r  drug addicted f a m i l y  (1) a p p e a r e d t o c o n t r i b u t e somewhat  l o w e r f r e q u e n c y c h r o n i c c a l l e r s r e v e a l i n g no p a r e n t a l (12)  and b e i n g  callers,  tendency  t o the  connection  ignored by t h e i r f a m i l i e s (14). For these  they reported t h e i r parents  generally unavailable to  119 them b e c a u s e o f t h e p a r e n t s ' parental connection severely neglected and  substance abuse.  Also, without  (12), t h e s e c a l l e r s r e p o r t e d t h e y were i n the family  (13) .  No p a r e n t a l  ignored  i n their family  ongoing i n these c a l l e r s ' l i v e s before into counselling, therapy  (1) a n d t h e  (14) w e r e r e p o r t e d a s the callers' early entry  o r other treatment  ( 2 ) . Whether t h e s e  variables influenced early entry into the helping remained u n c e r t a i n from t h e i n t e r v i e w data.  services  The l o w e r  chronic c a l l e r s ' e a r l y entry i n t o counselling, therapy treatment  being  (14) .  The a l c o h o l i c a n d o t h e r d r u g a d d i c t e d f a m i l y c a l l e r s being  often  connection  severe f a m i l y neglect both contributed t o t h e c a l l e r s  ignored by the e n t i r e family  a  frequency o r other  (2) was a s s o c i a t e d w i t h t h e c a l l e r s ' p h y s i c a l o r  psychological health, not necessarily the callers'  family  background. The l o w e r f r e q u e n c y c h r o n i c c a l l e r s r e p o r t e d more c o n s i s t e n t and m o s t l y a p p r o p r i a t e  therapy  and other help  (15), c o n t r i b u t i n g  to t h e i r mostly p o s i t i v e therapeutic experience  (16). With a  mostly p o s i t i v e therapeutic h i s t o r y , these c a l l e r s  indicated they  r e m a i n e d i n c o n t a c t w i t h a n d b e n e f i t e d f r o m many more h e l p i n g resources  ( 1 7 ) . W i t h more h e l p i n g r e s o u r c e s ,  and a mostly  p o s i t i v e therapeutic h i s t o r y , the lower frequency chronic said they used c r i s i s brain-storming  l i n e s f o r p r a c t i c a l purposes  and o b t a i n i n g other resources  These c a l l e r s ' l o w u s e o f c r i s i s  lines  callers  (18), such as  and r e f e r r a l s . (19) i s i n f l u e n c e d b y  t h e c a l l e r s c o n t a c t w i t h many more h e l p i n g r e s o u r c e s  (17), t h e i r  120 p r a c t i c a l u s e o f t h e phone s e r v i c e (18), t h e i r n e e d f o r and  contact  (9), and t h e fact  have a s p e c i a l  other  special  other  t h e s e c a l l e r s a r e more l i k e l y t o  (20) i n t h e i r l i v e s .  many more h e l p i n g r e s o u r c e s (20) r e d u c e d  Both these  the callers' reliance  deeply with.  lines  Lastly, positive  chronic  w i t h whom t h e y  lines.  could  F u r t h e r , w i t h many m o r e h e l p i n g  (17) , t h e c a l l e r s met t h e i r t h e r a p y a n d t r e a t m e n t  outside the c r i s i s crisis  a  on t h e c r i s i s  The l o w e r f r e q u e n c y  c a l l e r s reported t h a t they had other persons  resources  callers'  (17) a n d t h e l i k e l i h o o d h a v i n g  l i n e s f o r contact. and support.  share themselves  support  needs  These c a l l e r s t h e n o n l y needed t h e  f o r p r a c t i c a l help (18). t h e lower frequency  chronic callers often reported  experiences with the c r i s i s  lines that contributed t o  t h e i r frequent appreciation o f the service (21). Higher Frequency Chronic C a l l e r The  Characteristics  r e p o r t e d common c h a r a c t e r i s t i c  o f an alcoholic  o r other  d r u g a d d i c t e d f a m i l y (1) c o n t r i b u t e d t o t h e t r a u m a t i c p a r e n t a l connection  (22) .  A l r e a d y formed o u t o f a p a r e n t ' s  death,  p a r e n t a l a b u s e o r abandonment, t h e r e p o r t e d t r a u m a t i c i n t e n s i f i e d w i t h t h e f a m i l i a l substance  abuse.  p a r e n t a l c o n n e c t i o n then added t o t h e s e v e r i t y abuse  (23) f o r t h e h i g h e r f r e q u e n c y  combination,  t h e severe  f a m i l y abuse  drug a d d i c t e d f a m i l y background frequency (24) .  This  connection intensified  of the family  chronic callers.  In  (23) a n d a l c o h o l i c  o r other  (1) c o n t r i b u t e d t o t h e h i g h e r  c h r o n i c c a l l e r s b e i n g blamed f o r t h e f a m i l y ' s  ills  121 Both the a l c o h o l o r other drug addicted  f a m i l y background  (1) a n d t h e c a l l e r s b e i n g b l a m e d f o r t h e f a m i l y ' s i l l s contributed t o the higher to counselling, therapy reported being  frequency chronic c a l l e r s e a r l y  o r other treatment  ( 2 ) . These  family, these c a l l e r s  start  callers  the i d e n t i f i e d patient i n the family.  u s u a l l y forced i n t o therapy  experience  (24)  Therefore,  o r treatment by t h e i r parents  or  indicated their early therapeutic  began n e g a t i v e l y .  therapeutic experience  The c a l l e r s a l s o r e p o r t e d  u s u a l l y continued  i n an  their  abusive,  i n c o n s i s t e n t a n d i n a p p r o p r i a t e manner ( 2 5 ) , c o n t r i b u t i n g t o a general  negative  therapeutic experience (26).  With a negative  and i n c o n s i s t e n t t h e r a p e u t i c h i s t o r y , these  callers reported  that c r i s i s  appropriate  ( 2 7 ) . W i t h no o t h e r o r i n c o n s i s t e n t h e l p i n g  resources, negative callers  help  l i n e s became t h e o n l y c o n s i s t e n t a n d  a n d a r e l u c t a n c e t o engage o t h e r h e l p b e c a u s e o f a  therapeutic history, the higher s a i d they used c r i s i s  frequency  chronic  l i n e s as a therapeutic  resource  (28). B o t h t h e c a l l e r s ' dependency on c r i s i s consistent help  l i n e s as t h e i r  only  (27) a n d t h e c a l l e r s ' t h e r a p e u t i c u s e o f c r i s i s  lines  (28) c o n t r i b u t e d s t r o n g l y t o t h e c a l l e r s h i g h u s e o f c r i s i s  lines  (30). Using  (28)  the c r i s i s  l i n e s as a t h e r a p e u t i c  moved t h e s e c h r o n i c c a l l e r s b e y o n d c r i s i s  o n l y support and connection reasons f o r telephoning increased  resource  l i n e contact f o r  ( 9 ) , and added t o t h e c a l l e r s '  crisis  lines.  C r i s i s l i n e contact  ( 3 0 ) . A l s o , w i t h few o r no s p e c i a l o t h e r s  then  (29) i n  122 these c a l l e r s '  l i v e s t o share w i t h , t h e c a l l e r s ' c r i s i s  contact f o r support  and connection  (9) was e n h a n c e d .  line  Then,  both  these f a c t o r s provided f u r t h e r i n f l u e n c e f o rhigher use o f the crisis  l i n e s (30).  With the higher use of the c r i s i s  (30), these  callers  r e p o r t e d more f r e q u e n t u s e o f c a l l management t e c h n i q u e s  (31) b y  the c r i s i s  lines.  lines  The h i g h e r f r e q u e n c y  chronic callers  mentioned  t h e y d i s l i k e d c a l l management, i n c r e a s i n g t h e i r c o m p l a i n t s a n d negative experience with c r i s i s increased use of the c r i s i s  lines  lines  (32). Further, with  (30), these c a l l e r s  more n e g a t i v e e x p e r i e n c e s w i t h c r i s i s  lines  mentioned  (32), c a l l  management  aside. V a l i d a t i o n of the Chronic C a l l e r The  f i v e c a l l e r s reached  c a l l e r r e l a t i o n a l network. n e t w o r k was e x p r e s s e d .  R e l a t i o n a l Network  f o r follow-up confirmed the chronic  No d i s a g r e e m e n t w i t h t h e r e l a t i o n a l  Rather  the callers provided elaboration  o f t h e p o s s i b l e a s s o c i a t i o n s between c h a r a c t e r i s t i c s . example, one c a l l e r c l a r i f i e d frequency  the relationship  chronic c a l l e r characteristics  others" and "high use o f c r i s i s to burden a s p e c i a l c a l l e r telephoned frequency.  lines."  between t h e h i g h e r  o f "few o r no  lines  special  T h i s c a l l e r d i d n o t want  other w i t h personal concerns.  crisis  For  f o r support  Therefore, the  and w i t h g r e a t e r  123 Discussion S e v e r a l c h a r a c t e r i s t i c s arose from the data i n t h i s The  i n t e r v i e w d a t a s u p p o r t e d a n d e x p a n d e d some r e s u l t s  previous studies.  study.  of  Such c h a r a c t e r i s t i c s as the c h r o n i c c a l l e r s '  l i m i t e d s u p p o r t network and t h e i r e x p e r i e n c e w i t h o t h e r community r e s o u r c e s were c o n f i r m e d and c l a r i f i e d . s u p p o r t some p r e v i o u s f i n d i n g s , misuse.  Many new  A l s o , the data d i d not  such as t h e c a l l e r s '  substance  f i n d i n g s d i d emerge f r o m t h e c h r o n i c c a l l e r  i n t e r v i e w s , most i n t e r e s t i n g l y t h e d i f f e r e n c e s between t h e h i g h e r and  lower frequency c a l l e r s ,  and t h e l e i t m o t i f s .  The  following  d i s c u s s i o n w i l l examine t h e c h a r a c t e r i s t i c s as t h e y r e l a t e t o  one  a n o t h e r and t h e p r e v i o u s r e s e a r c h . F a m i l y Background and All  Victimization  the c a l l e r s d i s p l a y e d a p a t t e r n of  beginning i n t h e i r families of o r i g i n .  victimization  A l l indicated living  a n - a l c o h o l o r o t h e r d r u g a d d i c t e d f a m i l y , w i t h one  or  p a r e n t s u n a v a i l a b l e because o f the substance abuse.  both The  callers  r e p o r t e d f r e q u e n t l y l i v i n g through e i t h e r severe abuse o r n e g l e c t b y t h e i r p a r e n t s a n d o t h e r f a m i l y members. h a d become v e r y much a l i f e  theme f o r a l l t h e  For the lower frequency chronic c a l l e r s ,  in  severe  Victimization  callers. the parental  substance abuse c o n t r i b u t e d t o the n e g l e c t t h e y r e p o r t e d from the family.  For these c a l l e r s a p a t t e r n of v i c t i m i z a t i o n  through  s e v e r e n e g l e c t a n d f a m i l y abandonment b e g a n .  Often they reported  b e i n g u n w a n t e d c h i l d r e n a n d l e f t t o t h e i r own  resources  up.  growing  They s a i d n o t h i n g t h e y d i d , p o s i t i v e o r n e g a t i v e , got  them  124 a n y c o n s i s t e n t a t t e n t i o n f r o m t h e i r f a m i l y members. were t h e f a m i l y o u t c a s t s .  Later i nl i f e ,  intimate relationships that failed,  Usually they  these c a l l e r s reported  o f t e n from abuse o r n e g l e c t  b y t h e i r p a r t n e r s , a n d more f a i l e d r e l a t i o n s h i p s t h a n higher frequency telephoning counterparts.  their  They c l e a r l y  repeated  a p a t t e r n o f abandonment s t a r t e d i n t h e i r f a m i l i e s o f o r i g i n . The  h i g h e r f r e q u e n c y c h r o n i c c a l l e r s o u t l i n e d severe abuse  in their families. through death,  One o f t h e i r p a r e n t s a b a n d o n e d t h e f a m i l y  s e p a r a t i o n o r substance abuse.  The c a l l e r s  formed a t r a u m a t i c c o n n e c t i o n w i t h t h e r e m a i n i n g p a r e n t . abuse o c c u r r e d , t h e p a r e n t a l c o n n e c t i o n s h a t t e r e d .  then When  The c a l l e r s  r e p o r t e d t h e y e x p e r i e n c e d i n t e n s i f i e d abuse a n d abandonment because t h e substance a d d i c t e d parent d i d n o t see o r stop t h e abuse.  Their negative f a m i l i a l relationships continued.  s a i d t h e y were o f t e n blamed f o r t h e f a m i l i e s  1  ills.  Perhaps  d i s t r u s t i n g p e o p l e o r f e a r i n g f u r t h e r abuse, t h e h i g h e r chronic c a l l e r s never o r r a r e l y connected w i t h others When t h e y d i d e s t a b l i s h a n i n t i m a t e r e l a t i o n s h i p , a b u s e f o r them.  i n t h e i r work, f r i e n d s h i p s , Later,  frequency  intimately.  i t ended w i t h  This p a t t e r n o f abusive r e l a t i o n s h i p s  established i ntheir families.  They  The v i c t i m i z a t i o n t h e n  intimate relationships,  appeared appeared  and therapy.  some e v e n r e p o r t e d e x p e r i e n c i n g a b u s i v e r e l a t i o n s h i p s o n  the c r i s i s  lines. Isolation  The  c a l l e r s o f t e n expressed a sense o f l o n e l i n e s s o r  isolation.  The i s o l a t i o n t h e y e x p e r i e n c e d o f t e n a r o s e o u t o f  125 abusive  and d y s f u n c t i o n a l f a m i l y dynamics they r e p o r t e d .  From  t h e i r f a m i l y background developed p e r s o n a l and f a m i l i a l limitations  t h a t hampered t h e i r a b i l i t y t o c o n n e c t w i t h  others,  l e a v i n g f a m i l y and o t h e r s o f t e n u n a v a i l a b l e t o them f o r s u p p o r t . A lack of appropriate  social skills  and a d i f f i c u l t y  with  intimacy l i m i t e d t h e i r r e l a t i o n s h i p s w i t h f r i e n d s and others.  Adding t o t h e i r loneliness,  physical or financial limitations Isolation  the c a l l e r s  special  mentioned  t o reaching out t o others.  became a s t r o n g theme f o r a l l c a l l e r s .  The l o w e r  frequency  c h r o n i c c a l l e r s showed t h e y  connected w i t h t h e i r f a m i l i e s . ignored by t h e i r parents  never  They s a i d t h e y were n e g l e c t e d  and s i b l i n g s ,  two o f t h e c a l l e r s  r e p o r t i n g t h e u l t i m a t e n e g l e c t o f b e i n g unwanted c h i l d r e n . c a l l e r s o f t e n s a i d t h e y were e x c l u d e d Isolation  frequency  abuse from p a r e n t s  chronic callers  and s i b l i n g s .  said  lives.  they  suffered  The c a l l e r s r e p o r t e d t h e y  blamed and scapegoated f o r t h e f a m i l i e s  problems.  s a i d t h a t t h e y were f o r c e d o u t , even e x i l e d ,  abusive  and untrustworthy.  with t h e i r parents  were  They o f t e n  from the f a m i l y  l a t e r i n l i f e because o f t h e i r apparent i n a p p r o p r i a t e Their e a r l i e r connections  These  from f a m i l y a c t i v i t i e s .  a n d abandonment s t a r t e d e a r l y i n t h e i r  The h i g h e r  and  behaviours.  and s i b l i n g s  They went f r o m c o n n e c t i o n  became  to  isolation. Because o f t h e n e g l e c t , t h e lower rarely  r e c e i v e d any s k i l l s  higher  frequency  frequency  chronic  t o connect w i t h others.  c a l l e r s had t h e i r e a r l y connections  callers  Because t h e betrayed,  126 t h e y became r e l u c t a n t t o c o n n e c t w i t h o t h e r s . backgrounds,  these c a l l e r s '  limited ability  With t h e i r  family  t o engage and u s e  t h e i r s u p p o r t n e t w o r k o f f r i e n d s a n d f a m i l y becomes c l e a r . i s o l a t i o n emerges f r o m t h e i r i n a b i l i t y started i n their  Their  o r r e l u c t a n c e t o connect,  families.  With l i m i t e d  support networks  and c h a l l e n g i n g p e r s o n a l and  f a m i l i a l experiences, a l l c a l l e r s reached out t o therapy, c o u n s e l l i n g and o t h e r treatment. l i n e s as an ongoing callers,  they said  The c a l l e r s a l s o f o u n d  consistent helping resource. they received at least  and h e l p from t h e h e l p i n g r e s o u r c e s .  crisis  For a l lthe  some s u p p o r t , c o n t a c t  T h e i r sense o f  isolation  was r e d u c e d w i t h t h e i r c o n n e c t i o n s t o h e l p i n g s e r v i c e s . Unfortunately f o r the higher frequency c a l l e r s ,  they  r e p o r t e d t h e i r p a t t e r n o f abusive and n e g a t i v e e x p e r i e n c e s continued into lines.  their helping relationships,  even w i t h  crisis  Because o f t h e abusive and i n a p p r o p r i a t e h e l p i n g  relationships,  these c a l l e r s o f t e n l e f t the h e l p i n g service.  Their i s o l a t i o n repeated.  Differently,  the lower  frequency  seemed t o f i n d t h e a t t e n t i o n a n d c o n c e r n o f t h e h e l p i n g r e s o u r c e s (and t h e c r i s i s  lines)  positive.  They i n d i c a t e d t h e y c o n t i n u e d  w i t h most o f t h e i r h e l p i n g c o n t a c t s a s l o n g a s needed, e n j o y i n g the connection. Limited  Support  C o n s i s t e n t w i t h p r e v i o u s e x p e r i e n c e and f i n d i n g s o f a limited  support network  Jameton, 1979),  (Haywood, 1981/ Imboden, 1981/ S a w y e r &  o n l y two c a l l e r s r e p o r t e d s i g n i f i c a n t  and  127 meaningful  contact and support  f r o m f a m i l y members.  Even f o r  t h e s e t w o c a l l e r s , n o t a l l f a m i l y members w e r e p a r t o f t h e i r support network.  They s a i d t h e y h a d l i m i t e d o r no c o n t a c t w i t h  some f a m i l y members.  The r e m a i n i n g  s i x c a l l e r s showed no s u p p o r t  a n d r a r e c o n t a c t w i t h f a m i l y members, e s p e c i a l l y  their  parents.  L i m i t e d f a m i l y contact remains c o n s i s t e n t w i t h t h e c a l l e r s ' f a m i l y backgrounds.  A l l the c a l l e r s reported alcohol o r other  drug a d d i c t e d f a m i l i e s  where t h e c a l l e r s e x p e r i e n c e d  severe  o r n e g l e c t f r o m t h e i r p a r e n t s a n d o t h e r f a m i l y members. were f r e q u e n t l y e x c l u d e d from t h e i r f a m i l i e s . reported they a r e s t i l l their families  They  Some c a l l e r s  blamed f o r t h e f a m i l y ' s problems and  maintain l i t t l e  c o n t a c t w i t h them.  c a l l e r s made a c h o i c e t o m a i n t a i n l i m i t e d family t o the callers' benefit.  The o t h e r  contact with  Their limited  avoided a repeat o f the v i c t i m i z a t i o n experienced  abuse  their  family contact  they reported  they  i ntheir family.  Somewhat d i f f e r i n g f r o m t h e p r e v i o u s a n e c d o t e a n d r e s e a r c h (Haywood, 1 9 8 1 / Imboden, 1 9 8 1 / S a w y e r & J a m e t o n , 1 9 7 9 ) , s i x c a l l e r s r e p o r t e d a s o c i a l s u p p o r t n e t w o r k o f two o r more and  three o f these c a l l e r s  people.  socialized  regularly  w i t h f i v e o r more  However, t h e s e f r i e n d s m o s t l y p r o v i d e d s o c i a l  for the c a l l e r s , and very l i t t l e reported significant  support.  o r meaningful  support  friends,  outlets  O n l y two c a l l e r s from t h e i r network o f  friends. A Challenging Relationship History The  callers'  f r e q u e n t f a m i l i a l e x p e r i e n c e o f severe abuse o r  128 severe  neglect  seemed t o c o n t r i b u t e t o t h e i r l a t e r a b i l i t y  connect w i t h others. 1976;  Consistent with previous  research  to  (Greer,  Sawyer & Jameton, 1979), the c a l l e r s i n t e r v i e w e d  largely  r e p o r t e d t o be u n m a r r i e d o r u n p a r t n e r e d .  Six callers stated  had  L i v i n g alone,  no  s p e c i a l o t h e r i n t h e i r l i v e s now.  people o n l y had The  o t h e r two  t h e i r f r i e n d s and  callers,  s u b s t a n t i a l support the o t h e r p a s t and  f a m i l y as a support  currently i n relationships,  from t h e i r partners current  F i n d i n g and m a i n t a i n i n g  - one  past  these  network.  showed support,  s p e c i a l r e l a t i o n s h i p s proved The  lower  frequency  chronic  c a l l e r s t e n d e d t o r e p o r t more i n t i m a t e r e l a t i o n s h i p s t h a n chronic callers.  connection,  the lower  Perhaps, not  frequency  others because they d i d not  experiencing  higher  familial  c h r o n i c c a l l e r s h a d more s p e c i a l  l e a r n the s k i l l s t o  e f f e c t i v e l y with a s p e c i a l other. chronic callers,  and  support.  challenging f o r a l l the c a l l e r s .  frequency  they  connect  For the higher  perhaps the abusive  frequency  and b r o k e n c o n n e c t i o n s  in  t h e i r f a m i l i e s made t h e m c a u t i o u s w i t h l a t e r r e l a t i o n s h i p s . Whatever the reasons,  a l l the c a l l e r s shared  e s t a b l i s h i n g and m a i n t a i n i n g  a  special relationships, often  revealing a d i f f i c u l t y b u i l d i n g intimacy with Prolonged All  difficulty  others.  H e a l t h Concerns, then L i m i t a t i o n s c a l l e r s reported prolonged  t h i s began i n i n f a n c y o r childhood, For o t h e r s t h e y were i n t h e i r youth.  h e a l t h concerns. sometimes as a Often  For  some  disability.  t h e i r h e a l t h problems  g e n e r a t e d p e r s o n a l a n d p h y s i c a l l i m i t a t i o n s f o r them.  129 With t h e i r health limitations revealed limited callers  said  reduced.  employment.  From t h e i r l i m i t e d  the callers  employment, t h e  t h e i r f i n a n c i a l o p p o r t u n i t i e s and resources  These l i m i t a t i o n s  out and connect w i t h others limited  and d i s a b i l i t i e s ,  were  hampered t h e c a l l e r s ' a b i l i t y t o g e t s o c i a l l y and i n t i m a t e l y .  from engaging a s o c i a l and support  They were  network.  L i m i t e d A b i l i t y t o Use a n d Engage S u p p o r t N e t w o r k Often  t h e c a l l e r s r e p o r t e d d i f f i c u l t i e s moving beyond s o c i a l  c o n v e r s a t i o n a n d a c t i v i t i e s t o f r i e n d s h i p s w i t h more engagement a n d d e p t h .  A l s o , c a l l e r s remained disengaged and  d i s t a n c e f r o m t h e i r f a m i l y members o u t o f p e r s o n a l family intent. t h e i r support  choice or  The c h r o n i c c a l l e r s ' a b i l i t y t o e n g a g e a n d t o u s e n e t w o r k o f f a m i l y a n d f r i e n d s a p p e a r e d more a t  issue than t h e support  network  itself.  O n l y two c a l l e r s m e n t i o n e d a s u p p o r t i v e , their lives.  personal  The o t h e r s  said they l i v e d  and meaningful  contact  Another c a l l e r a l s o i n d i c a t e d  support  from f a m i l y , though n e i t h e r o f these  support  f r o m a l l t h e i r f a m i l y members.  showed s i g n i f i c a n t  someone i n  alone.  O n l y one c a l l e r r e p o r t e d s i g n i f i c a n t w i t h b o t h f r i e n d s and f a m i l y .  special  and supportive  two c a l l e r s  Another c a l l e r a l s o  friendships.  s i x c a l l e r s , t h e y r e v e a l e d no e x t e n s i v e nor  friends.  use  t h e i r f r i e n d s and f a m i l y f o r support  received  support  For the  remaining  network o f f a m i l y  F o r most c a l l e r s , t h e i r a b i l i t y t o c o n n e c t w i t h a n d remained  limited.  Connection Most c a l l e r s r e p o r t e d l i m i t e d  support  from others.  A l l the  130 c a l l e r s s a i d l o n e l i n e s s o f t e n was a f r e q u e n t f e e l i n g i n t h e i r lives.  H o w e v e r , b e c a u s e o f t h e s e o r i n s p i t e o f them, t h e theme  of contact o r connection recurred through any r e l a t i o n s h i p the c a l l e r s had. All  c a l l e r s a p p e a r e d t o want o r have a t l e a s t  connection with others.  some  The c a l l e r s showed t h e y s t r i v e d t o b u i l d  r e l a t i o n s h i p s and connect  with others, l i k e  f r i e n d s and f a m i l y .  T h e y showed t h e y h a d some c o n n e c t i o n w i t h o t h e r s t h r o u g h t h e friendships,  s o c i a l times and rapport they e s t a b l i s h e d .  a l s o showed c o n n e c t i o n t h r o u g h t h e r a p p o r t t h e y h a d w i t h friends,  their  family, special others o r helpers.  The c a l l e r s d e v e l o p e d  both rapport and intimacy w i t h  l i n e workers and h e l p i n g p r o f e s s i o n a l s . f e l t b e t t e r and connected helpers.  They  The c a l l e r s s a i d  they  when t h e y t a l k e d w i t h a n d w e r e h e a r d b y  They a l s o s a i d those telephone workers t h a t  similar l i f e  crisis  e x p e r i e n c e s w i t h them h e l p e d t h e c a l l e r s  even a b e t t e r c o n n e c t i o n t o those workers.  shared establish  For five of the  c a l l e r s t h e t e l e p h o n e w o r k e r s became a d i f f e r e n t k i n d o f f r i e n d . However, t h e c a l l e r s o n l y i n t e r p r e t e d f r i e n d l i n e s s f r o m t h e intimacy and rapport o f t h e h e l p i n g r e l a t i o n s h i p .  The f r i e n d s h i p  was n o t r e c i p r o c a t e d . Therapy, Treatment and t h e C a l l e r s '  Personal  Background  Previous o r Current C o u n s e l l i n g , Therapy o r Treatment P r i o r research by Greer  (1976) a n d M u r p h y e t a l . (1969)  r e p o r t e d f r o m 7 5 % t o 95% o f f r e q u e n t a n d one t i m e c a l l e r s have had p r e v i o u s therapy,  c o u n s e l l i n g o r treatment.  Consistent with  131 t h i s research, a l l the subjects i n the current study reported t h e y h a d r e c e i v e d some t y p e o f c o u n s e l l i n g , Four c a l l e r s a l s o s a i d they s t i l l  therapy o r treatment.  maintained contact with  additional helping services beside the c r i s i s  lines.  This  maintained contact with other services i s consistent with p r e v i o u s r e s e a r c h r e p o r t i n g c h r o n i c c a l l e r s have o r have had f r e q u e n t c o n t a c t w i t h o t h e r community s e r v i c e s (Farberow e t a l . , 1966; L e s t e r & B r o c k o p p , 1 9 7 3 ; S a w y e r & J a m e t o n , 1 9 7 9 ) . all  t h e c h r o n i c c a l l e r s reported an involvement  treatment,  i n therapy,  o r another h e l p i n g resource before t h e i r  with crisis  Further,  first  contact  lines.  Perhaps unique t o c h r o n i c c a l l e r s i n therapy o r other treatment.  i s their early  involvement  A l l the callers of this  study  r e p o r t e d they had been i n v o l v e d i n medical o r mental h e a l t h therapy o r treatment by t h e i r l a t e teens. began i n t h e i r c h i l d h o o d b e f o r e age 10. callers' treatment  Most s a i d  treatment  C l e a r l y because o f t h e  ages a t t h e time, t h e i r p a r e n t s i n i t i a t e d t h e t h e r a p y o r and had the c o n t r o l over t h e type and course o f i t .  F o r some t h i s e a r l y c o n t a c t w i t h m e d i c a l a n d m e n t a l h e a l t h s e r v i c e s was t o t h e i r b e n e f i t a n d t h e y c l e a r l y e x p r e s s e d appreciation o f the help they received.  Their early  their  experience  w i t h t h e r a p y o r o t h e r treatment began a p o s i t i v e t h e r a p e u t i c h i s t o r y f o r them. For t h e others, e s p e c i a l l y the higher frequency  callers,  t h i s e a r l y c o n t a c t w i t h t h e r a p y a n d t r e a t m e n t was t h e s t a r t o f a generally negative experience w i t h the helping professions. A l l  132 reported t h e i r parents treatment.  f o r c e d them i n t o  therapy or  other  Some c a l l e r s r e p o r t e d t h e i r p a r e n t s e v e n a t t e m p t e d  i n s t i t u t i o n a l i z e them.  For these c a l l e r s began a n e g a t i v e  to  and  often abusive therapeutic experience. Mental  Health  All  Contact  c a l l e r s reported contact w i t h mental h e a l t h or  psychiatric  s e r v i c e s a t some p o i n t i n t h e i r l i v e s .  s a i d t h e y had  received psychiatric  mental i l l n e s s .  All  for a  The  remaining  caller  received  reported  c o u n s e l l i n g from a community m e n t a l h e a l t h  c a l l e r s mentioned p r i o r p s y c h i a t r i c  n e c e s s a r i l y f o r a diagnosed  treatment,  mental i l l n e s s .  service.  though  al.,  1996/  L e s t e r & B r o c k o p p , 1970/  not  This i s consistent  w i t h t h e p r e v i o u s r e s e a r c h t h a t s t a t e d between 75% and chronic c a l l e r s reported prior psychiatric  callers  diagnosed  Four o t h e r c a l l e r s r e p o r t e d t h e y had  therapy from a p s y c h i a t r i s t . receiving  treatment  Three  treatment  85%  of  (Farberow e t  Sawyer & Jameton,  1979).  Suicide The  chronic callers  involved suicide.  1  contact w i t h therapy or treatment  In t o t a l five chronic callers revealed  suicidal or previous suicide research mentioning  attempts.  over h a l f  otherwise, d i s c l o s i n g  suicidal  L e s t e r & B r o c k o p p , 1970/  This i s similar  to  often feeling prior  of a l l c a l l e r s , chronic or ideation  or attempts  M u r p h y e t a l . , 1969/  (Greer,  1976/  Sawyer & Jameton,  1979).  O n l y t h r e e c a l l e r s , however, c o n t a c t e d c r i s i s  feeling  suicidal.  lines  while  133 No S u b s t a n c e Three  Misuse  c a l l e r s d i s c l o s e d t h e y had an a l c o h o l o r o t h e r drug  p r o b l e m a n d now  were i n r e c o v e r y .  The  remaining f i v e  callers  r e p o r t e d no d i f f i c u l t i e s o r c o n c e r n s w i t h t h e i r a l c o h o l o r o t h e r drug  use. The p r e v i o u s r e s e a r c h h a d s u g g e s t e d a p p r o x i m a t e l y  percent of those chronic c a l l e r s t o a c r i s i s substance abuse problem  l i n e have an  ( F a r b e r o w e t a l . , 1966;  Sawyer & Jameton, 1979).  The  do n o t s u p p o r t t h i s v i e w .  fifty  Greer,  1976;  r e s u l t s from the c u r r e n t r e s e a r c h  A possible explanation f o r the lack of  s u p p o r t f o r t h e p r e v i o u s r e s e a r c h c o u l d be t h e c a l l e r s ' around t h e i r  substance use.  The  o b t a i n i n f o r m a t i o n on s p e c i f i c dependency.  The  i n t e r v i e w was  "denial"  not designed to  i n d i c a t o r s o f substance abuse o r  interview protocol only contained questions that  asked t h e c a l l e r s ' views and d i f f i c u l t i e s about other drug use.  The  their alcohol  c a l l e r s c o u l d have been unaware t h a t  have a substance abuse problem, to d i s c l o s e any substance use  o r t h e y may  Farberow  support  e t a l . (1966) a n d t h e S a w y e r  substance use challenge.  Only Greer  independently of mental  mental  (1976) l o o k e d a t  illness or psychiatric  Perhaps, because of the e x c l u s i o n o f  challenged c a l l e r s  illness  and  (1979) l o o k e d a t s u b s t a n c e a b u s e o r d e p e n d e n c y and  i l l n e s s i n t h e same c a l l e r .  they  difficulties.  i n v o l v e s t h e a s s o c i a t i o n between substance use and mental i n the research.  or  have been r e l u c t a n t  Another p o s s i b l e e x p l a n a t i o n f o r the lack of  Jameton  ongoing  psychiatrically  from the c u r r e n t study, t h i s r e s e a r c h ' s  134 c h r o n i c c a l l e r s a r e d i f f e r e n t enough from t h e o t h e r s t u d i e s subjects t o produce d i f f e r i n g r e s u l t s . consideration,  Ignoring  P o s i t i v e Therapeutic H i s t o r y versus Negative lower  those  excluding the p s y c h i a t r i c a l l y challenged, are  not u n i q u e l y i d e n t i f i e d by a c u r r e n t substance  The  this  t h e g e n e r a l a s s e r t i o n c a n b e made t h a t  chronic callers,  1  frequency  misuse problem.  Therapeutic H i s t o r y  chronic c a l l e r s reported severe  neglect  and t h a t t h e y g e n e r a l l y were i g n o r e d a n d unwanted b y t h e i r parents and f a m i l i e s .  Perhaps,  s t a r v e d f o r a t t e n t i o n , when t h e y  entered therapy o r other treatment,  t h e i n t e r e s t and a t t e n t i o n  they received created a p o s i t i v e experience a t t e n t i o n and i n t e r e s t expressed p o s i t i v e experiences.  f o r them.  by helpers continued  began t e l e p h o n i n g c r i s i s  lines,  their positive  When  and contact.  lines for practical, They m a i n t a i n e d  they  experiences  Connected w i t h other h e l p i n g resources, they  they used the c r i s i s support  these  The c a l l e r s t h e n r e m a i n e d c o n n e c t e d t o  many h e l p i n g s e r v i c e s a n d t h e i r v a r i o u s n e e d s m e t .  continued.  Additional  reported  day t o day assistance,  c o n s i s t e n t , appropriate and  p o s i t i v e help from s e v e r a l sources. The  higher frequency  families differently. families i l l s ,  chronic c a l l e r s experienced  their  S e v e r e l y abused and blamed f o r t h e i r  they revealed a h i s t o r y o f abusive  beginning i n t h e i r families.  relationships  Pushed i n t o t h e r a p y o r treatment  by  t h e i r parents, they reported they started therapy negatively. They showed a p a t t e r n o f a b u s i v e a n d c o n t r o l l i n g that developed  and continued i n t o l a t e r therapy.  relationships They f r e q u e n t l y  135 s t r u g g l e d w i t h and i n c o n s i s t e n t and  l e f t h e l p i n g s e r v i c e s because of  inappropriate help they received.  t h a t when t h e y c o n t a c t e d c r i s i s  increased, the c r i s i s  They r e p o r t e d  l i n e s , t h e phone s e r v i c e s  f u l f i l l e d a need f o r c o n t a c t , ongoing o t h e r s e r v i c e s e x i s t e d f o r them.  the  support,  and therapy.  H o w e v e r , when t h e i r  l i n e s s t a r t e d t o manage t h e i r  calls calls.  L i m i t e d f r o m a n o t h e r h e l p i n g r e s o u r c e when i n n e e d , t h e s e reported another therapy,  and  negative situation  reminiscent of t h e i r  callers previous  even t h e i r f a m i l y l i f e .  Contradictions i n Helping  Experience  C a l l e r s o f t e n r e p o r t e d a double counselling,  No  edged e x p e r i e n c e  t h e r a p y and h e l p i n g p r o f e s s i o n a l s .  r e p o r t i n g t h a t t h e y were c o n s t r a i n e d , abused and  with  While f r e q u e n t l y disempowered,  the c a l l e r s o f t e n d i s p l a y e d p e r s o n a l growth, esteem-growth empowerment t h r o u g h  t h e i r c o u n s e l l i n g and o t h e r  and  treatment  experiences.  F o r example, t h r e e c a l l e r s  s t a t e d t h e y were  committed and  r e s t r a i n e d b y m e n t a l h e a l t h s e r v i c e s ; y e t , i t was  t h e s e v e r y same m e n t a l h e a l t h s e r v i c e s t h a t t h e y s a i d empowered t h e m t o b r e a k away f r o m t h e i r i n s t i t u t i o n a l i z a t i o n a n d i l l  label  t o take care o f themselves.  The  callers  mentally  indicated  h e l p i n g s e r v i c e s both repeated t h e i r sense o f v i c t i m i z a t i o n helped boost  t h e i r sense o f esteem.  Therefore,  and  they often  a p p e a r e d caught i n a c y c l e where t h e y r e p o r t e d h u r t and abuse t o achieve  some c o n n e c t i o n a n d p e r s o n a l p o w e r . Telephone C r i s i s  The  Centres  c a l l e r s ' years of contact remain c o n s i s t e n t w i t h  136 previous findings  (Sawyer & Jameton, 1979).  Most c h r o n i c c a l l e r s  interviewed reported telephoning the c r i s i s years: seven c a l l e r s 10 y e a r s . Also,  O n l y one  lines  f o r several  f o r o v e r 5 y e a r s , and t h r e e c a l l e r s c a l l e r had been c a l l i n g under a y e a r .  the chronic c a l l e r s ' telephoning frequency i s  c o n s i s t e n t w i t h p r e v i o u s r e s e a r c h (Lester & Brockopp, Johnson & B a r r y , 1978). to  f o r over  The  callers  f i v e t i m e s a month t o f o u r t i m e s a  1970;  said they telephoned three day.  I n c r e a s i n g C r i s i s L i n e C o n t a c t and M i s m a t c h e d Needs Disadvantaged  o r unmet r e l a t i o n s h i p n e e d s do n o t  strong factors leading to increased c r i s i s  l i n e use.  were t h e case, b o t h t h e h i g h e r f r e q u e n c y and  lower  appear If this  frequency  c h r o n i c c a l l e r s w o u l d l i k e l y h a v e more e q u i v a l e n t r a t e s o f l i n e use because both groups d i s p l a y a l i m i t e d a b i l i t y and use t h e i r  support  t o engage  network.  What d o e s seem t h e s t r o n g e r i n f l u e n c e i s t h e c a l l e r s ' for therapeutic contact.  need  The h i g h e r f r e q u e n c y c h r o n i c c a l l e r s  r e p o r t e d much more s e v e r e a b u s e t h a n t h e i r l o w e r counterparts.  crisis  frequency  A l s o , t h e y s t a t e d p r e v i o u s t h e r a p y and  treatment  t e n d e d t o i n c l u d e more f r e q u e n t a n d more s e v e r e n e g a t i v e therapeutic experiences than other c a l l e r s .  They a l s o tended  r e p o r t much more i n c o n s i s t e n t t h e r a p y a n d o t h e r t r e a t m e n t .  to  A l l  t h e s e f a c t o r s seem t o i n c r e a s e t h e s e c a l l e r s ' n e e d f o r c o n s i s t e n t and a p p r o p r i a t e t h e r a p y o r c o u n s e l l i n g . p r i o r n e g a t i v e and  However, t h e s e  callers'  i n c o n s i s t e n t experiences w i t h therapy would  appear t o i s o l a t e these c a l l e r s  from h e l p i n g resources from  which  137 they could benefit. Crisis  l i n e s are a r e a d i l y a v a i l a b l e h e l p i n g resource.  Though n o t t h e r a p i s t s , t h e c r i s i s  l i n e w o r k e r s c a n a n d do  a p o s i t i v e and b e n e f i c i a l h e l p i n g r e l a t i o n s h i p t o  provide  callers.  Because t h e s e c a l l e r s were i s o l a t e d from o t h e r p o t e n t i a l h e l p i n need o f a t h e r a p e u t i c resource, they s a i d the c r i s i s became a h e l p i n g r e p l a c e m e n t Therefore,  - a t h e r a p e u t i c s t o p gap  A mismatch between the c a l l e r s The  callers,  provide c r i s i s  1  the c r i s i s  anytime.  and c r i s i s  contact.  i n t e r v e n t i o n - not therapy.  resolved.  The  crisis  The  lines  telephone  workers  Greer  f o r both  As L e u t h e  and  the s e r v i c e increases.  experiences  volunteer  as the f r e q u e n c y o f c a l l e r s ' For the higher frequency  reported negative experiences w i t h the c r i s i s this  in  parties.  (1976) s t a t e d t h e q u a l i t y o f t e l e p h o n e  i n t e r a c t i o n s decreases  with  l i n e s ' need t o r e s o l v e c r i s e s  (1981) s a i d , t h i s m i s m a t c h b e t w e e n n e e d s r e s u l t s  negative experiences  workers,  needs  stop telephoning,  a n d t h e c a l l e r s ' w a n t o f t h e r a p y do n o t a g r e e .  who  lines'  However, t h e c r i s i s  t h e c a l l e r s t o improve q u i c k l y and  0'Conner  - f o r them.  looking f o r a therapeutic resource,  increase t h e i r telephone  expect  lines  they increased t h e i r c a l l s to the o n l y h e l p i n g  r e s o u r c e a v a i l a b l e t o them c o n s i s t e n t l y , a t  exists.  and  i s d e f i n i t e l y the case.  The  contact  chronic  decreasing q u a l i t y of telephone  callers,  l i n e s and  negative c r i s i s  f r o m t h e m i s m a t c h e d needs w o u l d be p a r t o f interactions.  with  the  their line  138 Building Limited family contact  Self-Esteem  helped  the c a l l e r s avoid a repeat  the v i c t i m i z a t i o n they reported having family.  I t a l s o helped  o f abuse and  neglect.  experienced  The  i n their  them r e b u i l d t h e i r esteem a f t e r t h e  enhanced t h e i r esteem and  that  empowered t h e m t o h e a l t h i e r l i v i n g .  They s a i d t h a t t h e y r e c e i v e d v a l i d a t i o n , acknowledgement,  and  of t h e i r l i f e  helping professionals.  s a i d the c r i s i s accepting  and  their lives. and  experiences  The  and  from telephone workers  However, f o r a l l t h e c a l l e r s ,  lines often provided  supportive  or  esteem.  c a l l e r s r e v e a l e d many i n t e r a c t i o n s w i t h h e l p e r s  understanding  years  However, t h e c a l l e r s n e e d e d a p l a c e ,  r e l a t i o n s h i p , where t h e y c o u l d b u i l d t h e i r  of  t h e most c o n s i s t e n t  environment where t h e y c o u l d  c a l l e r s i n d i c a t e d the  referrals, brain-storming  and  they  new  information,  perspectives  on  enhance resources their  concerns r e c e i v e d from telephone workers worked toward b u i l d i n g t h e i r esteem.  Through c r i s i s  l i n e w o r k e r s ' v a l i d a t i o n and  acknowledgement, the c a l l e r s d i s p l a y e d a sense o f a c c e p t a n c e support that boosted t h e i r  esteem.  Over the y e a r s of c o n t a c t w i t h the c r i s i s degree other h e l p i n g resources, to address the previous familial, past,  i n t i m a t e and  the c a l l e r s '  themselves. and  friends.  and  lines,  and  to  a  the c a l l e r s r e v e a l e d they s t a r t e d  abuse t h e y had  received i n their  helping relationships.  Resolving  their  esteem grew as t h e y began b e t t e r c a r i n g f o r  They e s t a b l i s h e d h e a l t h i e r r e l a t i o n s h i p s w i t h Those c a l l e r s w i t h o u t  new  family  relationships indicated  139 t h e y c o n t i n u e d t o m a i n t a i n and crisis  l i n e workers  f u r t h e r b u i l d t h e i r esteem w i t h  and o t h e r h e l p e r s .  They s t i l l  searched f o r  healthier relationships with others. The  c a l l e r s showed i m p r o v e d  with c r i s i s  lines.  The  p r o v i d e d by the c r i s i s  esteem through t h e i r c o n t a c t  e m o t i o n a l support and  understanding  l i n e s strengthened the c a l l e r s .  They were  a l l o w e d t o v e n t t h e i r e m o t i o n a l d i s t r e s s and concerns and shown w a y s t o o v e r c o m e t h e i r c h a l l e n g e s . C a l l e r s a n d  were  telephone  v o l u n t e e r s worked t o g e t h e r t o b r a i n s t o r m s o l u t i o n s and t o new  perspectives.  The  c a l l e r s i n c r e a s e d t h e i r esteem  and  empowerment, r e c e i v i n g e m o t i o n a l r e l e a s e a n d b u i l d i n g p l a n s t h a t improved The  crisis  their physical,  find  action  e m o t i o n a l and mental  health.  l i n e s a l s o p r o v i d e d a s a f e p l a c e where t h e  c a l l e r s could g a i n self-knowledge through personal exploration. L i k e a m i r r o r , the telephone workers the c a l l e r s '  v a l i d a t e d and  e x p e r i e n c e s and f e e l i n g s .  had a r e l a t i o n s h i p w i t h the c r i s i s  The  acknowledged  c a l l e r s showed t h e y  l i n e s where t h e y l e a r n e d t o  b e t t e r u n d e r s t a n d and accept themselves. t h r o u g h t h e encouragement, acceptance  T h e i r esteem grew  a n d c o n n e c t i o n w i t h someone  else. C r i s i s L i n e s as a T h e r a p e u t i c Resource Those c a l l e r s w i t h b e t t e r f i n a n c i a l r e s o u r c e s showed t h e y were b e t t e r a b l e t o cope w i t h t h e day-to-day improve themselves.  stressors  They c o u l d b e t t e r a f f o r d t h e r a p y  counselling services.  Those c a l l e r s w i t h r e d u c e d o r  and  and few  f i n a n c i a l r e s o u r c e s r e p o r t e d t h e y were l i m i t e d t o h e l p i n g  140 s e r v i c e s o f f e r e d a t a s l i d i n g s c a l e o r f r e e t h r o u g h community government a g e n c i e s .  When a f f o r d a b l e t h e r a p y  s e r v i c e s were found, t h e s e r e s o u r c e s t i m e and  inconsistent.  better paying  The  positions.  For these c a l l e r s w i t h  Negatives of Therapeutic  limited  l i n e s can and  between  crisis  Use  l i n e s appear t o provide  t h e r a p e u t i c and p o s i t i v e h e l p i n g r e l a t i o n s h i p .  crisis both  This  most o f t e n r e l y on t h e c r i s i s  only therapeutic resource. l i n e s and  the higher  therapeutic experiences  r e c e i v e from c r i s i s  lines.  and  w e r e v e r y v o c a l o n them.  negative  inappropriate  service the  l i n e worker behaviours  T h e s e c a l l e r s a l s o p r o v e d t o be  most p r e c i s e i n what t h e y f o u n d b e n e f i c i a l crisis  previous  crisis  These c a l l e r s d i s p l a y e d  g r e a t e s t awareness of i n a p p r o p r i a t e c r i s i s and  of  their  a p p e a r t o c o m b i n e t o c r e a t e more a w a r e  a n d more v o c a l c a l l e r s o n t h e n e g a t i v e t h e y may  1  frequency  l i n e s as  However, t h e r a p e u t i c u s e  frequency chronic c a l l e r s  callers  fulfilling  seems p a r t i c u l a r l y t r u e f o r t h e h i g h e r  c h r o n i c c a l l e r s who  lines  a  .Chronic  are meeting c o u n s e l l i n g needs t h a t t h e y a r e not elsewhere.  do  times.  Because c a l l e r s r e p o r t e d t h e y tended t o use therapeutically,  in  h e l p i n g p r o f e s s i o n a l o f t e n moved o n t o  "therapeutic" helping resource  P o s i t i v e and  counselling  f r e q u e n t l y were l i m i t e d  f i n a n c i a l l y a v a i l a b l e c o u n s e l l i n g , the c r i s i s become a  and  and  and  the  p o s i t i v e about  line service. The  The  higher  Chronic  Callers'  Negative Responses  frequency chronic c a l l e r s often reported  s u f f e r e d severe abuse i n t h e i r f a m i l i e s o f o r i g i n .  They  they  had  141 i n d i c a t e d t h e i r abusive  experiences  tended t o repeat  themselves  i n f u t u r e r e l a t i o n s h i p s : f r i e n d s , s p e c i a l others, and therapeutic.  T h e y r e v e a l e d a p a t t e r n o f v i c t i m i z a t i o n t h a t was  set e a r l y and continued The  higher  throughout t h e i r  frequency  chronic c a l l e r s suggested t h e i r  of v i c t i m i z a t i o n continued w i t h c r i s i s personnel  lives.  lines.  pattern  When c r i s i s  line  i n i t i a t e d c a l l management t o r e s t r i c t t h e i r c a l l s , t h e  c a l l e r s responded n e g a t i v e l y .  The c r i s i s  manage t h e i r c a l l s came a c r o s s  l i k e previous  experiences  lines'  efforts to  negatives  w i t h h e l p i n g s e r v i c e s , t h e i r f a m i l i e s and t h e i r  i n t i m a t e r e l a t i o n s h i p s . They r e p o r t e d f e e l i n g abused and mistreated. Additionally,  the higher  frequency  chronic c a l l e r s  reported  the c r i s i s  l i n e s as t h e i r only consistent therapeutic  contact.  The  l i n e w o r k e r s , d e t e c t i n g t h e change i n t h e  telephone  crisis  r e l a t i o n s h i p toward therapy, crisis  moved t o r e e s t a b l i s h t h e o r i g i n a l  intervention relationship.  These c a l l e r s a g a i n  they responded n e g a t i v e l y t o t h e c r i s i s  lines efforts.  reported This  a p p e a r e d t o them a s a n o t h e r abuse o r b e t r a y a l o f y e t a n o t h e r therapeutic  relationship.  Complaints Clearly f o rthe higher  frequency  chronic callers,  their  g r e a t e r a n d more d i v e r s e r e p o r t i n g o f c o m p l a i n t s  about  l i n e service relate t o t h e i r greater telephoning  frequency.  greater contact, the c r i s i s  crisis With  l i n e s a r e more l i k e l y t o c a l l manage.  However, a l s o c o n t r i b u t i n g t o t h e s e  complaints  c o u l d be t h e  142 reported tendency  o f t h e h i g h e r f r e q u e n c y c h r o n i c c a l l e r s t o have  h a d m o r e f r e q u e n t a n d more i n t e n s e n e g a t i v e e x p e r i e n c e s w i t h therapy, c o u n s e l l i n g and other treatment.  They c o u l d have  from  t h i s p r i o r experience with the helping professionals a greater awareness o f and s e n s i t i v i t y t o i n a p p r o p r i a t e and u n p r o f e s s i o n a l h e l p i n g behaviours toward  them.  C a l l Management Contradictions. Callers pointed out the contradictions i n crisis  line service.  When c a l l e r s f i r s t s t a r t e d c a l l i n g t h e  crisis  lines i n distress,  t h e y s t a t e d t h e y were encouraged  to  vent out t h e i r f e e l i n g s and express t h e i r concerns r a t h e r than keep them i n s i d e .  H o w e v e r , when t h e y b e g a n t o t e l e p h o n e t o o  f r e q u e n t l y , t h e y s a i d t h e y were p l a c e d o n t i m e l i m i t s . telephone workers to  The  a l s o s t a r t e d t o focus and t o d i r e c t t h e i r  move t h e c a l l e r s a l o n g a n d k e e p t h e m f r o m  C a l l e r s mentioned,  calls  "wandering."  even i f they telephone d i s t r e s s e d ,  t h e y were  not g i v e n t h e o p p o r t u n i t y t o vent completely t h e i r f e e l i n g s and c o n c e r n s b e f o r e t h e c a l l i s ended. left the c a l l s t i l l  Therefore, they said  h i g h w i t h unexpressed  emotions  They s t a t e d a c o n t r a d i c t i o n e x i s t e d between c r i s i s  and problems. line  e n c o u r a g i n g them t o t a l k and v e n t a n d t h e l a t e r c a l l when t h e y t e l e p h o n e d t o o o f t e n t o d o j u s t Application. crisis to  lines'  they  personnel  restrictions  that.  From what t h e c a l l e r s have s a i d a b o u t t h e  a t t e m p t s t o manage t h e i r c a l l s ,  crisis  lines  appear  c a l l manage u n i f o r m l y o n c e t h e c a l l e r h a s r e a c h e d a p a r t i c u l a r  t e l e p h o n i n g f r e q u e n c y t o a s p e c i f i c phone l i n e .  The c a l l e r s  143 showed t h e y a r e f u l l y a w a r e o f t h e c h a n g e s i n s e r v i c e t o them. They s t a t e d t h e changes o f t e n i g n o r e and  s p e c i f i c needs f o r a p a r t i c u l a r  their individual call.  uniqueness  They r e m a i n h i g h l y  r e s i s t a n t t o a n y c h a n g e s t h a t do n o t i n v o l v e t h e m i n t h e d e c i s i o n process, as d i s p l a y e d by t h e i r c o n t i n u e d phoning and frustration with the c r i s i s  lines'  service.  increased  144 I m p l i c a t i o n s and The  Conclusion  discovered chronic c a l l e r characteristics,  and t h e  a s s o c i a t i o n s b e t w e e n them, p r o v i d e new i n f o r m a t i o n f o r t h e operation o f telephone  crisis  intervention services.  Chronic  c a l l e r management i s a d y n a m i c e v e n t b e t w e e n t h e c r i s i s  l i n e s and  the chronic c a l l e r s .  The f i n d i n g s e n c o u r a g e a r e e x a m i n a t i o n  both chronic c a l l e r s '  and t h e c r i s i s  ongoing telephone Therefore,  lines'  contribution t o the  contact t o understand b e t t e r t h i s  the implications of the results the telephone  management o f t h e i r  c a l l s w i l l be d i s c u s s e d .  c a l l dynamics, and t h e  a p p l i c a t i o n o f some c h a r a c t e r i s t i c s  provided  w i l l be p r o v i d e d .  t o enhance c r i s i s  process.  f o rthe identification  of chronic c a l l e r s ,  identification  of  A possible  t o chronic  caller  A l s o , recommendations w i l l be  l i n e service with regard t o chronic  callers. Chronic Previous  Identification  Definition  Most c r i s i s identify  Caller  l i n e administrations use a l i s t  chronic callers.  the i d e n t i f i c a t i o n  Commonly, e i g h t c r i t e r i a  of chronic callers.  of contact;  a r e used i n  The i d e n t i f i c a t i o n  chronic c a l l e r u s u a l l y requires a combination (1) f r e q u e n c y  of criteria to  o f these f a c t o r s :  (2) d u r a t i o n o f o n g o i n g c o n t a c t ;  absence o f c r i s i s o r emergency;  (4) a n u n c l e a r  event o r s t r e s s o r f o r t h e c a l l ;  (5) t h e c a l l e r r a r e l y  immediate a c t i o n o r d e c i s i o n making; unreceptive  and r e l u c t a n t t o accept  of a  (3) a n  precipitating engages i n  (6) t h e p e r s o n i s i n t e r v e n t i o n s and develop  145 a c t i o n p l a n s ; t h e r e f o r e , a s s i s t a n c e u s u a l l y i s "yes, but..."  and  rejected;  and  (7) t h e c a l l e r o f t e n t e l e p h o n e s  for social  support  c o n t a c t ; a n d (8) t h e c a l l e r i s o f t e n d i f f i c u l t t o t e r m i n a t e (Chimo P e r s o n a l D i s t r e s s I n t e r v e n t i o n S e r v i c e s i n R i c h m o n d , 1 9 9 3 ; Langley  F a m i l y S e r v i c e s A s s o c i a t i o n , 1993).  current study,  these c r i t e r i a  are  With regard t o the  reviewed.  1. F r e q u e n c y o f c o n t a c t , r a n g i n g a n y w h e r e f r o m o n c e w e e k l y , to three times d a i l y , i s supported  t o three times p e r s h i f t .  by the research.  The c a l l e r s  However, a s  of telephoning alone  limited  c r i t e r i o n to identify a chronic c a l l e r  1978).  Chronic  crisis  callers.  c a l l e r s may t e l e p h o n e  (Johnson & B a r r y ,  j u s t as f r e q u e n t l y as  criteria.  2. D u r a t i o n o f o n g o i n g c o n t a c t , u s u a l l y o v e r This c r i t e r i o n i s supported  s e v e r a l months.  by the current research.  interviewed reported telephoning c r i s i s 13 y e a r s .  is a  What becomes e s s e n t i a l t o t h e i d e n t i f i c a t i o n o f  chronic c a l l e r s are additional  over  criterion  interviewed reported  t e l e p h o n i n g f r o m once/week t o f o u r c a l l s / d a y . p r e v i o u s r e s e a r c h has s t a t e d , frequency  This  The  callers  l i n e s f r o m 6 months t o  However, w h e t h e r t h i s i s c h r o n i c o r c r i s i s  c a l l i n g remains unclear. The r e s e a r c h l i t e r a t u r e o n c r i s i s emphasizes t h e r e e x i s t  i n t e r v e n t i o n and theory  l i m i t s t o the duration of a  crisis  (Auerbach & Kilman,  1 9 7 7 ; Rosenbaum & C a l h o u n , 1 9 7 7 ; S l a i k e u ,  1990).  d i s e q u i l i b r i u m experienced  The i n i t i a l  from a  crisis  event u s u a l l y i s e l i m i n a t e d and e q u i l i b r i u m r e s t o r e d w i t h i n f o u r to  s i x weeks.  H o w e v e r , t h i s l i t e r a t u r e shows t h a t t h e e f f e c t s o f  146 a c r i s i s may c o n t i n u e a n d t a k e u p t o a y e a r t o r e s o l v e . I f c a l l e r s telephone f r e q u e n t l y over a f o u r t o six-week p e r i o d , t h i s c o n t a c t may b e t h e r e s u l t o f c r i s e s .  Continued  t e l e p h o n i n g b e y o n d t h i s p e r i o d s t i l l may b e a n a t t e m p t t o r e s o l v e the c r i s i s  event.  These c a l l e r s c o u l d be i d e n t i f i e d a s " c h r o n i c "  c a l l e r s although they are s t i l l working t o resolve the e f f e c t s of the c r i s e s .  Therefore, e s p e c i a l l y i f frequent telephoning only  o v e r s e v e r a l months i s c o n s i d e r e d , d u r a t i o n o f o n g o i n g c o n t a c t i s a limited criterion to identify chronic callers.  However, i f  t e l e p h o n i n g c o n t i n u e s b e y o n d s e v e r a l m o n t h s i n t o a y e a r o r more, the c a l l e r s ' suspect. origin,  s u c c e s s f u l r e s o l u t i o n o f t h e c r i s i s would  grow  A f t e r a y e a r o r more, t h e p r o b l e m ( s ) , e v e n i f c r i s i s i n d e f i n i t e l y would appear  3. T h e r e  chronic i n duration.  i s a n absence o f a c r i s i s o r emergency.  4. The e v e n t o r s t r e s s o r p r e c i p i t a t i n g t h e c a l l i s u n c l e a r . These c r i t e r i a  g e n e r a l l y a r e supported by the study.  i n d i c a t e d they a t times telephoned c r i s i s r e s u l t o f some e v e n t o r s t r e s s o r .  The c a l l e r s  l i n e s i n c r i s i s as the  However, t h e y most  often  reported they telephoned wanting s o c i a l contact o r d i s t r e s s e d w i t h an ongoing Telephone  problem. workers, o p e r a t i n g from a c r i s i s  model, would be e x p e c t i n g a c r i s i s event.  intervention  c a l l p r e c i p i t a t e d b y some  T h o u g h t h e c h r o n i c c a l l e r may b e t e l e p h o n i n g d i s t r e s s e d  b y some o n g o i n g c o n c e r n , t h e u s u a l i n d i c a t o r s o f a c r i s i s be a b s e n t  (Rosenbaum & C a l h o u n ,  chronic callers'  problems  1977; S l a i k e u ,  1990).  would  The  p o s s i b l y c o u l d be t h e r e s i d u a l  effects  147 of past c r i s e s  (Auerbach & Kilman,  1977;  S l a i k e u , 1990).  H o w e v e r , a more l i k e l y f a c t o r w o u l d be t h e p a s t e x p e r i e n c e  of  the  callers. All  s u b j e c t s r e p o r t e d e x c e p t i o n a l l y n e g l e c t f u l and  f a m i l y backgrounds. and/or emotional  A l l a l s o reported prolonged  f a m i l y background, a l l the c a l l e r s  previous c o u n s e l l i n g , therapy,  or other treatment  A l l t h e c a l l e r s c l e a r l y s t a t e d , and  a d d i t i o n a l i n f o r m a t i o n t o support, they telephoned historical. to  the c r i s i s  Therefore,  5.  provided problems  and  workers would f i n d i t d i f f i c u l t  problem.  Immediate a c t i o n o r d e c i s i o n making by t h e c a l l e r by the study.  callers r a r e l y reported telephoning i n c r i s i s , motivations of a c r i s i s  t h e s t r i v i n g t o f i n d new  resources  m o t i v a t i o n t o immediate a c t i o n and the chronic Besides telephoned  callers  The  the  usual tension, missing  crisis  d e c i s i o n making does not  exist  caller.  s o c i a l contact, the subjects reported they  t o work on o n g o i n g p r o b l e m s .  p e r s o n a l and  the  t o cope - a r e  S l a i k e u , 1990).  rarely  Because  - p e r s o n a l d i s e q u i l i b r i u m and  (Rosenbaum & C a l h o u n , 1977;  The  reported  the f a c t that the  occurs. This c r i t e r i o n i s supported  for  With  for their  l i n e s w i t h were o n g o i n g  telephone  mental  i d e n t i f y e i t h e r a c r i s i s o r i t s p r e c i p i t a t i n g event from a  chronic c a l l e r ' s  and  physical,  h e a l t h concerns l a s t i n g s e v e r a l years.  t h i s p e r s o n a l and  problems.  abusive  Again,  their  f a m i l y h i s t o r y w o u l d be a s i g n i f i c a n t  often  reported  f a c t o r here.  s h o w e d t h e y h a v e l i v e d w i t h t h e i r c o n c e r n s f o r many  148 y e a r s and adapted their life  (or maladapted) t o the c h a l l e n g e s i n i t i a t e d by  experiences.  A l s o , seven of the c a l l e r s  s u b s t a n t i a l h i s t o r y of therapy or other treatment years.  The  indicated  a  l a s t i n g many  c a l l e r s p r o b a b l y a r e not e x p e c t i n g o r have  e x p e r i e n c e d q u i c k change i n t h e i r problems. motivation of a c r i s i s ,  Without  the  t h e c a l l e r s c o u l d be a s s u m e d u n l i k e l y  to  engage i n immediate a c t i o n o r d e c i s i o n making. 6. The  p e r s o n i s u n r e c e p t i v e and r e l u c t a n t t o  interventions,  accept  encouragement, o r d e v e l o p a c t i o n p l a n s ; t h e r e f o r e ,  a s s i s t a n c e u s u a l l y i s "yes, b u t . . . " and r e j e c t e d . T h i s i s p a r t i a l l y supported by the c u r r e n t r e s e a r c h . callers'  As t h e c h r o n i c  telephoning frequency decreases, c a l l e r support f o r t h i s  criterion also The  criterion  decreases.  higher frequency chronic c a l l e r s provided the  information that supported t h i s c r i t e r i o n . often telephoned c r i s i s  They s a i d t h e y most  l i n e s as a t h e r a p e u t i c r e s o u r c e t o o b t a i n  ongoing a s s i s t a n c e w i t h h i s t o r i c a l and u n r e s o l v e d l i f e  issues.  They s t a t e d t h e y o f t e n r e c e i v e d i n c o n s i s t e n t and i n a p p r o p r i a t e t h e r a p y i n t h e p a s t and  looked to the c r i s i s The  resources, r e f e r r a l s ,  p e r s p e c t i v e s and a c t i o n p l a n s ,  e f f e c t i v e f o r o t h e r s , p r o v e d t o be  l i n e workers  a  t h e r a p e u t i c replacement. new  crisis  l i n e s as 1  usual  l e s s h e l p f u l t o them because  t h e y were l o o k i n g f o r t h e r a p y , not j u s t i n t e r v e n t i o n s , problems.  Assistance short of the therapeutic help  i n d i c a t e d t h e y w a n t e d was The  for their  they  often rejected.  lower frequency chronic c a l l e r s reported they  currently  149 were i n v o l v e d i n t h e r a p y o r c o u n s e l l i n g .  They s t a t e d  they  r e c i e v e d e f f e c t i v e and c o n s i s t e n t t h e r a p e u t i c a s s i s t a n c e from t h e i r helping resources. chronic c a l l e r s  As a r e s u l t ,  the lower  frequency  i n d i c a t e d t h e y most o f t e n c o n t a c t e d c r i s i s  wanting p r a c t i c a l  support and a c t i o n s t o t h e i r problems.  lines Looking  more f o r d a y - t o - d a y a s s i s t a n c e a n d s u p p o r t , t h e y r e p o r t e d r e c e i v i n g a n d b e n e f i t t i n g f r o m t h e new r e s o u r c e s ,  referrals,  p e r s p e c t i v e s and a c t i o n p l a n s t o t h e i r concerns.  They  showed t h e y w e r e r e c e p t i v e t o i n t e r v e n t i o n s .  clearly  Further, the c r i s i s  l i n e i n t e r v e n t i o n s o f v e n t i n g , empathy, r e f e r r a l i n f o r m a t i o n , new p e r s p e c t i v e s and a c t i o n p l a n s a p p a r e n t l y f u l f i l l e d t h e needs o f these c a l l e r s .  Therefore, the interview data provided by  frequency c h r o n i c c a l l e r s d i d not support t h i s  lower  criterion.  7. O f t e n t h e p e r s o n c a l l s f o r s o c i a l s u p p o r t a n d t o meet h i s o r h e r n e e d f o r c o n t a c t . The s u b j e c t s g e n e r a l l y p r o v i d e d information that supported t h i s c r i t e r i o n . contact f o r s o c i a l to c a l l e r . at  The f r e q u e n c y o f  support and c o n t a c t c l e a r l y v a r i e d from c a l l e r  A t a minimum, a l l c a l l e r s r e p o r t e d t h e y d i d t e l e p h o n e  s o m e t i m e a n d t o some d e g r e e f o r c o n t a c t a n d s o c i a l  support.  However, t o s t a t e a l l c h r o n i c c a l l e r s t e l e p h o n e d often f o r contact and s o c i a l  s u p p o r t was n o t s u p p o r t e d b y t h e i n t e r v i e w  data. 8. The c a l l e r i s v e r y d i f f i c u l t t o t e r m i n a t e . No data referred t o t h i s c r i t e r i o n .  The p r i n c i p a l  interview  investigator d i d  n o t a s k a n y s p e c i f i c q u e s t i o n s o n how t h e c a l l e r s p e r c e i v e d t h e i r c a l l s ended.  S i x s u b j e c t s d i d r e p o r t how c r i s i s  line  150 personnel -terminated  their calls with c a l l  However, w h e t h e r t h e c r i s i s necessary  l i n e workers found c a l l  restrictions  because t h e c h r o n i c c a l l e r s were d i f f i c u l t t o  terminate, calls,  restrictions.  o r t e l e p h o n i n g t o o o f t e n , o r w a n d e r i n g t o o much i n t h e  o r some o t h e r r e a s o n was n o t d i s c u s s e d b y t h e s u b j e c t s .  The general  current study  supported  and c l a r i f i e d seven o f t h e eight  c r i t e r i a used t o i d e n t i f y chronic c a l l e r s t o  c r i s i s centres.  However, a s p r e v i o u s  demonstrate, i n d i v i d u a l positively  identifying  telephone  research and t h i s  study  c r i t e r i a a r e i n s u f f i c i e n t and l i m i t e d i n chronic callers.  The more  characteristics  u s e d t o d e t e r m i n e c h r o n i c c a l l e r s , t h e more c o n f i d e n t l y  chronic  c a l l e r s c a n be i d e n t i f i e d . The  New C r i t e r i a a n d T h e i r The  additional  Application  chronic c a l l e r characteristics  be u s e d t o i m p r o v e t h e c o n f i d e n c e  by which c r i s i s  identify chronic callers.  a distress  During  discovered can line  call,  personnel  telephone  workers e a s i l y c o u l d o b t a i n c a l l e r background i n f o r m a t i o n  helpful  i n c h r o n i c c a l l e r i d e n t i f i c a t i o n even from t h e i n d i v i d u a l ' s call.  first  The i n f o r m a t i o n f r o m f u r t h e r c a l l s t h e n c o u l d be u s e d t o  support  the chronic c a l l e r i d e n t i f i c a t i o n or t o reaffirm  individual  as a non-chronic  the  caller.  Individuals telephoning  f o r s o c i a l contact and c h i t - c h a t  e a s i l y c a n be i d e n t i f i e d as n o n - c r i s i s c a l l e r s . these people a r e chronic c a l l e r s  Whether o r n o t  s h o u l d n o t be a n i s s u e .  Insomuch t h e s e  individuals  are telephoning a crisis  c a l l s probably  a r e b e s t ended a f t e r  line,  their  a few minutes o f s o c i a l  151 c o n v e r s a t i o n t o open t h e telephone When i n d i v i d u a l s t e l e p h o n e  lines for crisis  callers.  i ndistress, not c r i s i s ,  crisis  l i n e w o r k e r s h e l p i n d i v i d u a l s who d o n o t c l e a r l y f i t i n t o t h e crisis  i n t e r v e n t i o n model.  Whether these  c h r o n i c c a l l e r s becomes a c o n c e r n . fit  clearly into the crisis  for  ongoing telephone  callers are potential  These c a l l e r s a l r e a d y do n o t  i n t e r v e n t i o n model and t h e p o t e n t i a l  c o n t a c t a n d c h a l l e n g i n g c a l l d y n a m i c s may  exist. Some d i s c o v e r e d c h a r a c t e r i s t i c s c a n b e u s e d t o i d e n t i f y c h r o n i c c a l l e r s even from a f i r s t criteria The speaking  i sdiscussed  callers'  1  problems.  concerns,  telephone  c o u n s e l l i n g , therapy,  1.  i f not essential,  understanding  workers would need t o o b t a i n a  t h e c a l l e r s have u s e d i n t h e p a s t , eg.,  the callers are currently using.  l i n e w o r k e r s w o u l d b e s t a s k what t h e c a l l e r s '  were l i k e w i t h those h e l p i n g  Previous  to  m e n t a l h e a l t h , o t h e r community s e r v i c e s ,  and what h e l p i n g r e s o u r c e s  experiences  taking a therapeutic or helping  While i n v e s t i g a t i n g t h e dimensions o f t h e  h i s t o r y o f what r e s o u r c e s  Also, the c r i s i s  O b t a i n i n g a H e l p i n g H i s t o r y . When  time c a l l e r s ,  h i s t o r y would be a p p r o p r i a t e , the c a l l e r s  The a p p l i c a t i o n o f t h e s e  below.  F i r s t Telephone C a l l : with first  call.  resources.  o r current counselling, therapy  o r other  treatment. 2. M e n t a l h e a l t h  contact.  3. M o r e y e a r s w i t h h e l p i n g s e r v i c e s t h a n c r i s i s An  lines.  a f f i r m a t i v e response t o previous mental h e a l t h  contact  152 and/or any p r e v i o u s c o u n s e l l i n g , therapy o r treatment positive indicator of a potential chronic c a l l e r .  w o u l d be a  A l l research  subjects r e p o r t e d p r i o r mental h e a l t h contact and previous involvement  i n c o u n s e l l i n g , therapy o r treatment.  Also, a l lthe  i n t e r v i e w e d c a l l e r s r e p o r t e d more t i m e w i t h h e l p i n g other than c r i s i s  lines.  Therefore,  those  first  resources  time  callers  w i t h a h e l p i n g resource h i s t o r y and s a y i n g t h e c a l l i s t h e i r first  ever contact w i t h a c r i s i s  chronic c a l l e r  another  characteristic.  4. N e g a t i v e therapeutic  l i n e w o u l d be showing  therapeutic h i s t o r y versus mostly  positive  history.  5. C r i s i s  l i n e d e p e n d e n t v e r s u s many more h e l p i n g  resources.  The t h e r a p e u t i c h i s t o r y o b t a i n e d f r o m a n i n d i v i d u a l s 1  first  c a l l would be b e n e f i c i a l i n i d e n t i f y i n g t h e i n d i v i d u a l s 1  telephoning frequency crisis  and p o t e n t i a l use o f c r i s i s  lines.  l i n e c a l l e r s t h a t mentioned a mostly p o s i t i v e  The  therapeutic  h i s t o r y a n d c u r r e n t c o n t a c t w i t h o t h e r h e l p i n g s e r v i c e s w o u l d be showing a p o t e n t i a l f o r lower  frequency  telephone  t h e s e c a l l e r s p o t e n t i a l l y would be u s i n g c r i s i s  contact.  Also,  lines f o r only  p r a c t i c a l i n t e r v e n t i o n s , l i k e developing a c t i o n plans and o b t a i n i n g new r e s o u r c e s .  Those c r i s i s  l i n e c a l l e r s that shared  n e g a t i v e t h e r a p e u t i c h i s t o r y and no c u r r e n t involvement  a  i n other  h e l p i n g r e s o u r c e s would be showing a p o t e n t i a l f o r h i g h e r frequency  telephoning.  helping resource,  Also, with c r i s i s  l i n e s as t h e i r  only  t h e s e c a l l e r s p o t e n t i a l l y w o u l d be u s i n g  l i n e s as a therapeutic resource  rather than f o r p r a c t i c a l  crisis  153 interventions. The F i r s t T e l e p h o n e C a l l :  E x p l o r i n g the C a l l e r ' s Support  System. Telephone w o r k e r s a l s o c o u l d a p p r o p r i a t e l y a s k about a c a l l e r ' s support system on a f i r s t  call.  The  s i z e and  strength  o f t h e s u p p o r t n e t w o r k t h e c a l l e r s c a n engage a n d u s e c o u l d b e n e f i c i a l t o the r e s o l u t i o n of the c a l l e r s ' about t h e c a l l e r s ' to  problems.  In asking  support network, telephone workers would need  ask about t h e i r f r i e n d s , f a m i l y and s p e c i a l o t h e r s  callers'  be  that the  have a v a i l a b l e f o r support.  6. D e f i n i t e l y f r i e n d s . 7. L i t t l e  family contact.  8. Few w i t h s p e c i a l o t h e r s . 9. L i m i t e d a b i l i t y t o e n g a g e a n d u s e s u p p o r t s y s t e m s . C a l l e r s t h a t r e p o r t e d some f r i e n d s , n o c u r r e n t r e l a t i o n s h i p s , and l i t t l e  f a m i l y c o n t a c t w o u l d be  positive indicators of a p o t e n t i a l chronic c a l l e r .  significant  showing Also, those  c a l l e r s r e p o r t i n g d i f f i c u l t y i n t a l k i n g i n t i m a t e l y about t h e m s e l v e s , few p e o p l e t h e y f e l t c l o s e t o , and d i s t a n c e o r none x i s t e n t r e l a t i o n s h i p s w i t h t h e i r f a m i l y w o u l d be d i s p l a y i n g a l i m i t e d a b i l i t y t o engage and u s e t h e i r s u p p o r t n e t w o r k .  This  l i m i t e d a b i l i t y f o r the c a l l e r s t o use t h e i r support network a l s o would support the i d e n t i f i c a t i o n of a chronic c a l l e r . because o n l y s i x s u b j e c t s a t t h e most r e v e a l e d a n y characteristic, in  t w o o r more o f t h e s e p a r t i c u l a r  combination would increase the confidence  identification.  However,  one  characteristics  of chronic  caller  154 Further Telephone C a l l s . discovered  i n this  chronic c a l l e r  The  remaining  s t u d y w o u l d be  d i f f i c u l t t o use  from a f i r s t time c a l l .  identify Crisis  to gather  chronic callers  l i n e personnel  additional information  from the remaining  asking to  characteristics.  would need t o r e l y on  Unfortunately,  further calls  to  more c o n f i d e n t l y  with further calls,  the  chronic  c a l l e r p a t t e r n of frequent  c a l l s over ever i n c r e a s i n g days  m o n t h s may  l i n e personnel  be  set.  Crisis  management s t r a t e g i e s e a r l i e r  than  crisis  centres  mentioned negative  short.  experiences  negative  experiences  Yet  frequency chronic  a l l callers  telephoning  crisis  acknowledgement, the and  perspectives,  Again,  the higher  t h e most g l o w i n g  These  l i n e s most o f t e n were m e n t i o n e d callers.  the contact,  referrals  and  frequency chronic c a l l e r s appraisals of c r i s i s  strengths  the v a l i d a t i o n  s u p p o r t and u n d e r s t a n d i n g ,  the resources,  used  supervisors.  r e l a y e d t h e b e n e f i t s and  lines:  telephone  Some e v e n m e n t i o n e d o u t r i g h t  i n a p p r o p r i a t e t e l e p h o n e w o r k e r s and  by the h i g h e r  with  focusing techniques  abuse by  with crisis  initiate  Telephoning  t h r o u g h t i m e l i m i t s and  t o keep t h e c a l l moving and  would best  and  later.  A Continued Cycle of Most c a l l e r s  a  callers'  i n a p o s i t i o n of  obtain additional c a l l e r information to identify chronic c a l l e r s .  to identify  Depending on t h e  c o n c e r n s , t h e t e l e p h o n e w o r k e r s w o u l d be inappropriate questions  characteristics  of and  t h e new  options  information.  o f t e n g a v e some o f  lines.  W i t h a l l the d i s c l o s e d mistreatment by c r i s i s  lines,  one  155 c o u l d a s k ( a s some c e n t r e s a n d t e l e p h o n e  workers have):  What  (1978) s p e c u l a t e d t h a t p e r s i s t e n t c a l l e r s  were  causes t h e c a l l e r s t o keep phoning? Previous  Research  Rudestam  profoundly depressed  and s u i c i d a l .  The t e l e p h o n e  i n c r e a s i n g l y f r u s t r a t e d because these c a l l e r s quickly.  But t h e workers s t i l l  fail  w o r k e r s become t o improve  feel obligated t o help.  The  c a l l e r s r e m a i n u n w i l l i n g t o g i v e up one o f t h e few h e l p i n g resources  t h e y have n o t t o t a l l y a l i e n a t e d o u t o f h e l p e r  frustration.  They keep p h o n i n g because t h e y need t h e c o n t a c t .  However, t h e c a l l e r s depression.  profound  O n l y two c a l l e r s d i s c l o s e d c u r r e n t t r e a t m e n t f o r  manic-depression. and  i n t h i s study d i dnot report  T h e y s a i d t h e i r i l l n e s s was v e r y w e l l managed,  they appeared emotionally l e v e l .  m e n t i o n e d rarely  telephoning c r i s i s  was a n i d e n t i f i e d m a n i c - d e p r e s s i v e  F u r t h e r , o n l y two c a l l e r s lines  feeling  suicidal.  One  caller.  A C y c l e o f Abuse The  c a l l e r s ' continued telephoning i n spite of t h e i r  of mistreatment  by c r i s i s  lines.  c o u l d be t h e c a l l e r s a r e t r a p p e d  reports  A p o s s i b l e answer f o r t h i s i n a c y c l e o f abuse.  The c y c l e  r e p e a t s t h e p a t t e r n o f abuse and v i c t i m i z a t i o n t h e y i n d i c a t e d they experienced  i n their  lives.  For t h e c a l l e r s , t h e i r family, f r i e n d s o r helpers f r e q u e n t l y w e r e t h e o n l y p l a c e s f o r c o n t a c t a n d some s u p p o r t . reported their them.  The c a l l e r s  f a m i l y and f r i e n d s o f t e n would n e g l e c t o r abuse  Particularly,  the higher frequency  chronic callers  also  156 reported i n c o n s i s t e n t and i n a p p r o p r i a t e t h e r a p e u t i c r e l a t i o n s h i p s with helpers.  To m a i n t a i n a t l e a s t some c o n n e c t i o n w i t h o t h e r s ,  the c a l l e r s endured t h e abuse.  Further, because o f t h e i r  f a m i l y b a c k g r o u n d , t h e c a l l e r s may f e e l p o w e r l e s s and h e l p f r o m anyone e l s e . restrictions  Therefore,  imposed b y c r i s i s  abusive  t o g e t support  i n spite of the c a l l  l i n e s , the c a l l e r s continue i n a  c y c l e w h e r e t h e y r e c e i v e some s u p p o r t  and contact from  persons  they p e r c e i v e as abusive and h u r t f u l . Therapeutic  Trap  The h i g h e r f r e q u e n c y the c r i s i s  c h r o n i c c a l l e r s showed t h a t t h e y u s e d  l i n e s as a t h e r a p e u t i c resource.  With a reported  h i s t o r y o f i n c o n s i s t e n t and negative t h e r a p e u t i c experiences, t h e y d i s p l a y e d a r e l u c t a n c e t o engage o t h e r h e l p i n g o r therapeutic resources.  However, t h e y a l s o r e p o r t e d t h e m o s t a n d  most s e v e r e n e g a t i v e r e s p o n s e s and  still  t o how c r i s i s  l i n e s t r e a t e d them  continued telephoning a t a high frequency.  They appear  t r a p p e d w i t h one t h e r a p e u t i c r e s o u r c e a n d c o n t i n u e t e l e p h o n i n g i n s p i t e o f t h e mistreatment  they report.  C r i s i s l i n e personnel are trained t o provide i n t e r v e n t i o n , not telephone frequency  therapy.  Although  crisis  the higher  c h r o n i c c a l l e r s d o f i n d some b e n e f i t i n t h e c r i s i s  line  i n t e r v e n t i o n s o f v e n t i n g , empathy, r e f e r r a l a n d r e s o u r c e information, a c t i o n planning, e t c . ,they are looking f o r therapy from a resource t h a t cannot p r o v i d e therapy.  Crisis  p e r s o n n e l do n o t i c e t h e change i n t h e t e l e p h o n e these chronic c a l l e r s .  The c r i s i s  line  relationship  l i n e workers then  initiate  with  157 c a l l management s t r a t e g i e s t h a t r e s t r u c t u r e t h e r e l a t i o n s h i p toward  crisis  intervention again.  telephone Without  other  therapeutic or h e l p i n g resources, these chronic c a l l e r s t h e i r perceived mistreatment little  t h e r a p e u t i c support  A Repeated P a t t e r n of The  of t h e i r  few  b e g i n t o over use crisis  to maintain  they r e c e i v e from the c r i s i s  lines.  Victimization  lines.  sources  They a r e dependent on c r i s i s f o r support  and  contact.  impose c a l l r e s t r i c t i o n s frequency. telephone  The  telephone  t o reduce the c a l l e r s  the  personnel  telephoning  workers a l s o work t o r e s t r u c t u r e t h e  r e l a t i o n s h i p away f r o m t h e r a p y .  c a l l e r s do t e l e p h o n e  line  lines  When t h e y  t h e s e r v i c e a n d / o r show t h e y a r e u s i n g  l i n e as a t h e r a p e u t i c r e s o u r c e , c r i s i s  with crisis  concerns  A f t e r w a r d s , when t h e or other  difficulties,  t h e y a r e c u t s h o r t a n d moved a l o n g , t h e i r p o w e r r e m o v e d t o the h e l p t h e y need.  The  c a l l e r s then perceive another  c a l l e r s continue phoning because the c r i s i s s o u r c e o f c o n s i s t e n t h e l p and  get  abuse  o c c u r r e d much l i k e t h e i r f a m i l y o r t h e r a p e u t i c h i s t o r y .  ongoing  the  c h r o n i c c a l l e r s appear caught i n a dependent-abusive  cycle w i t h the c r i s i s a s one  by c a l l r e s t r i c t i o n s  endure  has  The  l i n e s are the  only  s u p p o r t a v a i l a b l e t o them.  F r i e n d l i n e s s i n the Caller-Worker R e l a t i o n s h i p Chronic c a l l e r s  i n t e r p r e t the c a l l e r - t e l e p h o n e worker  r e l a t i o n s h i p a s more t h a n j u s t h e l p i n g .  Six callers  t h e i r c o n n e c t i o n and  l i n e w o r k e r s was  friends.  rapport with c r i s i s  reported like  A d d i t i o n a l l y , a l l t h e c a l l e r s r e p o r t e d some d e g r e e o f  s o c i a l banter w i t h telephone  workers,  much l i k e w h a t  friends  158 w o u l d do.  From t h e i r i n t e r a c t i o n s w i t h t e l e p h o n e  workers, the  c a l l e r s would appear t o have m i s i n t e r p r e t e d t h e workers' interest,  concern and understanding  Although  as f r i e n d s h i p .  f o u r c a l l e r s c l e a r l y s t a t e d t h e y knew t h e i r  r e l a t i o n s h i p w i t h t h e w o r k e r s was n o t t r u e f r i e n d s h i p , c o n c e r n arises with the information that five chronic c a l l e r s l i m i t e d a b i l i t y t o engage a n d u s e t h e i r s u p p o r t f r i e n d s and f a m i l y . to  engage s u p p o r t :  Additionally, history. abusive  s i x c a l l e r s demonstrated a c h a l l e n g i n g r e l a t i o n s h i p these  callers discussed  r e l a t i o n s h i p s . They a l s o  previous  reported  e s t a b l i s h i n g i n t i m a c y and interdependency w i t h  O v e r a l l , seven c a l l e r s have c u r r e n t d i f f i c u l t i e s  b u i l d i n g and e s t a b l i s h i n g i n t i m a c y and support relationships.  their with  i n their  Because they have d i f f i c u l t y w i t h i n t i m a c y and  l i m i t e d s k i l l s t o develop support  f r o m o t h e r s , t h e c a l l e r s c a n be  expected t o m i s i n t e r p r e t h e l p i n g behaviours  as f r i e n d s h i p .  Because t h e c h r o n i c c a l l e r s a r e c o n t a c t i n g c r i s i s telephone  ability  one f r o m f a m i l y , a n d t h e o t h e r f r o m f r i e n d s .  and non-supportive  partners.  networks of  Two o t h e r c a l l e r s i n d i c a t e d l i m i t e d  U s u a l l y l i v i n g alone,  difficulties  showed a  lines, the  workers would encourage t h e c a l l e r s t o d i s c u s s and  d i s c l o s e about themselves. appropriate  listening,  The w o r k e r s t h e n w o u l d r e s p o n d w i t h  empathy a n d q u e s t i o n i n g t o h e l p t h e  c a l l e r s r e s o l v e t h e i r concerns.  A t no p o i n t w o u l d t h e c a l l e r  be  expected t o respond t o the worker w i t h any degree o f understanding telephone  and i n t e r e s t as i s e x p e c t e d t o be d i s p l a y e d b y t h e  worker.  An i n t i m a c y and r a p p o r t develop between t h e  159 c h r o n i c c a l l e r a n d t h e w o r k e r t h a t a r e i n one d i r e c t i o n . the c a l l e r perceives t h e r e l a t i o n s h i p "friendship"  like a friendship, the  i snot reciprocated.  When t h e c a l l e r s i n t e r p r e t telephone  Though  t h e h e l p i n g as f r i e n d l i n e s s , the  w o r k e r s now m u s t d e a l w i t h c a l l e r s t h a t h a v e d e v e l o p e d  different expectations expectations  about t h e telephone  of friendship  can operate  relationship.  openly,  The  such as t h e c a l l e r  r e q u e s t i n g c o f f e e w i t h t h e w o r k e r , t o c o v e r t l y when t h e c a l l e r becomes u p s e t b e c a u s e t h e w o r k e r r e q u e s t s s h o r t a f t e r t h e y have c h a t t e d b e f o r e The  callers  1  t o keep a s o c i a l  call  t o t h e time l i m i t o r over.  perception of friendship  d o e s make t h e h e l p i n g  r e l a t i o n s h i p more d i f f i c u l t a n d u n c l e a r .  To m a i n t a i n a n  e f f e c t i v e and appropriate h e l p i n g r e l a t i o n s h i p ,  the c r i s i s  line  workers need t o e l i m i n a t e t h e p e r c e p t i o n o f f r i e n d l i n e s s . However, w i t h t h e c h r o n i c c a l l e r s r e p o r t e d b a c k g r o u n d o f a b u s e and v i c t i m i z a t i o n , t e l e p h o n e  workers a r e i n a d i f f i c u l t  where t h e i r " r e j e c t i o n " o f t h e f r i e n d s h i p rejection of the caller.  c a n be p e r c e i v e d as a  The c h a l l e n g e e x i s t s t o e s t a b l i s h  limits t o the helping relationship misperception  situation  that eliminate the  o f f r i e n d l i n e s s and maintain  the established  contact and rapport. Working w i t h Chronic Chronic  Callers  c a l l e r s remain an ongoing challenge  for  c r i s i s centres.  The c a l l e r s m e n t i o n many p o s i t i v e  about t h e c r i s i s  l i n e services:  supportive,  l i s t e n , problem-solve and g i v e resources.  telephone  attributes  f r i e n d l y ; there t o Still,  t h e c a l l e r s and  160 the c r i s i s  l i n e s o f t e n deadlock o v e r t h e f r e q u e n c y and n a t u r e  of  their contacts. Contradictions i n Service When c a l l e r s distress,  first  the workers  start telephoning c r i s i s  encouraged  lines  in  them t o v e n t o u t t h e i r  and t a l k about t h e i r problems t o d e a l w i t h t h e i r  feelings  concerns.  However, when t h e c a l l e r s b e g a n t o t e l e p h o n e t o o f r e q u e n t l y , were p l a c e d on c a l l r e s t r i c t i o n s . s t a r t e d t o f o c u s and d i r e c t and keep t h e c a l l e r s  from  Also, the telephone  workers  t h e i r c a l l s t o move t h e c a l l e r s  "wandering."  they  C a l l e r s mentioned,  along even  i f t h e y t e l e p h o n e d d i s t r e s s e d , t h e y were n o t g i v e n t h e o p p o r t u n i t y t o v e n t c o m p l e t e l y t h e i r f e e l i n g s and concerns the c a l l  i s ended.  before  They s t a t e d t h e y f e l t h u r t and abused because  t h e y were d e n i e d support and h e l p t h a t t h e c r i s i s  lines  i m p l i c i t l y or e x p l i c i t l y agreed t o provide. C a l l Management C a l l management d i d n o t seem t o g r e a t l y r e d u c e t h e telephone frequency.  They k e p t p h o n i n g up t o f o u r t i m e s a  potentially  across several different  c a l l e r s may  be  limited  callers'  t o one  crisis  lines.  Though t h e  c a l l p e r day p e r c r i s i s  c a l l e r s have a v a i l a b l e s e v e r a l d i f f e r e n t  crisis  day,  lines  line,  the  i n the  Lower M a i n l a n d and F r a s e r V a l l e y a r e a . Some c a l l e r s  s t a t e d ' i n t h e i r comments a b o u t c r i s i s  s e r v i c e t h a t the telephone workers  line  be g i v e n t h e d i s c r e t i o n  d e c i d e t h e l e n g t h and c o n t e n t o f t h e c a l l s . they a p p r e c i a t e d the telephone workers  The  callers  to said  that l i s t e n for their  161 p a r t i c u l a r needs f o r each c a l l , then " n e g o t i a t e " t h e l i m i t s on the c a l l .  T h e s e w o r k e r s a s k e d i n s o many w o r d s ,  of busy t o n i g h t .  " I t ' s been k i n d  I ' d l i k e t o keep t h e c a l l s h o r t and open t h e  l i n e up f o r o t h e r s , " a f t e r t h e w o r k e r s d e t e r m i n e d t h e c a l l e r s were n o t i n d i s t r e s s o r c r i s i s . The  c a l l e r s s u g g e s t e d t h e y w a n t e d more r e g a r d f o r t h e i r  s p e c i f i c needs i n a c a l l .  They i n d i c a t e d t h e y h a d u n i q u e needs  on a c a l l b y c a l l b a s i s a n d t h a t u n i f o r m  chronic  caller  procedures were n o t e f f e c t i v e i n h e l p i n g w i t h . C a l l management d o e s n o t a p p e a r t o w o r k Chronic  c a l l e r s continue  different crisis  lines.  t o telephone  effectively.  f r e q u e n t l y t o many  Also, the callers report  their  p a r t i c u l a r needs f o r a c a l l sometimes a r e m i s s e d w i t h a chronic c a l l e r policy.  uniform  C a l l e r s and workers remain o f t e n  f r u s t r a t e d b y mismatched needs. Crisis  I n t e r v e n t i o n o r Therapy?  All and  c a l l e r s reported telephoning c r i s i s  support,  higher  for  contact  even f r i e n d s h i p , reasons d i f f e r e n t from t h e c r i s i s  i n t e r v e n t i o n mandate o f t h e c e n t r e s . from c r i s i s  centres  H o w e v e r , e v e n more d i s t a n c e  i n t e r v e n t i o n , there e x i s t e d a strong tendency f o r the  frequency  c a l l e r s t o use c r i s i s  lines therapeutically: i n  p l a c e o f o r t o supplement i n c o n s i s t e n t and i n a p p r o p r i a t e counselling, therapy  o r other treatment.  These c a l l e r s  t h e y were r e l u c t a n t t o engage o t h e r t h e r a p y because o f t h e i r p r e v i o u s l y negative professionals.  and c o u n s e l l i n g  experiences  A d d i t i o n a l l y , the higher  showed  with  frequency  helping  chronic  162 callers reported limited  f i n a n c i a l resources.  Because o f t h i s ,  these c a l l e r s c o u l d not r e a d i l y a f f o r d therapy o r  counselling  even i f t h e y were i n t e r e s t e d i n "therapy" o t h e r t h a n t h e lines. or  Therefore, t o suggest these c h r o n i c c a l l e r s get  c o u n s e l l i n g e l s e w h e r e may Crisis  be  crisis therapy  pointless.  l i n e personnel's efforts  t o l i m i t c a l l i n g and  to  r e f o c u s c h r o n i c c a l l e r s away f r o m t e l e p h o n e t h e r a p y do n o t w o r k effectively.  The  higher frequency chronic c a l l e r s  continue t o telephone i n s p i t e of i n i t i a t e d c a l l  in  particular  management.  Both c a l l e r s and t e l e p h o n e workers c o n t i n u e t o have n e g a t i v e frustrating  experiences through the continued contact  mismatched needs.  The  t h e r a p e u t i c use of c r i s i s  and  and  lines  remains.  The p h o n e l i n e s h a v e made t h e c h r o n i c c a l l e r s a w a r e t h a t c o u n s e l l i n g o r t h e r a p y i s beyond the scope o f telephone intervention centres. that the c r i s i s  crisis  M o s t c a l l e r s a l s o showed t h e y r e c o g n i z e d  l i n e s cannot p r o v i d e therapy o r o t h e r  Yet, they continue t o c a l l ,  treatment.  i m p l i c i t l y or e x p l i c i t l y wanting  a  greater depth of service.  C r i s i s lines are l e f t p r o v i d i n g f o r  o n l y some o f t h e i r n e e d s .  C l e a r l y telephone c r i s i s  intervention  i s not meeting t h e c a l l e r s ' needs f o r t h e r a p e u t i c a s s i s t a n c e . Whether t h e c r i s i s c e n t r e s can o r s h o u l d p r o v i d e s e r v i c e s beyond the c r i s i s  additional  i n t e r v e n t i o n , o r even the  s u p p o r t i v e c o n t a c t a l r e a d y p r o v i d e d t o most,  ongoing  remains.  Recommendat i o n s 1. F l e x i b l e  C a l l Management. C h r o n i c c a l l e r s  perceive the imposition of c a l l r e s t r i c t i o n s  clearly  as i n a p p r o p r i a t e and  163 abusive.  For the callers, the c a l l  restrictions  revisit  p a t t e r n o f v i c t i m i z a t i o n t h e y have e x p e r i e n c e d t h r o u g h  a  their  l i v e s w h e r e t h e y h a v e b e e n a b u s e d a n d h u r t b y t h o s e whom t h e c a l l e r s r e l y on f o r support, comfort and c o n t a c t . There i s a n i m p l i c i t , i f n o t e x p l i c i t , agreement t h a t callers  s h o u l d t e l e p h o n e when t h e y a r e i n d i s t r e s s t o d e a l w i t h  t h e i r concerns. call  restrictions  H o w e v e r , when t h e y s t a r t t o t e l e p h o n e t o o o f t e n , a r e i m p o s e d o n them.  Sometimes, t h e c a l l e r s  then a r e c u t short before they can vent t h e i r f e e l i n g s and g e t r e s o l v e t o t h e i r problems.  Other times, telephone workers  focus  a n d d i r e c t t h e c a l l away f r o m w h a t t h e c a l l e r s c o n s i d e r i m p o r t a n t to the c a l l . All  t h e c h r o n i c c a l l e r s s u g g e s t e d t h e y knew t h a t t h e y c o u l d  not telephone t h e c r i s i s  l i n e s a l l the time.  acknowledged t h e r e e x i s t e d p r a c t i c a l  They  limitations  clearly  to their  t e l e p h o n i n g f o r support and contact c o n s i s t e n t l y . From t h e above i n f o r m a t i o n , c a l l r e s t r i c t i o n s w o u l d be b e t t e r n e g o t i a t e d between t h e telephone worker c a l l e r on a c a l l by c a l l b a s i s .  Involving the c a l l e r i n the  process would help e l i m i n a t e the c a l l e r s ' from t h e i m p o s i t i o n o f c a l l telephone workers  restrictions  sense o f v i c t i m i z a t i o n o n them.  Also, with  having the d i s c r e t i o n t o negotiate c a l l  r e s t r i c t i o n s w i t h c a l l e r s , t h e workers immediate needs o f t h e c a l l e r . crisis  and the chronic  l i n e workers  can b e t t e r respond t o t h e  W i t h no p r e s s i n g c o n c e r n s , t h e  even c o u l d suggest ending t h e c a l l before t h e  u s u a l t e n t o f i f t e e n minutes  allotted t o a chronic caller.  The  164 phone l i n e s t h e n w o u l d be open f o r c r i s i s  callers.  2. R e p e a t t h e L i m i t s o f C r i s i s I n t e r v e n t i o n S e r v i c e .  The  higher  frequency chronic c a l l e r s c l e a r l y i n d i c a t e d they used  crisis  lines  f o r therapeutic assistance.  recognized  the limitations  resource.  (As w e l l ,  sometime b y c r i s i s  of c r i s i s  l i n e personnel  therapeutic history  created limitations than from c r i s i s Crisis  l i n e s as a  also  therapeutic  they a l l reported they had been t o l d a t  i n t e r v e n t i o n i s not therapy.) negative  A l l these c a l l e r s  that telephone  However,  crisis  these c a l l e r s  and l i m i t e d  said  their  f i n a n c i a l resources  f o r t h e m t o e n g a g i n g more a p p r o p r i a t e  have  therapy  lines.  l i n e personnel  are best  t o continue  p u t t i n g out t o  chronic c a l l e r s that telephone workers are not t h e r a p i s t s , counsellors, psychologists, etc. higher  Chronic  callers,  especially  f r e q u e n c y c h r o n i c c a l l e r s , n e e d t o be r e m i n d e d o f t h e  limits of c r i s i s  intervention services.  I f possible,  these  c a l l e r s a l s o need encouragement t o f i n d o t h e r h e l p i n g  resources  t h a t a r e b e t t e r a b l e t o meet t h e i r n e e d s f o r c o u n s e l l i n g o r therapy. 3. B e t t e r U n d e r s t a n d How C r i s i s lines provide especially  planning,  Callers.  interventions to chronic  callers,  the lower frequency chronic c a l l e r s .  reported the c r i s i s resource  effective  C r i s i s Lines Help Chronic  These  l i n e interventions of venting,  callers  empathy,  and r e f e r r a l i n f o r m a t i o n , expanding p e r s p e c t i v e s , e t c . as b e n e f i c i a l  t o them.  t h e s e c a l l e r s manage t h e i r p r o b l e m s .  These i n t e r v e n t i o n s However,  the higher  action helped  165 frequency chronic c a l l e r s reported a therapeutic b e n e f i t i n t h e i r crisis  l i n e contacts.  These c a l l e r s i n d i c a t e d t h e y were l e s s  receptive to the usual c r i s i s  line interventions.  T h e y seemed t o  b e n e f i t more f r o m t h e a c k n o w l e d g e m e n t a n d v a l i d a t i o n t h e y received i n r e l a t i o n s h i p w i t h telephone workers. Crisis  l i n e a d m i n i s t r a t i v e s t a f f w o u l d be b e s t  f u r t h e r e x a c t l y how  the telephone worker s k i l l s  With t h i s c l a r i t y ,  crisis  a s s i s t other c a l l e r s i n d i s t r e s s , not P e r h a p s e v e n more e s s e n t i a l , c o n s i d e r and resource crisis  u n d e r s t a n d how  to higher  s e r v i c e s and callers'  lower  ongoing  l i n e workers could  better  just crisis.  crisis  centre personnel  they are p r o v i d i n g a  frequency chronic c a l l e r s .  l i n e personnel  consider  encourage  f r e q u e n c y c h r o n i c c a l l e r s t o manage b e t t e r t h e i r concerns.  to  need t o  therapeutic  Once u n d e r s t o o d ,  w o u l d be more a b l e t o a d j u s t c r i s i s  t r a i n i n g t o manage t h e h i g h e r  need f o r a t h e r a p e u t i c resource  frequency  without  line  chronic  wandering  from  t h e i r mandate o f t e l e p h o n e c r i s i s i n t e r v e n t i o n . 4.  C l a r i f y i n g the Helping  Relationship. Chronic  callers  showed t h e y i n t e r p r e t e d t h e t e l e p h o n e w o r k e r s ' i n t e r e s t , and u n d e r s t a n d i n g relationship.  as  f r i e n d s h i p r a t h e r than p a r t of the  S i x chronic c a l l e r s stated they enjoyed  contact w i t h the c r i s i s like  friends.  Also,  w i t h b u i l d i n g and Further,  helping their  l i n e w o r k e r s b e c a u s e t h e r e l a t i o n s h i p was  s e v e n o f t h e c a l l e r s showed  e s t a b l i s h i n g i n t i m a c y and  difficulties  support w i t h  w i t h the chronic c a l l e r s i n d i c a t e d p a t t e r n  victimization,  concern  telephone workers that  " r e j e c t " the  others.  of callers'  166 f r i e n d s h i p c o u l d i n i t i a t e the c a l l e r s '  sense o f r e p e a t e d abuse.  C r i s i s l i n e personnel would best c l a r i f y the s e r v i c e  and  i n t e r v e n t i o n s they can p r o v i d e d i r e c t l y w i t h the c a l l e r s . callers'  misconceptions around  the c r i s i s  The  line relationship  f r i e n d s h i p n e e d s t o be c o r r e c t e d a n d g e n t l e l i m i t s a r o u n d  the  helping r e l a t i o n s h i p established to avoid i n i t i a t i n g the sense o f v i c t i m i z a t i o n . friendship arise,  F u r t h e r , when a n y  t h e y n e e d t o be  as  callers'  indications of  caller  i m m e d i a t e l y and g e n t l y  c o n f r o n t e d , and t h e t e l e p h o n e r e l a t i o n s h i p c l a r i f i e d as h e l p i n g . 5. R e d u c e C h i t - C h a t o n C r i s i s L i n e s . C r i s i s  l i n e s do p r o v i d e  a b e n e f i c i a l service t o those chronic c a l l e r s s o c i a l l y and t e l e p h o n i n g j u s t t o c h a t .  The  callers'  eliminated for a brief while.  However, r a t h e r t h a n  e x t e n s i v e l y , o r even f o r the c a l l e r s '  loneliness i s  time l i m i t ,  chatting  these  c a l l s w o u l d be b e t t e r h a n d l e d s i m i l a r l y a n d r e d u c e d all  isolated  chit-chat  i n time f o r  callers. The  crisis  expectation i s that c r i s i s  i n t e r v e n t i o n - not chat.  lines provide  telephone  A f t e r d e t e r m i n i n g t h a t no  or d i s t r e s s e x i s t s f o r the c a l l e r ,  the telephone workers  move t o e n d t h e c a l l .  c o u l d say words t o the  "You  The  workers  seem t o be d o i n g a l r i g h t .  tonight.  The  crisis  would effect:  l i n e i s v e r y busy  I need t o open t h e l i n e f o r o t h e r s i n c r i s i s . "  workers w o u l d t h e n end t h e  crisis  The  call.  E n d i n g t h e c a l l a f t e r d e t e r m i n i n g no c r i s i s o r e x i s t s would e l i m i n a t e the p o s s i b l e f r u s t r a t i o n of  distress socializing  w i t h a c a l l e r when t h e e x p e c t a t i o n i s t o r e s o l v e c r i s e s  and  167 distress.  A l s o , t h e number o f c h i t - c h a t c a l l s w o u l d b e r e d u c e d  to the c r i s i s  l i n e s as t h e chronic c a l l e r s r e a l i z e d  of the telephone l i n e s 6. T h e r a p e u t i c callers  i s crisis intervention.  Management. The h i g h e r  i n d i c a t e d they telephoned c r i s i s  therapeutic contact provide  despite the c r i s i s  frequency  lines  callers also reported that c r i s i s  l i n e workers' i n a b i l i t y t o  lines are the only  t h e y have a c u r r e n t and c o n s i s t e n t c o n t a c t  Because o f t h e i r  "privileged"  These helping with.  p o s i t i o n i n the chronic  callers'  h e l p i n g network, c r i s i s  consider  t h e t h e r a p e u t i c management o f h i g h e r  callers.  chronic  wanting  such s e r v i c e and imposed c a l l r e s t r i c t i o n s .  resource  t h e purpose  l i n e personnel  may w a n t t o  frequency  T h i s management c o u l d b e a c c o m p l i s h e d t h r o u g h  chronic assigning  a s p e c i f i c telephone worker t o a chronic c a l l e r and arranging s p e c i f i c day, time and d u r a t i o n f o r t h e " s e s s i o n . "  a  The g o a l s i n  t h e t h e r a p e u t i c management w o u l d b e : (a) r e d u c e t h e number o f calls;  (b) p e r s u a d e t h e c a l l e r s t o become more s p e c i f i c  d i s c u s s i n g t h e i r problems; goals  (c) e s t a b l i s h a n d w o r k t o w a r d  t o r e s o l v e t h e i r p r o b l e m s ; a n d (d) i f a n d when  c o n n e c t t h e c a l l e r w i t h a more a p p r o p r i a t e therapeutic resource.  The p a r t i c i p a t i n g  would r e q u i r e a d d i t i o n a l t r a i n i n g manage t h e c h r o n i c The  when specific  appropriate,  and c o n s i s t e n t  telephone workers a l s o  and s k i l l s t o t h e r a p e u t i c a l l y  callers.  c h r o n i c c a l l e r t h e r a p e u t i c management w o u l d r e d u c e a n d  restructure the c a l l e r s ' telephone contact. need f o r t h e r a p e u t i c  The c h r o n i c  s u p p o r t a n d a s s i s t a n c e w o u l d b e met  callers' while  168 e l i m i n a t i n g and  reducing  telephoning  from t o p i c t o t o p i c w i t h i n the c a l l , telephoning.  Also, c r i s i s  chronic callers  and  to other  and  s t u d y had  a s m a l l sample s i z e .  accessibility  Only eight  Even w i t h t h i s  consistent with previously identified  strong support  these  Research  f o u n d some s t r o n g t e n d e n c i e s  characteristics,  problems i n  callers.  p a r t i c i p a t e d i n the interview. the researcher  wandering  w o u l d be h a n d l i n g  i n c r e a s i n g the  L i m i t a t i o n s of the The  caller  the c a l l e r s '  l i n e personnel  more e f f e c t i v e l y  o f t h e phone l i n e s  frequency,  like suicide history.  s m a l l sample  i n the  chronic  callers  i n t e r v i e w data  caller  Also, the c a l l e r s  f o r the newly i d e n t i f i e d  size,  characteristics,  an a l c o h o l o r o t h e r drug a d d i c t e d f a m i l y background.  showed such  as  However,  whether the c h r o n i c c a l l e r c h a r a c t e r i s t i c s would h o l d w i t h  a  l a r g e r sample r e q u i r e s f u r t h e r i n v e s t i g a t i o n . More c r i t i c a l l y , usual c r i s i s  the r e s e a r c h had  line callers.  Previous  no  comparison group  literature  and  discussed the usual or c r i s i s c a l l e r to a c r i s i s Kilman,  1977;  C r i s i s C l i n i c , February,  S e r v i c e s A s s o c i a t i o n , 1993; C a l h o u n , 1977;  research  line  1988;  S l a i k e u , 1990;  S l a i k e u & Leff-Simon,  However, f u t u r e r e s e a r c h c o m p a r i n g t h e two c l a r i f y the i d e n t i f i e d  Langley  L e s t e r & B r o c k o p p , 1973;  have  (Auerbach &  Chimo P e r s o n a l D i s t r e s s I n t e r v e n t i o n S e r v i c e s  R i c h m o n d , 1993;  of  in  Family  Rosenbaum & 1990).  groups would f u r t h e r  c h r o n i c c h a r a c t e r i s t i c s a s u n i q u e t o them.  Implications f o r Future Because the r e s e a r c h e r  Research  interviewed only chronic  callers,  169 future research that i n v e s t i g a t e d both the u s u a l c r i s i s c a l l e r s and needed.  c h r o n i c c a l l e r s on i d e n t i f i e d c h a r a c t e r i s t i c s i s  This r e s e a r c h would c l a r i f y whether p a r t i c u l a r  c h a r a c t e r i s t i c s are d i s t i n c t i v e of usual c r i s i s chronic  line callers  or  callers.  Research i n v e s t i g a t i n g the s p e c i f i c chronic behaviours  that c r i s i s  beneficial. specific  line  l i n e personnel  From t h i s r e s e a r c h ,  caller  found c h a l l e n g i n g would  crisis  line staff could  develop  s t r a t e g i e s and p r o c e d u r e s a r o u n d t h e s e b e h a v i o u r s  l e s s e n t h e i r impact on t h e c a l l dynamic. p r o c e d u r e s t h e n c o u l d be t h e same b e h a v i o u r s . c a l l e r s w o u l d be  The  be  to  These s t r a t e g i e s and  applied across a l l c a l l e r s need t o i d e n t i f y and  reduced because behaviours  exhibiting  label  w o u l d be  chronic directly  dealt with instead. Perhaps u s i n g recorded  telephone  conversations,  studies  s p e c i f i c a l l y i n v e s t i g a t i n g the chronic c a l l e r - t e l e p h o n e worker r e l a t i o n s h i p w o u l d g i v e b e t t e r i n f o r m a t i o n and u n d e r s t a n d i n g t h i s ongoing dynamic. continuous  This research would help c l a r i f y  c y c l e o f c h r o n i c c a l l e r t e l e p h o n i n g and  worker i n t e r a c t i o n s m a i n t a i n i n g the dynamic. telephone w o u l d be  the  Further,  the callerthe  workers' b e h a v i o u r i a l c o n t r i b u t i o n t o the c a l l i n v e s t i g a t e d and  overcome t h e s e b e h a v i o u r s  on  dynamic  s p e c i f i c s t r a t e g i e s and p r o c e d u r e s  to  developed.  A d d i t i o n a l research that i n v e s t i g a t e d the i d e n t i f i e d c a l l e r g l o b a l themes o f i s o l a t i o n , e s t e e m w o u l d be b e n e f i c i a l .  The  connection,  chronic  victimization  leitmotifs provided a  and  context  170 for the callers'  lives.  Further, these l e i t m o t i f s  o p e r a t e o n two d i f f e r e n t d i m e n s i o n s : v i c t i m i z a t i o n and esteem.  appeared t o  i s o l a t i o n and connection,  S t u d y i n g t h e s e themes w o u l d p r o v i d e  a d d i t i o n a l i n f o r m a t i o n t o understand b e t t e r t h e i r i n f l u e n c e on the chronic c a l l e r s ' Lastly, populations,  contact and use o f c r i s i s  lines.  future studies that looked a t other chronic such as frequent attenders t o a medical p r a c t i c e o r  the c h r o n i c a l l y mentally i l l ,  could begin t o investigate the  connections between d i f f e r e n t c h r o n i c p o p u l a t i o n s .  A  larger  understanding o f c l i e n t c h r o n i c i t y i n t h e h e l p i n g s e r v i c e s would t h e n be b u i l t . Summary Chronic c a l l e r s reported they telephoned f r e q u e n t l y and over many y e a r s .  F o r t h e lower frequency chronic c a l l e r s ,  suggested t h e c r i s i s  l i n e s were j u s t a n o t h e r h e l p i n g s e r v i c e .  For the higher frequency chronic c a l l e r s ,  they stated the c r i s i s  l i n e s u s u a l l y were t h e i r o n l y h e l p i n g r e s o u r c e . callers,  they said c r i s i s  contact, and f r i e n d - l i k e All  they  For a l l the  l i n e personnel provided support, relationships.  c a l l e r s shared a c h a r a c t e r i s t i c a l c o h o l o r other  a d d i c t e d f a m i l y background.  drug  Coming f r o m e i t h e r s e v e r e l y a b u s i v e  o r n e g l e c t f u l f a m i l i e s , a p a t t e r n o f v i c t i m i z a t i o n seemed s e t i n motion t h a t repeated through out t h e i r l i v e s i n h e l p i n g and other intimate  relationships.  They a l l in life,  s a i d they entered therapy and other treatment  o f t e n forced i n t o treatment f o r p h y s i c a l ,  early  emotional o r  171 mental i l l s  by t h e i r parents and f a m i l i e s .  Here t h e c a l l e r s  began t h e i r l o n g h i s t o r y w i t h h e l p i n g r e s o u r c e s . All  c a l l e r s reported prolonged h e a l t h concerns,  often  g e n e r a t i n g p e r s o n a l a n d p h y s i c a l l i m i t a t i o n s f o r them. their health limitations,  With  t h e y i n d i c a t e d l i m i t e d employment a n d  reduced f i n a n c i a l resources.  These f i n a n c i a l and p h y s i c a l  l i m i t a t i o n s then c r e a t e d a b l o c k f o r the c a l l e r s t o engaging a s o c i a l and support network. All  t h e c a l l e r s r e p o r t e d some f r i e n d s o r a c q u a i n t a n c e s ,  though v e r y few s a i d they had c u r r e n t s p e c i a l  relationships.  They r e v e a l e d a c h a l l e n g i n g r e l a t i o n s h i p h i s t o r y and family contact.  little  M o s t o f t e n t h e y showed t h e y f e l t i s o l a t e d  f a m i l y and f r i e n d s .  Their a b i l i t y  from  t o engage a n d u s e t h e i r  support network o f t e n appeared, v e r y  limited.  Lower f r e q u e n c y c h r o n i c c a l l e r s r e p o r t e d a h i s t o r y o f p o s i t i v e therapeutic experiences.  They s a i d t h e y remained  i n v o l v e d w i t h many h e l p i n g s e r v i c e s .  Because t h e y e x p e r i e n c e d  n e g l e c t and were u s u a l l y i g n o r e d b y t h e i r f a m i l i e s , t h e y to  tended  r e p o r t more p o s i t i v e e x p e r i e n c e s w i t h h e l p e r s a n d t h e c r i s i s  lines,  these c a l l e r s a p p r e c i a t i n g t h e contact and support  receive.  they  W i t h more h e l p i n g r e s o u r c e s a n d c o n t i n u e d p o s i t i v e  therapy, they i n d i c a t e d they telephoned c r i s i s  lines less often  and o n l y f o r p r a c t i c a l h e l p . Higher frequency chronic c a l l e r s reported a h i s t o r y of negative therapeutic experiences.  A b u s e d i n t h e i r homes,  suggested t h e v i c t i m i z a t i o n continued throughout  their  they  lives,  172 often i n t o the helping relationships they established. f r e q u e n t l y mentioned i n c o n s i s t e n t and i n a p p r o p r i a t e developing  a reluctance  They  therapy,  f o r engaging other h e l p i n g s e r v i c e s .  They r e v e a l e d t h e c r i s i s  l i n e s h a d become a t h e r a p e u t i c  resource  f o r them. With increased telephoning, callers reported management.  the c r i s i s  the higher  the r e s t r i c t i o n s as another negative  the c r i s i s service,  chronic  l i n e workers responded w i t h  R e s t r i c t e d by the c r i s i s  ones t h e y h a d b e f o r e .  frequency  lines,  call  the c a l l e r s  regarded  helping experience,  l i k e the  The c a l l e r s s a i d t h e y w e r e m i s t r e a t e d  by  l i n e s . However, when t h e y c o m p l a i n e d a b o u t t h e  t h e y s a i d t h e y were d i s r e g a r d e d  by the c r i s i s  line  personnel. These c h a r a c t e r i s t i c s c a n a l l o w f o r t h e b e t t e r i d e n t i f i c a t i o n a n d more e f f e c t i v e management o f c h r o n i c contacts.  C r i s i s l i n e personnel  e a s i l y can screen  c a l l e r s w i t h i n t h e h e l p i n g process f o r any f i r s t caller. and  Background i n f o r m a t i o n on the c a l l e r s '  t h e i r experience  appropriate This  caller  f o r chronic  time,  o r more,  support network  with other helping resources  w o u l d be  t o o b t a i n from c a l l e r s t o help r e s o l v e the problems.  i n f o r m a t i o n t h e n c o u l d be u s e d t o i d e n t i f y  chronic c a l l e r s from the c h a r a c t e r i s t i c s .  Crisis  potential line  personnel  c o u l d o b t a i n a d d i t i o n a l i n f o r m a t i o n f r o m f u r t h e r c a l l s t o more confidentially identify chronic c a l l e r . may s e t a p a t t e r n o f t e l e p h o n i n g difficult  t o break.  However, f u r t h e r c a l l s  and i n t e r a c t i o n t h a t i s  173  A continued chronic callers for  contact  personnel and  cycle of telephoning  looking t o the c r i s i s lines  and therapeutic assistance.  to fulfil  When c r i s i s  they experienced  the chronic callers  a sense o f v i c t i m i z a t i o n  l i f e and previous  similar  needs  line  therapeutic history.  victimization  and inappropriate use o f c r i s i s  Both the c a l l e r s  and c r i s i s l i n e personnel  The t e l e p h o n e sense o f  lines. are frustrated by  the mismatch o f c a l l e r needs t o c r i s i s l i n e s e r v i c e . identification  indicated  to their  w o r k e r s t h e n s t r u g g l e t o overcome b o t h t h e c a l l e r s '  earlier  their  r e s p o n d t o t h e movement away f r o m c r i s i s i n t e r v e n t i o n  initiate call restrictions,  earlier  i s i n i t i a t e d with the  and i n t e r v e n t i o n , c r i s i s l i n e  With personnel  c a n r e s p o n d b e t t e r w i t h management s t r a t e g i e s t h a t r e d u c e a n d e l i m i n a t e t h e most c h a l l e n g i n g a s p e c t s Crisis  of chronic c a l l e r  l i n e workers can inform the c a l l e r s  contact.  about t h e l i m i t s o f  t h e c r i s i s l i n e s e r v i c e w h i l e e n g a g i n g them i n t h e h e l p i n g process.  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T o r o n t o : A l l y n a n d Slaikeu,  American  & G u r l a n d , B. J .  Journal, of Psychology,  K. A.  surveys.  238-245.  methods o f p s y c h i a t r i c i n t e r v i e w i n g :  Slaikeu,  t e l e p h o n e , a n d home  s t r a t e g i e s f o r household h e a l t h  of Public Health,  S i m o n , R. Two  (1979). A comparison  32,  K u l k a , R. A.,  counseling  Thomas.  L e s s l e r , J . T.,  & W h i t m o r e , R.  W.  179 (1983).  Personal versus  telephone  surveys  for collecting  household h e a l t h data a t the l o c a l l e v e l . American Journal of Public Health, Wells,  73,  1389-1394.  K. B., Burnam, M. A., L e a k e , B.,  Agreement between f a c e - t o - f a c e and versions of the depression  & Robins,  L. N.  (1988).  telephone-administered  s e c t i o n o f t h e NIMH D i a g n o s t i c  I n t e r v i e w S c h e d u l e . J o u r n a l o f P s y c h i a t r i c R e s e a r c h , 22., 207-220. Wiseman,  F.  surveys.  (1972).  Methodological  bias i n public  P u b l i c O p i n i o n Q u a r t e r l y , 36,  105-108.  opinion  A  180 Footnotes 1. J o h n s o n , K a y . E x e c u t i v e D i r e c t o r , L a n g l e y Society, Langley,  BC.  2. M a r s h a l l , D a y n a . S u p e r v i s o r , Langley,  I s h t a r T r a n s i t i o n House,  BC.  3. C h a n d , M a n j i t . S u p e r v i s o r o f V o l u n t e e r s , Centre,  Hospice  Richmond  Crisis  Chimo P e r s o n a l D i s t r e s s I n t e r v e n t i o n S e r v i c e i n R i c h m o n d ,  Richmond,  BC.  4. R a w l y n s , J o a n . S u p e r v i s o r , Family S e r v i c e s , Langley,  Langley  Crisis Line,  Langley  BC.  5. L o h n e s , Tammy. C o o r d i n a t o r , Information L i n e , Share Family  Greater  Coquitlam  & Community S e r v i c e s ,  Crisis  &  Coquitlam,  BC. 6. K n i g h t ,  Diane. C r i s i s Line F a c i l i t a t o r , M i s s i o n  L i n e , M i s s i o n Community S e r v i c e s S o c i e t y , M i s s i o n , 7. The l e t t e r s The l e t t e r s  a f t e r the quotes i d e n t i f y  correspond  the t a b l e s and f i g u r e s .  with the i d e n t i f i c a t i o n  Crisis  BC.  specifc subjects. l e t t e r s used i n  181 Appendix Sex  A  Callers  The c a l l e r s e e k i n g s e x u a l s t i m u l a t i o n c a n b e s u b d i v i d e d i n t o two t y p e s o f s e x c a l l e r s : 1. T h e c a l l e r who o p e n l y a d m i t s h e w a n t s t o m a s t u r b a t e o r i s already i n t h e process o f masturbating. He p l e a d s w i t h t h e telephone c o u n s e l l o r t o s t a y on t h e l i n e u n t i l he i s f i n i s h e d . 2. (a) T h e c a l l e r t e l l s a f a n t a s y p r o b l e m p r e s e n t e d a s r e a l . U s u a l l y , b u t n o t always, i t i s o f an o v e r t s e x u a l nature. While t a l k i n g w i t h t h e telephone c o u n s e l l o r , he masturbates, (b) T h e c a l l e r t e l l s a f a n t a s y p r o b l e m . However, r a t h e r t h a n m a s t u r b a t i n g d u r i n g t h e c a l l , he uses t h e d i s c u s s i o n as sexual s t i m u l a t i o n and masturbates a f t e r completing t h e c a l l . Detecting t h e Sex C a l l e r The f o l l o w i n g c h a r a c t e r i s t i c s n e e d t o b e a l l c o n s i d e r e d when identifying a sex caller. A c a l l e r demonstrating one o f these c h a r a c t e r i s t i c s i n i s o l a t i o n s h o u l d n o t b e deemed a s e x c a l l e r . R a t h e r , a c o m b i n a t i o n o f t h e s e c h a r a c t e r i s t i c s i s more i n d i c a t i v e of a sex c a l l e r . A c a l l e x h i b i t i n g t h r e e o f more o f t h e s e c h a r a c t e r i s t i c s i s most o f t e n a s e x c a l l e r . Common C h a r a c t e r i s t i c s 1. V o i c e t o n e d e v o i d o f e m o t i o n 2. H e s i t a t i o n i n s p e a k i n g 3. G i v e s f i r s t name i m m e d i a t e l y a n d / o r a s k i n g f o r t h e t e l e p h o n e c o u n s e l l o r ' s name 4. A s k s p e r s o n a l q u e s t i o n s a b o u t t h e t e l e p h o n e c o u n s e l l o r 5. G r e a t d e a l o f c a l l e r s i l e n c e 6. R e s i s t a n c e t o w a r d s r e s o l u t i o n o f t h e p r o b l e m 7. P r e s e n t s s e l f w i t h i n n o c e n c e a b o u t s e x 8. U s e s t h e w o r d " e m b a r r a s s i n g " f r e q u e n t l y 9. A s k s t h e t e l e p h o n e c o u n s e l l o r ' s o p i n i o n a b o u t t h e " p r o b l e m " 10. G i v e s d e t a i l e s s e x u a l d e s c r i p t i o n 11. U s e o f f o r m a l l a n g u a g e i n d e s c r i b i n g s e x a c t s o r b o d y p a r t s 12. H a n g s u p a b r u p t l y b e f o r e c a l l i s c o m p l e t e d 13. R e s i s t s t a l k i n g a b o u t f e e l i n g s 14. M a y s o u n d l i k e t h e c a l l e r i s c a l l i n g l o n g d i s t a n c e 15. U s e s a w h i s p e r y t o n e o f v o i c e 16. S t a t e s a g e a s 17 1. 2. 3. 4. 5. 6. 7. 8.  Common O p e n i n g L i n e s I want t o t a l k . Can I t a l k about anything? I s t h e r e a man t h e r e t h a t I c a n s p e a k t o ? I've never c a l l e d before. Are you understanding? W i l l y o u t a l k t o me? I have a n embarrassing problem. I'm l o n e l y .  9. H a v e we t a l k e d  before?  Common S t o r y Themes 1. D o m i n a n t woman 2. A s k i n g f o r s e x u a l i n f o r m a t i o n o r a d v i c e 3. P e n i s i s t o o l a r g e o r t o o s m a l l 4. S e x w i t h f e m a l e members o f t h e i m m e d i a t e o r s t e p - f a m i l y 5. L e n d i n g g i r l f r i e n d o r w i f e t o a n o t h e r man o r woman 6. M u l t i p l e s e x u a l p a r t i c i p a n t s 7. E n j o y i n g s e x w i t h y o u n g b o y o r g i r l 8. T r a n s v e s t i s m 9. F e t i s h i s m 10. V o y e u r i s m 11. N u d i t y 12. H u m i l i a t i o n 13. S a d o - m a s o c h i s m 14. B l a d d e r c o n t r o l Adapted from: Wark, V. ( 1 9 8 4 ) . T h e s e x c a l l e r a n d t h e t e l e p h o n e c e n t e r . S p r i n g f i e l d , I L : C h a r l e s C. Thomas.  counseling  183 Appendix B Protocol f o rRequesting P a r t i c i p a t i o n o f Return C a l l e r s by Telephone Workers B e f o r e y o u g o , r p e r s o n ' s name i f known! , t h e c r i s i s l i n e w o u l d l i k e t o make a r e q u e s t o f y o u . The r e q u e s t d e p e n d s o n w h e t h e r you have c a l l e d c r i s i s l i n e s b e f o r e . I f y o u have, y o u c a n h e l p u s o u t i n b e t t e r u n d e r s t a n d i n g how c r i s i s l i n e s a r e u s e f u l t o return callers. L i k e w i s e , i f y o u a r e a r e t u r n c a l l e r , we b e l i e v e i f we know more a b o u t o u r c a l l e r s , we w o u l d b e b e t t e r a b l e t o p r o v i d e s e r v i c e t o them. H a v e y o u u s e d a c r i s i s l i n e b e f o r e ?  If no, thank them for listening If  to the request  and hang up.  yes,  Great! S i n c e y o u h a v e c a l l e d c r i s i s c e n t r e s more t h a n o n c e , y o u can be v e r y h e l p f u l t o u s . You r e a l l y a r e i n a u n i q u e s i t u a t i o n . The r e q u e s t we w o u l d l i k e t o make o f y o u i s w r i t t e n u p . I n e e d t o r e a d i t p r e t t y w e l l w o r d f o r w o r d t o make s u r e I t e l l y o u e v e r y t h i n g I need t o . We a r e p a r t o f s t u d y t o u n d e r s t a n d how c r i s i s l i n e s a r e responding t o r e t u r n c a l l e r s . A l s o , we b e l i e v e i f we know more a b o u t o u r r e t u r n c a l l e r s , we w o u l d b e b e t t e r a b l e t o p r o v i d e t e l e p h o n e s e r v i c e t o them. We w o u l d r e a l l y a p p r e c i a t e y o u r h e l p with this. Are you interested i n p a r t i c i p a t i n g ?  If no, thank them for their If  time and listening.  Hang up.  yes  Okay, t h a n k s . Now l e t me g i v e y o u a l i t t l e m o r e d e t a i l . This w i l l take a couple o f minutes because I need t o t e l l you e x a c t l y w h a t y o u may c h o o s e t o h e l p w i t h . The p e r s o n who w o u l d b e t a l k i n g w i t h y o u i s R i c h a r d K r a m e r . Richard i s t h e person doing the study. He i s a s t u d e n t a t t h e U n i v e r s i t y o f B r i t i s h Columbia. He i s d o i n g t h i s r e s e a r c h t o f i n i s h a masters degree i n c o u n s e l l i n g psychology. He's w o r k e d with c r i s i s l i n e s i n the past f o reight years. R i c h a r d hopes t o speak w i t h r e t u r n c a l l e r s . The g o a l i s improving c r i s i s l i n e service t o r e t u r n users, l i k e y o u r s e l f , by k n o w i n g y o u b e t t e r a n d how c r i s i s c e n t r e s s e r v e y o u . Y o u r p a r t i c i p a t i o n i s v o l u n t a r y . The c r i s i s l i n e i s n o t d o i n g t h e r e s e a r c h . You won't r e c e i v e a n y e x t r a t i m e , s p e c i a l a t t e n t i o n o r s p e c i a l treatment from t h e c r i s i s l i n e i f you h e l p . L i k e w i s e , y o u w o n ' t l o s e a n y t h i n g i f y o u d o n ' t h e l p e i t h e r . The  184 r e s e a r c h f i n d i n g s may r e s u l t i n c h a n g e s t o c r i s i s could b e n e f i t you.  lines  that  What d o y o u t h i n k s o f a r ? If any question comes up about how the research will be conducted, who will have the information, or what will the c r i s i s line gets back from the research, say: " I b e l i e v e I h a v e t h e a n s w e r f o r t h a t c o m i n g u p " , and continue with the protocol below. If any other questions questions and answers  come up for the callers, below, and then continue  If no questions or other protocol below.  concerns  use the with the  come up, continue  The i n t e r v i e w w o u l d b e d o n e o v e r t h e t e l e p h o n e . no f a c e - t o - f a c e c o n t a c t w i t h a n y o n e .  with  scripted protocol. the  There would be  The i n t e r v i e w w i l l t a k e a h o u r a n d a h a l f . T h i s r e a l l y w o u l d g i v e y o u a chance t o t a l k about t h e s e r v i c e y o u a r e g e t t i n g and how t h e c r i s i s l i n e s c o u l d s e r v e y o u b e t t e r . However, t h e i n t e r v i e w d o e s n ' t have t o b e done a l l a t once. F o r whatever reason, another time t o t a l k can be s e t up. What y o u s a i d w o u l d b e c o n f i d e n t i a l t o t h e r e s e a r c h e r , Richard. O n l y h e w o u l d know y o u r a n s w e r s t o a n y q u e s t i o n s . We w o u l d n o t be t o l d w h a t y o u s a i d a b o u t a n y s e r v i c e y o u h a v e r e c e i v e d o r w h a t y o u s a i d a b o u t y o u r s e l f . He i s t a l k i n g w i t h a l o t o f d i f f e r e n t people. A l l we w o u l d b e t o l d i s a g e n e r a l d e s c r i p t i o n o f w h a t o u r c a l l e r s a r e l i k e , a n d what t h e y t h i n k about t h e s e r v i c e they're g e t t i n g from c r i s i s l i n e s . A l s o , we w o u l d g e t s u g g e s t i o n s o n how we m i g h t b e more h e l p f u l t o r e t u r n c a l l e r s like yourself. We w o u l d f i n d t h i s i n f o r m a t i o n v e r y u s e f u l a n d would appreciate your help. Do y o u h a v e a n y q u e s t i o n s ? «possible  questions  and  How many people are you t a l k i n g to? have you asked so far?  OR  answers» How many other people  R i c h a r d h o p e s t o t a l k t o a r o u n d 15 o r 20 p e o p l e . T h e more people he t a l k s t o , the better the understanding o f return callers t o crisis lines. A n d t h e more h e l p f u l t h e s t u d y t o the c r i s i s l i n e s t o improve t h e i r s e r v i c e t o r e t u r n c a l l e r . Is i t going t o be tape  recorded?  Richard would l i k e t o record the interview.  He d o e s n ' t w a n t  188 « o p t i o n s box c o n t i n u e d » .. .or if  interviewer  phoning  caller...  The i n t e r v i e w e r , R i c h a r d K r a m e r , w i l l t e l e p h o n e f t e l e p h o n e number g i v e n ! , a n d a s k f o r [name c a l l e r g a v e l . I s t h a t r i g h t ? . . .and continue  with  protocol  outside  options  After response from the caller, and corrections misunderstandings i f needed. . . .  box. in any  Now, i f y o u h a v e a n y p r o b l e m w i t h t h e i n t e r v i e w t i m e o r d a y , f r e e t o phone R i c h a r d about i t . Thanks a g a i n .  Your help i s appreciated.  Take  care.  feel  189 Appendix C P r o t o c o l f o r R e q u e s t i n g P a r t i c i p a t i o n o f R e t u r n C a l l e r s byTelephone Workers, Workers n o t S c h e d u l i n g I n t e r v i e w Times B e f o r e y o u g o , [ p e r s o n ' s name i f known! , t h e c r i s i s l i n e w o u l d l i k e t o make a r e q u e s t o f y o u . The r e q u e s t d e p e n d s o n w h e t h e r you have c a l l e d c r i s i s l i n e s b e f o r e . I f y o u have, y o u c a n h e l p u s o u t i n b e t t e r u n d e r s t a n d i n g how c r i s i s l i n e s a r e u s e f u l t o return callers. L i k e w i s e , i f y o u a r e a r e t u r n c a l l e r , we b e l i e v e i f we know more a b o u t o u r c a l l e r s , we w o u l d b e b e t t e r a b l e t o p r o v i d e s e r v i c e t o them. H a v e y o u u s e d a c r i s i s l i n e b e f o r e ?  If no, thank them for listening  to the request  and hang up.  If yes, Great! S i n c e y o u h a v e c a l l e d c r i s i s c e n t r e s more t h a n o n c e , y o u can be v e r y h e l p f u l t o u s . You r e a l l y a r e i n a u n i q u e s i t u a t i o n . The r e q u e s t we w o u l d l i k e t o make o f y o u i s w r i t t e n u p . I n e e d t o r e a d i t p r e t t y w e l l w o r d f o r w o r d t o make s u r e I t e l l y o u e v e r y t h i n g I need t o . We a r e p a r t o f s t u d y t o u n d e r s t a n d how c r i s i s l i n e s a r e responding t o r e t u r n c a l l e r s . A l s o , we b e l i e v e i f we know more a b o u t o u r r e t u r n c a l l e r s , we w o u l d b e b e t t e r a b l e t o p r o v i d e t e l e p h o n e s e r v i c e t o them. We w o u l d r e a l l y a p p r e c i a t e y o u r h e l p with this. Are you interested i n p a r t i c i p a t i n g ?  If no, thank them for their  time and listening.  Hang up.  If yes Okay, t h a n k s . Now l e t me g i v e y o u a l i t t l e m o r e d e t a i l . This w i l l take a couple o f minutes because I need t o t e l l you e x a c t l y w h a t y o u may c h o o s e t o h e l p w i t h . The p e r s o n who w o u l d b e t a l k i n g w i t h y o u i s R i c h a r d K r a m e r . Richard i s t h e person doing t h e study. He i s a s t u d e n t a t t h e U n i v e r s i t y o f B r i t i s h Columbia. He i s d o i n g t h i s r e s e a r c h t o f i n i s h a masters degree i n c o u n s e l l i n g psychology. He's w o r k e d with c r i s i s lines i n the past f o reight years. R i c h a r d hopes t o speak w i t h r e t u r n c a l l e r s . The g o a l i s improving c r i s i s l i n e service t o r e t u r n users, l i k e yourself, by k n o w i n g y o u b e t t e r a n d how c r i s i s c e n t r e s s e r v e y o u . Y o u r p a r t i c i p a t i o n i s v o l u n t a r y . The c r i s i s l i n e i s n o t d o i n g t h e r e s e a r c h . You won't r e c e i v e a n y e x t r a t i m e , s p e c i a l a t t e n t i o n o r s p e c i a l treatment from t h e c r i s i s l i n e i f you h e l p . L i k e w i s e , y o u w o n ' t l o s e a n y t h i n g i f y o u d o n ' t h e l p e i t h e r . The  190 r e s e a r c h f i n d i n g s may r e s u l t i n c h a n g e s t o c r i s i s could b e n e f i t you.  lines  that  What d o y o u t h i n k s o f a r ? If any question comes up about how the research will be conducted, who will have the information, or what will the c r i s i s line gets back from the research, say: " I b e l i e v e I h a v e t h e a n s w e r f o r t h a t c o m i n g u p " , and continue with the protocol below. If any other questions questions and answers  come up for the callers, below, and then continue  If no questions or other protocol below.  concerns  use the with the  come up, continue  The i n t e r v i e w w o u l d b e done o v e r t h e t e l e p h o n e . no f a c e - t o - f a c e c o n t a c t w i t h a n y o n e .  scripted protocol.  with the  There would be  The i n t e r v i e w w i l l t a k e a h o u r a n d a h a l f . T h i s r e a l l y w o u l d g i v e y o u a chance t o t a l k about t h e s e r v i c e y o u a r e g e t t i n g and how t h e c r i s i s l i n e s c o u l d s e r v e y o u b e t t e r . However, t h e i n t e r v i e w d o e s n ' t have t o b e done a l l a t once. For whatever reason, another time t o t a l k can be s e t up. What y o u s a i d w o u l d b e c o n f i d e n t i a l t o t h e r e s e a r c h e r , Richard. O n l y h e w o u l d know y o u r a n s w e r s t o a n y q u e s t i o n s . We w o u l d n o t be t o l d w h a t y o u s a i d a b o u t a n y s e r v i c e y o u h a v e r e c e i v e d o r w h a t you s a i d about y o u r s e l f . He i s t a l k i n g w i t h a l o t o f d i f f e r e n t p e o p l e . A l l we w o u l d b e t o l d i s a g e n e r a l d e s c r i p t i o n o f w h a t o u r c a l l e r s a r e l i k e , a n d what t h e y t h i n k a b o u t t h e s e r v i c e they're g e t t i n g from c r i s i s l i n e s . A l s o , we w o u l d g e t s u g g e s t i o n s o n how we m i g h t b e more h e l p f u l t o r e t u r n c a l l e r s like yourself. We w o u l d f i n d t h i s i n f o r m a t i o n v e r y u s e f u l a n d would appreciate your help. Do y o u h a v e a n y q u e s t i o n s ? «possible  questions  and  How many people are you t a l k i n g to? OR have you asked so far?  answers» How many other people  R i c h a r d h o p e s t o t a l k t o a r o u n d 15 o r 20 p e o p l e . T h e more people he t a l k s t o , the b e t t e r the understanding o f r e t u r n callers t ocrisis lines. A n d t h e more h e l p f u l t h e s t u d y t o the c r i s i s l i n e s t o improve t h e i r s e r v i c e t o r e t u r n c a l l e r s .  192 So, i f t h e r e a r e n o more q u e s t i o n s , p a r t ic i p a t i n g ?  are you s t i l l  interestedi n  If the caller is uncertain or says no, try to c l a r i f y the reasons and correct any misunderstandings, i f possible. Thank him or her for the time and hang up. If yes, .... Great! A l l I n e e d t o g i v e y o u now i s t h e t e l e p h o n e you c a n c a l l R i c h a r d t o s e t up a n i n t e r v i e w t i m e .  number w h e r e  Do y o u h a v e a p e n c i l ? When yes. . . Okay, t h e t e l e p h o n e number i s 8 5 6 - 4 2 7 4 . I f t h i s p h o n e number i s l o n g d i s t a n c e f o r you, p l e a s e c a l l c o l l e c t . You c a n p r e t t y w e l l c a l l h i m a n y t i m e b e t w e e n 8:00 am a n d 11:00 pm to s e t up a n i n t e r v i e w time. I want t o s a y a g a i n y o u r p a r t i c i p a t i o n i n t h i s s t u d y w i l l be v e r y helpful to crisis lines. You r e a l l y a r e i n a unique s i t u a t i o n t o give valuable information t o us. Thanks a g a i n f o r y o u r p a r t i c i p a t i o n . Take c a r e .  Your help i s appreciated.  193 Appendix D Protocol Confirming P a r t i c i p a t i o n Return C a l l e r by Interviewer Hello.  Is this  of  fname c a l l e r g a v e l ?  If  no...  May  I talk to with  [name] ?  If yes. . . Oh, g r e a t ! Thanks f o r a g r e e i n g t o be i n t e r v i e w e d f o r t h i s I'm R i c h a r d K r a m e r . I'm t h e i n t e r v i e w e r .  study.  B e f o r e we b e g i n , I w o u l d l i k e t o s a y a g a i n w h a t ' s g o i n g t o happen. I have i t w r i t t e n up. I need t o read i t p r e t t y w e l l w o r d f o r w o r d t o make s u r e I t e l l y o u e v e r y t h i n g I n e e d t o . The p u r p o s e o f t h i s i n t e r v i e w i s t o g e t i n f o r m a t i o n t h a t w i l l help c r i s i s l i n e s b e t t e r help out r e t u r n c a l l e r s . A s someone who has u s e d c r i s i s l i n e s e r v i c e s b e f o r e , y o u c a n be v e r y h e l p f u l t o us. Y o u c a n t e l l u s w h a t c r i s i s l i n e s do f o r y o u a n d how t h e y a f f e c t you. A l s o , c r i s i s l i n e s would b e n e f i t by knowing about r e t u r n c a l l e r s s o t h a t t h e y c a n b e t t e r h e l p a n d w o r k w i t h them. That' s what t h e i n t e r v i e w i s a l l a b o u t : y o u r e x p e r i e n c e s w i t h and your thoughts about c r i s i s l i n e s . A n d w h a t we n e e d t o understand about you t o g i v e you b e t t e r s e r v i c e . The a n s w e r s a b o u t 15 t o Nothing you w i l l remain  from a l l the people I i n t e r v i e w , and I' m i n t e r v i e w i n g 20 p e o p l e , w i l l b e p u t t o g e t h e r f o r t h e r e p o r t . s a y w i l l e v e r be i d e n t i f i e d w i t h y o u p e r s o n a l l y . You anonymous a n d unnamed i n t h e f i n a l r e p o r t .  A n y t h i n g y o u t e l l me a b o u t y o u r s e l f w i l l r e m a i n o n l y w i t h me. No i d e n t i f y i n g i n f o r m a t i o n about y o u r s e l f w i l l be g i v e n t o anyone else. And I want t o m e n t i o n s p e c i f i c a l l y t h i s i n c l u d e s t h e crisis lines. The i n t e r v i e w may t a k e a h o u r a n d a h a l f , p r o b a b l y l e s s . This r e a l l y would g i v e you a chance t o t a l k about t h e s e r v i c e you a r e g e t t i n g a n d how t h e c r i s i s l i n e s c o u l d s e r v e y o u b e t t e r . However, t h e i n t e r v i e w d o e s n ' t h a v e t o b e d o n e a l l a t o n c e . For w h a t e v e r r e a s o n , a n o t h e r t i m e t o t a l k c a n be s e t up. I want t o s a y y o u won't l o s e o r g a i n a n y t h i n g b y b e i n g p a r t o f t h i s study. A n y s p e c i a l a r r a n g e m e n t y o u may h a v e w i t h a c r i s i s l i n e w o n ' t c h a n g e w h e t h e r y o u p a r t i c i p a t e o r n o t . The c r i s i s l i n e i s not doing the research. I'm r e s p o n s i b l e f o r w h a t h a p p e n s during the interview, not the c r i s i s l i n e .  195 Appendix Interview  E  Protocol  I w o u l d l i k e t o s t a r t w i t h how y o u b e l i e v e c r i s i s l i n e s a r e s e r v i n g you. I r e a l l y want t o g e t a sense o f what t h e s e r v i c e you a r e g e t t i n g from them i s l i k e . I w o u l d l i k e t o know how o f t e n y o u t e l e p h o n e a n d w h a t h a p p e n s when y o u c a l l . A l s o , how you b e l i e v e c r i s i s l i n e s have i n f l u e n c e d y o u .  Frequency  and Duration  of Ongoing  Contact  1. Y o u ' v e s a i d t h a t y o u h a v e p h o n e d c r i s i s l i n e s more t h a n o n c e . The f i r s t t h i n g I w o u l d l i k e y o u t o d o i s t h i n k a b o u t t h e d i f f e r e n t times you've telephoned. Can y o u go back a n d t h i n k about t h e t i m e s you've c a l l e d i n t h e l a s t few days, . . .the l a s t week,...the l a s t few weeks? W i t h t h i s i n mind...: a . How o f t e n d o y o u p h o n e c r i s i s l i n e s ? b. How c o n s i s t e n t i s t h a t c o n t a c t ? L i k e , d o y o u p h o n e e v e r y d a y , e v e r y o t h e r d a y , t h r e e t i m e s a week f o r a f e w m o n t h s , then not a t a l l f o r awhile? c. When d i d y o u f i r s t s t a r t c a l l i n g c r i s i s l i n e s ? d. How d i d y o u f i r s t f i n d o u t a b o u t c r i s i s l i n e s ?  Reasons  for Contacting  the Crisis  Line  2. I w o u l d l i k e t o t a l k a b o u t y o u r u s e o f c r i s i s l i n e s s o t h a t I c a n u n d e r s t a n d b e t t e r how t h i s f i t s i n t o y o u r e v e r y d a y l i f e . T h i n k o f a f a i r l y t y p i c a l r e c e n t d a y t h a t w o u l d g i v e me a g o o d p i c t u r e o f how y o u u s e c r i s i s l i n e s . Can y o u t h i n k o f one?  Negotiate  on the day  Now I w o u l d l i k e y o u t o t e l l me how c a l l i n g c r i s i s l i n e s f i t s i n t o t h e day. L i k e , w h a t ' s g o i n g o n f o r y o u when y o u c a l l ? What's y o u r r e a s o n s f o r c a l l i n g ?  Callers  Reactions  - Likes  and D i s l i k e s - about C r i s i s  Lines  3. Now t h a t we t a l k e d a b o u t y o u r u s u a l c a l l t o t h e c r i s i s l i n e , overall... a. What d o y o u l i k e a b o u t c r i s i s l i n e s ? b. How a b o u t t h e o t h e r s i d e ? What d o y o u n o t l i k e a b o u t crisis lines?  Caller  Recognition  by Crisis  Line  4. I i m a g i n e t h a t i f y o u h a v e p h o n e d a c r i s i s l i n e more t h a n once, w i t h a n y frequency, t h e workers would b e g i n t o r e c o g n i z e you. Some p e o p l e may f i n d t h e r e c o g n i t i o n a r e l i e f . They f e e l more c o m f o r t a b l e w i t h someone t h a t knows t h e m a n d n o t h a v i n g t o  196 repeat t h e i r story. O t h e r s may f i n d t h e r e c o g n i t i o n a n n o y i n g . T h e y e v e n may f e e l t h r e a t e n e d b e c a u s e t h e y d i d n ' t w a n t t o be recognized. a. How do y o u f e e l when t h e y r e c o g n i z e y o u ? b. How d o e s t h e t e l e p h o n e w o r k e r r e s p o n d o n c e h e / s h e knows i t ' s you? c. How do y o u f e e l when t h e y d o n ' t r e c o g n i z e y o u ? d. What d i f f e r e n c e s i n s e r v i c e do y o u n o t i c e when t h e workers don't r e c o g n i z e you?  Purpose  in Telephoning  Crisis  Lines  5. C r i s i s l i n e s h e l p t h o s e c a l l e r s i n c r i s i s o r d i s t r e s s c o p e a n d work t h r o u g h t h e i r problems. Others, besides those i n c r i s i s , a l s o telephone, perhaps f o r support o r c o n t a c t , perhaps t o problem-solve w i t h another person. a. G e n e r a l l y , w h a t do y o u p h o n e t h e c r i s i s l i n e f o r ?  L i f e Changes and  the Crisis  Line  6. C r i s i s l i n e s h e l p p e o p l e t h r o u g h t h e i r c r i s e s a n d p r o v i d e support t o c a l l e r s through d i f f i c u l t times. Besides t h i s , c r i s i s l i n e s h o p e t o e n c o u r a g e c h a n g e i n t h e p e o p l e who c a l l . a. I n t h e t i m e y o u h a v e b e e n t e l e p h o n i n g c r i s i s c e n t r e s , how has y o u r l i f e changed? b. How h a v e t h e c r i s i s l i n e s a d d e d t o y o u r l i f e c h a n g e s ?  Helps  and Hinders  the Most from Crisis  Lines  7. P e o p l e p h o n e c r i s i s l i n e s f o r many d i f f e r e n t r e a s o n s . Often, t h e y have p r e s s i n g concerns, o r t h e y r e a c h out f o r support i n a time of l o n e l i n e s s or d i s t r e s s . These p e o p l e f i n d c r i s i s l i n e s h e l p f u l because o f the workers t h a t l i s t e n and understand, p r o v i d e s u p p o r t , and h e l p f i n d s o l u t i o n s t o t h e i r problems. Others f i n d c r i s i s l i n e s f r u s t r a t i n g because the workers o n l y want t o h e l p w i t h t h e c a l l e r s ' p r o b l e m s . The w o r k e r s d o n ' t seem too f r i e n d l y or w i l l i n g just t o t a l k . For yourself: a . What do y o u t h i n k h e l p s y o u t h e m o s t f r o m c r i s i s l i n e s ? b. What do y o u f i n d n o t s o h e l p f u l f r o m c r i s i s l i n e s ?  Caller  Preferences  on Crisis  Centres  8. A s y o u p r o b a b l y know, t h e r e i s more t h a n one c r i s i s l i n e i n t h e Lower M a i n l a n d and F r a s e r V a l l e y a r e a . Some p e o p l e f i n d i t u s e f u l t o c a l l some p h o n e l i n e s o v e r o t h e r s b e c a u s e o f t h e s e r v i c e they get, the workers they t a l k t o , o r j u s t p e r s o n a l likes or dislikes. a. W h i c h c r i s i s l i n e s do y o u l i k e p h o n i n g ?  them?  follow-up  b. W h i c h c r i s i s u s e f u l phoning?  probe:  What do they do that you  like  l i n e s don't you t a l k t o , o r don't  phoning  find  197 you  follow-up don't find  Crisis  Line  probe: What do they do (or have i t useful to call them?  Changes  to Serve  the Caller  they done)  that  Better  9. a . How d o y o u t h i n k c r i s i s l i n e s c o u l d c h a n g e t o s e r v e y o u better? b. What d o y o u t h i n k w o u l d b e d i f f e r e n t i n y o u r l i f e i f t h e s e changes happen? Caller  Contact  with  other  Community  Services  10. We a p p r e c i a t e y o u r f e e d b a c k o n how c r i s i s c e n t r e s s e r v e y o u . Y o u r r e t u r n u s e t e l l s u s t h a t i n some w a y c r i s i s l i n e s a r e a n important p a r t o f your present l i f e . S t i l l , we know t h a t c r i s i s c e n t r e s a r e n ' t t h e o n l y s e r v i c e s a v a i l a b l e i n t h e c o m m u n i t y . We know p e o p l e h a v e d i f f e r e n t n e e d s met b y o t h e r s e r v i c e s . a. B e s i d e s c r i s i s l i n e s , w h a t o t h e r s e r v i c e s h a v e y o u u s e d o r do y o u use i n t h e community? follow-up probes: (i) How much contact do you have with these other services? (ii) How did you find out about these services? b. C r i s i s l i n e s a r e a b i t l i k e c o u n s e l l i n g o r s u p p o r t o v e r the telephone. So, b e s i d e s t h e community s e r v i c e s you've mentioned, what h a s been y o u r e x p e r i e n c e w i t h c o u n s e l l i n g o r therapy? . . .if yes. . .follow-up probes: (i) When was that? (ii) What problems did you deal with? c. How d o e s t h e c r i s i s l i n e s e r v i c e d i f f e r f r o m t h e o t h e r s e r v i c e s y o u have used o r are using? B e f o r e I a s k y o u some q u e s t i o n s a b o u t y o u r l i f e e x p e r i e n c e s , a r e t h e r e a n y o t h e r comments y o u w o u l d l i k e t o a d d a b o u t c r i s i s lines? T h i s n e x t s e t o f q u e s t i o n s i s a b o u t y o u r own l i f e a n d experiences. The p u r p o s e i n t h e s e q u e s t i o n s i s t o h e l p c r i s i s l i n e s u n d e r s t a n d t h e d i f f e r e n t p e o p l e t h a t have u s e d t h e i r phone s e r v i c e s more t h a n o n c e . I w a n t t o g e t t o know c a l l e r s , l i k e y o u r s e l f , b y a s k i n g a b o u t your background. T h i s i s n ' t meant t o b e a b r a i n - p i c k i n g exercise. You can answer the q u e s t i o n s w i t h a s l i t t l e d e t a i l a s you want. A n d you don't have t o answer a n y q u e s t i o n you f e e l uncomfortable with. A person's background i s important t o help b e t t e r and t o s t a r t needed s e r v i c e s i n t h e community. To use a n example: I n t h e p a s t s c h o o l t e a c h e r s h a d n o t i c e d t h a t some s t u d e n t s f e l l asleep i n c l a s s , appeared d i s t r a c t e d , and d i d p o o r l y i n school.  198 The o r i g i n a l t h o u g h t h e r e was t h a t t h e c h i l d r e n w e r e j u s t b a d students. When we s t a r t e d a s k i n g a b o u t t h e i r b a c k g r o u n d , we s t a r t e d t o s e e t h a t some o f t h e s e s t u d e n t s came t o s c h o o l w i t h o u t breakfast. Hungry and l a c k i n g energy, t h e y f e l l a s l e e p and d i d poorly. B r e a k f a s t and l u n c h programs were s t a r t e d t o f e e d t h e c h i l d r e n ... a n d t h e i r a t t e n t i o n a n d g r a d e s i m p r o v e d . With other students they found l e a r n i n g d i f f i c u l t i e s . They c o u l d n ' t u n d e r s t a n d w h a t was g o i n g o n i n t h e c l a s s r o o m a n d became d i s t r a c t e d , b o r e d a n d g o t p o o r g r a d e s . When s p e c i a l h e l p a n d t e a c h e r s were used t o d e a l w i t h t h e c h i l d r e n ' s l e a r n i n g problems, the s t u d e n t s a t t e n t i o n and grades improved. The e x a m p l e g i v e s t h e i d e a b e h i n d a s k i n g q u e s t i o n s a b o u t y o u r c u r r e n t l i f e and background. We a r e l o o k i n g t o u n d e r s t a n d y o u r c u r r e n t a n d p a s t l i f e e x p e r i e n c e s s o t h a t p h o n e s e r v i c e s may b e i m p r o v e d o r c h a n g e d o r new s e r v i c e s s t a r t e d t o meet y o u r n e e d s .  Support  Network:  Current  Friends  1 1 . To s t a r t t o g e t t o know y o u b e t t e r , I w o u l d l i k e t o a s k a b o u t what s u p p o r t y o u have. That i s , t h o s e p e r s o n s y o u t a l k t o , v i s i t , and s o c i a l i z e w i t h u s u a l l y . We know f r o m t a l k i n g w i t h c a l l e r s t h a t p e o p l e o f t e n p h o n e t h e c r i s i s l i n e when t h o s e t h e y t u r n t o for support are t i r e of hearing the c a l l e r s ' d i f f i c u l t i e s . O t h e r s p h o n e when t h e y f e e l t h e i r u s u a l s u p p o r t s w o n ' t u n d e r s t a n d o r w i l l j u d g e them. Some c a l l e r s p h o n e t h e c r i s i s l i n e l o o k i n g f o r s u p p o r t b e c a u s e t h e y a r e away f r o m f a m i l y a n d f r i e n d s , o r b e c a u s e t h e y l i k e b e i n g a l o n e o v e r h a v i n g many p e o p l e a r o u n d . I'm i n t e r e s t e d i n t h o s e r e l a t i o n s h i p s y o u h a v e w i t h y o u r f a m i l y and f r i e n d s . a. How many d i f f e r e n t p e o p l e do y o u s e e r e g u l a r l y ?  follow-up probes: (i) Who are they? (ii) How often do you see them? (Hi) How would you describe your r e l a t i o n s h i p s with them? (iv) How much about yourself do you tell them? (v) What are a few of the things you do together?  Support  Network:  Past  Friendships  12. I ' d l i k e t o t a l k a b o u t y o u r p a s t f r i e n d s h i p s f o r a b i t . a . How w e r e y o u r r e l a t i o n s h i p s w i t h y o u r f r i e n d s ?  Support  Network:  Family  13. A p e r s o n ' s f a m i l y c a n b e a n e v e r y d a y s u p p o r t . L i k e w i s e , t h e y c a n be a m a j o r p a i n . a. When y o u t h i n k a b o u t y o u r p a r e n t s , y o u r b r o t h e r s a n d y o u r s i s t e r s , how much c o n t a c t do y o u h a v e w i t h y o u r f a m i l y ? b. W h e r e ' s y o u r f a m i l y now? c. How w o u l d y o u d e s c r i b e y o u r c u r r e n t r e l a t i o n s h i p s w i t h  199 your parents, brothers and s i s t e r s ? f o l l o w - u p p r o b e s : ( i ) How d o y o u f e e l a b o u t t h a t relationship? ( i i ) What d o y o u t h i n k a b o u t t h a t r e l a t i o n s h i p ? d. A s y o u w e r e g r o w i n g up, how w o u l d y o u d e s c r i b e t h e r e l a t i o n s h i p s i n your family? Support  Network:  Current  Relationships  14. I ' d l i k e a s k a b o u t y o u r c u r r e n t r e l a t i o n s h i p s t o f i n d o u t a b o u t t h e s u p p o r t y o u h a v e now. a. Do y o u h a v e a s p e c i a l someone i n y o u r l i f e r i g h t now? ...if yes, probe: (i) What is that like? (ii) What do you enjoy about your current relationship? (iii) What are some challenges in your current relationship ? b . What p r e v i o u s r e l a t i o n s h i p s h a v e y o u h a d ? . . .if yes, probe: (i) What did you enjoy about these relationships? (ii) How were they challenging? (iii) What happened that these relationships ended? c. I f y o u h a v e a n y c h i l d r e n , w h a t i s y o u r r e l a t i o n s h i p w i t h them l i k e ? B e f o r e I a s k y o u a l i t t l e b i t more a b o u t y o u r f a m i l y b a c k g r o u n d , a r e t h e r e a n y comments y o u w o u l d l i k e t o a d d a b o u t y o u r f r i e n d s or f a m i l y support? Okay, I ' d l i k e t o a s k some q u e s t i o n s a r o u n d y o u r f a m i l y background. I come f r o m t h e b e l i e f t h a t w h a t we a r e t o d a y , a t l e a s t a l i t t l e b i t , i s p a r t o f our f a m i l y background. The i d e a h e r e i s n ' t - t o blame anyone i n y o u r f a m i l y f o r a n y t h i n g h a p p e n i n g i n y o u r l i f e t o d a y . The i d e a i n a s k i n g about y o u r f a m i l y b a c k g r o u n d i s t o u n d e r s t a n d y o u r b e t t e r , and, p e r h a p s , b e a b l e t o adapt c r i s i s l i n e s e r v i c e t o h e l p y o u b e t t e r . The f a m i l y c a n b e a s e n s i t i v e a r e a f o r some p e o p l e . I'm n o t looking f o r skeletons i n the closet. A l l I would l i k e i s that information that youare comfortable giving. You don't have t o answer a n y q u e s t i o n y o u d o n ' t want t o . Changes in the  Family  15. Sometimes major changes i n o u r f a m i l y c a n g r e a t l y i n f l u e n c e for the good o r b a d our f a m i l y l i f e . The changes c a n be v e r y d i s r u p t i v e , o r they can b r i n g the f a m i l y c l o s e r t o g e t h e r . a. F o r y o u r s e l f , w h a t w e r e some m a j o r c h a n g e s t h a t o c c u r r e d i n y o u r f a m i l y . ... l i k e b i r t h s , d e a t h s , s e v e r e i l l n e s s o r i n j u r y , m a r r i a g e s , s e p a r a t i o n s o r d e p a r t u r e s . . . . t h a t i n f l u e n c e s you? b. How d i d y o u r f a m i l y members r e a c t t o t h e s e c h a n g e s ?  200  Mental  Health  and Substance  Misuse  in the  Family  16. S o m e t i m e s when we h a v e a f a m i l y member w i t h a m e n t a l i l l n e s s o r a l c o h o l o r o t h e r d r u g problem, t h e f a m i l y r e l a t i o n s h i p s c a n be thrown i n t o chaos. F i g h t s o v e r someone's d r i n k i n g . The m e n t a l l y i l l f a m i l y member a c t i n g o d d l y a r o u n d t h e home o r i n t h e neighbourhood. These e x p e r i e n c e s c a n have e f f e c t s on o t h e r f a m i l y members y e a r s a f t e r . a. What was t h e m e n t a l h e a l t h o f o t h e r f a m i l y members l i k e growing up?  . . .if yes. ..follow-up probe: (i) What was the of the mentally ill family member on the family?  affect  b. What h a s b e e n y o u r e x p e r i e n c e w i t h a l c o h o l i s m o r d r u g a d d i c t i o n growing up i n y o u r f a m i l y ?  follow-up (ii)  probes: (i) Who was the a l c o h o l i c or drug addict? How do you believe that has affected you today?  c. What h a s b e e n y o u r e x p e r i e n c e w i t h m e n t a l i l l n e s s o r a l c o h o l and o t h e r drug misuse i n your f a m i l y today?  Would Have Liked,  and Never  Received  17. One l a s t q u e s t i o n a b o u t y o u r f a m i l y - What w o u l d y o u h a v e l i k e d from your f a m i l y you never received? B e f o r e I a s k y o u some q u e s t i o n s a b o u t y o u r h e a l t h , a r e t h e r e a n y comments y o u w o u l d l i k e t o a d d a b o u t g r o w i n g u p i n y o u r f a m i l y ? The n e x t q u e s t i o n s I w o u l d l i k e t o a s k d e a l w i t h m e n t a l h e a l t h , a l c o h o l and o t h e r drug use, and s u i c i d e . These c a n be s e n s i t i v e i s s u e s f o r some p e o p l e . I would l i k e o n l y t h a t i n f o r m a t i o n you're c o m f o r t a b l e t a l k i n g about. P l e a s e don't answer a n y t h i n g you don't want t o .  Mental  Health  18. C r i s i s l i n e s r e g u l a r l y r e f e r c a l l e r s t o o t h e r s e r v i c e s i n t h e community. A l s o , community s e r v i c e s s u c h a s d o c t o r s , m e n t a l h e a l t h , a l c o h o l a n d d r u g p r o g r a m s , e t c e t e r a , w i l l recommend t o t h e i r c l i e n t s c r i s i s l i n e s as a p l a c e f o r between appointment support. We know f r o m e x p e r i e n c e a n d r e s e a r c h w i t h c a l l e r s t h a t many p e o p l e u s i n g c r i s i s l i n e s have had p r e v i o u s c o n t a c t w i t h mental health. They a l s o c o u l d be u s i n g mental h e a l t h s e r v i c e s presently. We u n d e r s t a n d t h a t s o m e t i m e s u p t o t h r e e q u a r t e r s o f o u r c a l l e r s c a n b e e x p e r i e n c i n g some t y p e o f m e n t a l i l l n e s s from p a n i c a t t a c k s , t o d e p r e s s i o n , t o s c h i z o p h r e n i a . Knowing a c a l l e r ' s mental h e a l t h background r e a l l y can h e l p c r i s i s l i n e s g i v e more u s e f u l s e r v i c e t o t h e i n d i v i d u a l . a. What t y p e o f m e n t a l h e a l t h s u p p o r t a r e y o u u s i n g ?  follow-up  probes:  (i) What type of treatment  and  201 medications  are you getting? (ii) What is that for? b. What h a s b e e n y o u r p r e v i o u s e x p e r i e n c e w i t h m e n t a l services? follow-up  probe:  (i) What was that  health  for?  Suicide 19. C r i s i s c e n t r e s o f t e n w e r e s t a r t e d t o h e l p t h o s e p e o p l e feeling suicidal. We know f r o m r e s e a r c h a n d e x p e r i e n c e w i t h c a l l e r s t h a t many p e o p l e t e l e p h o n i n g c r i s i s l i n e s a r e s u i c i d a l o r have been s u i c i d a l i n t h e p a s t . a . How o f t e n h a v e y o u t e l e p h o n e d t h e c r i s i s l i n e f e e l i n g suicidal? b. Have y o u e v e r a t t e m p t e d s u i c i d e ? ... . i f " yes, probes: (i) When was that? (ii) What were the circumstances around your suicide attempt? (iii) What type of help did you receive at the time? I would l i k e t o t a l k about a l c o h o l a n d o t h e r drug use n e x t . A g a i n , t h i s c a n b e a s e n s i t i v e a r e a f o r some. Y o u d o n ' t h a v e t o answer a n y q u e s t i o n y o u d o n ' t want t o . P l e a s e j u s t g i v e what information you're comfortable g i v i n g . Alcohol  and Other  Drug Use  20. A l c o h o l a n d o t h e r d r u g u s e i s v e r y common among p e o p l e , a n d c a l l e r s t o c r i s i s l i n e s a r e no d i f f e r e n t . Frequently people t e l e p h o n e t h e c r i s i s l i n e h a v i n g h a d some a l c o h o l o r d r u g s b e f o r e h a n d . Some o f t h e s e p e o p l e d o n ' t t h i n k t h e i r a l c o h o l o r drug use i s a problem. Other c a l l e r s worry about t h e i r use o f drugs o r a l c o h o l . a. What d o y o u t h i n k a b o u t y o u r a l c o h o l a n d o t h e r d r u g u s e ? b. What t y p e o f d i f f i c u l t i e s h a v e y o u h a d f r o m u s i n g d r u g s or a l c o h o l ? A r e t h e r e a n y o t h e r comments y o u w o u l d l i k e t o a d d a b o u t well-being o rhealth? Final  your  comments  I s t h e r e a n y t h i n g e l s e t h a t y o u w o u l d l i k e t o a d d now t h a t we a r e c l o s i n g the interview? Ending  Protocol  Thanks a l o t f o r y o u r h e l p . Would you be i n t e r e s t e d i n t a l k i n g about y o u r i n t e r v i e w once i t  202 was d o n e u p ? I c o u l d c a l l y o u b a c k o r y o u c o u l d c a l l me b a c k . w o u l d r e a d y o u a summary o f t h e i n t e r v i e w . T h a t way y o u c o u l d h e a r w h a t y o u s a i d a n d i f i t was r i g h t . > If yes, schedule necessary.  a call  back  time.  «options  Negotiate  date  I  and time as  box»  *  . . .for  caller  call  back...  Okay, y o u c a n c a l l me b a c k o n Tdatel number w i l l b e 8 5 6 - 4 2 7 4 . . . . a n d continue . . .for  with  interviewer  protocol  call  outside  options  The t e l e p h o n e  box.  back...  Okay, c a n I c a l l y o u b a c k o n f d a t e l Once  a t Ttimel.  a t TtimeT ?  scheduled...  What number c a n I r e a c h y o u a t ? . . .and record . . .and continue  telephone with  number with  protocol  > If no. . .and to continue.  outside  date  options  box.  .. .  Okay. W o u l d y o u b e i n t e r e s t e d i n f i n d i n g turned out? If  and time. . .  o u t how t h e s t u d y  yes. . .  Good. Y o u c a n p h o n e b a c k i n O c t o b e r t o me, R i c h a r d K r a m e r , a t 8 5 6 - 4 2 7 4 , my home, o r 5 3 4 - 7 9 2 1 , my w o r k . I ' l l t e l l y o u how i t turned out. If  no....  I w a n t y o u t o know, i f y o u p h o n e o t h e r c e n t r e s , o t h e r c r i s i s lines a r e asking c a l l e r s t o participate i nt h i s study as well. I ' m t e l l i n g y o u t h i s s o t h a t y o u know t h a t y o u may b e a s k e d again. And one l a s t t h i n g b e f o r e I go. I f y o u have a n y c o n c e r n s o v e r what y o u s a i d i n t h e i n t e r v i e w , o r f e e l u n c o m f o r t a b l e o r u p s e t b y how t h e i n t e r v i e w w e n t , p l e a s e c o n t a c t me, R i c h a r d K r a m e r , a t 8 5 6 - 4 2 7 4 , my home, o r 5 3 4 - 7 9 2 1 , my w o r k . I'm t h e r e s e a r c h p e r s o n  203 and r e s p o n s i b l e f o r t h e study, n o t t h e c r i s i s l i n e s . a v a i l a b l e t o h e l p you w i t h your concerns and unease.  I'm  A g a i n , t h a n k s a l o t . I r e a l l y e n j o y e d g e t t i n g t o know y o u . h e l p w i t h t h i s s t u d y i s v e r y much a p p r e c i a t e d . Take c a r e .  Your  204 Appendix F Initial  Codes  DESCRIPTION  CODE  QUESTION  THE CALL OR CALLING  [CALL]  can be thru out  CALL: CALL: CALL: CALL:  CALL-FRQ CALL-ORG CALL-REAS CALL-GETS  1 a b. 1 c d. 2 5 a  THE CRISIS LINES  [LN]  can be thru out  LN: CALLER LIKES, FINDS HELPFUL OR POSITIVE LN: CALLER DISLIKES,FINDS HINDERING OR NEGATIVE LN: CALLER HAS NEUTRAL OR UNCERTAIN REACTION REGARDING LN: HOW THE CRISIS LINES COULD CHANGE FOR THE PUBLIC FOR THE CALLER SOLELY LN: HOW CRISIS LINES ARE DIFFERENT FROM OTHER SERVICES LN: CALLERS' REACTIONS TO POSITIVE EXPERIENCE WITH CRISIS LINES LN: CALLERS' REACTIONS TO NEGATIVE EXPERIENCE WITH CRISIS LINES LN: HOW CALLERS' LIFE WOULD BE DIFFERENT IF CRISIS LINES CHANGED  LN-POS  3 a , 7.a., 8 a 3 b , v.b., 8 b  FREQUENCY OR REGULARITY ORIGINS OR START ISSUES CALLER PHONING WITH CALLER RECEIVING FROM CRISIS LINES  LN-NEG LN-MIX LN-CHNG LN-CHNG/PUB LN-CHNG/PRIV LN-DIFF LN-POS/REAC LN-NEG/REAC LN-CHNG/LIFE  3  7., 8.  9 a 9 a 9 a 10. c. 3 a , 7.a., 8 .a 3 b , 7.b.,8 .b 9 b  RECOGNITION OF THE CALLER BY CRISIS LINES OR THE TELEPHONE WORKER  [KNOW]  4  KNOW: POSITIVES OF RECOGNITION KNOW: NEGATIVES OF RECOGNITION KNOW: POSITIVES OF NOT BEING RECOGNIZED KNOW: NEGATIVES OF NOT BEING RECOGNIZED KNOW: DIFFERENCES BETWEEN THE TIMES RECOGNIZED AND TIMES NOT  KNOW-POS KNOW-NEG KNOW-NOT/POS KNOW-NOT/NEG KNOW-DIFF  4 4 4 4 4  THE CALLERS' LIFE  [LIFE]  can be thru out  LIFE: HOW CALLER'S LIFE HAS CHANGED SINCE PHONING CRISIS LINES LIFE: HOW CRISIS LINES CONTRIBUTED TO THESE LIFE CHANGES LIFE: HOW OTHER SERVICES HAVE CONTRIBUTED TO THOSE LIFE CHANGES LIFE: HOW OR WHERE THE CALLER'S LIFE IS STUCK LIFE: HOW CALLER HOPES LIFE WILL CHANGE  LIFE-CHNG  6 a  LIFE-CHNG/LN  6 b  LIFE-CHNG/OTH  6  LIFE-STCK  can be thru out  LIFE-CHNG/FUT  can be thru out  a b.c. a b. c c d  205 DESCRIPTION  CODE  QUESTIONS  CALLER'S SOCIAL SUPPORT NETWORK OF FRIENDS NET: CALLER'S SOCIAL AND SUPPORT NETWORK, AND RELATIONSHIPS WITH THOSE FRIENDS NET: RELATIONSHIPS WITH FRIENDS IN PAST NET: FREQUENCY OF CONTACT WITH SOCIAL AND SUPPORT NETWORK  [NET]  11, 12  NET-REL  11. a . ( i ) ( i i i ) ( i v 12. a. 11. a . ( i i )  NET-REL/H NET-FRQ  X  13, 15, 16, 17  CALLER'S FAMILY  [FM]  FM: RELATIONSHIPS IN FAMILY FM: RELATIONSHIPS IN FAMILY IN PAST FM: MENTAL HEALTH/ILLNESS OF FAMILY MEMBERS FM: MENTAL HEALTH/ILLNESS OF FAMILY MEMBERS IN PAST FM: VERBAL, EMOTIONAL, PHYSICAL, SEXUAL ABUSE AND NEGLECT IN FAMILY FM: ALCOHOL AND OTHER DRUG USE IN FAMILY FM: ALCOHOL AND OTHER DRUG USE IN FAMILY IN PAST FM: WHAT CALLER NEVER GOT FROM FAMILY FM: CHANGES IN FAMILY AS GROWING UP FM: FAMILY'S REACTIONS TO CHANGES  FM-REL FM-REL/H FM-MHTH  13. a.b.c. 13. d. 16. c.  X  FM-MHTH/H  16. a.  FM-ABU  15 and thru out  X  FM-A&D FM-A&D/H  16 c. 16 b.  FM-NOT FM-CHNG FM-CHNG/REAC  17 15 a. 15 b.  CALLER'S SPECIAL OR SIGNIFICANT OTHER  [SOT]  14  SOT: RELATIONSHIP WITH SPECIAL OTHER SOT: PAST RELATIONSHIPS WITH SPECIAL OTHERS SOT: NO CURRENT SPECIAL OTHER SOT: ABUSE BY SPECIAL OTHER  SOT-REL SOT-REL/H  14 a. 14 b.  SOT-NOT SOT-ABU  14 a. 14 and elsewhere  CALLER'S CHILDREN  [CHLD]  14 c.  CHLD: RELATIONSHIP WITH CHILD(REN) CHLD: NO CHILDREN CHLD: PAST RELATIONSHIP WITH CHILD(REN)  CHLD-REL CHLD-NOT CHLD-REL/H  14 c. 14 c. 14 c.  THERAPY OR COUNSELLING  [THPY]  10  THPY: POSITIVE EXPERIENCES WITH THERAPY OR COUNSELLING THPY: NEGATIVE EXPERIENCES WITH THERAPY OR COUNSELLING THPY: FREQUENCY OF CONTACT WITH THERAPY OR COUNSELLING THPY: HOW THERAPY OR COUNSELLING DIFFERS FROM CRISIS LINES THPY: THERAPEUTIC ABUSE  THPY-POS  10 b.  THPY-NEG  10 b.  THPY-FRQ  10 a.b.  THPY-DIFF/LN  10 c.  THPY-ABU  10 and elsewhere  X  x  X  DESCRIPTION  CODE  QUESTION  CALLER'S EXPERIENCE WITH MENTAL HEALTH  [MHTH]  10, 18  MHTH: CALLER'S MENTAL HEALTH AND EXPERIENCE MHTH PAST EXPERIENCES WITH MENTAL HEALTH MHTH FREQUENCY OF CONTACT WITH MENTAL HEALTH MHTH HOW MENTAL HEALTH DIFFERS FROM CRISIS LINE  MHTH  10.a.b., 18.  CALLER'S PHYSICAL HEALTH OR EXPERIENCES WITH MEDICAL SERVICES PHTH  CALLER'S PHYSICAL HEALTH AND EXPERIENCE PAST EXPERIENCES WITH PHYSICAL HEALTH FREQUENCY OF CONTACT WITH HEALTH SERVICES  MHTH-H  18. b.  MHTH-FRQ  10.a.(i), 18  MHTH-DIFF/LN  10.c.  [PHTH]  10  PHTH  10.a.  X  PHTH-H  10. a.  PHTH-FRQ  10.a.(i)  CALLER'S CONTACT WITH OTHER COMMUNITY SERVICES  [COMY]  10.a.  COMY: CALLER'S EXPERIENCE WITH OTHER COMMUNITY SERVICES COMY: FREQUENCY OF CONTACT WITH THESE SERVICES  COMY-OTH  10. a.  COMY-OTH/FRQ  10.a.(i)  SUICIDE  [SUI]  19  SUI: FREQUENCY OF SUICIDAL THOUGHTS AND FEELINGS SUI: SUICIDE ATTEMPTS  SUI-FRQ  19. a.  SUI-H  19. b.  CALLER'S ALCOHOL AND OTHER DRUG USE  [A&D]  20  PHTH PHTH  A&D: (^LLER'S PERSONAL EXPERIENCES WITH ALCOHOL AND OTHER DRUG USE  X  X  A&D  20. a.b.  207 Appendix G P a t t e r n Codes CODES  DESCRIPTION  VICTIM  VICTIMIZATION: T h i s i n c l u d e s t h o s e i n c i d e n t s where the c a l l e r s a r e a c t u a l l y p h y s i c a l l y , v e r b a l l y o r e m o t i o n a l l y abused b y family, s p e c i a l others o r helping professionals. T h i s a l s o i n c l u d e s where the c a l l e r s a r e neglected. Also, this includes t h o s e c i r c u m s t a n c e s where t h e c a l l e r s a r e u n a b l e t o g e t what t h e y need, o r d e n i e d a s e r v i c e , o r h a v e some s e r v i c e f o r c e d o n t h e m b e c a u s e o f t h e i r r e a l o r p e r c e i v e d l a c k o f power i n t h e s i t u a t i o n .  ESTEEM  SELF-ESTEEM B U I L D I N G / EMPOWERMENT: T h i s encompasses t h o s e q u a l i t i e s a n d i n t e r a c t i o n s that the c a l l e r s have phone w o r k e r s , p r o f e s s i o n a l s a n d s i g n i f i c a n t o t h e r s i n t h e i r l i v e s w h i c h enhance t h e i r s e l f - e s t e e m a n d empower t h e m t o h e a l t h i e r living. F o r example: v a l i d a t i o n , a c c e p t a n c e , acknowledgement o f them a n d t h e i r e x p e r i e n c e , i n f o r m a t i o n a n d r e f e r r a l s , b r a i n - s t o r m i n g a n d new perspectives on t h e i r concerns. Their actions i m p l y empowerment a n d e s t e e m when t h e y a r e a b l e t o stand-up f o r themselves; take a c t i o n s which improve t h e i r p h y s i c a l , mental o r emotional h e a l t h ; and chose h e a l t h i e r , l e s s dependent r e l a t i o n s h i p s f o r them s e l v e s .  LONELY  ISOLATION: T h i s i n c l u d e s t h e c a l l e r s e x p r e s s i o n s of l o n e l i n e s s a n d i s o l a t i o n from o t h e r s due t o their physical or financial limitations, their l a c k o f a p p r o p r i a t e s o c i a l s k i l l s t o engage t h e i r support network o f f a m i l y o r friends, and t h e i r emotional o r mental challenges. The i s o l a t i o n t h e y h a v e e x p e r i e n c e d i s shown i n t h e a b u s i v e a n d d y s f u n c t i o n a l f a m i l i e s t h a t t h e y have grown up i n w h i c h hamper t h e i r c o n n e c t i o n s w i t h t h e f a m i l y a n d a s o c i a l n e t w o r k . Where t h e i r f a m i l i e s a n d o t h e r s a r e n o t a v a i l a b l e t o them, t h e c a l l e r s a r e isolated.  208  CODES  DESCRIPTION  CONNECT  CONNECTION: T h i s e n c o m p a s s e s t h e c a l l e r s b u i l d i n g r e l a t i o n s h i p s and connecting w i t h others, l i k e f r i e n d s , c r i s i s l i n e s , f a m i l y members, a n d h e l p i n g professionals. C o n n e c t i n g w i t h o t h e r s i s shown through having f r i e n d s h i p s and s o c i a l time w i t h others and having conversation and being l i s t e n e d to b y h e l p e r s . Rapport and contact i s there i n the r e l a t i o n s h i p w i t h t h e f r i e n d , f a m i l y o r professional. Also, connection i s implied by the c a l l e r s being emotionally understood and u n d e r s t o o d g e n e r a l l y , a n d where t h e y s h a r e s i m i l a r experiences w i t h helpers.  

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