God bless anyone who works on a crisis line (a.k.a. a suicide line). The work can be very demanding and almost everyone who does it does it for free. It's also easy to burn out and to shuffle it out of your life whenever it's inconvenient. I have worked on one for two years and I'm actually starting this write-up at the tail end of a shift (the phones are quiet today—it's 2:55 a.m. on a Monday). I work on a late night (midnight to 3:00) shift, so I only get a few calls at most but they are almost always serious.
If you are reading this and work on a line or are considering working on a line, you should understand that nothing I say is evidence-based research nor is it a professional opinion: I am not a specialist. I am simply someone who has done this for awhile and I've found a few things that work. This is not legal or medical advice. What follows should augment but in no way replace your professional standards or better judgement. These are simply things that I wished I knew when I started and instead had to make up on the fly when someone was crying about having been raped. Some facts have been altered for anonymity's sake but they don't change what I recommend.
Tips and tricks in no particular order:
- Review your training, possibly periodically. For many of us, we go through a week of training (in my case, Applied Suicide Intervention Skills Training or ASIST) and then we move on and get into a groove of what works for us. It's worth revisiting for a few reasons. First off, we might forget what we learned and there is valuable information in that training. Furthermore, the training itself can change and improve. Since we don't go to the office every day, we don't see the internal memos. It's worth it to try to attend a day of training maybe once every six months just to see what it's like and share your experience with new trainees.
- Take a break. This is true in any job. You will experience burn-out and your work will suffer. For a few of us, a vacation isn't necessary. For most of us, it is. This isn't you being a bad person or being lazy, it's you doing self-care. If you're still on the fence, think of it this way: You will be better at your job if you can recharge your batteries and come back refreshed. There are ample data about how productivity declines as you overwork or when you work while distracted by illness and your personal life. Sometimes, you have to take a break due to personal factors. I knew someone who was murdered after I'd been working on the line for a year. I knew that if I talked to a caller who had an experience that hit a little too close to home, I might have a breakdown on the phone and that would not help the caller nor would it help me. Do what you have to do to keep from becoming overwhelmed and eventually quitting altogether.
- Leave good notes. You will receive many calls of the type, "Yeah, I lost my prescription and I need a new one" or "I need directions to the hospital." These calls are simple referrals and can be dealt with swiftly. Other calls seem substantial at first but then turn out to not be once you get into them. This is where you writing good notes for your fellow operators comes in handy. For instance, I received a phone call from someone who sounded like he had some mental retardation his call was mostly him talking about his day and needed some simple placating, which I did for about 10 minutes before trying to wrap up the conversation. I asked if he had anything else that he needed to discuss and made casual reference to child molestation. I put the brakes on it and probed more to figure out if he was being abused or had been abused, if he needed any intervention, etc. I went to the logs to see what had been written before about his previous calls and it turns out that he was a convicted sex offender (on the registry and everything) and he calls the line to talk about molestation for sexual gratification. I should have immediately terminated the call. Instead, I wasted my time and tacitly taught him that it's okay to call us when in fact he was banned. This was a stupid error on my part that I could have avoided had I read the helpful notes that were left to me instead of being lazy.
- Not all callers are the same and your responses should not all be the same. The first half of this advice is evident but the latter needs a little explanation. Simply put, there are things that I will say to some callers that I will not say to other callers. When to say what is a judgement call that only you can make but I want to provide some examples of when I bent the rules or made an exception to what is usually best practice:
A teenager calls about shooting up his school. This is a very serious and delicate situation. It's hard to know what to do about this call. I received it and I was lucky enough to have previous call logs from this caller and had some context for how to talk with him. It turns out that he had called us before a few times and he was actively being monitored by the police after having made several rape and death threats to his fellow students (he was suspended from school when he called).
The reason he was calling was not because he was trying to telegraph an actual crime, nor was he asking for help. Instead, he called because he wanted to shock someone and feel like a big man. His call was mostly about trying to trick me into saying something contradictory or showing how he was smarter than the cops and therapists and his parents. Once I figured out that this was his modus operandi, I knew that I could challenge him and push back some. I pointed out his contradictions and called BS (in polite terms) when he made fantastical or demonstrably false claims. Keep in mind that I was not combative: I just used his own words and methods against him.I did not get crass and I did not let him control the conversation by going down the rabbit hole of endless debates and tangents. At the end of the call, he told me that I was the only person that he knew who was as smart as him and he asked if I would give him my Steam account info so we could game together (I declined). The take-away here is not that you should try to garner the respect of every caller but that in this very narrow and particular circumstance, the best thing I could do was fight fire with fire in a measured and professional way. I called the cops afterward. The caller called back again two weeks later and he and I had another conversation that went something like the first one.
I have received a few threats from actual violent callers. Some are violent to themselves and some to others. I have received calls from someone who has already overdosed (I called an ambulance, she survived) and from callers who threatened to kill cops. (Once, I got a call from someone who was seriously depressed and we scheduled a call-back for a week later. She answered that she was doing better now but she had overdosed right after we hung up the phone and almost died.) It takes a kind of judgement without judgementalism to figure out how serious these threats are. They aren't like the attention-getting teenager above: these are adults who are in the process of doing something to end their lives or others'. Calls like this are rare but you should be prepared for them. Don't show that you're alarmed and try to get as much information as possible about the person's identity, location, and what their plan is but do it without being explicit. If someone like this senses that you're trying to thwart his plan, he'll probably just hang up immediately.
As an aside about the cop-killing callers, they both occurred on the same night. I called 911 after the first one and reported it and then called back and got the same dispatcher 90 minutes later who said, "This is weird but I got virtually the same call a little while ago..." "Yeah, that was me—weird night." Neither man has done anything to follow through with his plan.
- I sometimes get calls from psychotic callers. Their apprehension of reality is warped. It's still possible to talk to them with compassion and respect even though what they are saying has no basis in reality. The way that I will discuss the angelic visions of light that dance around them is validating to their feelings and experience without actually affirming that these things are true. By definition, someone suffering from a delusion is not going to be talked out of it and certainly not by an anonymous stranger on a phone line. For callers like this, it's usually best to let them vent for awhile because they may literally have no one who is willing or able to listen to what they have to say. You mileage can vary widely with this advice, though and you should never let that person monopolize your shift. It's a fine line but I would definitely recommend that you familiarize yourself with the disordered and chaotic thinking of schizophrenia before you have to have a conversation with someone psychotic (I was fortunate enough to have worked in the special needs field for a decade prior to this, including with clients who were psychotic). I would recommend doing some light reading on the topic from a psychology textbook or if you are more adventurous, reading Is There No Place on Earth for Me? by Susan Sheehan (ISBN 0804169187).
- I get callers who are drunk/high/stoned/strug out/otherwise intoxicated. These are some of the most difficult calls. It's virtually impossible to make any progress with these and even if you did, it's likely to all be undone when the person gets sober (or is momentarily sober between scoring drugs). Just as above, it's definitely possible to be helpful and kind—nothing is stopping you from actively listening, reflecting back the caller's feelings, etc. Just be aware that there is a very short shelf-life on any advice you can give or headway that you can make. For many of these callers, the best thing you can do is convince them to sleep.
- The only thing more difficult than psychotic callers and ones under the influence are sex abuse cases. These calls are brutal and in my experience, they are oftentimes the first time that someone has ever spoken about what has happened. These callers will need a lot of time to talk so you should assume that you will be in this one for awhile. In my training, we were advised to have a talking to silence ratio of about 1:4 (that is, we should only be talking about 20% of the time and the rest should be the caller talking or no one talking). In these cases, you may want to let it drop to 1:10. Someone working through sex abuse for the first time will need a lot of space. Similarly, I had a call from a woman whose toddler son had recently drowned in the family's pool. As you can imagine, there was survivor's guilt, the death put a huge strain on her marriage, there was trauma for the surviving siblings, etc. This woman didn't need to hear anything I had to say: she needed to talk and let it out. The best thing I could do was be quiet with the occasional, "That has to be so difficult" and "I understand—you're really struggling". The upside in this case was that she was a medical professional for several years who had experienced death and had also had her father die when she was young. She had a strong support network, had already seen several therapists and gotten a prescription which was working for her, and was taking leave from work. She was a competent and capable professional with a safety net but that's not true for most callers.
- Make use of stock phrases but never make them seem like stock phrases. If you use some trite cliches like, "You're too blest to be strest" then you will come across as disinterested and shallow. Also, you will be. There are no silver bullets that will "cure" depression over the phone. Nothing will. Eventually, you will hang up and that person will have a life to live that has all the same problems as before. All you can do is try to help ease a moment of crisis. And sometimes, it's effective to use some tricks that you can keep in your back pocket and introduce them if you think they will be useful:
If a caller is suicidal, let him know that suicide can always be Plan B. I realize that this may seem controversial for some of you and it may not be the right thing to say in every case but I've found it very effective for a few reasons. First off, talking about suicide doesn't make someone suicidal: anyone who calls the line has already thought of it; this isn't a novel idea. I've had callers who had clear and specific plans and methods chosen with timelines and suicide notes. Nothing I would say would encourage suicide. Instead, telling them that they can always have suicide as an option gives them agency.
A common—but not universal—feature of suicidality is that the person feels like he's not in control of his life. Saying that he's allowed to commit suicide and that it's his choice to make but you hope he doesn't choose it can be very empowering. It can also give some relief to the feelings of fatalism about how suicide is inevitable. I've found this to be a powerful tool that you can use when some other options have been exhausted.
- Oftentimes, depression and the associated feelings of guilt, shame, and isolation are framed as being for others' benefit. E.g. "I don't want to burden my friends with all my problems" or "I just feel like my family would be better off if I weren't here". This type of thinking is heart-breaking but at it's core, there is a very good and altruistic impulse: these suicidal callers aren't being selfish but selfless. I've found that when someone starts talking this way, you can encourage to caller to imagine someone just like him with the same problems. Say something like, "Imagine if you had a friend from high school and you two reconnected after several years. And this friend says that he has all the same problems you just mentioned and feels like a burden, and so on. What would you tell that friend?" Invariably, that person will say, "It's not a burden—you deserve to be happy. I want to help you. Have you reached out to anyone yet?" Stepping outside of your own circumstance and viewing objectively (even if for a moment in a hypothetical scenario) can be a powerful way of refactoring the conversation.
Suggest journaling and writing letters to throw away. The nice thing about these activities is that they are very low-cost and can be very cathartic. Suggest to callers that journaling can take many forms (just like our daylogs): maybe one day you write out what happened to you and how you felt and another day you write a poem that comes to mind. Maybe on another day, you talk a walk and find a feather that you press between the pages which represents that day to you. Another nice feature of journaling is that it keeps things for posterity's sake. A caller can look back on something that seemed like an insurmountable crisis six months ago but which barely registers in his memory now. Clearly, he was stronger than he realized.
A variation on this is writing a letter to throw in the trash or acting out a conversation in the mirror. They can use these opportunities to tell someone exactly how he feels without the possible fallout from telling off someone. Plus, it allows you to organize your thoughts so that if you have a confrontation with someone in the future, you can clearly explain yourself and get to the point without getting emotionally overwhelmed and rambling or having your legitimate feelings degenerate into name-calling and threats.
Don't read the news. Don't Facebook stalk someone. Really don't actually stalk someone. You will feel the urge or at least temptation to follow up with someone outside the boundaries of the crisis line. This might be the best advice that I got in all of my training: my mentor Morris frequently interacts with a regular caller who talks about her daily life and has mentioned several times the grocery store where she works. One day, he was on that side of town and considered stopping in to see what she looks like—put a face on the voice. But that was too much. Not say "hi", not follow up on her most recent call. Just looking at her would cross the line.
Similarly, don't read the news to follow up on if someone followed through. If you read the obituaries, you will only ever get bad news. I once got a call from someone who was in the middle of a news story at the time: she was a professional caretaker for children and had been in the newspaper and on television nationally for alleged abuse. Luckily, I had not seen the newspaper that day, so I had not formed some prior opinion about her being guilty or an abominable person or whatever thing would have clouded my judgement and compassion (due to my personal failings). Try to leave the calls after you hang up the phone knowing that you did all you could do.
There are many crisis line operators far more experienced and skilled than me. My advice is just my own and will not work in every scenario. Sometimes, it should be applied with delicate care to avoid exacerbating a situation. But I have found these suggestions to work time and again when they are appropriate. Maybe you will as well.
A note on this write-up: I anticipate getting feedback from others and amending this as appropriate. I intend to change this write-up itself and welcome anyone who wants to attach their own write-ups to this node. If you have any words of wisdom that you want added, please message me and I can add them with or without attribution.