The empirical research pertaining to the effectiveness of telephone counseling and referral systems personnel was critically reviewed. The assessment was organized according to several evaluation strategies that researchers have utilized to evaluate effectiveness. These strategies included, for example, client self-reports, client "shows" versus "no-shows" following referral, data pertaining to suicide rates, counselor ratings of personal effectiveness, and phone workers' ability to offer empathy to clients. It was concluded that discussions of effectiveness should be constrained by a careful consideration of the specific index of efficacy chosen by investigators as well as methodological issues associated with current research in this area. There is reason to believe that the availability of telephone crisis services may be related to reduced suicide rates among young white females. Also, there is a significant need to empirically associate counseling technique and indices of effectiveness with substantive measures of client outcome in future research. Additional topics reviewed include the probable differential effectiveness of lay workers with various presenting problems of clients, and the role that training and maturity seem to play in successful interventions. Guidelines for the use of evaluation techniques which coincide with service goals are also offered.