Clinical Grand Round 1 - Debunking Myths of Phone Coaching in Dialectical Behavior Therapy

Phone coaching between sessions is a critical treatment mode of Dialectical Behavior Therapy (DBT) that functions to mitigate crisis, enhance therapeutic alliance, and generalize skillful behaviors learned in the natural environment. It is also the least frequently adopted DBT treatment component, in part due to concerns of its impacts on therapist burnout. Clients in DBT often present with life-threatening behaviors and other problems that are difficult to treat, which may make phone coaching intimidating and stressful for therapists. However, some of the therapists’ concerns may be due to myths and not facts about phone coaching.

The invited panelists aim to discuss and debunk the myths of phone coaching when working with clients with suicide risk and emotion regulation difficulties in DBT. Panelists will identify common misconceptions therapists have about how DBT phone consultation is implemented, critically discuss the challenges to effective phone coaching (e.g., therapy interfering behaviors), and clarify the rationale, utility, and procedure of phone coaching.

Specifically, myths around when the phone coaching is utilized between sessions (e.g., “It is the same as suicide crisis management”), what treatment principles underly phone coaching to target acquisition of skillful behaviors and reduction of maladaptive ways of coping (e.g., “Phone coaching fosters dependency”), and the procedure of phone coaching, such as the timing, length, and structure (e.g., “Therapists must be available 24/7”), will be discussed. Important considerations of therapist limits around phone coaching will also be presented, along with concrete clinical examples and relevant research findings to illustrate the effective use of phone coaching.