Telephone coaching in dialectical behavior therapy: A decision-tree model for managing inter-session contact with clients

Several studies have indicated that telephone coaching can play an important role in psychological intervention (Beebe, 2001; Burgess & Chalder, 2001; Meyersberg, 1985). Less well understood, however, is the role of telephone coaching with severe, complex, multiproblem clients, such as those diagnosed with borderline personality disorder. Dialectical behavior therapy (DBT), a comprehensive, cognitive-behavioral treatment, provides structure and guidance in this area by describing a target hierarchy relevant to telephone coaching. In order of importance, the targets to be addressed in DBT telephone coaching are: (1) decreasing suicidal/nonsuicidal self-injurious behaviors, (2) increasing generalization of behavioral skills, and (3) decreasing the sense of conflict, alienation, and/or distance from the therapist (Linehan, 1993a). This article introduces a decision-tree model for telephone contacts based upon the DBT target hierarchy for telephone coaching. The decision tree model is designed to: (a) assist therapists in identifying the type of phone call received from clients (e.g., calls related to suicide attempts/nonsuicidal self-injurious behaviors, skills generalization calls, relationship repair calls, or inappropriate calls); (b) outline a priority course of action; and (c) suggest which skills and principles of DBT apply in which circumstances.