Phone coaching is an aspect of DBT that distinguishes it from many other types of therapy. Phone coaching is a component of adherent DBT and is included within the treatment. The primary function of phone coaching is to help people who are learning DBT skills in a group setting and talking about them in individual sessions actually use those skills in day-to-day moments. In technical terms, this is called “skills generalization,” which means increasing one’s ability to use skills in different situations. When someone is faced with a scenario that they are struggling to be effective in (that is, struggling to use skills to help manage a situation), phone coaching can help by allowing people to call or possibly text their primary therapists to get more immediate help using skills rather than waiting until their next appointment.
So what does phone coaching actually look like, and when can someone use it? Phone coaching works when a person reaches out to their therapist before engaging in an ineffective behavior. In other words, if a person has an urge to do something ineffective (such as self-harming, storming out of an event, or yelling rude things at a loved one), phone coaching can help that person use skills instead of acting on those ineffective urges. When reaching out for phone coaching, it is recommended that the person identifies their emotion and intensity of that emotion, any skills they have already tried, and what their goal is for the phone coaching call (for example, help with calming down to resume participating in an activity). Telling these things to the therapist during the call will help them know more about what is going on and what next steps to recommend.
Phone coaching is usually short, generally in the realm of 5-10 minutes, and is about using skills in the moment. It is not about doing major problem-solving or diving deeper into behavior patterns. Looking at patterns, perhaps by completing a behavior chain analysis to look at what led to the ineffective urges in the first place, may happen in the next full session.
It is important to know that phone coaching is not a crisis line and that each therapist has their own limits around when they are available for phone coaching. For example, therapists are often not “on-call” with their phones unmuted in the middle of the night while they are sleeping. The primary therapist will communicate what their specific limits are, including hours each day, days of the week, any holiday restrictions, etc., so it is clear when they are open to phone coaching. It is also important to know that while the goal of phone coaching is to help someone use skills in the moment, the therapist is not expected to drop whatever they are doing to respond to a phone coaching call – if they are in a different session or otherwise preoccupied, they will respond in a short period of time. This “short period of time” may also differ from therapist to therapist, usually in the range of a few hours if during the day, and is another limit that will be communicated ahead of time so you know how long it may take for your therapist to get back to you.
Phone coaching is a vital part of DBT. Someone can have the entire “language of DBT” memorized, know every acronym, and be able to talk about the skills masterfully during group or individual sessions; however, using skills in a moment when they are really needed can be a lot more challenging. Those real-life moments are where phone coaching can be used to help you apply what you are learning when you need it most.
Written by, Kevin Rowen, PsyD