Q. Can clients just call whenever they want? How can anyone be that available?
A. Clients can call and leave a message or text, and then it is ok for you to get back to them when it is convenient. In the real world help is not always available instantaneously. It is helpful for clients to know the latest that you are likely to return their call – for example if you always check your messages last thing at night or first thing in the morning. But even then they must have a plan B for if they do not hear from you.
Q. Won’t clients be ringing the whole time for support? Lots of clients are lonely.
A. The function of the telephone contact is to help clients select and implement the appropriate skill at the appropriate time. It is a way of them generalising skills learned in group to their everyday life. Therefore calls are likely to be brief and focussed. If the client is lonely the skills coached would be those to combat loneliness. If the client over-used telephone contact then that would be a therapy-interfering behaviour and a chain and solution analysis would be conducted.
In reality the most common problem is that clients don’t call.
Q. What if I get a really suicidal client on the phone and can’t talk them out of it?
A. It is important to follow the DBT risk management protocols and to know your organisation’s policy for these circumstances. For example, who is the duty manager or what are the out-of-hours procedures? These are your back-up plan. Remember, though, that clients who call for coaching have already been skilful in calling you, and by following the DBT principles it is usually possible to encourage some skilled behaviour. De-motivating the therapist by misusing telephone contact would also be a therapy-interfering behaviour and subject to behavioural analysis.
Q. I’m really anxious about doing it.
A. That makes perfect sense, as it may be a very big shift from your usual practice. Unwarranted anxiety can be diminished via exposure and it is unlikely to reduce until you experience what you fear. It is only by trying it out that you are able to dispel some of the myths. Remember that if this was a modality of therapy that caused therapists a lot of problems they simply wouldn’t do it.
Q. Because none of us want to do phone contact we have trained the regular out-of-hours staff to handle DBT calls. Will that suffice to meet the function of generalisation?
A. Certainly this will help your clients to generalise skills. It is an example of out-sourcing a component of DBT from your program. However, unless the people offering skills coaching are part of your consult meeting, this out-sourced system will not be considered as part of your actual DBT program. This may become important when the program accreditation system comes into force, as your program may not meet the criteria.
Q. Our program is on an in-patient unit so there is no point in client’s having access to their individual therapist – can’t they just ask any of the staff on the ward for help?
A. As long as the staff on the ward forms part of the consult team then this provide the function of helping the client to generalise skills. However, it is still worth considering the merits for your clients in having access to the therapist who knows them best, and knows what they are working on in their target hierarchy. Even though another member of staff is involved, the client may call her individual therapist from the ward to get coaching on how to behave skilfully.