Patterns of phone coaching in dialectical behavior therapy : frequency and relationship to therapeutic alliance, suicidal behaviors, and baseline severity

Telephone coaching is a mode of treatment in Dialectical Behavior Therapy (DBT) that is thought to help clients generalize skills, prevent suicidal behaviors, and offer an avenue to repair the therapeutic relationship. To date, phone coaching has received scant empirical investigation and little is known about the type and frequency of contact that DBT therapists receive from clients with Borderline Personality Disorder (BPD). In addition, no studies have investigated predictors of phone coaching use. The present study as three aims: 1) describe patterns in frequency of telephone calls and text messaging between clients and their individual therapists; 2) investigate whether baseline severity and suicidal behaviors are predictive of phone coaching frequency; 3) investigate whether the strength of the therapeutic alliance is associated with phone coaching frequency. Study participants were 51 adults (35 treatment completers) with a primary diagnosis of BPD who attended a six-month comprehensive DBT treatment program. The average number of contacts for phone coaching per month was 2.55 (SD=4.49) with a range of 0-18 contacts. Four of the 35 treatment completers comprised 56% of the contacts in this study. The most frequent reason clients used phone coaching was for help with skills generalization followed by check-ins, suicidal behaviors, and issues related to the therapy relationship. Having a recent history of suicidal behaviors, degree of severity at baseline, or the strength of the therapeutic alliance were not predictive of phone coaching use at post-treatment. Lower income was significantly associated with a higher frequency of phone coaching use. These results can help clinicians and administrators to make decisions on how to better provide phone coaching and clarify the effort that is involved in providing this service to clients with BPD.Psy.D.Includes bibliographical referencesby Pedro Vieira de Oliveir