While DBT phone coaching serves the important function of providing after-hours consultation

to clients, it is not expected that a therapist be immediately available always. In fact, being immediately available may actually reinforce passive dependent behaviors (Manning, 2011). Furthermore, occasions may occur when the therapist is in a location where confidentiality cannot be assured or perhaps the therapist has their own crisis to manage at that particular moment. An important aspect of orienting a client to phone coaching is communicating to your client what they can expect if a clinician is C59 datasheet not available at the time they call. As demonstrated in the video, when unavailable the therapist can place a brief call to the client explaining that they cannot CHIR-99021 nmr coach right in that moment and provide information as to when the client can expect a call back. In the interim, clients should be instructed to use their skills. During the orientation therapists should instruct their clients that if they feel that they cannot keep themselves safe they should call 911. Most important, clients should also be informed about the clinician’s personal limits around telephone contact. In DBT each therapist is asked to observe their own personal limits. While all DBT clinicians need to be able to observe their

own limits, they must also make a good-faith effort to be available to their clients. Bongar (1991) has suggested that those individuals who work with suicidal clients need to make them available after hours. DBT takes this commitment very seriously. Being available during weekends is particularly

important as this is often a high-crisis time period for clients. Thus, individuals who aspire to be DBT therapists must be certain that providing after-hours phone coaching is within their own personal limits. Therefore, some individuals on a DBT team may find that they have broader limits (e.g., access to their therapist anytime) whereas others may set firmer limits around this (e.g., turning a pager off at 10:00 p.m.). Different therapists having different limits can result in discourse among G protein-coupled receptor kinase clients. Sometimes clients are angry or hurt that their therapist’s pager is turned off at 8:00 p.m. when another therapist leaves their pager on all night. In DBT, this is explained to clients by describing the third therapist consultation agreement, titled, the consistency agreement. The consistency agreement states that the role of the treatment team is not to provide consistency for each and every client. In fact, consistency is rarely found in the real world. Thus, differences and inconsistencies in limits among therapists are viewed as an opportunity to generalize DBT skills to the natural environment. An important aspect of phone coaching is to shape clients into skill use. One way to do this is to insist that clients use two DBT skills prior to calling.