The fourth treatment modality, and perhaps the most radical departure from other approaches used to treat BPD, is the use of telephone coaching as a standard operating procedure in DBT. Telephone coaching assists therapists in balancing the dialectic of providing

additional contact to clients during crisis periods while simultaneously extinguishing passive, dependent behaviors and reinforcing active, competent skill use (Linehan, 1993). All clients enrolled in DBT are given access to their therapists between sessions and after hours to assist in the generalization of skills taught in the group skills training sessions (Linehan). While considerable attention in the literature has been devoted to DBT individual therapy and group skills training, only eight papers have been published on telephone coaching (Ben-Porath, Selleck UMI-77 2010, Ben-Porath, 2004, Ben-Porath SCR7 molecular weight and Koons, 2005, Koons, 2011, Limbrunner et al., 2011, Linehan, 2011, Manning, 2011 and Wisniewski and Ben-Porath, 2005). Koons (2011) has described the important role the DBT consultation team plays in maintaining fidelity to phone coaching and preventing burnout in the therapist. Steinberg, Steinberg,

and Miller (2011) have described important and critical issues related to DBT telephone coaching when working with adolescents and families. Wisniewski and Ben-Porath Thiamet G (2005) have adapted the DBT telephone coaching model for BPD to patients with eating disorders. However, what is glaringly absent from the literature is

a basic overview of how to orient new clients to DBT phone coaching. Indeed, Manning (2011) identified failure to orient DBT clients to phone coaching as one of the most common errors clinicians make when implementing DBT telephone consultation. Given that phone coaching is not a standard operating procedure in most therapies, it is important to address this area as many clinicians are unsure how phone coaching differs from intersession crisis-oriented contact. Thus, the goal of this paper is to highlight the functions of phone coaching in DBT and describe how to orient clients to phone coaching who are new to DBT. Research demonstrates that when individuals are informed of goals and expectations in treatment, compliance in therapy increases. For example, Yeomans et al. (1994) have demonstrated that when clients are informed of their expectations and responsibilities in treatment, premature termination decreases and compliance to treatment increases. In spite of this, many clinicians fail to orient their clients to treatment. For example, Kamin and Caughlan (1963) interviewed former clients about their experience in treatment and found that almost 75% had no clear understanding of their role or the role of the therapist.