Alexander L. Chapman, Ph.D., R.Psych., a DBT_ LBC Certified Clinician, is the President of the DBT Centre of Vancouver, as well as the director of the Personality and Emotion Research Laboratory at Simon Fraser University, where he studies the role of emotion regulation in BPD, self-harm, impulsivity, and other behavioral problems.
A DBT Trainer and Consultant for Behavioral Tech, Dr. Chapman has published numerous scientific articles and chapters on these and other topics and has given many scientific presentations on his research.
In addition, he regularly facilitates local, national, and international workshops on DBT and the treatment of BPD, as well as provided expert training and supervision to clinicians in Canada, the U.S., and the U.K. Dr Chapman has agreed to speak with us regarding his latest publication Phone Coaching in Dialectical Behavior
Therapy, as well as lend his perspective on DBT – LBC Certification.
Q. One of your latest publications is the Guildford DBT Practice Series book Phone Coaching in Dialectical Behavior Therapy. Having an entire book dedicated to successfully navigating this standalone mode of DBT is long overdue. What made you decide to take on this topic?
Although the idea of phone coaching sometimes strikes fear into the hearts of clinicians, this mode of DBT is a critical way to generalize or transfer what clients are learning to difficult situations in their everyday lives. The vast majority of the time, phone coaching calls are effective, helpful, and at times, maybe even life-saving. Through many years practicing DBT and being a member of DBT consultation teams, I realized that phone coaching is often misunderstood, experienced as burdensome or difficult to fit in, and that therapy interfering behaviours during phone coaching are often the most challenging behaviours to manage.
Many of our team discussions have focused on ways to effectively navigate challenges in phone coaching, keep calls brief, helpful and focused on skills, and so forth. Interestingly, very few pages of Marsha Linehan’s original DBT text (Linehan, 1993a) focused on phone coaching.
I wanted to combine the wisdom I have gleaned from working with DBT masters earlier in my career (Dr. Clive Robins and Dr. Thomas R. Lynch, Dr. Marsha Linehan, Dr. Katie Korslund, and other clinicians at the BRTC) with my experiences since then and put together a practical guide to this essential component of DBT. My hope was that, using this book as a resource, clinicians would feel enthusiastic about using phone coaching and confident that they had practical strategies on hand to make phone coaching effective and manage common challenges.
Q In the text, you address common phone coaching myths, build a structure for establishing effective intervention, and share strategies for effective collaboration and shaping. As a DBT supervisor and trainer, have you noticed common points of “drift” from phone coaching? Would you be able to note some of those for a therapist working to practice fidelity to DBT?
Yes, there are several ways in which drift occurs with phone coaching.
One common area of drift involves clinicians focusing on topics other than skills during phone coaching calls. Therapists sometimes do the same things during phone coaching calls as they do during individual therapy sessions, turning phone coaching into brief therapy sessions on the phone. Phone coaching is essentially skills coaching on the phone; thus, the focus should be on skills. I usually start my phone coaching calls by asking my clients for a brief summary of the problem they’re dealing with and the skills they’ve already tried. I also remind them that we’re going to focus on skills they can use in the short-term to deal with the situation. Early in therapy, I orient clients to the skills-focused nature of calls, so they are aware that phone coaching is not individual therapy on the phone. I’ve often found that, when clinicians remain focused on skills, other areas of drift tend to… drift away.
A second area of drift is that clinicians sometimes have difficulty keeping calls brief and to the point. They stay on the phone too long. Once in a while, this is fine, but I’ve observed that clinicians sometimes get into a pattern of lengthy calls that raise their risk of burnout. To avoid this problem, I often recommend that clinicians tell clients how much time they have (e.g., “I’ve got about 5-10 minutes, and I’ll let you know when I have to get off the phone.”), and remain aware of how long they’re spending on the phone. Also, it’s okay to end a call, even if the discussion has not wrapped up beautifully or the client doesn’t seem to feel any better. As long as some helpful skills coaching has occurred, it can be considered a potentially effective call.
An additional area of drift that can have dire consequences occurs when therapists are not up to speed on the literature on suicide risk, their conceptualization of their own client’s suicide risk, and the various ways to manage imminent risk. I highly recommend that clinicians conducting phone coaching remain up to speed on the suicide literature, conduct a thorough suicide risk assessment and monitor ongoing risk with their clients, and become familiar with effective protocols for addressing suicide risk during phone coaching (described in one of the chapters in my book).
Q: In the theme of constantly evolving and shaping ourselves as DBT clinicians, the idea of training oneself to attain certification standards can be daunting! In your work with supervising, training, and consulting with DBT clinicians at all levels of training, what are your thoughts on the potential value of DBT- LBC Certification standards?
I think that the DBT-LBC certification standards have been long awaited. DBT has proliferated across the world, extending to various cultures, contexts, client problem areas, and clinicians with various training backgrounds. Clients need to know what kind of treatment they are receiving, and when a clinician is certified, a client knows that clinician has attained at least a foundational level of knowledge or competence. Although the vast majority of clinicians practicing DBT are uncertified, and this is likely to continue to be the case, having delineated certification standards can (a) help clinicians evaluate their own training and background and how it applies to their DBT work, and (b) help clients (if they are made more aware of standards) consider whether their clinician might meet reasonable standards for DBT practice. When I do trainings in DBT, people often ask me what it takes (in terms of training, experience, and key skills, etc.) to become a DBT therapist. Having clear certification standards can help inform a reasonable answer to that question.
