The 24-hour rule in DBT: Rationale of Life-Threatening Behavior Reinforcement

The 24-hour rule.

It may come as a surprise that DBT therapists are actually not supposed to provide intersession contact for patients after they have engaged in life-threatening behavior. Therapists are not allowed in DBT to speak with patients or to have contact with them other than regularly scheduled therapy sessions until a full 24 hours have passed since the patient’s last life-threatening behavior. That includes suicide attempts and self-harm. This practice is referred to in DBT as the 24-hour rule.

The rationale for the 24-hour rule goes like this. The patient has solved the problem. In DBT, what therapists view as being problems such as self-harm are seen by the patient as solutions. I cut myself and I feel better. DBT provides a set of alternative solutions known as skills that are meant to substitute or to replace the problematic and dysfunctional behaviors that the patient was engaging in previously. So one of the reasons why we do not provide telephone coaching which is a skills-based intervention, why we do not provide telephone coaching after a life-threatening behavior such as self-harm or a suicide attempt is because the patient has solved the problem.