Introduction to Inter-Session Contact

By Stephanie Vaughn, PsyD

This presentation is an excerpt from the online course “DBT in Practice: Mastering the Essentials”.

Highlights

  • Inter-session contact includes any communication between therapists and patients other than that which occurs during designated therapy sessions.
  • Inter-session contact is not therapy.
  • In DBT, a patient does not have to be in crisis in order to contact the therapist.

 

 


Individual therapists are required to be reasonably accessible between sessions in order to provide intersession contact in full comprehensive DBT. Intersession contact is one of the four components in the standard DBT protocol. Any contact therapists have with clients between therapy sessions is categorized as intersession contact. This includes email, text, phone calls and in-person exchanges. As the name implies, intersession contact is not a therapy session and should not be treated as such. DBT therapists will often use the term phone coaching to refer to both telephone calls and texts or simply coaching to comprise all methods of contact.

 


DBT is the only model of psychotherapy in which intersession contact is actually mandatory for treatment. This contact is not crisis dependent. In other words, the client is not required to need to contact the therapist in order to contact them. There are specific targets for telephone coaching that will be addressed in the next recording. Any abuses or failures to engage in telephone coaching appropriately are considered to be a therapy-interfering behavior.

 


The methods for coaching include telephone, email, text and in-person and each of these is traditionally provided by the individual therapist.

 


The individual therapist will provide a personal cell phone number and email address at minimum. At times, a therapist may provide a pager in order to allow a client to leave their telephone number and potentially the severity of their need so that the therapist may return their phone call.

 


If a group leader talks to a patient between sessions whether that is in person or over the phone, most of the time, the function of the contact is going to be to keep the member in group or potentially to coach them on skills on a break within group. But the majority of the calls will be directed to the individual therapist. This is even during the course of group. If an individual group member’s issue is such that it is not effective to address it one on one in group, the group leader may prompt them to call their individual therapist for coaching.

 


Telephone coaching may be adapted and would need to be adapted for individual or residential treatment or other places where having a phone and calling a therapist isn’t feasible. It may also be adapted for adolescents and there are certain rules that do not apply in adolescent and family treatment. And in the case that there are logistical barriers for whatever reason, it’s important to work with one’s team in order to come up with a plan for addressing this vital component of the DBT to fidelity model.

 


The frequency and length of intersession contact varies. It varies according to the patient, meaning their preferences and tendencies. Some will call more than others. In some, you will have difficulty getting them to call at all. It varies according to the therapist’s limits. So some therapists are more willing than others to receive calls. Some are more willing to engage in texting. Some will or will not engage in email coaching. And the therapist’s limits also vary from day to day and just from their general personality. This is addressed further in the section on Observing Limits.
Life circumstances will also determine the frequency and length of calls. This is life circumstances of the patients and the providers. So when a patient is in a higher state of need, most likely, they’re going to be attempting to reach the therapist more frequently. This is not always the case but when you have a client who is consistently using telephone coaching as an adjunct, they are most likely going to increase their contact during stressful periods. The frequency and length also vary according to the function, meaning why is it that we’re doing intersession contact to begin with? If the function is to increase the client’s utilization of skills in their environment, then we may have more calls in the beginning of therapy when clients are just beginning to grasp the application of the skills versus later on down the line when they are better able to access, retrieve those skills from memory and have practiced them enough that they don’t need the therapist’s help in implementing them.

 


Generally, calls are brief. And calls lasting longer than 10 minutes are rare. It is possible for them to last up to 20 minutes or longer depending upon the nature of the call. For life-threatening behavior, hopefully, this is rare but there will be times when a therapist will need to fully assess a client for life-threatening behavior and potentially for hospitalization. Of course, this is the case with any model of psychotherapy and not specific to DBT. The calls can be scheduled or spontaneous. So there may be times when the therapist will initiate a phone call or perhaps may have asked a client to give them a call by the end of the day. Or in an example I had most recently, I asked a client to contact me and let me know that her diary card had been placed in the location that would be most helpful for her to remember to complete it. So she texted me a photo of that diary card. So these may be scheduled but also they may come out of the blue. They may be unexpected.

 

Key points

  • Intersession contact includes any communication between therapists and patients other than that which occurs during designated therapy sessions.
  • Intersession contact is not therapy.
  • In DBT a patient does not have to be in crisis in order to contact the therapist.

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