This feature by Elizabeth Burns, M.A., LPC is Part 1 of 2 in a series about use of multimedia in DBT phone coaching. Through this series, Elizabeth explores how she uses supplemental resources in her work with clients when delivering DBT, sharing a variety of specific resources from her files. In this first part, Elizabeth begins by giving examples how she uses multimedia with different client scenarios.
I am always gleaning the landscape for materials to use in service of delivering DBT. When I became a DBT clinician in 1997, my team and I were limited to a landline phone and a pager to communicate with our clients outside of sessions. Our skills classrooms were not equipped with smart TVs as they are now. When a client reached out for consultation, we had only our voice. To be clear, voice to voice connection is awesome. I still prefer it as the most important way to validate AND (the dialectic here) I have found the use of texting content to inspire and assist skills use to be highly impactful.
I decided to contribute to the Behavioral Tech blog some examples of how I have enhanced phone coaching by sharing multimedia content with clients. I realize that I am not the only one who works as I do. It is my hope that I’ll start sharing content that I use, and other clinicians will join me.
DBT is not adherent without phone consultation. It is a labor intensive, innovative component of treatment allowing for shaping change in our clients’ lives in the moment. The purpose of DBT phone coaching is to attend to the therapeutic alliance, reduce suicidal ideation and behaviors, and generalize DBT skills. https://pubmed.ncbi.nlm.nih.gov/22035988/
I imagine that my client’s Emotion Mind reaches out and asks me to function briefly as their Wise Mind or Reasonable Mind. Over the years, I’ve gotten feedback that simply suggesting “Consider trying self soothe “or “What Can you distract with?” or “What would be helpful to radically accept about_____?” was not always helpful. When the client was overwhelmed, disassociating, demoralized, or had exhausted their skillset, they welcomed a link on their phone with a skill suggestion.
I use my handy dandy smart phone to assist me that effort.
My little phone is a vault of wisdom and irreverence.
It is a treasure trove of DBT handouts, quotations, poems, YouTube videos, and other online content. I use it daily to remind, soothe, excite, amuse, and instruct my clients as they build their lives worth living.
Here’s how it works for me:
I use my humble and uncool Android (according to any client under the age of 60). I access most of the DBT content in photo gallery. This is where I can send screenshots of handouts from DBT Skills Training Handouts and Worksheets by Marsha Linehan.
I require all clients to own the DBT skills book but often times they don’t have the book with them. Once I have an understanding of what is going on, I text a handout and some multimedia content.
I use the YouTube App on my phone so I can easily access my channel. This channel connected to my practice is where I have curated videos in DBT skills categories. I regularly use this channel during DBT skills class, and clients can access it via my website at any time.
I would like to share a few anecdotal skills coaching examples. My first example regards generalizing skills in vivo.
Client calls regarding feeling anger towards her teenager for his poor choices. She has been working on parenting without being mean spirited but that is all she can think about doing. Skills suggested included: radical acceptance of the limitations of a teenage brain, taking a nonjudgmental stance with a focus on effectiveness.
I would either direct her to these handouts in the book or text them to her if need be. I would follow up two YouTube video links:
Teen Brain BPS
Brené Brown on Blame
My next example deals with therapy interfering behavior.
A 22-year-old client has missed her second session in a row. She slept through it last week but made it to her DBT class later in the week. I send her a text message stating that I missed her today and wanted to know that she was okay. She responds with a self-effacing apology while stating that she has no idea why it keeps happening. Skills suggested: nonjudgmental and dialectical stance, DBT Assumptions and a Chain analysis.
I would either direct her to these handouts in the book or text them to her if need be. I would follow it up with this dialectical quotation from by photo gallery:
and an irreverent YouTube video link from DBT –RU to assist in completing the chain analysis:
This example deals with an urge to misuse alcohol.
A 40ish professional female with Type 1 Diabetes calls for help with a strong urge to binge on alcohol. She describes her urge as a 3 on a 5 scale but has no alcohol in her home. She feels so lonely, again. “The pandemic is so hard on me.” She describes struggling to remember why she should abstain from alcohol. We speak on the phone for a short time, and I validate the pain associated to loneliness. I normalize the desire to escape the pain and suggest distress tolerance skills instead of alcohol. I text the pros/cons of using skills worksheet. Here are some of the videos I might choose to send her to enhance our call:
Marsha Linehan – Dialectical Behavior Therapy and Its Attention to Escape Behaviors
The Truth about Alcohol *WOW* BBC Documentary 2020
Here is one more example. A 35-year-old NFL player is struggling with a depressive episode. He thinks that it is his third one, but the first one he has treated. He has problems with road rage. Prior to treatment, he was ticketed twice for aggressive driving. He is highly motivated to change his response to “stupid drivers.” He reaches out for a reminder of what skills to use while driving his girlfriend to dinner. I suggest he reviews the handout on nonjudgmental thinking and distract with other emotions, for example, by playing calm music while driving. I’ve attached two videos that I might forward to him.
Why Mindfulness Is a Superpower: An Animation
I send him the Mindful of Sound playlist from the practice YouTube Channel and suggest that he consider making his own driving music playlist as well.
Mindful of Sound
Now that part 1 has set the stage, read here for part 2 of this series, in which Elizabeth will discuss the value of reciprocal communication of content as a part of a phone consultation, class homework, or therapeutic alliance building. She will also address how to create your own professional practice YouTube channel and give a few examples. She will touch on ethics and setting / respecting boundaries. Lastly, she will discuss the natural shift towards instructing the client to use their phone as their own personalized treasure trove of DBT skills.
Elizabeth Burns, M.A., LPC is an advanced intensively trained DBT therapist. She has provided DBT therapy and skills training to individuals and families for 19 years. She has been the Ethics Chair for the Licensed Professional Counselors Association of Georgia 2015-2016. Read Elizabeth’s full bio here.