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DBT Telephone Coaching — MRCPsych Paper B MCQ

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ModeratePsychotherapyDBT Telephone CoachingMRCPsych Paper B

A 20-year-old woman with emotionally unstable (borderline) personality disorder is receiving a comprehensive dialectical behaviour therapy programme. During agreed telephone-coaching hours, she develops an escalating urge to self-harm and calls her therapist before acting. Within standard DBT, what is the primary purpose of this contact?

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Correct answer: A — To coach the use of previously learned DBT skills in the immediate situation

The correct answer is A. Telephone coaching in comprehensive DBT is a brief, focused intervention intended to generalise skills from therapy to the patient's immediate environment. The therapist helps the patient select and use an appropriate skill, such as distress tolerance, mindfulness or emotion regulation, before ineffective behaviour occurs. It is not an extra individual therapy session or a source of prolonged, unstructured counselling. A detailed behavioural chain analysis would usually occur in a subsequent individual session. Assessment and action regarding immediate safety may still be necessary, but hospital-admission assessment is not the defining purpose of DBT telephone coaching. The original post-self-harm wording was removed because standard DBT may restrict routine coaching after self-injurious behaviour to avoid inadvertently reinforcing it.

Reference: Ruork AK, Yin Q, Fruzzetti AE. Phone consultation and burnout among providers of dialectical behaviour therapy. Clinical Psychology & Psychotherapy. 2022;29(2):744–753. https://pubmed.ncbi.nlm.nih.gov/34490677/