Observing Limits

I’m finishing up a book on telephone consultation in DBT, and this has gotten me thinking about the idea of observing limits. Telephone consultation, often called “phone coaching,” is a key ingredient of DBT, involving the therapist being available between-sessions to coach clients in skills they can use to get through difficult situations in daily life. The primary purpose of phone coaching is to help clients take what they’re learning in therapy and apply it in everyday life, particularly to difficult, upsetting, or challenging situations. The therapist also is available for clients when they need help in an emergency/crisis or when they have issues in the therapy relationship they’d like to discuss briefly before the next session. These phone calls are brief and focused on what skills the client can use and are not a remedy for loneliness, a substitute for therapy, or an opportunity to chat. In standard DBT, where the client receives individual therapy and group skills training, the individual therapist is the one who is available for phone coaching calls.

Perhaps not surprisingly, when I talk about phone coaching during presentations or clinical workshops, many clinicians become fearful that their clients will burn them out, call too often, and intrude on their personal lives. To prevent these worries from coming true, they often come up with a variety of rules and firm limits regarding their availability. Some are only available during work hours, for a few hours per day, or will only take a specific number of calls per week, and so on. Sometimes, these rules work, and at other times, such as when the clinician is working with highly suicidal patients (who experts agree should be able to reach their therapists when needed; see Bongar, 1991; Linehan, 1993a), these limits on phone coaching are unrealistically tight.

Coming up with a set of pre-defined rules is an example of what we call “setting limits.” Of course, I usually encourage clinicians who have pre-defined limits to let their clients know about this, but in DBT, we focus a lot more on observing limits rather than setting limits. In part, this is because rigid, pre-defined limits are inevitably arbitrary and somewhat artificial. There are few personal relationships where each participant has pre-set rules about how often and how to interact. For example, you probably wouldn’t say, “OK, we can get married, but you’re only allowed to talk with me once a day before dinner for a maximum of 30 minutes, and I can’t take spontaneous phone calls or texts.” Although our relationships with our clients are not the same as our relationships with partners or friends, in DBT, we think it’s important for relationships to have as many real and genuine elements as possible, while maintaining appropriate professionalism. Rigid limit-setting doesn’t usually fit this goal. Next time, I’ll talk about how observing (rather than setting) limits applies in DBT and in relationships in the rest of our lives. ~ Alexander L.Chapman, Ph.D., R.Psych.