As seen in the video, clients are informed in the orientation session that after-hours telephone coaching is offered for three important reasons: (a) to decrease suicidal and nonsuicidal self-injurious behaviors, (b) to assist in generalizing the skills taught in treatment to everyday life, and (c) to provide an opportunity to make a repair in the therapy relationship if warranted (Linehan, 1993). When working with suicidal clients or nonsuicidal self-injurious clients, an important goal is to reduce the risk of a completed suicide while not simultaneously reinforcing future suicide behaviors Enzalutamide clinical trial (Linehan, 1993). This can be a delicate

walk as the very intervention that is at times required to prevent suicide (e.g., hospitalization, additional therapy contact, etc.) can also serve to perpetuate suicidal behaviors. Thus, it becomes critical to properly orient DBT clients to the first function of telephone coaching: decreasing suicidal behaviors. Many individuals with BPD have previously been reinforced for nonsuicidal self-injurious/suicidal behaviors or have found that the only way in which their needs are met is through escalation and crisis-oriented behaviors. Thus, some individuals with BPD have learned to use nonsuicidal self-injurious/suicidal behaviors as a method to communicate distress,

while other clients become so dysregulated it becomes a habitual problem-solving response. For these reasons, teaching clients new and appropriate ways to ask for help is critical. When orienting clients to the first function of telephone GSK1210151A datasheet coaching in DBT the therapist must ADP ribosylation factor emphatically state to the client that they call before engaging in a nonsuicidal self-injurious act ( Linehan,

1993). This changes the timing of the reinforcement so that the reinforcer (e.g., therapist time and attention) is no longer provided after nonsuicidal self-injury or suicidal behaviors but rather is provided prior to nonsuicidal self-injury/suicidal behaviors, thereby rewarding and teaching the client to “catch” nonsuicidal self-injurious and/or suicidal urges. Sometimes clinicians are working with individuals with BPD who may not engage in nonsuicidal self-injury, but rather use suicidal thoughts, urges, and/or threats as communication or problem-solving attempts. If a client does not self-injure but instead becomes suicidal, the therapist then instructs the client that they must call during the ascending arm of the suicidal crisis rather than waiting until the crisis reaches its peak or during the descending arm of the crisis. This can be difficult territory to navigate and misunderstandings between client and clinician are common here. Clients, understandably, feel that they have been instructed to call their therapist when they are distressed and at risk for suicide.