I've been seeing my T for 4 years and have only texted her a couple times, both within the past couple months. The first time, I was having really bad panic attacks riding back from vacation, and she gave me some advice on dealing with it, plus had me check in a couple times to see how I was doing. The other time was when she was going to talk to my p-doc about something, and I asked her to let me know she'd done it.

I've talked on the phone to her a few times outside of work hours as well if I was really upset. I've left a few messages on her work voicemail, and she's called me back to talk. Then another time recently, I was in a really bad place at midnight and called her cell (she'd given me permission to do so). Woke her up, but she still talked to me for about 10 minutes to make sure I was OK and that I was safe.

I also texted my marriage counselor once fairly recently, but it was at 3 a.m. on vacation when I was feeling very lonely (which is basically what I said in the text--I have some transference for him, which he's aware of, as is my husband). That wasn't the most appropriate use of texting, but he was very kind and caring about it when responding the next day and talking about it later in session. I occasionally e-mail him as well. And I've left him a few voicemails on his office phone when I've been upset with something he said to me or that happened in session. He usually took a day to get back to me, but he's talked to me for up to a half hour before.

To answer your question, I feel OK with both e-mailing and calling office voice mail, but I feel like I need to reserve texting or calling cell phone for more urgent/crisis-type situations. And I often need reassurance that it's OK that I contacted them if it's something more than an e-mail (or even if it's just an e-mail for MC).