Both my therapist and psychiatrist are in private practice and my emails go directly to them.

My therapist is the only one that reads my emails. She may or may not print them out to file, but again, she's the only one that sees her files. I do send fairly detailed, personal emails to her.

My psychiatrist does have an office manager and he copies her on all replies that he sends out. The office manager prints out the email and files it in my file. There is no additional paperwork done. I send only updates related to medication or emails to keep him in the loop with things between sessions.

Neither of my mental health providers accept insurance, so there is no insurance related paperwork involved. Neither one charges extra for emails, but they don't spend an extensive amount of time on them. My psychiatrist answers in between appointments. My therapist answers in the morning before appointments or at the end of her day - she will send thoughtful but not detailed responses. I used to send emails weekly to my therapist, but I feel less of a need to do so and have reduced my emailing in the past year or so.