Therapist contact between sessions?

Hi everyone,

I'm new here so here is some background:
I'm a 17 female and a high school senior. I've struggled with depression and anxiety and have been on a dozen meds since over the past 6 years. I go through spells of deep depression and now is probably the worst I've been.

So my concern is about contacting my t in-between sessions. I've been obsessively googling this and have seen other posts about it, but I still don't feel like I've found what I'm looking for.

My t is great. I love her. I've seen her on and off for two years and started seeing her again one month ago. We have sessions once a week. She gave me her phone number (personal cell phone number) and email address and told me to text, call, or email whenever I needed. Last week I called her in a crisis situation. Lets just say I was a danger to myself. I immediately felt guilty for calling her especially because it was 9 at night. She didn't answer, which I had mixed feelings about, but then I emailed her the next day and she called me as soon as she saw it. I've emailed her about once a week when I'm especially unstable, need to vent about a bad day, or need to tell her about urges/something I've done, and she either calls me or emails me back saying we'll talk about it next session. I HATE bugging her and it makes me feel so guilty and I never feel like my problems are big enough to call or email about. I feel like she thinks I'm annoying and needy. I don't know when things are bad enough to where she would've liked me to call. She said whenever, and I know she means it but she's the only one I have to talk to so I feel like I ask too much of her.

Today, after emailing her last night and no call or reply, I deleted her number from my phone, deleted all of our emails and threw out my copy of her contact info she gave me (quite ceremoniously actually, I ripped it up and flushed it down the toilet, then laid on the floor and cried.) I feel so bad for being so needy but now I don't know what to do in a crisis. I'm stressed out and anxious about the whole thing. I think about it ALL THE TIME.

Do you and your t have contact between sessions?

Under what circumstances would you contact your t?

What kind of boundaries should I set with my t?

Thank all of you for being part of this community, I already feel like I belong.

Nomad

Yes, my T and I have contact between sessions. It was necessary for me to be able to build trust in my T. I typically email T at least once between sessions, and can call her if needed as well. We've also texted a few times - that's mostly about appointment time changes or a very quick check in.

For me - I email non-urgent things and call for urgent things. Emails are usually me processing a session, or sharing thoughts, or laying the groundwork for bringing up difficult topics in session. Also, when I'm really struggling, T asks me to check in daily by either email or text. Phone calls are for when I need fairly immediate help and feel like I simply can't manage things on my own or feel like I might be a danger to myself.

I used to feel like I was imposing every time I'd contact her, and that was my own insecurities and embarrassment at needing to reach out. I finally had a conversation with my T about between session contact, and we basically set expectations for when I should contact her, how often is reasonable, how quickly I could expect a reply, and what kind of reply I could expect. T and I agreed that non-urgent stuff can be by email, but I promised to call or text her with urgent things. We agreed that she will reply to emails within 24 hours during her work week, and emails sent after 4 pm on Thursday will get a reply on Monday. We agreed that email replies will typically just be an acknowledgement that she received it, unless T feels it's reasonable to give a longer response. T usually gives me some words of encouragement in her replies, but she rarely gives detailed replies. Phone conversations are limited to 15 minutes, and if I need more time, then we have to schedule it and I will be charged for the time. If I call her office voicemail during her office hours, she will return the call typically within an hour. If I call her cell phone outside of office hours, she usually gets back with some kind of reply within an hour or two - but that reply might be a text saying she'll call me back at a certain time.

So - I think the really important thing for between session contact is to set expectations. Ask your T how she prefers you to contact her - email, phone, text, and when you can expect a reply if you do contact her. It's important to remember that outside of their working hours, T's have other obligations and may not be able to respond right away. You might also talk to your T about some skills you can use to cope with things when she's not able to contact you right away.

Only occasionally do I contact my T between sessions. I may go months without any out-of-session contact; however, if I'm in a crisis, I may speak to him between sessions or more likely, have an additional session or so with him. I only contact him between sessions if I'm truly in a crisis or headed in that direction. He knows if I contact him that it is an important matter and he always gets back to me pretty quickly. He doesn't do emails or texts, nor do I have his private number. If I need him, I call and leave a message or call his answering service which contacts him for me.

I like my T's boundaries about contact. He wants me to use the skills I have to work through my feelings of crisis, and I suspect if he allowed more contact, I'd be less likely to make myself work through things independently. I do think there is such a thing as too much availability that can lend to a sort of helplessness. Learning to sit with my feelings and anxieties, etc. and learning to use the skills he works with me on so that I can feel some empowerment in dealing with those stresses has been extremely helpful. It has helped me truly distinguish between feeling uncomfortable (which while uncomfortable isn't in itself dangerous or really a need for his help) and truly being in a crisis where I truly need some intervention.

With those kinds of boundaries, I never feel guilty for contacting my T (or Pdoc) because I know I have done what I can to work through what is going on and that I am not in any way abusing his good graces.

This is what works for me in my relationships with my T and my Pdoc. I suspect you will get a wide range of answers, and the thing is, most of them work for each individual T relationship (they are all different). I have seen instances here where T's didn't have good boundaries about contact and had to rein things in after awhile because it was getting excessive, so it is a good idea to have a frank and honest discussion about this and set up some guidelines and procedures; that way you will feel more comfortable and safe about making whatever contact you need to make.

If your T has given you her out-of-hours contact info, trust that she means that you can contact her and she'll respond as soon as she's able.

My T has given me his cell and home numbers and encourages me to use them. I rarely do, but I know he means it. We've spent a lot of time talking about it, with me not understanding why he wants me to call him (he doesn't do text or email) and him steadfastly maintaining that he doesn't just care about me in the office. I fussed about not knowing how to identify when I "need" to talk to him versus just wanting to. He told me to forget that - if I think it will make me feel better, I should call. He'll manage the boundaries, so I needn't worry about it.

I called him a couple of days ago and he sounded almost giddy that I'd called. He's a keeper.

Yes, I sometimes contact T.

Circumstances: T has asked me to stay in contact (if we're having a break due for whatever reason) or I contact when I need to connect or if I'm in distress about something. I really hate talking on the phone so I'd only ever email and even then, I wouldn't email saying "I'm feeling suicidal" but would email and say that "I'm struggling". I would also email to book an additional or earlier session. Sometimes just having some contact, even just a short email is enough to push me through to the next week.

Boundaries: Ask your T what her boundaries are. It's a lot easier when you know what her personal boundaries are so you don't keep second guessing yourself if it's okay to call or email.

Do you and your t have contact between sessions?
Until recently I did not contact t between sessions. My in between contact has been limited to one specific issue.

Under what circumstances would you contact your t?
T actually asked me to contact her with updates about the situation. So I did. However she also said I could call her office number and leave messages/ask for more sessions if things were difficult.

What kind of boundaries should I set with my t?
I think that's a good conversation to have with your t. If you feel guilty about contacting her outside of sessions, tell her.

I email my T during the week when I need to. I email her because I have emotional amnesia and forget how bad I feel once I'm over it. SOmetimes I e-mail her 6 or 7 times a week.. sometimes once or twice. I think you should e-mail your T and ask her. My T told me.. she will read it all, but can't always respond and that works fo rme. She is pretty good at responding though, and I think because it's the holidays you should be a little more understanding.

I don't think its up for you to set the boundaries with your T. I think you have her set the clear boundaries so you don't have to worry about being needy.

I used to worry about being needy as well, but once my T and I had a talk, I felt much more comfortable. But I don't ever call. That's just part of my anxiety though.

Nomad17 - I can relate to the difficulty of waiting for a reply from t.

I found that there can be many reasons for the delay. Once I was in horrible pain about her failure to reply for a few days. I forwarded the email she hadn't replied to and told her I was doing very badly. Come to find out she had answered but did not hit send so she thought I recieved her reply days earlier.

I email on an as needed basis. I keep them as short as possible to respect her time. We've also worked out a system in which I write at the end that I'm not anticipating a reply. Some times she replies anyway but it takes the pressure off both of us when I know I can make it without a reply. If I leave that no reply thing off she replies about 80% to those. Her replies are always short - a sentence or two but I can tell she read what I wrote. I've lerned her patterns too. Some days she only checks email once - early. If I haven't written before that I know it will be at least 24 hours for a reply.

I also have her personal cell number for calls and texts. I think I called 3-4 times in 2012. We only text for scheduling mainly or a did you get home okay on thes snowy roads.

Your reaction and distroying of her contact information would probably be a good thing to talk about with your t. As far as boundaries, the t is usually the one that sets them. I add to them out of respect.

How are you feeling now?

I haven't been feeling any better. I really feel like I need her. Nobody knows about my problems because some kids found out at school and made fun of me after I told a close friend (High School sucks, right?) so I only talk to/trust her. I have bad urges and just overall crazy thoughts like I've never had before so my anxiety is very high right now and I'm home alone, darn New Years Eve parties...I'm also feeling really stupid for the whole contact deletion thing, but its New Years Eve anyways so I would especially feel bad to annoy her now. I do need HER to set the boundaries...sooner than later so i can stop making myself feel worse. My appointment isn't until Friday though! Thank you for asking and for replying.

Nomad, this is something you need to settle with your T. A lot of people on this site have the same difficulties as you about contacting your T, including me. I think you should tell your T exactly what you have written here, and I suspect she will help ease your guilt and maybe give you some guidelines.

Nomad This is a common emotion (anger), also, when your T fails to respond to your email/phone call/text. You are definitely NOT alone, Nomad. I hope you can talk to your T about this also. It is something that your therapist would want to know in order to help you.



Do you and your t have contact between sessions?
Under what circumstances would you contact your t?
What kind of boundaries should I set with my t?
Everybody's therapist is different and has different boundaries. Every patient is different and needs individualized boundaries at times. I hope you ask your therapist these questions

Thank all of you for being part of this community, I already feel like I belong.
I am so glad you are here, Nomad. Post here as often as you need, there a lot of friendly people who will help you. Keep us posted on how it goes with your therapist. We are here for you. I am here for you

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Thank you for the advice and hugs.

I remember high school sucking greatly! Kids can be cruel. I kept to myself except for one solid friend. I'm glad you have a t that you trust to talk to. I can relate to that feeling of needing t, too. I wonder if you have any healthy ways you can use tonight to distract yourself - as long as you don't think of harming yourself with these crazy thoughts occuring. If you are afraid of hurting yourself call t and tell her it is an emergency or find someone you cn call or be with even if you don't tell them what the problem is. If you can manage maybe a movie or a book or writing may help hold you over until you can explain it all to t.

Keep posting here on pc toniight. Many of us have faced these crisis times ourselves and can definitely understand at least parts of what you are feeling.

Thank you. I've felt like this before and called her which made me feel better. I've been working hard on not harming myself, but its a struggle to distract myself sometimes. I feel really weird and unnatural tonight. My thoughts are really freaking me out (more so than usual.) and I feel crazy. I feel like my parents are really here (they aren't) and they're waiting somewhere to come out and kill me when I turn my back, but I know they would never do that but I still believe it and its driving me up a wall.

When you have felt like this before and called t can you remember what it was that made you feel better? What reassurance she gave you? Can you try to recreate any good feelings you get from your work with her? Has she given you any advise in dealing with these scary thoughts?

If you did get a hold of t tonight think about what you would tell her about what is going on and imagine the best possible answer from her. What would help you the most from her?

If you still have the email address somewhere maybe you can try writing to her to help you deal with the feelings even though she probably won't answer until Wednesday at the earliest. T's can usually sense when you really need them and you won't be crossing any boundaries right then. YOu're right about needing to get the boundaries straightened out the next time you get a chance.

It is good that you know your parents would never do that. Maybe you can try to ground yourself a bit by repeating that and remembering good times with your parents. Try smiling to try to bring on a positive feeling. Do you have a pet you can show special attention to? I know that these scary thoughts are not easy to overcome and I'm not suggesting something simple will help but I'm trying to think of things that you might try...

Talking to my t generally just helps. She's really kind and just hearing her voice makes me feel better. Sometimes she changes the subject to calm me down and sometimes we talk it out and breathe deeply. Writing emails to her makes me feel better, so maybe I could write out what I would say like you said and save it as a draft or something or print it for when I can contact her. She tells me to be with people, or go for a walk and to use substitutes for harming myself like the ice thing and snapping rubber bands, and to do something for someone else which I usually don't have the energy for.

I feel better and less scared because you guys are hearing me out and letting me know I'm not crazy.

I do have a dog that I spend a lot of time with and he's always kind of helped me.

EDIT: I've never thought people were out to get me before tonight, so that's a totally new feeling for me that my t (obviously) doesn't know about. That's what's making me uneasy. I've never felt this way before. I think they're here and I wonder how they'll get me. That's what worries me.

I kept a voice mail from my t for a long time just so I could listen to it. It is gone now but I surely know what you mean by the reassurance her voice can bring. Also the fact that she knows all that you've told her about yourself and understands.

I'm very glad you are feeling a little better and less scared right now.
I hope you write that email. And keeping writing on this post as long as it helps.

Nomad17- I didn't see your edit when I replied. That is a scary thing to think someone is out to get you. These things never happen at convenient times to reach t do they???! New Year's Eve... Maybe you should include all that in what you're writing to t. If you feel unsafe (even though it sounds like there is nothing physically in your environment that will harm you) is there a place where you can lock the door to make yourself feel better? Your room with phone and/or computer, dog?

One step ahead of you on that one. I'm in my room with my dog and my laptop and phone and I'm writing the email and flipping back and forth from it to here to talk to people. I keep feeling the need to check around my house, just for peace of mind, but I can't even tell if this is real or not so I'm scared.

Good news. After some digging I found my t's email. I sent her the draft but then I thought "oh no, I hope she's not going to freak out." She probably won't read it until Wednesday because she tells me to text her when I email her and I don't have her number. So I sent her another email that said don't read my other one. I feel slightly better and more calm now, but I just wonder if she'll trust me enough not to read my first email. I feel like this is something that we need to talk about in person so she knows I'm safe.

Nomad

Just a warning - My xT allowed me to contact her between sessions and greatly encouraged it. At the last time, I was in severe crisis and was imminently sui. I called her and she told me not to call her anymore and just hung up on me. Ethically she should have at least called the police to come help me as I had OD'ed and she knew it. I reached her limit and instead of her setting up appropriate boundaries, she just shut me down. Our relationship ended immediately after that. My new T says that she should have handled that much differently, that she was not professional and was unethical to handle things as she did. My xT and I had a 7 year relationship and I NEVER thought it would end that way. But it can and it does. Sp please, be careful.

Wow. That's awful. I hope your current t is much better than your xt. I don't even believe that. I don't think my t would do that, but I do need her to set boundaries. I love my t and I don't want things to end, especially like that.

I'm sorry you had to go through that! I'll definitely be careful.

Thank you for sharing,

Nomad

I realize this posting was several years ago, but my comment is as relevant today as it was back then:

Due to HIPAA laws, including updated laws in 2013, it is common practice for therapists to simply reply to emails by stating that they have received and read them.

Emails are NOT considered 100% confidential under HIPAA laws because they go through the internet and are stored on servers.

This is not to say that your therapists are not going to keep your emails confidential, I'm not saying that at all. It just has to do with third party gray areas like gmail, SBCGlobal, etc.

I would consider not putting your full name on the emails, just for security reasons.
I worked in I.T. and I know ALL the private emails were read (!) in both esteemed companies I worked for, so be sure to only use your PRIVATE email.

Just try to remember that therapists have strict ethical and confidentiality laws they must abide by.
Chances are, if your therapist has encrypted email, he/she may respond in more detail. Others are most likely just following the HIPAA confidentiality laws. In other words, it's nothing personal against you. Not at all.

And by all means, talk about their lack of lengthy responses during session.

Interesting timing for this thread to come back up. I posted a vote a couple of hours ago (that hasn't shown up yet, I guess because I made a new account) but I am struggling SOOOO bad right this second about contacting my t. I have tried to be so good about not doing it and have a few times but made sure it was during business hours, but I want to so bad right now. I keep getting ready to grab my phone and stopping myself.

this is thanksgiving weekend my gosh... and THIS would be when I break my out of work hour stop... aaaaaaauuuuuuggggghhhhhhh I don't know what to do!!!!!!

I'm of the opinion that if you want to contact T, do it. Just understand that your T may not respond. Does you T have boundaries around out of session contact?