Text me, call me, or email me....

boredporcupine · Jul 18, 2013, 10:20 AM

Quote:

the client texts/e-mails more and more in order to seek reassurance, to express their thoughts to T right away, to try and get a response from T, and/or to "do therapy" via text/email. It becomes excessive. It becomes a way to get out of "sitting with" the hard feelings. It becomes a way of depending on T for reassurance rather than using coping skills and becoming more independent. The client feels like T is more of a "friend" than a therapist. The boundaries become too blurred. And, when the T can't (or won't) respond to all of these texts/emails, or doesn't respond quickly, or doesn't respond in the way the client wanted-- the client feels rejected and obsesses about T's response (or lack thereof).

I do think that is a danger. For me it has not been the case. One of my main problems going into therapy was that I was TOO independent. Learning to ask for and get support has been important to me. One rule is that if I want something in response, I have to ask for it specifically, otherwise I can't guarantee anything. So I need to say "I need reassurance about X" or "can you tell me if what I wrote made sense to you?" and then I get answers for those things. It has stretched me to really figure out what I need and ask for it directly. Sometimes I have used email just to vent, without even asking for a response. That has helped me to feel like I don't have to hold my feelings all by myself, and enabled me to tolerate them better as a result.

It's true that at times I have been upset over T's emails or the lack thereof, and have read things into them that weren't there. In the end this has been helpful to me. By being able to go back and talk about these misunderstandings, I've gotten better at not jumping to conclusions about emails in the rest of my life.

In conclusion, I think email has legitimate purposes in therapy, but can be a bad thing if there is too much transference already or if expectations about it are unreasonable. Another thing is that I never had a problem respecting other people's boundaries. In fact I was terrified of "bothering" my T too much, even when she said I wasn't. I got to learn, partly though email, that just being in contact with someone isn't necessarily annoying and invasive behavior.

Willowleaf · Jul 18, 2013, 03:03 PM

I too am probably too independent and t always jokes the boundaries I put on myself are higher than hers. I text if I want an immediate answer or call. I email if I want to tell her something. She will still reply if I ask her to but it may take a while. I tend not too but I am starting to use it when I need to. I went through a stage of texting but it just made me feel worse so now the rule of thumb I use is I text if I want help.

Jul 18, 2013, 03:05 PM

Willowleaf, my T jokes about me protecting his boundaries for him. He says I don't need to be quite so diligent about guarding his boundaries for him. One, he can do it, and two, he doesn't like them as far out as I put them.

wotchermuggle · Jul 18, 2013, 03:59 PM

Quote:

Originally Posted by scorpiosis37

I think having frequent outside of session contact with one's T tends to cause more harm than good. At first, it makes the client feel cared about and it seems like it's helping. Then, the client texts/e-mails more and more in order to seek reassurance, to express their thoughts to T right away, to try and get a response from T, and/or to "do therapy" via text/email. It becomes excessive. It becomes a way to get out of "sitting with" the hard feelings. It becomes a way of depending on T for reassurance rather than using coping skills and becoming more independent. The client feels like T is more of a "friend" than a therapist. The boundaries become too blurred. And, when the T can't (or won't) respond to all of these texts/emails, or doesn't respond quickly, or doesn't respond in the way the client wanted-- the client feels rejected and obsesses about T's response (or lack thereof). I think it's safe to say that a good 1/3 of the posts in the Psychotherapy forum are about distress over e-mailing T. I think the issue here is that clients *want* to e-mail T. They say that it helps because they want to be able to continue e-mailing and/or receiving e-mails from T. They don't want to lose that outside of session contact. But, in my opinion, that contact is actually not in the client's best interests. It feeds into and increases transference and an insecure attachment to T. It creates this whole drama around the T-client relationship (outside of the therapy room) which detracts from the client actually working on their presenting issues. Some transference in the T relationship is normal or even beneficial-- but I think increasing that transference (and dependency) through e-mail is a hinderance to the therapeutic process.

My T allows calls, texts, and e-mails, but I do not use them on any kind of a regular basis. I use them almost exclusive for scheduling purposes. I've e-mailed T 3 times in 3 years and have texted her maybe 10-12 times in 3 years. I certainly think it's okay to let T know if the client is in crisis, to ask for an additional session, to get truly time-sensitive information to T, or something of that nature. I think it becomes "too much" when it is once a week or more, outside of session. I should also point out that I'm referring to clients who are functioning satisfactorily in their daily lives, and are going to therapy on a voluntary basis. If a client is in-patient treatment or in a day program, I'm sure the rules and needs are different.

(I'm sure some will disagree with me; this is purely my opinion. However, I think a lot of Ts are adopting this opinion as technology (email/text) becomes a bigger part of our lives. A lot of Ts who previously gave out their cell numbers and e-mail addresses have since changed their accounts, and no longer give that information to clients. I think there is a reason why this is happening more and more frequently. My T said that she has had a problem with clients "abusing" their text/e-mail privileges and she has taken them away. She says she wants to keep those lines open for clients who are truly in crisis, but she does not want regular contact from clients).

ETA: I think it is helpful, though, to bring in things I have written to discuss in person. It's like e-mail, except it is brought into the session and discussed then-and-there so that I can get T's response in real time, there's no misunderstanding, and it does not create dependency.

Dependency isn't necessarily a bad thing. I used to think it was, but my therapist has shown me that it's not. It's helpful to be able to depend on someone and though it seems backwards, it allows you to feel secure in your relationship and become more independent because of it.

My T really encourages out of session contact. There are ALWAYS boundaries that he has set up for himself so I could theoretically bump those, but I don't. There is always a limit, but I think out of session contact is very helpful - especially with an experienced and encouraging therapist who understands how depending leads to independence.

ultramar · Jul 18, 2013, 04:06 PM

The thing is, outside contact 'feels good' for all kinds of reasons. And when something feels good, understandably, many are unlikely to limit or stop it on their own. This is where it's the therapist who has to create boundaries entirely depending on the needs of the patient (which may not coincide with 'wants'). Sometimes, though, I think therapists cannot (or have not) anticipated that it would cause a problem and this is where things escalate, and then the therapist imposes boundaries -rather late in the process and this causes a lot of pain.

I think good, stable boundaries are extremely important to any relationship and to people's well-being in general. In this sense, the boundaries of contact in therapy can be very beneficial as they may well help both short and long-term with IRL relationships. Seeking constant reassurance or depending on someone else to regulate one's emotions IRL relationships can end up pushing significant others/friends away (and/or cause other problems); in therapy this is unlikely to happen, so it's the perfect place to learn and practice.

How is someone's issues with boundaries and/or enmeshment going to be resolved if there is blurring of boundaries and/or enmeshment allowed or even encouraged in therapy? If this is a person's comfort zone, then it's not going to improve (either in therapy or IRL relationships) if it's not challenged somehow in therapy.

The problem I've seen sometimes, is that some therapists, due to *their own* issues, do not set boundaries, do not discourage enmeshment, when it is clearly needed. Some therapists have problems with boundaries and enmeshment themselves that they never resolved in their own therapy (if they've undergone therapy), so it ends up playing out in their relationships with their patients.

I think when a therapist's 'issues' coincide with a patient's 'issues' that's where things can really go awry. And then maybe the patient never resolves these issues, just like their therapist never did. Maybe moving towards resolving such things would actually be threatening to the therapist him/herself, in some ways.

In an ideal world, therapists would be required to do their own therapy, and a lot of it, and resolve major issues that might impede their patients' therapy. Unfortunately, this is not an ideal world.

critterlady · Jul 18, 2013, 04:57 PM

Count me in amongst the fiercely independents, with emphasis on the fierce. It's so hard for me to even tell the difference between a need and a want. As a result, I default to everything being a want and therefore I don't have to ask for it. Indeed, I shouldn't ask for things I just want.

So, yeah, I stay as far away from T's boundaries as I can. I think he'd actually consider it huge progress for me to bump up against his boundaries once in a while.

Jul 18, 2013, 05:57 PM

This seems like a really, really, REALLY bad idea. Especially for those who live in the U.S. (I can't speak for other countries). E-mail, phone calls, and texts aren't secure so it would be bad to have a conversation with a therapist other than making an appointment. Hell, this website is insecure too, but it's not as readily known that we're being spied on in here. Who knows what will be used against us in the future.

So, for me personally, I'd be more afraid to say anything to a therapist over the phone etc., than in person. But I wouldn't talk to them in person either until I get solid proof that the patient/client privilege is still intact or was ever a real thing.

pbutton · Jul 18, 2013, 08:34 PM

I'm currently on a self-imposed ban against reaching out, so I really shouldn't comment.

mandazzle · Jul 18, 2013, 08:44 PM

I don't have T's number so I can't text her... although I secretly really wish I could. I asked her about contacting and she said when she is in the office I can call if something is going on but I have only done that once. Otherwise I only call about scheduling stuff. I do email her although I probably should stop doing that because I feel like I am bothering her and she doesn't like when I do it. I wish I could have more contact outside of sessions with her because what if something really goes wrong? Renfrew (the center I go to) has an on-call clinician number which is like a crisis line to call in emergencies but the phone rotates between different therapists who work there and I am too afraid to call it. She always tells me to but I think she knows I won't. Ugh... so frustrating.

unaluna · Jul 19, 2013, 12:41 AM

Quote:

Originally Posted by Stringcheese

Does anyone have a T that encourages contact between sessions? and supports the contact?
Things like letting the client text, giving multiple phone numbers to call, and email addresses to write?

I read here about lots of people who don't have outside contact with their T, or have it stopped because it gets out of control...

....but do you think it is a technique for clients who are more fearful of T?

Yeah we might gorge ourselves at first, and then go back to starving ourselves of contact, but I think the point is to "right-size" the amout of contact. For those of us who were neglected, we've learned not to impose (on the parent in our past), but sometimes that means we don't call when we really should - the other person(our partner in the present) is left worrying. So yesterday my t called me to check how I was handling the extreme heat and said he would call again today. When he didnt call, I texted him to let him know I was okay, and he texted me a short note back. I felt that my taking that initiative showed me taking responsibility for the relationship.

1stepatatime · Jul 19, 2013, 12:41 AM

My T allows emails between sessions. I always email her the same evening after my session. I do this because it helps me in processing what we talked about. My T always responds,usually the next morning. She is consistent. I am fully aware that she does not do therapy via email. Her responses are usually two or three sentences. But for me, and I only speak for me; this is helpful. It helps me feel connected to T. It reminds me that there are people in my life who will be consistent. I feel secure. I have only been in therapy for six months so perhaps down the road I won't feel the need to email her. Time will tell.

Irrelevant221 · Jul 19, 2013, 01:03 AM

I'm allowed to e-mail my T, as long as the e-mails aren't really personal or delve into anything deep. They're usually more along the lines of, "Hi, can we reschedule my appointment for next week?" or "Could you please send me the link to that video you mentioned in session?"

She doesn't give out her cell phone number, but I am allowed to call her office to talk to her during her office hours. I generally keep the phone calls pretty simple as well, but I have called her once when I was in crisis. If I am in crisis outside of office hours, I have to call one of the local helplines or go to the ER.

Jul 19, 2013, 03:33 AM

I have two Ts for now.

The one I have been seeing for longer allows emails...I think it makes it easier for him to respond to people. I use it sometimes, but more for informational purposes since I see him ever other week and sometimes I want to tell him something, but I also say I don't expect a response. For things we need to discuss, and there have been some based on a few things he has been helping me with, we have had a few phone calls. I definitely feel okay about our contact and one day he assured me, especially with the strength of my sadness and anxiety, I am doing more than fine boundary-wise.

My newer T allows phone calls and has returned a few frantic calls from me at the end of the day. He is the one who can calm me down very easily, but he always talks me to me a little longer if I need it. I don't depend on him, however. I learned a long time ago not to trust anyone, so I don't EVER depend on anyone for anything. It's nice he has been able to help the few times I was so upset, however.

They are both truly great.

Jul 19, 2013, 03:36 AM

Quote:

Originally Posted by I.Am.The.End.

This seems like a really, really, REALLY bad idea. Especially for those who live in the U.S. (I can't speak for other countries). E-mail, phone calls, and texts aren't secure so it would be bad to have a conversation with a therapist other than making an appointment. Hell, this website is insecure too, but it's not as readily known that we're being spied on in here. Who knows what will be used against us in the future.

So, for me personally, I'd be more afraid to say anything to a therapist over the phone etc., than in person. But I wouldn't talk to them in person either until I get solid proof that the patient/client privilege is still intact or was ever a real thing.

Patient/client privilege IS a real thing. They can loose their license over it.

And who is spying on us in here?

ECHOES · Jul 19, 2013, 05:37 AM

Quote:

....but do you think it is a technique for clients who are more fearful of T?

I don't know. Possibly.

My T encourages contact. I don't often, but I like to. When I express a worry about being too much, or writing too much or too often, she assures me that it's fine.

WikidPissah · Jul 19, 2013, 07:57 AM

The t's I have had have all "begged" me to contact them. I am also one of those really independent people who worries that I am being too dependent.

XT gave me his cell and home numbers as well as his office and home emails. He wanted me to email once a week because I was having extreme difficulty talking. I maybe emailed once every few months, and usually it was to tell him something I couldn't say in session. He used text messaging as well, and I used that more often than calling...usually things like "having a rough time, can you call if you get a chance?" or even "do you have any extra sessions open this week". He hated checking voice mail and found a text message to be much easier, as did I. After a session he would frequently say "can you text me later to let me know you're okay?" and I seldom would because it felt too demanding. After really hard sessions he would end up texting me later in the day with a "just checking on you" and even that would piss me off.

I have to add that I never contacted in between more often than once a month, or even once every few months.

Jul 19, 2013, 08:36 AM

I think it's about meeting the client where they are emotionally and then establishing the rules. I had one T who was anti outside contact and another who to this day still emails and checks on me. Some people need it and some dont.

rainbow8 · Jul 19, 2013, 12:11 PM

It's painful for me to read this thread but I needed to. I wish I were in the category of being encouraged to email and have outside contact with my T like I was in the first year or so of therapy with her.

But I'm not.

It seems like those who are allowed and encouraged to email don't have a problem with it, and don't even use it much. Then there are some who find it helpful to email and receive short responses from their T. Some can text or call or email their Ts because they don't abuse the privilege. Then there are those like me who want more contact but are discouraged because we need to work on separation, not attachment.

Emailing my T made the relationship too personal and informal. It's so hard to give that up. When T said it's best not to email her because of "the work" we're doing, that really stung. But looking at it positively, it may have meant that she enjoys my emails, and it's not that there's anything terrible about my emailing her, but in order for me to heal, and be able to go on with life without her, it's best that I don't have this extra contact.

It hurts in a bad way even when I know it's for my own good.

unaluna · Jul 19, 2013, 12:49 PM

Quote:

Originally Posted by rainbow8

Then there are those like me who want more contact but are discouraged because we need to work on separation, not attachment.

Aren't separation and attachment two sides of the same coin? After you are fully attached, you feel safe to separate. Like an Oreo. And there is still good stuff between you. But if you're enmeshed, like a chocolate chip cookie, to separate means to break apart.

Why didn't it happen with this t? If it wasnt happening in little increments every session, then how could it add up to something positive? Now with the end looming over you, you can either continue on the same track or change tracks. Whatever that means to you.

boredporcupine · Jul 19, 2013, 12:57 PM

Quote:

Originally Posted by hankster

Aren't separation and attachment two sides of the same coin? After you are fully attached, you feel safe to separate. Like an Oreo. And there is still good stuff between you. But if you're enmeshed, like a chocolate chip cookie, to separate means to break apart.

Love this analogy!

Rainbow, sometimes I do wonder if sharing lots of mundane life details with your T is kind of a substitute for feeling a real connection, which you're not yet good at. I'm not even sure what I mean by that, but it just enters my mind.

rainbow8 · Jul 19, 2013, 01:11 PM

Quote:

Originally Posted by hankster

Aren't separation and attachment two sides of the same coin? After you are fully attached, you feel safe to separate. Like an Oreo. And there is still good stuff between you. But if you're enmeshed, like a chocolate chip cookie, to separate means to break apart.

Why didn't it happen with this t? If it wasnt happening in little increments every session, then how could it add up to something positive? Now with the end looming over you, you can either continue on the same track or change tracks. Whatever that means to you.

I do feel fully attached to my T. I like your cookie analogy. I'm not enmeshed because I know I CAN separate from her. It's just HARD to do. There's a lot of good stuff between us. I have to remember that. I'm somewhere between and Oreo and a chocolate chip cookie. I don't know what you mean? What didn't happen? I'm attached to her. I know she cares deeply for me, and she will always be in my heart. It's positive but it still hurts.

Quote:

Originally Posted by boredporcupine

Love this analogy!

Rainbow, sometimes I do wonder if sharing lots of mundane life details with your T is kind of a substitute for feeling a real connection, which you're not yet good at. I'm not even sure what I mean by that, but it just enters my mind.

I do feel a real connection with my T. It's VERY real, but I also want to share the mundane deals. She's a package deal for me, and it's hard to give that up.

Jul 19, 2013, 02:48 PM

I have frequent emails my therapist. I probably email 3-4 times every week. Sometimes more. It is encouraged and works well for us. She is on vacation this week, so I respect that and won't send any emails. Instead, I write them and keep them in my draft folder. Then, the night before our session, I will send them to her so that she can see what's been going on with me while she was gone.

Email has been a big part of my therapy. In fact, she has told me numerous times that email IS part of my therapy and that I should email as often as I need to. It has had some rough spots, but only because I was too insecure to believe that she really wanted me to send them.

I am not one to talk on the phone, but she's fine with that if I need to call her. I have only done that about 3-4 times in the past 3 years. I only text about appointment times.

The_little_didgee · Jul 19, 2013, 05:57 PM

My psychiatrist lets me send email. Usually, it is for rescheduling appointments and medication issues. She always responds. It isn't something I do often.

My ASD counsellor accepts email but does not reply. She encourages me to write when I have relationship and social issues, because the feelings are fresh. We then discuss them in-depth when we meet.

I don't expect my therapists to fulfill roles they cannot. Anyway, I am very independent.

BlessedRhiannon · Jul 19, 2013, 07:44 PM

Quote:

Originally Posted by Stringcheese

Does anyone have a T that encourages contact between sessions? and supports the contact?
Things like letting the client text, giving multiple phone numbers to call, and email addresses to write?

I read here about lots of people who don't have outside contact with their T, or have it stopped because it gets out of control...

....but do you think it is a technique for clients who are more fearful of T?

Yup - my T encourages contact via text, email, or phone calls. Mostly because she knows that my boundaries are way more strict than hers, and I would never abuse it. My T is trying to help me understand that sometimes it's okay to reach out and that I'm not being intrusive and it's better to ask for help early than to let things spiral to a crisis point.

I'm very careful about how I use each form of contact. Emails are for detailed things that I want to share with T, but that don't require much from her in reply. I accept that my T will usually give me a brief reply relevant to what I've emailed her, and will suggest that we talk about it more in the next session. I usually manage to bring up the email and talk about it...if I don't, then T will bring it up, which is why I sent her the email in the first place. It's sometimes easier to bring things up in email first. Text is used for brief status updates when I'm struggling, for scheduling, or when I need to talk to T but am hesitant to call. Phone calls are for when I really need to talk to T asap.

Oh- and my pdoc prefers emails to phone calls, because he can quickly respond to emails between clients, when he may not be able to make a call as easily.

daledge99 · Jul 19, 2013, 08:13 PM

scorpiosis is right - there cannot be any "therapy by text". but so much depends on why you are in therapy. I was coming apart at the seams when my husband was having an affair. In those horrible months my therapist was very available via text or phone. I am not sure what would have become of me had he not been so available.

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