[amandalouise]

a recent thread got me thinking.... how many of us really know what happens to our emails when we email our treatment providers..

heres what happens to my emails when I send one to my mental health treatment providers ...

I go into my email account, write the email. the email goes through the websites (ie yahoo, google, gmail and what ever) a copy is auto saved in my sent box and gosh knows how many internet servers

(I know that when I watch the news and some crime has happened sometimes the reports state the authorities have copies of emails they have obtained from servers and website domains so I know copies of my email somehow get saved on all the different programs that are working together to pass my email from my home computer on to my therapists office computer system. this process means my emails are not held with confidentiality, like a face to face session)

then my therapist logs on to her work computer, (or the receptionists who's responsibility to check the mail and emails does it which again means my emails may not be confidential just between my therapist and I)

a paper copy of my email is made, then this copy is stamped with date and time that they received the email. mental health agency forms for documentation.

my therapist reads the email and documents that she received the email (the documentation form requires my therapist to initialize that she received the email)

after reading through my email my therapist must fill in the therapy plan form surrounding the email (does this email require a reply, discussion, is this email and advocacy where I am asking her to go with me to do something or help me get signed up for a class or some other service besides having a face to face therapy session, is this a scheduling request... what exactly needs to be done about this email...)

if sending a reply back to me my therapist must write the email, make a copy of the email for the files and document on another form that she sent me an email...

if the email is a request for scheduling she or her receptionist calls me and documents on their call log that a scheduling call was made and a statement paper is entered into my file reflecting that a scheduling call was made.

a billing form is filled out under the services of therapy or advocacy is done.

this whole process can take anywhere between an hour and many hours but my therapist only bills for one hour of hers and the agencies time and labor (equivalent of one therapy session).

with my insurance plan I get 52 therapy sessions a year. since the mental health agency bills for their time and energy it takes to process and address the issues in my email, like a therapy session I have to be mindful of how many emails I send my therapist.

for me I value my face to face sessions as being more important than an email not to mention the confidentiality factor of face to face session, which means I rarely send my therapist and email. instead what I do is keep a journal of what I want my therapist to know or discuss / work with me on. then I hand it to my therapist during my therapy sessions.

question .... have you asked or do you know what happens to your emails that you send your therapist?

[Waterbear]

My T is private practice and I send to her personal email account. I am sure that it is traceable and hackable but actually, I don't think I mind. It isn't like anyone could identify me and my family, where I live etc so I am not sure it matters. Other than that I don't actually want to think about it!!

[BayBrony]

My T is in private practice and I just use her personal email . as far as I know it just goes to her inbox. She GE really reads them before my sessions although they occasionally get buried. I know she saves them all in a file BC she has looked up old emails before. But other than that I don't think much gets done about my emails

[stopdog]

The ones I see are in private practice as solo practitioners. They have no staff.
The first uses email - it is published on her website and she invites the use of it.
The second does not have an email address published but has a cell phone number that she gives to clients and encourages use.
I see no problem (other than insurance = which I do not use) for the therapist to charge for emails in 10ths of an hour just like I do when billing as an attorney. The one I see has never made mention of it -but I don't see that it would be unfair to bill for it. The second one stated up front that she bills in 10ths of an hour for phone calls over 15 minutes - again - fair enough as far as I can see. The second one does not take insurance at all.

[pbutton]

My T is in private practice. My emails travel through the normal internet servers etc..etc... I am not concrrned about any interception of my emails, as they are quite dull, really. He occasionally has a printed copy in hand to discuss. Sometimes he has my email pulled up on his laptop screen suring my session. Not sure if those eventually get printed or not. It doesn't matter very much to me. He often encourages me to email, so it must not cause a time concern for him.

[Pennster]

Yes, no staff or paper copies involved. He just reads them and occasionally gives me a couple of sentences in reply. This probably takes him two minutes max per email.

I am really glad I don't have a therapist with the kind of bureaucracy your therapist does, AmandaLouise! That sounds really inefficient, and I wouldn't like all those layers of interference between me and my therapist. Good if it works for you, though!

[BudFox]

That sort of bureaucracy sounds like something out of the Victorian era (apart from the emails). Maybe they need to bring in an efficiency expert to tighten up the ole procedural side of the biz.

I think at most my therapists printed a copy and put it "in my file".

As for security, nothing electronic is truly secure and I think that's the price you pay for convenience.

all contact with my P and T is made through and screened by their office staff

[ScarletPimpernel]

My T is private practice. So only she gets the email. She probably makes a copy and puts it into my file. Maybe she doesn't? The email is not used as part of my treatment goals/plan.

Maybe it gets stored in a server somewhere, but whatever. I'll take that risk in order to have contact with her. If someone finds it, they'll have a boring read. I don't put sensitive information in my emails.

[ScrewedUpMe]

Amandalouise, thanks for this, I found that a really interesting read and quite bizarre how your T has to really document every bit of the process!

My T is in private practice so she is the only one that reads my mails. She once asked me if I ever re-read the mails I send her, I said no, and she said she didn't either! I don't think she even prints them out or files them. I think it's a case of deal with it at the time and then move on. I kind of wish she would keep records a bit more. Sometimes she seems a bit slack like that.

Originally Posted by Pennster

I am really glad I don't have a therapist with the kind of bureaucracy your therapist does, AmandaLouise! That sounds really inefficient, and I wouldn't like all those layers of interference between me and my therapist. Good if it works for you, though!

I agree. It sounds really bizarre and kind of crazy. I wonder if most therapists operate like that.

[BayBrony]

I know my T also serves as an advocate for victims of assault/domestic violence. She coordinates court, social worker visits, housing/charitable assistance. I wonder if that sort of work requires more documentation of communication.
However she will not serve in both an advocate and therapist capacity for someone. It's one or the other

[amandalouise]

Originally Posted by Pennster

Yes, no staff or paper copies involved. He just reads them and occasionally gives me a couple of sentences in reply. This probably takes him two minutes max per email.

I am really glad I don't have a therapist with the kind of bureaucracy your therapist does, AmandaLouise! That sounds really inefficient, and I wouldn't like all those layers of interference between me and my therapist. Good if it works for you, though!

yes sounds confusing and strange I know to those not used to this, but making copies of correspondence between therapist and client for the files and working treatment plans and documentation around that correspondence has been in affect here in NY for decades. there are some files where I work at a crisis center and at the local hospital that date back to the 1970's and 1980s that still have copies of letters between therapists and clients in the files, a documentation slip of when those letters were received and what the therapists and clients did about those letters.

the only difference is that NY is finally catching up with the computerized way of doing things where files and treatment plans now includes computer correspondence (emailing\texting)

when my therapist first told me I could email her my first question was if I email you what happens to those emails? at first I was a bit upset about the fact that she was copying and documenting for the files what I was going to be emailing her but then she told me to think about how treatment providers how before computers what happened to the letters and all that doctors therapists got stamped\ documented and filed. then she had me request some of my older therapy records and get copies. I was amazed how many letters, drawings, and other correspondence was in those files.

the way my location is doing things isnt new. its just been expanded to include computerized correspondence between therapist and client.

[Bipolar Warrior]

This is a really peculiar concept to me. They're just emails. It's meant to be a quick and efficient form of communication, not a bureaucratic nightmare! By the sounds of it they turn it into a five-man operation or similar. How ridiculous.

I have never emailed my private therapist. I know I could, though, as she has her own private practice and would simply read, and maybe respond, without any further hassle. And I used to email my uni therapist all the time, and even though she is employed by the university there was no craziness to it; I sent the emails to her private email address, she read and responded to them, and that was all that happened. She communicated via email and text (and sometimes phone calls) between sessions because she wanted to, not as part of her job (I know this because she told me).

I would never send an email if I knew it would end up going through a process like the one you are describing!

Don't really care.

[itisnt]

I retract my previous post on the other thread, amandalouise, stating that it only takes a T a few minutes to send an email notifying a client that their email has been read and received . . . at least in response to how things are done in your clinic. Sounds like a T working at your clinic needs to bill for a double session when faced with all that bureaucracy! That said, I do think that the kind of actions you described sound more like a CYA kind of bureaucracy. I do understand that in this sue happy work world businesses have to protect themselves, but that lengthy procedure is ridiculous! When T and/or clinics begin to get bogged down in CYA procedures, then they're really not thinking deeply about the needs of their clients, they are more wrapped up in making sure they aren't paying out big bucks in in litigation. Personally, if I was faced with that procedure whenever a client sent me an email (if I was a T which I'm not), I'd be resentful and have difficulty focusing on what the client needed. But that's just me and my personal difficulty with jumping through the hoops that I don't view as necessary.

I have to also add that I think that the world has definitely changed in regard to safety issues. The recent "political" hacking of email has been embarrassing to lot of U.S. leaders. It has made me think about my "emails" to my T and my friends over the years. A few were cringeworthy, along the same lines as poor Colin Powell's emails that reveals that he engages in gossipy talk in his emails just like the rest of us. I'm not sure that I'd send some of the emails I've sent nowadays. I think maybe snailmail is a little safer in this day and age. Yikes! Terrible to think that we're going backwards instead of forward in regard to technology.

[BlessedRhiannon]

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.

[runlola72]

My T is in private practice at his home but I worry about his wife seeing the emails because she is in the same/similar field I am going into, and I'm sure knows some of my professors. So, I do worry a bit. I do not think he ever prints emails.

[stopdog]

I don't see that anything I write is all that interesting to anyone except myself. I doubt the woman I pay is all that interested in it - let alone anyone else. I don't worry about email as being un-secure when dealing with the therapist. As an attorney, the rules in my state require me to put a lengthy disclaimer on my email correspondence.

Nothing is completely secure. Regular post office mail can be intercepted and opened, paper files can be opened and stolen, phones can be tapped, medical records are being hacked, etc. So if one is going to worry about communications - worry away - but to get all worked up over email specifically does not seem worth it to me.

Agencies often do have a lot of bureaucratic busy work rules that practitioners in solo or other types of private practice can handle differently. Look at some of the silly post office rules about how long a mail carrier's stride should be and other things:
http://uspsmiscl.lettercarriernetwor...CE%20GUIDE.pdf

[MobiusPsyche]

My T is in private practice and I am very glad of that. Like others, she does print it and put it in my file. She always responds to my emails and she doesn't charge me extra for them (but might if they were excessive). I do use insurance with this T.

[Lauliza]

My T and Pdoc are in a private group practice. The office staff reads the emails, prints them out and gives them to clinicians to sign off on. The printed email goes into the clients file. I've never emailed my T but my pdoc responds to emails with phone calls. There is no charge for emails. I use insurance for both providers and I think this is why they don't email. I know where I work insurance carriers wont pay for time billed for emails. So private practice Ts don't have to worry about this but others probably don't email for this reason.

[sweepy62]

My t is not in private practice, we don't do emails, but when I use to leave letters for t1 with the reception to leave in her mailbox, I didn't know the process, the receptionist, gets to open it. Read it log it in, then send it up to her
I then stopped doing that.

[ThisWayOut]

My t is private practice. To my knowledge, she is the only one to read her work emails. Aside of the general lack of confidentiality of using electronic communication, I don't think there are many confidentiality concerns. Even if someone hacked her email and read what I sent (or hacked my own and read it), I doubt they would get anything useful.
T seems to only bill for face to face sessions. I guess if we had a phone or Skype session, she would bill for that, but since we really only do f2f, she doesn't bill for anything else (nor does it take that much red tape to get an email response from her).
I would be frustrated by that level of complexity around contacting t, especially with an email about scheduling!

I have only seen therapists in private practice and use insurance to get some reimbursement from "out of network" benefits. Both of my therapists respond to emails to a limited extent and the second one actually encourages between sessions contact but he only engages in a minimalistic way. No extra charge for any of that.

I personally would find it a bit disturbing to have my emails read by administrative staff, not primarily because they contain top secret things, more because I do not address my communication to them. As for confidentiality, almost anything that goes through the internet can be intruded unless we use specific, extra secure tools for the communication but I doubt any of those are 100% secure either. I personally don't worry about strangers I never see potentially hacking into it, and I think it's quite unlikely that someone would be interested in my stuff to do so, but I can imagine for some people in certain positions this is a realistic threat and something to pay attention to. There are therapists who use encrypted methods and other higher security tools when they are asked for it, but I imagine these would mostly be in private practice.

[ruh roh]

I could not justify seeing a therapist who takes an hour to deal with one email. Imagine if she gets 8 emails in a day. Does she cancel all her appointments? Does the insurance company actually reimburse for that? It seems fraudulent to me and does not add up. Maybe it's done that way to deter clients from emailing.

I think the question/issue of confidentiality of electronic communications is that basically...nothing is private. Not even this site. So anyone communicating in this way should probably come to grips with that and accept there is risk in all electronic media.