Am I the only one to think that having out-of-session contact with a therapist or psychiatrist is unprofessional?

Here I go playing the Devil's Advocate again. But, ask yourself, what seems to be in common with so much strife we are reading about difficult and tenuous patient/doctor relationships. I see a real correlation in many of these posts that one can pinpoint out-of-office communications as being a cause or aggrivation of relationship difficulties. I have read a lot about issues that seem to be grounded a great deal in misunderstandings that happen while texting, directly calling, or emailing back and forth with one's care provider.

I am not suggesting this is a one way only issue. Misunderstandings and the putting up of walls apparently as I see here seem to be equally the cause of the doctors as they are patients.

Having contact with one's professional just seems to me to be too big a window of opportunity for disaster.

Would it not be better to maintain contact by way of the office?

[Waterbear]

Not for me, no. I can see where you are coming from but I have not had any issues with it because my T is consistent in the timeframe and method of response; she won't delve into deep issues by this manner but responds exactly as I need her to 99% of the time. I guess I am very lucky in this that what she can provide is just right for me and so it works for us, but I can see how it wouldn't work for many, even with the same setup. Each relationship is individual and I think it is up to both parties to say what does and does not work for them. Transparency and honesty. If the client doesn't feel what is happening is working then they should tell the T and they to work it out. If the T can't provide what they need then it is up to the client to decide if they want to continue working with the T or not. That sounds very clinical, I am aware of that, and I know it rarely is as easy as that, unfortunately.

I also think a lit of Ts are not professional anyway, and that is what causes the problems, not the method of communication.

Out of session contact can be useful and in some cases essential for clients. If it's not for you then that's fine, but in no sense is it unprofessional in of itself.

[stopdog]

I don't think everyone wants such a thing - but in no way is it unprofessional. I find it quite infantilizing to tell a client that they may not contact the person they are hiring outside of the appointment. One can contact every other professional they hire outside of appointments - I see nothing and no reason why therapists would not be treated as any other person that one hires.

[ScarletPimpernel]

I find out of session contact very useful. My T is very good about responding in the way I need her to. It's direct and concise. She doesn't try to resolve anything; just provides support. We do have clear boundaries with out of session contact. Text is for scheduling. Calling is for emergencies. Email is for support, reassurance, and check-ins.

I can see though how email can be easily misinterpreted. So can texts. That's why boundaries are vitally important. And if too much miscommunication happens, there should be limited to no out of session contact.

[Pennster]

It is part of the way my therapist works that he is willing to be available for coaching calls outside of office hours. It's probably one of the most helpful aspects of my therapy. There is nothing unprofessional about these calls - it's explicitly part of the therapy.

Being about to reach out at an early stage of a depressive episode has helped me stop from relapsing or falling deeper into crisis.

I suspect when people have problems with relationship difficulties with their therapists, these difficulties would happen with or without outside contact. And several times, in the beginning of our work together, being able to contact him for clarification helped avert trouble that was brewing due to misunderstanding each other in session.

In contrast, I remember having very difficult times with my first therapist as it simply hadn't occurred to me that I could ever contact him between sessions - we had a few misunderstandings that led to deeper problems thanks to my tendency to ruminate. Not being able to clear the air for a week or two caused me a lot of emotional anguish.

[stopdog]

The second I see has said she sees being available by phone to be part of her job.
Further, they have both acted overly happy and enthused the times I did contact them - mostly because they wrongly assumed I was reaching out to them because of some bond thing they thought had happened.

I don't think it is unprofessional in and of itself. I do think there are therapists who have really loose boundaries and allow too much contact, then when they realize their lack of boundaries is creating problems, they backtrack and create more issues for their clients. THAT is unprofessional.

I have always had out-of-session contact ability with my therapists and psychiatrists, but they were professionally boundaried about that contact which, for me, allowed it to work without it ever causing problems on either end.

None of them used email or text messaging for contact, and I agree with that boundary. Too many miscommunications seem to hover around that kind of contact because there is really no way to put actual limits on it. If a client decides they want to impulsively send 10 emails or texts in one day, there is nothing to stop them, which often ends up with the scenario that the T has to put limits on what was at one time an unlimited means of communication, creating anger and confusion on the part of the client.

My T and pdoc were always available by phone call. I could call during office hours and leave a message and they always returned calls within a few hours, and after hours I could contact them via their answering service -- again, they always returned calls promptly. It was a boundaried availability in that it wasn't that idea that I could contact that them any time I wanted to and expect immediate attention. Texts and emails often give people that illusion that the people on the receiving end should respond very quickly. I've been on the receiving end of that expectation from parents of students who had an expectation that I would respond right away and got angry if I didn't -- not fun. I also have found actual phone conversations are rarely a point of contention because we can hear each other's voice inflection, ask immediate questions, and have a real conversation in real time.

That is my personal opinion on outside contact. Others will say it is still too restrictive or old-school, but one thing I've learned about technology is that is has sometimes created unnecessary problems that just muddy the waters.

[kecanoe]

I find out of session contact to be helpful most of the time. There was a time where I was expecting sessions via text and we had to talk about it. And I didn't like not being able to have long texting sessions, but t1 handled it well and it's ok now.

Some ts deliberately offer out of session contact. It is very common with DBT. And some ts think that some clients need to practice asking for help and out of session contact is a good way to practice that.

[mostlylurking]

My T has been consistent, replying to my emails typically within a couple of hours with brief (although still meaningful) replies, so this hasn't caused problems. His replies have given me immediate relief during crises even though they're usually just a couple of sentences. At other times, when I have a realization of some sort between sessions, I think I get even more insight or clarity as I try to articulate it in writing.

I see this as very helpful, but I do think he maybe should have stated what his email policy was right up front. I limit myself so it's less than one email per week on average, which has been fine, but I don't know where the limits are. Maybe T's don't want to state the limits up front because they don't actually want to encourage their clients to text, email or call? "Up to 4 emails a week" sounds like an invitation. Maybe the limits should be in the small print at least, so the T could point to it later and the client would not feel they were being rejected or punished?

[Argonautomobile]

Well, you're certainly not the only one who's thought it. I have. After hearing many positive accounts of out-of-session contact, however, I no longer believe it's inherently unethical. I think there's always the risk of it going awry or being mismanaged, and am personally grateful this is not something that my own T offers or encourages. I'm glad it's there for people who do find it helpful.

[BayBrony]

I'd find it the opposite. Dealing with the intensity of abuse history, SI, body dysmorphia, etc I think it would be unethical for my T to NOT provide out of session contact. How would it be ethical for her to stir all this up and then leave me high and dry for days with no assistance? That would be extremely upsetting and not productive. Of course there are risks but I can't imagine doing this work with someone unless i could count on them to be there

[Pennster]

Originally Posted by BayBrony

I'd find it the opposite. Dealing with the intensity of abuse history, SI, body dysmorphia, etc I think it would be unethical for my T to NOT provide out of session contact. How would it be ethical for her to stir all this up and then leave me high and dry for days with no assistance? That would be extremely upsetting and not productive. Of course there are risks but I can't imagine doing this work with someone unless i could count on them to be there

I really agree with this -- in my first round of therapy, with no contact between sessions, I dredged up so many traumatic memories and really developed a sense of myself as a deeply traumatized person with no one to rely on. It damaged me terribly.

My therapist's availability now has done so much to give me the sense that there's a safety net for me, and I am not alone. That sense of not being alone now has really helped me to see all the ways in which I used to abandon myself. And feeling like someone is really there for me has made me much better at figuring out ways I can be there for myself as well. Being able to count on someone so consistently has changed so much.

Originally Posted by justafriend306

Am I the only one to think that having out-of-session contact with a therapist or psychiatrist is unprofessional?

Here I go playing the Devil's Advocate again. But, ask yourself, what seems to be in common with so much strife we are reading about difficult and tenuous patient/doctor relationships. I see a real correlation in many of these posts that one can pinpoint out-of-office communications as being a cause or aggrivation of relationship difficulties. I have read a lot about issues that seem to be grounded a great deal in misunderstandings that happen while texting, directly calling, or emailing back and forth with one's care provider.

I am not suggesting this is a one way only issue. Misunderstandings and the putting up of walls apparently as I see here seem to be equally the cause of the doctors as they are patients.

Having contact with one's professional just seems to me to be too big a window of opportunity for disaster.

Would it not be better to maintain contact by way of the office?

Is not the out of session contact that is the pattern here of disharmony. It's normally a T not very good in the session also