Therapist response in crisis appropriate?

Yesterday I had a bit of a mini meltdown and took a day off sick from work because I wasn't coping mentally at all. At 9 in the morning, I texted my therapist to ask if he had appointments available that day - - I didn't add context as we had a discussion about a month ago about how texting is for scheduling only. As my texting was two sentences every other week, I figured I shouldn't add any detail whatsoever and go by the book.

I didn't hear back from him till 4 (I later realised he doesn't work Mondays). He replied that he could see me the next day and that he hoped I was OK. I declined because by then my friend and husband had talked to me for several hours and I work a job where taking time off is frowned upon. I was also angry as anything.

I found his response upsetting because he didn't ask if I was OK or even why I wanted another appointment. I've seen him for nearly six months, and never asked him to see me outside our regular sessions. I haven't had something like this happen in years to me. He told me in session to contact him if I was ever in crisis, but now I wonder if that was just a bunch of garbage.

My husband and friend both say his response is appropriate. Is it? I think it's pretty heartless. I'm currently searching for a new therapist (with no luck!) because I think he's too rigid, but I'd still like to know whether I should say something about this to him. I was not in a good way yesterday so I'm not sure if I'm thinking this through correctly.

That response, for me, would have been appropriate and appreciated. But I'm not you - and you feel how you feel. Talk to him about it. Or don't, if you don't want to. Sorry his response didn't work for you. I hope you can find a new, less rigid t.

How would he know it's a crisis if you didn't give context? I think his response is appropriate considering you hadn't said why you needed to see him. Even if his texting guidelines are restricted to scheduling, it would make sense to say--I'm in crisis. Do you have an appointment today?

Of course, crisis has become a vague and overused term, so unless he knows what a crisis is to you, it might be important to write a brief explanation, like: I lost my job and am spiraling fast, can you see me today?

Sometimes, when it's not a crisis, but I'm just having trouble coping, I'll say something like, "I'm really struggling and couldn't go to work. It's not a crisis, but I could use support to keep from getting worse. Do you have an opening today?

If texting is limited to scheduling and because you didn't put any context into your text, I'm not sure why you expected him to go outside the lines and ask questions. It seems reasonable for me for the T to get back to someone by the end of the working day, whether they are at work or not. If you text a T on their day off, I'm not sure how they are expected to do anything different other than offer a slot the next day. By standards of many things heard on this board, where people wait for days and days and then have extended back and forth about scheduling, your T's response again seems professional and prompt.

But I wonder if there is another way that you can, in the future, get more assistance in a crisis. Some T's prefer you call on the phone (my does) if I need help immediately and with few exceptions, I've gotten calls back a few minutes or a few hours later. Could you discuss this with your T and ask if it's possible to call on the phone next time?

This is basically how I approach it with my T, who also only uses texts for scheduling. Like, an example from last month: "Hi [Dr. T]. Is there any chance at all that we could talk on the phone for a bit (I’ll pay!) sometime between now and, say, 12:30 Monday? It’s a long story, but I just got off of a rather soul-crushing phone call with [MC] and am not doing so great... Thanks, [LT]." He responded just saying his availability the next morning. Which was fine with me, and I was able to get in to see him. But I also gave him context for why I wanted the extra session, so he could see that there was some sort of urgency behind it. There was another time I asked for extra session or call, and I'd mentioned I just learned my uncle had just passed away, plus right before learning that, I'd had a big fight with H. He responded with "Sorry for your sadness, [LT]," then said he had availability to meet the next day (I hadn't known before that he worked on some Sundays). That little extra line of compassion from him was nice, but I know not to expect that every time.

For OP, I'd definitely suggest talking to your T about it next session. Express your disappointment in his response and say what you would have preferred. And find out: How would he want you to handle this in the future? Is there a better way to approach asking him for extra session? If he doesn't work Mondays, would he be willing to do a brief phone call? (My marriage counselor will talk on his days off, for example.)

My T generally follows me lead on stuff like that. If I ask for a specific thing (like scheduling or rescheduling an appointment or for a specific piece of information), she will provide it if she can but will generally not ask more until I see her in session next. If I give her more emotion-based information, she will usually engage with me on that level. But she isn't somebody I would describe as rigid and she does allow outside contact when I want/need it, so I don't know if this necessarily applies to your situation.

I do think this is the kind of thing that makes for great therapy material. It has been helpful for me to talk about what happened, how I felt, what the implications are, etc. A lot of really great growth has come from those conversations. I think it has also helped my T better understand how to help me, by realigning my expectations or by changing how she responds to my requests or by explaining why she responded the way she did. I have also been surprised by how often I make assumptions about why things went the way they did that have little to no basis in reality (e.g., you think I am too demanding, my needs don't deserve to be met, etc). It can be tricky stuff, but I hope your T is able to talk to you about it in a way that is helpful. Or you don't think he is the therapist for you, I hope you are able to find one who can help you through things like this. I'm sorry you're having a rough time, and I hope things start feeling better soon.

I do feel that response was appropriate. Your T would not have any way of knowing that you were in crisis. He clearly inferred something was bothering you, but unless you tell a T that you're in crisis, they can't know.

The response was absolutely appropriate. Your therapist could not have known you were in a crisis. Next time you are in that situation I would encourage you to elaborate, or to call a crisis line/go to the emergency room.

Your T's response was appropriate. When I want or need something from my T, I ask her directly and clearly. Sometimes she can't address the issue right away, but she'll acknowledge it and reassure me it will be addressed. Ts aren't mind readers. You really do have to tell them what you need from them.

This is tricky. First of all I think that it is perfectly understandable that you would be angry at him. You needed him and he wasn't there. Even there wasn't something he clearly did wrong, you still needed something and he wasn't there to give it to you. And that sucks. You have a right to feel angry and sad about it.

The question is what should you do about it? I really think it could be helpful to you if you talk to him rather than changing therapists right now. Working out problems with a therapist can be very helpful. I wouldn't come at it blaming him exactly. I'd focus more on your feelings about the situation. Did you feel hurt? abandoned? like you have lost some trust for him? And is there something you could do in the future differently to convey that the need is urgent?

Also, if he is not available and you are in crisis is there someone else that you could talk to? Some places have an emergency therapist on call that can help with some of that. I think you could reasonably expect him to help you come up with a plan in case it happens again.

Have the two of you ever discussed what you should do in a crisis situation? A crisis plan is always a good thing to have in advance when you're in therapy. Like, did he have an office phone you could contact at the time, someone on call for him, or does he take "emergency" calls? Or does he direct you to the local emergency room or crisis hotline? Might be a good idea to discuss for the future

i might be slightly irked he took all day to respond to my text, but as you said--he doesn't work on Monday's (but you didn't know that then). Also, he did say he hoped you were okay and offered you a session for today? To me that all seems perfectly appropriate.

The term crisis is very subjective depending on whose using it and their definition...

my ex t would have defined urgency as someone whos is about to die in the next 5 to 10 minutes.

I can understand that if they are use to people throwing the word around. But if you need an extra support session, that hopefully would be possible.

If I received that response then I would interpret "I hope you are ok" as a sign of caring from my T and also as an invitation to tell him more if I was not ok. If I was in a crisis then I might text a reply to the effect that no, I am not ok, and try to share something about what's going on.

I think lots of people are finding your T's response appropriate, but remember we are all looking at it objectively and we are not super-upset or in a crisis. When you are really feeling bad like that then it's totally understandable that you might find some things upsetting which seem fine to other people. IMO if you can share your upset with your T, that's the kind of thing they should be able to help with.

Thanks all - - it's good to get some perspective since mine has left me for the time being.

I'm not annoyed that he took the time he did to respond, it's more that he didn't check that I was OK and just sent a 'hope everything is fine' message without followup. That's my fault for not including context, but also his because his boundaries are so flipping rigid I didn't feel like I could text him the context.

Will talk to him tomorrow. Hopefully he'll admit some fault or regret, instead of his usual 'I'm sorry you feel that way'. I'm not holding out much hope though.

I don't think it would hurt to tell him your annoyance, but I can't see any single thing he did wrong. He had discussed boundaries with you before your text. He called on his day off. He "hoped" you were okay--to which you could have replied "Not"-- and he cleared his schedule to meet with you the very next day. And you say the crisis had been averted by the time he called. As they say on the phone: "If this is an emergency, hang up and dial 911."

Why would he admit fault or regret, though? I get that you are hurt, but I honestly don’t think your T did anything wrong. He’s not a mind reader.

I think it’s totally fair to go in there and express yourself- say hey, I never ask for extra help and I was hurting the other day, and felt like I needed some support and texted you, and didn’t feel satisfied with your response because _____. Take the conversation from there, and perhaps in the future should it come up again hopefully he will know how to help support you better. But I don’t understand how you can be disappointed when he inevitably doesn’t express fault or regret because he didn’t read between the lines.

That’s just me, though!

One thing that's been helpful for me is to recognize that I can be incredibly angry with my T and have my feelings be valid and real, even if my T hasn't done anything wrong. The same thing is true even if I think she has done something wrong but she won't apologize for it. There are ways to repair the relationship in both situations, and exploring the angry feelings is so, so important. The first time I got white-hot infuriated by my T, it was because of a very small, very forgivable mistake. But the experience of being free to express my (admittedly mostly irrational) anger was so important and useful, and my T was very calm and helpful and took it like a champ.

I think this is a real opportunity to understand your feelings, and your feelings are real and valid regardless of whether your T or anybody here thinks his response to the text was appropriate. Therapy is messy stuff, but that's okay.

Because he's so strict with boundaries I literally didn't feel comfortable adding the words, "I am not OK and need your help," to a text. I still don't. I considered writing it but then didn't because I thought he'd think it inappropriate, based on past conversations I've had with him.

When he said, "Hope you're OK," I didn't feel like I could say, "I'm not, actually," because it's not a sentence about scheduling. Again, I desperately wanted to, but don't feel like he'd approve.

And if that's how a client feels after six months, the therapist has failed their client in a big way. Again, it's why I'm looking for someone else at this point.

I don't have any problems with how long he took to get back to me or the appointment he offered. He didn't clear his schedule nor would I expect him to. Wonderfalls, your comment about calling 999 is very patronising. My friend came over, crawled into bed with me, and held me for seven hours while But thanks.

I think trying out new ones and finding a better one for you sounds like a good plan.

For me, the response would have been what I expected from the woman. Her phone message tells people to call 911 or to go to the emergency room if there is a crisis because she does not respond to crises. But she would not be who I contacted in a crisis because I do not believe there is anything a therapist can do if I am in a crisis. Others do have therapists who they contact. I think hiring one who works in the way that is best for you is the way to go.

Thanks, stopdog. I agree. I've sent messages to therapists explaining what I'm looking for but they've all declined. I live in a smallish town and can only see someone in the evenings so my options are a bit limited - - there are only about ten private practice therapists in my area and one of them is my current therapist's wife. Gah!

The situation with the midwife sounds awful, and I wonder if it makes you sensitive, or "triggered" as some say, if you find yourself in a situation which you feel is a serious crisis, but you have the perception that the person who is there to help is not responding to your communication, or not responding in a timely way.

I don't think it's the T's fault this time but I think your upset and anger seems completely understandable and maybe a good thing to discuss in therapy.

I agree with Electric Manatee, I found it very healing to be allowed to express my anger, regardless of where the fault might have been in whichever situation had triggered it off.

Thanks, Satsuma. I've no doubt the two things link up. I chose a private therapist partly because I wanted to get away from the NHS (public healthcare system). I was hoping a private therapist, in a country with public healthcare available, would be a tad more intetested in my general wellbeing.

That is so true for me too. I was mad at my therapist for something stupid last week. I told him. I'm over it. But the most important thing was that I felt just a tiny bit safer knowing that he didn't withdraw the second I got angry. I didn't even want him to apologize. I just wanted him to understand my feelings and not hate me for them.

But that's the thing - I don't know that a feeling can be both valid and irrational. Just because it's real doesn't make it valid. I think what's valid is perhaps the reason a person has come to respond the way they do, but I don't think just because someone feels a certain way, that it must be validated. I mean, think about it in the context of a sexually abusive person. Would you say that their expectation that someone else provide sex whenever they want it, however they want it is irrational? I assume you would. Would you then say that the abuser's feelings of outrage and entitlement are still valid? I wouldn't. I guess I'm just confused about real vs. valid.