[circlesincircles]

Some brief background: I've been working with my therapist for almost 5 years. Maybe six months ago she offered to have email be "a part of our work," because I often struggle to articulate what I'm feeling in session. I end up feeling frustrated and stuck. Email has been helpful in allowimg me to introduce topics I'd like her to help me discuss, and to broach things that I feel too ashamed to bring up in person. On average I've probably been emailing her every other week.

In the last month or so though, I've been feeling increasingly compelled to contact her between sessions - to connect, to seek reassurance, to clarify session topics, to ask questions. The desire is pretty directly related to increased intensity of the work we've been doing. At the same time, I'm also feeling increasingly worried about asking her for too much.

I'm thinking about proposing that I pay her for email contact as a way to contain my guilt/worry. If I'm paying her then it becomes much more transactional and maybe I can feel freer in writing longer, more detailed emails. Ultimately I want to be able to talk about these things with her directly, without email as an intermediary, but years of self-censorship tell me that I don't know if I'll ever get there if I'm just relying on face-to-face conversations.

I'm wondering if anyone has experience with paying for email contact. I'd love to hear about the logistics and how it's influenced your course of therapy (or not).

[ChickenNoodleSoup]

I know some members on here pay for email contact, they can certainly provide better answers. The only thing I can say is my T charges me for all outside contact except texts (which are only used for scheduling). I only get phone calls, but for those I have to pay the call charges, plus I pay him some rate for his actual work.

There's no logistics, really, he just charges me more at the end of the month through my health insurance. I like having the outside contact, but paying for it has not influenced it in any way. I think it's only reasonable to pay if the T works with you, it's their job after all and they need to earn money somehow.

However, my T has said himself that I'd have to pay. I think that's the Ts business, they need to know whether some form of contact is work for them or just quickly reading something without investing too much.

[mindmechanic]

I can send emails to the therapists with an understanding that she wouldn't respond. If I really need some kind of response or reassurance, I would let her know, and she would respond with a short message. But the therapist wouldn't get into therapy content through text or email. I don't pay her to read those emails or texts. Sometimes I free associate between sessions, so I type them, and send them over to her. We would then talk about it in session if I want to.

It seems that some therapists charge for all outside contact, but some don't. If I were you, I would bring up my need, and see how she wants to proceed with it and any transaction. I don't think that you have to take care of your therapist's feelings about what might be too much for her. I think that therapists are the ones who would let us know when something is too much and needs to be charged for.

[feileacan]

Originally Posted by circlesincircles

I'm thinking about proposing that I pay her for email contact as a way to contain my guilt/worry.

But why not really work with your guilt/worry by talking about it instead of acting it out?

[Ididitmyway]

This is a very interesting topic and the one that rarely gets discussed or explored in therapy or on therapy forums.

I also had a problem expressing myself freely face-to-face with all my therapists. Writing felt like a much better way of communicating what I needed to say. It allowed me to go much deeper right away and to relay all details and nuances that were important to me. I could focus better when I was writing, because when I would talk to a T face-to-face I needed to always make a connection with a T first in order to be able to bring up whatever I needed to talk about.

I've noticed that quite a few people have this issue in therapy, but, sadly, the profession doesn't recognize it as something that needs to be taken seriously. The only guidelines around it is to treat it as a "boundary" issue when it often has nothing to do with the boundaries.

To answer your question, no I had never paid for email contact in therapy, but, I think, that if the therapist is willing to meet your needs such payments can be arranged. The payments could be calculated based on the word count and on the number of interactions. I think, this is what therapists who only work online do. Those who provide online therapy sometimes have email as one of the options though video sessions seem to be more common.

So, yeah, I think, such payments could be arranged with no problem if the therapist agrees to working in this manner. This makes me think if online therapy might be a better option for some people all together.

[LonesomeTonight]

I'm also someone who finds outside contact helpful. My current T charges for e-mails if it takes him longer than 15 minutes to read/respond (he'll charge $45). But in those cases, he responds really thoroughly, like multiple fairly long paragraphs. I've had maybe 4 or 5 of those in the course of 8 months working with him. He doesn't charge for shorter e-mails, like if he responds with a sentence or two (even if what I wrote him was somewhat long).

At first I was bothered by the charging when he told me about it because my ex-T and ex-marriage counselor never charged for any outside contact. (I also mistakenly thought he wasn't OK with the shorter, no-charge e-mails.) But in talking to him about it, I realized it's actually helpful, because, as he puts it, for the longer ones, he's getting paid for his time. It's not like he's just doing me a favor. So it feels safer to me in a way.

This is mostly because, as I mentioned, ex-T and ex-MC allowed outside contact (e-mail, text, and occasional phone calls) with no charge. I often wrote quite long e-mails to them. Ex-T didn't usually respond, or would just say something like "good thoughts, let's discuss in session." Then at one point, I was upset that she hadn't responded to an e-mail where I was really distressed about something. She replied, in a frustrated tone, "Your e-mails have just gotten longer and longer, I only have so much time!" Yet she hadn't said anything till I asked. I felt hurt. So, then I backed off quite a bit.

With ex-MC, he replied more often, but with something brief (and would often take a few days to get back to me. (We also had phone calls maybe once every month or two, lasting from 15 minutes to 45 minutes, for no charge). After what happened with ex-T, I kept checking in with him to make sure I wasn't contacting him too much or writing anything too long. He continually reassured me that it was fine, as long as I understood that he couldn't always read or respond right away. Then we had a sort of falling out in December (too complicated to get into here), and at the end of the brief phone call during that, he said, "And you need to reduce outside contact with me." Which really hurt (and which he kept insisting was not his rejecting me--there was lots of transference going on there). We terminated a couple months later.

So all of that is why I feel better/safer with current T charging for longer e-mails. He also, for longer or shorter ones, has always responded within 24 hours--once was to apologize for not having time to write yet (was a weekend), but that he'd reply in full the next morning, which he did. Which is nice because the others either didn't reply or were very inconsistent in how long they took to reply. And current T has reassured me recently that his e-mail policy hasn't changed, that it's always OK to e-mail him, he'll just charge if it's over certain length (whenever I send him a longer e-mail, I say something like, "If you choose to reply at length, I accept the charge." Or "brief, free reply is fine, then we can talk more in session.") He also only allows texts for scheduling and tends to only do phone calls for out of state clients (like students away at college), but will schedule an extra session if wanted and he's available, which he often is. This structure has helped me get out of the habit of sending frequent long e-mails (or texts with expectation of quick reply) and also makes me less worried that he'll decide to change the rules on me or get annoyed if I contact him too much. Incidentally, he did let me know once when a text--that I thought was about scheduling--was "a bit intrusive" because of the timing/content, so he seems pretty true to his word that he'll be honest with me.

So, all that being said (that was probably more detail than you were looking for!), I do think paying for e-mails could potentially help you. However, be prepared that your T may be unwilling to accept payment for them. Also know that insurance generally does not cover written communication, if that's a factor. (For me, knowing the $45 is coming entirely out of my own pocket makes me consider how important an e-mail really is.) I think it would be a good discussion to have though.

Edited to add: Forgot to mention I've also been seeing him twice a week for the past few months, which has also really helped. I'd been used to seeing ex-T and ex-MC in the same week, so as he put it, my therapy time had basically been cut in half by seeing MC less (like once a month for a bit), then terminating. So he offered twice a week if I wanted, so I'm doing that for now.

[ElectricManatee]

Originally Posted by circlesincircles

I'm thinking about proposing that I pay her for email contact as a way to contain my guilt/worry.

Regardless of how your T feels about payment, I think this is worth working through. My T offers email and phone contact between sessions for free, and my guilt/worry about reaching out was huge and astonishingly tenacious. It has taken years to get to where I can reach out and expect that she won't get angry at me for being "needy." (I'm still not perfect at it.)

I was doing the same thing with her that I was doing with other people, being unable to express my distress or ask for support if the other person wasn't being compensated or paid back in some way. It was keeping me isolated and stuck. Working through that in therapy has helped me be more comfortable and connected in the rest of my life. Obviously therapists are a bit different from friends in that it is a paid relationship, so I think it's fine to talk about how your therapist feels about paid outside contact. But I do think there could be some rich material around your anxiety about reaching out. It could be a missed opportunity if you side-step the whole emotional issue by using payment to assuage your guilt.

[stopdog]

I never paid for emails or phone calls. However, I do think it would have been reasonable to have therapists charge like I do as an attorney in 10ths of an hour. It makes it clear and understandable, it relieves guilt or worry about taking advantage of a therapist (which I never worried about but some others seem to do so), and it stops the therapist from being parental and puts them back as professional. I never wanted responses from the therapists, I wrote to get stuff out and away from me - to clarify. The therapist's responses were never better than her talking in person - so useless to me.

[peacelizard]

You could bring it up with your therapist but, even if he/she agreed, I question whether it would assuage your guilt.

I don't know what your finances are like, but if money doesn't grow on trees for you, maybe try asking them about emailing thoughts or questions or whatever you have trouble saying in person and they can read it at their leisure, not have to respond and also not waste a ton of valuable appointment time reading these sheets?

[maybeblue]

I have an arrangement with one of my therapists where I email her before every session with issues/concerns/thoughts etc. She replies only briefly with something like "thank you for your email, I am looking forward to talking to you tomorrow." Then we go over the content of the email in session. It works very well for me, and essentially the email is really part of the session...so I just pay for the session.

Once in awhile I have needed extra contact between sessions. In that case I have emailed her and she has responded. I felt a little guilty about it, but she was always reassuring that it was fine. Recently though I have needed much more contact because of a traumatic event. I have also asked her to communicate with a medical provider for me. I also felt guilty or concerned about the amount of time I was taking. And so I did offer to pay her. She has reassured me that what I have asked for is reasonable and that she will let me know if it takes enough time that she needs to charge.

Respecting professional boundaries is really important to me, just as I expect them to respect mine. Even though I like my therapist a lot, I know that I do not need for her to be a friend. I need for her to be a professional. I don't think that I am responsible for her feelings, but I do think I should respect and pay for her time.

So if I were you, I would absolutely share your concerns and offer to pay. Even just asking will make you feel better, and I believe it will make her respect you more because you are respecting her professionally.

[circlesincircles]

Originally Posted by mindmechanic

I don't think that you have to take care of your therapist's feelings about what might be too much for her. I think that therapists are the ones who would let us know when something is too much and needs to be charged for.

This is a helpful reminder. I tend to try to take care of everyone’s feelings, mostly as a way of avoiding conflict and seeking acceptance.

[circlesincircles]

Originally Posted by feileacan

But why not really work with your guilt/worry by talking about it instead of acting it out?

You mean do the work of therapy? Lol.

I know that if I bring it up with my therapist, she’ll want to help me work through the feelings regardless of whether she accepts payment. The guilt and worry are twofold, I guess. One the one hand, worrying about being too much applies to everyone in my life. On the other hand, I do want to respect her time as a professional.

[circlesincircles]

Originally Posted by Ididitmyway

This is a very interesting topic and the one that rarely gets discussed or explored in therapy or on therapy forums.


I also had a problem expressing myself freely face-to-face with all my therapists. Writing felt like a much better way of communicating what I needed to say. It allowed me to go much deeper right away and to relay all details and nuances that were important to me. I could focus better when I was writing, because when I would talk to a T face-to-face I needed to always make a connection with a T first in order to be able to bring up whatever I needed to talk about.


I've noticed that quite a few people have this issue in therapy, but, sadly, the profession doesn't recognize it as something that needs to be taken seriously. The only guidelines around it is to treat it as a "boundary" issue when it often has nothing to do with the boundaries.


To answer your question, no I had never paid for email contact in therapy, but, I think, that if the therapist is willing to meet your needs such payments can be arranged. The payments could be calculated based on the word count and on the number of interactions. I think, this is what therapists who only work online do. Those who provide online therapy sometimes have email as one of the options though video sessions seem to be more common.


So, yeah, I think, such payments could be arranged with no problem if the therapist agrees to working in this manner. This makes me think if online therapy might be a better option for some people all together.

It does seem like it gets labeled as a boundary issue. I can see how that might be part of it, and maybe it’s what I’m internally reacting to.

It sounds like emailing has been helpful for you too.

[Anne2.0]

I like LT's policy and perspective on emailing. I do think it's fair for T's to charge for a substantial response as well as to limit responding so their time is protected. Like phone calls.

Most T's, if they have much experience, received no training on how to handle emails and by that I mean doing therapy via email, in the substantive way that LT's therapist handles things. Maybe there are CLE's on the issue but doing therapy via email (as in responding substantively) is a whole nother ball of wax than therapy in real time. Email has an impact different than in person communication, so does text, and both have the potential to go off the rails for all kinds of reasons. I'm glad there are therapists who can make this work for clients and I can see how this kind of outside contact is good for people. It isn't my thing and in my professional context, tend to think about whether phone v. email is preferable in certain situations.

But I have received free phone contact, at times very often and substantial from my T. I did talk about expectations around this such as how quickly I could expect him to call back and how much was too much and whether certain topics were off limits.

[circlesincircles]

Originally Posted by LonesomeTonight

So it feels safer to me in a way.

Edited to add: Forgot to mention I've also been seeing him twice a week for the past few months, which has also really helped. I'd been used to seeing ex-T and ex-MC in the same week, so as he put it, my therapy time had basically been cut in half by seeing MC less (like once a month for a bit), then terminating. So he offered twice a week if I wanted, so I'm doing that for now.

I’m sorry you had such painful experiences with *two* previous therapists. I like how you frame it in terms of safety. That’s not a descriptor I had come up with, but it feels like it fits.

I’ve also considered asking for an additional session per week instead of paying for emails, but also have a fear that she’ll think there’s no real need for it. I’m not in crisis, I’m functioning just fine. But of course I can’t know that she would reject either proposal without asking!

[circlesincircles]

Originally Posted by ElectricManatee

Regardless of how your T feels about payment, I think this is worth working through. My T offers email and phone contact between sessions for free, and my guilt/worry about reaching out was huge and astonishingly tenacious. It has taken years to get to where I can reach out and expect that she won't get angry at me for being "needy." (I'm still not perfect at it.)


I was doing the same thing with her that I was doing with other people, being unable to express my distress or ask for support if the other person wasn't being compensated or paid back in some way. It was keeping me isolated and stuck. Working through that in therapy has helped me be more comfortable and connected in the rest of my life. Obviously therapists are a bit different from friends in that it is a paid relationship, so I think it's fine to talk about how your therapist feels about paid outside contact. But I do think there could be some rich material around your anxiety about reaching out. It could be a missed opportunity if you side-step the whole emotional issue by using payment to assuage your guilt.

I think you’re absolutely right. As I mentioned above, I’m fairly certain that regardless of whether she accepts payment, my therapist will want to work through the feelings with me. Which is good.

Do you think it was mostly repetition and time that have helped you to get to the place of feeling able to reach out (mostly) without fear/concern? I’m terrible at asking for help IRL. Or even realizing it’s an option.

Several weeks ago I cut my finger while cooking dinner and was debating whether I needed stitches. My first thought was how I was going to be able to take my kids with me to the ER and get them to bed at a decent hour because I don’t have a partner. Upon later reflection, I realized it didn’t even occur to me to ask a neighbor to watch the kids, or to ask someone to help get me to the ER. Long story short, I decided I didn’t need stitches, but it’s stuck with me since. So there’s something about wanting this help from my therapist that’s different, and something I also need to explore.

[circlesincircles]

Originally Posted by peacelizard

You could bring it up with your therapist but, even if he/she agreed, I question whether it would assuage your guilt.

I don't know what your finances are like, but if money doesn't grow on trees for you, maybe try asking them about emailing thoughts or questions or whatever you have trouble saying in person and they can read it at their leisure, not have to respond and also not waste a ton of valuable appointment time reading these sheets?

Yeah, no money tree for me. I think your suggestion is a good one and it also makes me recognize that part of what I really want from the contact is acknowledgment and connection. So I think a response would be important. But it wouldn’t have to be anything lengthy.

[circlesincircles]

Originally Posted by maybeblue

Respecting professional boundaries is really important to me, just as I expect them to respect mine. Even though I like my therapist a lot, I know that I do not need for her to be a friend. I need for her to be a professional. I don't think that I am responsible for her feelings, but I do think I should respect and pay for her time.


So if I were you, I would absolutely share your concerns and offer to pay. Even just asking will make you feel better, and I believe it will make her respect you more because you are respecting her professionally.

Yes, respecting professional boundaries is a big part of it for me too. I’m glad you’ve been able to get extra support from your therapist as needed.

[ElectricManatee]

Originally Posted by circlesincircles

Do you think it was mostly repetition and time that have helped you to get to the place of feeling able to reach out (mostly) without fear/concern? I’m terrible at asking for help IRL. Or even realizing it’s an option.

I think it was both the experience of reaching out and having her respond in a genuinely kind way every time and also talking about it in session a lot. In session I would usually tell her what I was feeling before I called, how I felt about the conversation, what I imagined she might be feeling (my guess was often inaccurate, as it turns out), etc. So both the experience and processing the experience.

It's still a work in progress for me, but I see now that not everyone thinks I'm a burden or that my feelings are annoying or too much (like my family did). I've always been the kind of person who is happy to help but can't ask for help, and understanding my feelings around asking for extra unscheduled help from my therapist has been really useful for me.

[Fuzzybear]

Originally Posted by feileacan

But why not really work with your guilt/worry by talking about it instead of acting it out?

I’m not dealing with this exact issue, but this post resonates..

Why?

I often ask myself this

I find talking does help (at least some of the time) no matter what some “professionals” (irl).... fades off into the Fuzzybear forest...

[circlesincircles]

Originally Posted by ElectricManatee

I think it was both the experience of reaching out and having her respond in a genuinely kind way every time and also talking about it in session a lot. In session I would usually tell her what I was feeling before I called, how I felt about the conversation, what I imagined she might be feeling (my guess was often inaccurate, as it turns out), etc. So both the experience and processing the experience.


It's still a work in progress for me, but I see now that not everyone thinks I'm a burden or that my feelings are annoying or too much (like my family did). I've always been the kind of person who is happy to help but can't ask for help, and understanding my feelings around asking for extra unscheduled help from my therapist has been really useful for me.

I hear you on the happy to help but not being able to ask for help. Hearing your experience is helpful. Sometimes I start to question whether all this therapy is getting me anywhere. It feels comforting to know how others have benefitted.