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Default Feb 11, 2021 at 03:48 PM
  #41
When I started therapy some 40 years ago, email wasn't a thing and certainly texting wasn't a thing. If I needed to talk to my therapist, I had to pick up the phone and have that conversation. I think that probably was very helpful in keeping healthy boundaries around contact, and even in later years my last therapist did not text or use emails for contact at all and it never bothered me.

I never felt I was in any way limited by those boundaries, perhaps because I never knew any differently, but I'm grateful it was never an issue I had to contend with. It never felt as a punishment or rule; it was just the way we worked.

I knew I could pick up the phone and speak to my therapist if I really needed that additional support between sessions, but knowing it had to be an actual phone conversation helped me to make sure that a) I really had tried on my own to handle whatever it was first, b) it was something that could not wait until our next session which was usually just a few days away at most, and c) I knew what I needed from my therapist because I had to verbalize it to him. I also found the direct conversation where we could both ask questions and clarify with each other kept those contacts from miscommunications that sometimes occur with texts and emails, not to mention there was no lag time between question and response.

If I was really in dire straights and needed more contact that a brief phone call, I was able to make an appointment. Almost always, I was able to get in within 24-48 hours for an additional session if necessary. In the meantime, if I was truly in an emergency (suicidal), then I could call after hours if needed, but those times were months apart and not a regular event by any means.

The natural limitations I started therapy with due simply to the lack of technology helped me not get caught up in that need for instant response and instant gratification. It helped me sit with whatever was going on and internally pace myself a bit.

I love my cell phone and other technology now, but I also know how much I rely on it for immediate action and gratification if I don't turn off those alerts and consciously choose to just sit occasionally on whatever is on my mind rather than having to "do" something about it right away. I am ever grateful I didn't get into texting and emailing mode with my therapists - it would have been just too much access and that's really not necessarily a good thing for me - I've learned I need to give myself time before I act so that I act with some reason and conscious thought. The outcomes always are better for me when I approach things from that angle.
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Default Feb 12, 2021 at 05:36 PM
  #42
I could tell on Tuesday my therapist really wanted to break the no outside contact rule so I could email her. I could tell by the way she was trying to figure out her sentences and by her facial expressions. She set up boundaries before but then broke them and allowed outside contact again. This was during the summer. But I think on Tuesday she didn’t want to look like a hypocrite or confuse me. I never once talked during our session about outside contact. At times I can sense a bit of countertransference. She seemed really relieved in my moms email that I’d have two more sessions with her.

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Default Feb 23, 2021 at 10:55 AM
  #43
Mindmechanic, I'm so sorry this happened with your T, and the sense of hitting her limits. It would be very hard for me to continue with therapy in this situation so I admire you for doing the work here.

My T has very good pitch with outside contact. He will sometimes write a brief, heartfelt email if he is "holding" something from the session, is proud of me, or if he is wanting to say he was sorry about something.

He freely allows me emails for the same sort of ethos.

With my first T "M" , email was intense, with whole sessions contained inside them, and both of us writing novels.

I experience outside contact with my second T as tiny splashes of intense care. I tend to be avoidant, or even disorganized in attachment style, and my T is very immediate with me if I reach out. He says he is trying to teach me that he will do his damndest to meet my needs, though inevitably he will fail sometimes.

These little experiences of outside contact represent lots of growth for me.

I used to feel squeamish after writing long, deep email back and forth with my first T "M" . It was too intense, then I had a hard time facing him.

I agree with Elio that there's dynamic at play between wanting to write and write and write v not wanting the T to feel bombarded and decide the level of care required is unsustainable.

For me I regulate how much outside contact, bc I know even though it can feel good in the moment to get the connection, I will inevitably want to avoid the next session or be tongue-tied due to emotional pressure .

My T is far more gifted than my first one at be there, being real, showing up, and having a "be as you are" message.

However , if he suddenly did what mindmechanic's T decided, and said hey no more outside contact, I would probably feel he was less invested in our relationship than previously. I doubt our relationship would survive that, which is not to my credit.

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Default Mar 03, 2021 at 01:38 AM
  #44
I need to get some things out.

The therapist had previously terminated me about two to three months into our work in the fall of 2019. She terminated me because she felt that she couldn't meet my need for outside contact. But she changed her mind and decided to work with me on it. She was well aware of my needs and where I'm at developmentally. The moment she decided to go back on her termination and take me back as a patient, she made the commitment to work with me knowing that I have certain needs. I trusted her and invested in her. For her to turnaround and come up with rigid rules now or threaten to terminate me when I violate her rules of outside contact is just wrong and a betrayal.

She has always worked with me on it until she sought consultation in January this year after that upsetting incident in December. It was just a day before she sought consultation when the therapist said that there has to be some changes, but that she wouldn't do anything drastic and it wouldn't be no contact right off the bat. But she changed her stance because according to the therapist, her trusted consultant said some very strict things to her about rules and boundaries. I hate it whenever therapists make drastic changes after seeking consultation or supervision.

I said to the therapist that she's giving me more than I can handle and setting me up for failure. And indeed, I failed. It's only a matter of time. Today, I failed.

She's expecting me to be able to handle something that's beyond what I can achieve given my needs, presenting condition, and where I'm at developmentally. Today, after an upsetting therapy meeting that triggered some of my deepest fears, I was anxious and spiraled into text messaging the therapist. Her response was that she's honestly thinking of terminating me, and that one more infraction and we're done.

Infraction? Infraction?!?! What patient can work like that? Instead of helping me to cope, she comes up with a rule and that she would terminate me if I violate the rule. The rule may stop the behavior, but it doesn't address the underlying issues. Last Friday, I said to her that sometimes no matter what I do to try and calm myself down, I can't seem to self-soothe. Her response was that I needed to work harder. She said that with a laugh. I called her out on it. She said that she didn't mean it literally and that's why she said it with a laugh.

I think that we were done the moment the therapist went back on her commitment to work with me and take me back as a patient knowing that I have certain needs. We were done the moment when her assurance that she would work with me to figure out what the changes and rules are went out of the window, and she decided to go with what her trusted consultant said and came up with a rigid rule and drawing a big X across the board regarding outside contact.

What triggered me in therapy today? Long story short, a couple of weeks ago, I conveyed what my needs are to the therapist and I said that I need that from her in our therapy; otherwise, the alternative would be termination. The therapist responded that rigid rules are in place right now for containment, but that when circumstances change, her trusted consultant's advice would no longer be relevant and would be outdated, and we could talk about bringing back some outside contact. That sounded very hopeful. But today, she seemed to contradict our previous conversation when she said that she has relied on this trusted consultant for many years and that his words have a very strong influence over her. She went on to say that certain contact – specifically short calls – are off the table – period. That triggered some of my greatest fears.

One of my deepest fears is being given more than I can handle and being left to my own devices; in other words, I fear falling apart. Another great fear that I have is not being heard, listened to, or given a voice. When the therapist put her trusted consultant on a pedestal today, it immediately put a sense of dread in me. I felt like I had lost the therapist who I have known – the therapist who was flexible and who could listen to me and work with me on a pace that works for me.

I feel really fed up and frustrated. Even after the upsetting incident in December but before the therapist sought consultation, we were still having outside contact that didn't result in things blowing up. It's only after she sought consultation that things became tense and rigid.

I'm also fed up because the therapist knows since our initial few meetings that I have certain needs for outside contact. She knows where I'm at developmentally and my presenting condition. But she decided to take me on. That's a commitment to work with me. And when things get hard, her response is to come up with rigid rules and put it on me for not working harder to soothe myself. That's ridiculous. If I know how to do it, I would do it.

All this while, too, the therapist hasn't been observing her limits. When I needed outside contact, she would respond and give a call even when she's feeling tired or stressed. That only leads to build up feelings of resentment. Rather than rigid rules or a big X across the board regarding no contact, isn't it about observing limits in each given moment? As some of you mentioned, your therapist tells you not to worry about overwhelming them, and that they would observe their own limits by saying yes when they're able to be available to you and no when they can't.

Last edited by mindmechanic; Mar 03, 2021 at 01:50 AM..
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Default Mar 03, 2021 at 03:31 AM
  #45
mindmechanic, I certainly am hearing your frustration and how difficult all of this is for you. I've been in multiple situations where I have been hurt by a therapist, and it's hard.
Your struggle with this is valid. I must state, however, in no uncertain terms that you are lucky that your therapist has not terminated you. What you said in the message may not have been intended to be threatening, but I believe that any reasonable therapist would have interpreted it that way. If I were your therapist's supervisor or consultant, I would have advised you to terminate, and frankly, if I were your therapist, I'm not even sure I would have been willing to terminate with you in person, which is what my code of ethics states to do. Imagine for a moment that you receive a text message like that, and you're not sure if the person who sent it is delusional, paranoid, having active hallucinations, etc. How would you feel knowing that the person who sent you that message is potentially mentally unstable? It's a text. She has no way of knowing what your state was when you sent it. And now with the technology that we have, it's so easy to get someone's address, car information, places they like to go in their free time, etc.

Based on some of the statements you made, it sounds like you are in a place where you are really struggling. In your last post you said that you don't think that you can abide by these new boundaries that your therapist has put into place. And by the way, your therapist is dead wrong in how she's handled this from the beginning. I think it's better to set firm boundaries in the beginning of therapy to avoid situations like this, and I intend to have disclosures about contact outside of session in my disclosures and in my informed consent. From what I've seen on this board, out of session contact never really leads to anything good and I think it should be used in only very specific situations. For instance, I text my therapist when I'm about to go into the hospital to alert him that I need to suspend sessions until further notice and that he should expect contact from the hospital once I am nearing discharge. Anyway, that was a bit of a ramble. The point that I wanted to make is that it sounds like your therapeutic needs and your therapist's needs are incongruent. Terminations suck, and I wouldn't wish them on anyone. I would implore you to start to seek out a new therapist and to talk about your needs for the therapeutic relationship in a phone consultation, even before an intake appointment. That way your not wasting your time with someone who isn't going to be a good fit for you.

I have other, more broad thoughts, but it's 3:30 in the morning, so I'll save them for a later time. I wish nothing but the best for you, mindmechanic.
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Default Mar 03, 2021 at 05:39 AM
  #46
My T is working with me on my sever attachment to him. This attachment and loving adornment to him is painful and crushes me soul. The way I saw it the outside contact was like eating sweets. The more you eat sweet things the more your brain wants sweet things and more addicted you get and the harder it is to abstain. The same with me contacting him. The more I emailed him and the more responses I got that gave me the warm fuzzy feelings the more my brain wanted and the more addicted and needy I got. Oh and when he did not answer the bigger the trigger. So I started curtailing myself from contacting him. It took a year but I am down to now no contact between sessions. I would fight againts that part of me that wanted to email him to get a response. I decided to only contact once a week. It took all my energy but slowly my brain changed and did not rely on it anymore.

You are going to have to help yourself more here because your T's ultimate goal is to have you not to contact her and rely on her anymore. You do have to put in more of the work outside of session and start by not contacting her on your own.

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Default Mar 04, 2021 at 02:43 PM
  #47
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Originally Posted by daisydid View Post
mindmechanic, I certainly am hearing your frustration and how difficult all of this is for you. I've been in multiple situations where I have been hurt by a therapist, and it's hard.
Your struggle with this is valid. I must state, however, in no uncertain terms that you are lucky that your therapist has not terminated you. What you said in the message may not have been intended to be threatening, but I believe that any reasonable therapist would have interpreted it that way. If I were your therapist's supervisor or consultant, I would have advised you to terminate, and frankly, if I were your therapist, I'm not even sure I would have been willing to terminate with you in person, which is what my code of ethics states to do. Imagine for a moment that you receive a text message like that, and you're not sure if the person who sent it is delusional, paranoid, having active hallucinations, etc. How would you feel knowing that the person who sent you that message is potentially mentally unstable? It's a text. She has no way of knowing what your state was when you sent it. And now with the technology that we have, it's so easy to get someone's address, car information, places they like to go in their free time, etc.

Based on some of the statements you made, it sounds like you are in a place where you are really struggling. In your last post you said that you don't think that you can abide by these new boundaries that your therapist has put into place. And by the way, your therapist is dead wrong in how she's handled this from the beginning. I think it's better to set firm boundaries in the beginning of therapy to avoid situations like this, and I intend to have disclosures about contact outside of session in my disclosures and in my informed consent. From what I've seen on this board, out of session contact never really leads to anything good and I think it should be used in only very specific situations. For instance, I text my therapist when I'm about to go into the hospital to alert him that I need to suspend sessions until further notice and that he should expect contact from the hospital once I am nearing discharge. Anyway, that was a bit of a ramble. The point that I wanted to make is that it sounds like your therapeutic needs and your therapist's needs are incongruent. Terminations suck, and I wouldn't wish them on anyone. I would implore you to start to seek out a new therapist and to talk about your needs for the therapeutic relationship in a phone consultation, even before an intake appointment. That way your not wasting your time with someone who isn't going to be a good fit for you.

I have other, more broad thoughts, but it's 3:30 in the morning, so I'll save them for a later time. I wish nothing but the best for you, mindmechanic.
Mostly agree with that, except that I would state my needs and implore the new T to set boundaries and tighten them over time.
I don't write my T during the week, and I don't have her number. I can totally understand getting addicted and I would rather not grow to rely on her that way.
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Default Mar 05, 2021 at 01:19 PM
  #48
Where I live, the majority of therapists don't even give clients their email address, and they certainly don't allow texting. Clients in crisis call an answering service.
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Default Mar 06, 2021 at 01:32 AM
  #49
Therapists are professionals, yes? Find me a working professional – be it a medical doctor, attorney, or teacher – who has rules forbidding emails or phone calls.
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Default Mar 06, 2021 at 05:19 AM
  #50
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Therapists are professionals, yes? Find me a working professional – be it a medical doctor, attorney, or teacher – who has rules forbidding emails or phone calls.
What do you think would happen if you sent multiple emails to an attorney or teacher, including one message which stated your desire to kill them, and then you were observed outside their work place? Aside from any legal action which would be taken, I doubt that you would be retained as their client or pupil.
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Default Mar 06, 2021 at 06:09 AM
  #51
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Therapists are professionals, yes? Find me a working professional – be it a medical doctor, attorney, or teacher – who has rules forbidding emails or phone calls.

Professionals like you mentioned may expect emails outside of working ours for important things like court cases and inquiries from parents. In those two professions they may be unavailable during daytime working hours so they have to communicate after the day is over. Therapists do not have to do it that way. I think your therapist was unethical and inconsistent with you about contact. The minute she realized that your needs to beyond the sessions you have she should have referred you to maybe an iop, php or to a person that could see you multiple times a week to help you with this need for contact.

That aside, I think the kind of support you are looking for will not ever be fulfilled by a therapist. I feel like you are looking for someone to intensively work with you and allow constant contact or near constant contact. In my opinion that is not only unethical but it is also unhealthy for you. You do need to learn some skills that will help you when you’re not in therapy. I’m not trying to be harsh I’m just trying to look at the situation from all perspectives.

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Default Mar 06, 2021 at 08:02 AM
  #52
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Therapists are professionals, yes? Find me a working professional – be it a medical doctor, attorney, or teacher – who has rules forbidding emails or phone calls.
I would guess many professionals have various ways to handle phone calls and emails. They may only read, listen, and respond to them during work hours. They may have a secretary or answering service that fields their calls for actual emergencies and only forwards certain calls directly to them, delegating the rest. If a client routinely abuses means of contact, they may forward those contacts to superiors to handle. They may simply cut off working with a client who routinely abuses contact and/or threatens them, and if threatened, they may get law enforcement support for such threats.

I am a teacher. I generally have no problem dealing with emails outside of work, but I also usually have zero people who ask for more than a quick piece of information. I NEVER give out my personal phone number or email. I NEVER make parent contact via my personal phone or email. I have had the occasional parent who becomes abusive (probably one every year or so - it is fortunately not a common problem). In those cases, I immediately begin copying my administration on every single email and I let the parent know if they have any further issues to consult that administrator; I simply cut off any further contact with that parent unless I have an administrator’s eyes and ears on the situation. Generally, the parent suddenly had nothing to say when they knew there was a witness to their abuse.

So yes, most professionals do have procedures for handling correspondence with clients and do not give clients carte blanche in their contact with them.

Last edited by ArtleyWilkins; Mar 06, 2021 at 09:54 AM..
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Default Mar 06, 2021 at 10:45 AM
  #53
All a therapist would have to do is bill their time like any other professional. Therapists are not busier or more important (a lot less for sure) or anything else than other professionals. Bill in tenths of an hour and it would all be a lot clearer for everyone

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Default Mar 06, 2021 at 11:06 AM
  #54
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All a therapist would have to do is bill their time like any other professional. Therapists are not busier or more important (a lot less for sure) or anything else than other professionals. Bill in tenths of an hour and it would all be a lot clearer for everyone
Yes, exactly. My T uses a policy where he bills for his time (at same rate as sessions, but in quarter hours) for emails over a certain length and frequency (though he's mostly suspended it for all clients during the pandemic). But he's said he does that so he's still getting paid and won't come to resent clients for taking up time with emails. Texts are only for scheduling, and he only does scheduled, paid phone calls, except if it was a client trying to determine if they need to go to the ER or not (even then, he said he turns off his phone at 8:30 or 9).

So he allows emails, but has boundaries. I could see a T handling it where there's a charge for time spent on any email that isn't billing (like, "Could you please send me the invoice for last session? I haven't received it" or scheduling-related). My T is just a bit more lenient.

I think as long as any billing policies for outside contact are laid out from the start of working with a client, it's fine. And the client would just need to decide whether or not they could accept it. To me, the problem arises when a therapist is unclear about their policies--or doesn't have any to begin with (ex-T and ex-MC, in my case)--and then it can get messy. Or if they don't communicate with the client that the client is contacting them too much until they're at a breaking point.
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Default Mar 06, 2021 at 01:14 PM
  #55
Wrong thread

Last edited by Shotokan; Mar 06, 2021 at 01:48 PM..
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Default Mar 06, 2021 at 01:59 PM
  #56
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All a therapist would have to do is bill their time like any other professional. Therapists are not busier or more important (a lot less for sure) or anything else than other professionals. Bill in tenths of an hour and it would all be a lot clearer for everyone
Ooh! That would work for therapists. Can I bill my public school students and their parents? Cool! LOL.

I never had a therapist or psychiatrist bill for phone calls or emails, but I never did much of either. I know of doctors who bill for after hours calls though. I don’t blame them. I do think there are people who abuse the system and call after hours for things that can clearly wait until office hours.
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Default Mar 10, 2021 at 12:28 AM
  #57
So I think that a therapist should absolutely be available via phone and e-mail if needed. I guess upon reflection I wasn't clear how I would define "out of session contact." When it becomes problematic is if it's content that's related to the actual business of therapy. Would I allow it? Maybe, I have a few years before I begin practicing before I figure that out. But whatever I decide I would make my concerns explicitly clear with my client if and when it came up, and I would make sure to have that conversation before any therapy-related contact took place. But if you're trying to reschedule an appointment or ask a billing question, that's fine.
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Default Mar 10, 2021 at 08:50 AM
  #58
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So I think that a therapist should absolutely be available via phone and e-mail if needed. I guess upon reflection I wasn't clear how I would define "out of session contact." When it becomes problematic is if it's content that's related to the actual business of therapy. Would I allow it? Maybe, I have a few years before I begin practicing before I figure that out. But whatever I decide I would make my concerns explicitly clear with my client if and when it came up, and I would make sure to have that conversation before any therapy-related contact took place. But if you're trying to reschedule an appointment or ask a billing question, that's fine.
In my experience making clear the expectations clear up front is very important.

With long term T, I had never thought of outside contact as I was new to therapy. She one day told me to contacted her if I needed to. I discussed needing it too much. She said if it ever became an issue she would tell me. She normally answered my email very quickly. She was a workaholic and didn't have family.

With current T, I asked her about outside contact. She was new to private practice after working foe a clinic for 10 years where everything went through thr secretary. We discussed it. We talked about her concerns with it such as people reaching out making suicidal statements and her not receiving them in a timely manner. I told her out of all thd years I have been in therapy I have not and would not do that. She also said she is horrible about checking her phone...even her personal phone. So she couldn't guarantee when she would get the messages. When I brought up fears of bothering her she said of it became an issue we would talk about it. Also she mentioned the HIPAA issues.

Especially during the pandemic she has been bad at responding. Sometimes, it has taken days. Both she and her husband are working from home now caring for their 5 year old and the uncertainties of school.

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Default Mar 10, 2021 at 03:46 PM
  #59
I wonder if the differs from country to country or if it's just a question of patient, T preferances..
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Default Mar 11, 2021 at 06:12 PM
  #60
I spoke briefly with my T about outside contact with their clients and he said “it’s an ethics violation.” I told him I agreed and too many things can go wrong once a boundary is broken. I’m not sure if each state has different rules or regulations about this it’s not something I would do.

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