Out of session contact

For those who have (or have had) the option for out of session contact, what are your thoughts on it? Pros and cons?

I’ve been really hung up on contact with my therapist lately because I feel like I rely too much on it, but it’s so hard not to. I’m welcome to email whenever I need and my T will respond. That’s the deal. I text if in crisis or getting to it.

My T encourages this, welcomes it as a means for me to feel connected and supported/safety plan.

I guess I want to know others take on it because it is causing an internal conflict with me at the moment.

I love that I can contact her whenever. I never want to lose that and in all honesty, I don’t want to restrict myself as I am at the moment. But I’m feeling guilty about it - like a burden , needy, taking advantage and just dependent.

I’m trying to, figure it out I guess. I so very much want to just email as a checkin as it has been 4 days of no contact. But I’m trying to restrict myself still. I don’t know what this has come from…

Hi 20oney,

The fact that R is open to out of session contact is a plus for me.
I sometimes find it difficult when an important message goes unanswered, but we will talk about that in the next session usually.

I used to find it difficult not knowing whether she'd seen an email...but now I sometimes use an email tracking programme on particularly important messages.

Having that peace of mind helps me sit in the waiting.

Is it a sense of wanting to know that T is still there?

Perhaps when you meet again, you could ask for a note of some kind.
For the first summer break with R, I remember making quite a 'performance' of asking for a three word post it note.

She's never forgotten that moment, either...but it's been extremely helpful for me to have that.

I was able to make out-of-session contact, but I was pretty deliberate about limiting it to times of real urgency. So, I might go months with no need for that kind of contact, and then have a week or two when I was in crisis mode where we might touch base every day or so until the crisis passed.

It was important for me to not become too reliant on that kind of contact. Taking the time to sit with things, using other means to work through the kind of day-to-day anxiety, etc. was important for me so that I didn't default to needing that immediate feedback all the time. It helped me recognize that most of my discomfort I could work through enough to wait for a session. And, it also made it easier to contact them when I really was in crisis because they absolutely knew if I was contacting them, there was a definite problem going on that required their attention and they responded very helpfully. I had absolutely no guilt about contacting my T or my Pdoc out-of-session because I felt confident that I was in absolute need of their assistance when I made that contact.

I have a vivid memory of talking to my pdoc about this one time when I was hospitalized. He was getting ready to discharge me and was telling me to call him if needed. I said something about the answering service asking about whether it was an emergency or not. He said, "You tell them it is an emergency. You have never, ever contacted me when it was not emergency. You have never abused phone contact. There are those that do, but you aren't one of them. Just always tell them it is an emergency." (He was such a sweet, soft-spoken man.)

Out-of-session contact is something that each client and therapist negotiates independently. For me, it was important to work to handle things mostly on my own between sessions. As my therapist put it, therapy is about more than what goes on during the session; it is about be able to live well outside of session with autonomy so that therapy eventually is not necessary. That was important to me. We were on the same page; I went into therapy with the goal of getting beyond the need for therapy. Part of that process, for me, was being mindful of how I used my own personal resources healthily.

That process is different for each. Therapy needs and goals are different for each. Each person has to think about what will work best to get them through and to whatever their end-point might be, and only you can really decide that for yourself.

I have some mixed feelings about out of session contact. I am certain that I could not have gone into the deeper work without it--it was just too destabilizing. And I have attachment issues, so being able to reach out as a way of acknowledging that he's still there has been invaluable. I think of it as when I get "wobbly," I can reach out and steady myself, much like a person might steady themselves by reaching out to a hand railing when navigating difficult terrain.

That said, email has also caused a lot of consternation. I try not to, then I break down, then I feel shame. And I obsessively check email to see if he has responded. And if he doesn't, there is often disappointment, and sometimes it makes me want to quit. And I sometimes wonder if the attachment hasn't become secure in 7 years and over 1,000 emails, when is it going to? If the 1000th "I'm here" didn't sink in, will the 1001st?

But also, it does feel like things are shifting. The nature of my emails has shifted, from pretty emotional and erratic in the beginning, to shorter touchpoints now. Often I am just expressing gratitude after a good session, or sharing an insight, or possibly a topic I want to talk about next time. I send fewer "Are you still there" emails. I obsess less while waiting for a response, and I am more ok with not getting a response if that's what happens.

So mostly I try to trust the process, and check in with myself every once in awhile as to whether it's helping or if something needs to change. And I do try to hold off emailing sometimes, just to build my distress tolerance. But I try to balance that with the message that it's OK to need people, to seek connection, and to ask for help, because those are also things I'm trying to come to believe in therapy.

That is one of the issues with new T and I. New T said he checks texts and emails twice a day and it is OK to send him messages, but he might not get to them. He charges a prorated amount for phone calls. But then he got angry that I messaged him. he said he set a boundary about it but he didn't, at least not a clear one. So now texts are simply scheduling and emails have stopped. I can be OK with that, especially if it helps us work out the other crap he and I have been dealing with.
Awesome T let me call, text and email as much as I needed. It ebbed and flowed... sometimes it would be just one message to let him know what I got from our session... other times they would be almost daily. He never promised to get them all read before session but usually he did. Often he would reply. BUT there was NEVER any resentment or strings. That is essential for me... if you are going to offer me something then no resentment or strings.
I think I relied on the messages with awesome T too much... I didn't need them but they became a comforting habit. I miss them. I was trying to create a different habit with New T and not message and I had been doing well... clearly not well enough for him.
So, for me, outside contact and if it is good for me or not depends on the therapists ability to keep it safe... no resentment, no strings.

This has been a constant negotiating task with my T.
At the beginning I used email as a way to tell him stuff I couldn’t in session. He was absolutely fine with this and would respond with a short, brief message.
As time went on, those responses didn’t feel like enough. I felt he was distant, cold and too formal in his replies and it would hurt me that he didn’t say what I wanted him to say. I would also freak out and get angry if he didn’t respond within his 24 hour window that he set for replies and could lash out at him for this.
We spoke about it and realised that I really struggled to interpret any warmth and compassion via emails as there was no tone for me to infer that and my brain automatically searches for the very slightest hint of rejection or criticism, often finding it when it’s not actually even there.
We debated whether he should not reply at all or whether I should stop emailing completely. This led to a conversation about him keeping all of my emails in my file, which I didn’t realise was happening and I was furious about it as I hadn’t been informed.. It led to a massive rupture, in which he admitted he had been wrong not to tell me that was what was happening.
So we agreed to move forward with no emails, however he recognised I needed some form of out of session contact due to my attachments issues and inability to hold on to any form of connection to him between sessions.
So now we have an agreement in place for texting. He will text me once between sessions as a way to let me know he’s there and he’s thinking about me. I’m allowed to send a brief reply, but the boundary is that we don’t get in to a back and forth text exchange. One text each, that’s it.
This is still relatively new, but so far I like it. Him initiating the contact really makes a huge difference to me. However I have a feeling this may end up going the same way as the emails and it will get to the point where it doesn’t feel enough. But I think we are both aware of that and it falls under the bigger picture of transference - whatever he offers isn’t enough because I want him to fulfil a parental role, which obviously he can’t do. I’m hoping being aware of this now means it will make it easier to manage the outside off session contact and any problems that arise from it.

I definitely like the option of out-of-session contact. My T allows emails that he generally responds to in the mornings (so if I sent one right after session, he'd reply the next morning, usually between 7 and 9 am). If it takes him more than 15 minutes to read and respond, or if I send him a fair number in a short period of time (even if very brief), he technically charges me for them in 15-minute increments. Though usually the ones he charges for are very long responses, like 5 paragraphs of a decent length. He says he does this to avoid possible resentment, as he's getting reimbursed for his time.

The reason I say "technically charges" is that he's rather inconsistent in how he does that. He might say, "This did take me more than 15 minutes, but I won't charge you." He also suspended all email charges during the first 2 years or so of the pandemic. And now he's back to potentially charging, which is very difficult for me, after going so long with not having to think about that (I didn't overdo it during that time though).

I've also come to realize that the majority of those he's charged for (maybe 10-12 over 5 years) have led to or intensified some already-existing conflict between us. So I said recently that it's probably better if he just sends something fairly brief, then says we can discuss more in session. Or if I'm really upset about something, I'll ask for an extra or earlier session if he has one available (he often does) because it's generally better to talk through things.

I do really appreciate the option of email though. Sometimes, like mentioned, it's due to a conflict between us. Sometimes, it's me just making sure he's OK with something difficult we talked about or to check on whether he still exists, like if he's out of town (he allows them then, too). Those tend to be very brief, like, "Just making sure you're OK with what we discussed," and he would say something like, "All is well on my end." Or I might say, "Just confirming you still exist," and he'll say that he does.


Then there are those about an outside stressor going on in my life, seeking support and or suggestions on how to handle it (he doesn't seem to mind those at all and has never charged me for one of those, now that I think about it--only ones involving some sort of therapeutic conflict).

I have gotten better with email for the most part. Just recently, I had typed up an email to him on something that had happened, looking for guidance. Then I was like, "I don't need to send this, I can manage it on my own." So I just saved it as a draft. I've been doing that more. It helps to know the option is there though.

And this past Friday, we discussed some therapeutic relationship stuff. With it being a holiday weekend (and his being off Monday), I asked if it's still OK to email. He said he's treating it like any other weekend, when email is allowed. I haven't emailed him so far and don't really expect to (trying to trust in his saying at the end of session that he was fine with all we'd discussed), but it helps me knowing the option is there.

He doesn't allow unscheduled phone calls, and texts are just supposed to be for scheduling (though he was a bit more lenient with those last year), so it's just emails. But I'm OK with that. I may share the conflict they caused with ex-T in another post.

Sorry for the novel there!

When I was with my old therapist R I needed the out of session contact to prove he was still there. I didn't have object consistency. He was unreliable and kept changing the boundaries with it though which only lead to intermittent reinforcement as I never knew if he would reply or not- so I did over email about changing my session. He used to allow it then got really strict about not replying to anything without warning or discussing. We had a rupture that couldn't be fixed so I left.

New person I'm working with actually replies when I message. Not strict about it. I know he will get back to me when he can and that creates less tension.

It very much depends on the therapist and the boundaries they set, some are ok with it and some aren't. Some charge and some don't.

T1 allowed email, text and phone out of session contact, would always reply, sometimes at length, and never charged.

T2 allowed emails but had difficulty with typing replies so always said they would be read but not replied to.

T3 allowed email, text and phone, usually gave a brief reply, preferring to discuss in next session.

Current T allows email which she will read but not promise to reply to, but insists on phone if in crisis.

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I think so much of it is the T being clear and consistent in their email/text rules and boundaries. For example, will they allow an unlimited amount? If so, is it truly "unlimited"? Or will the client hit some invisible limit, where the T gets upset/annoyed (this happened to me with ex-T). And then possibly limits them or cuts them off entirely?

If it's too much, will they let you know early on, before it becomes a big problem for them and they potentially blow up at you? My T has always said he'd do this. (With ex-T, it was only after I asked her at one point, and it was clear she was already frustrated about them, like, "They just got longer and longer. I only have so much time. I have to give all my clients equal time" etc.)

Will the T always reply? Or only if requested? Or only if urgent? Or just to confirm receipt? What's the time frame--that day? Within 24 hours? Longer? Only during work hours/next business day (so if emailing a Friday night, maybe not till Monday morning)?

Will they ever charge for emails?

Can clients email over holidays or vacations?

Just some things to consider and potentially ask when talking to a T about their policy.

I had really bad issues before I moved with a therapist who should have set clear boundaries from the start regarding emails. I'm pretty sure most of what happened between us wouldn't have gone on if the emails didn't happen.

Now I am encouraged to email between sessions. My therapists like to know whats going on. I have learned from past mistakes not to email any crisis type info. My current therapist isn't really good about replying back even though she said she would. Its not really a big deal though.

This is one thing my T is very clear on. She will reply within 24 hours where possible. Certain emails will be responded to asap, I just have to say the word.

She’s very clear - email as much/whenever you need. I appreciate that. But I now feel too reliant on it, but I also don’t want to give up that privilege.

I’ve trying really hard the last few days to not email, and so far I have made it. But that urge grows stronger every afternoon, every day.

Ehh. 🤷🏻*♀️