Out of Session Support

Echoes,
I admire your ability to accept and believe your T when she tells you it is OK for you to contact her outside of the session. For some reason I have great difficulty just accepting that it is OK for me want to contact her, let alone that it is OK for me to actually do it.

I was in the perna boat up until this one... now i'm in the mckell boat, staring at my shoes. Don't ya just hate it when she has to point out all the really good, hard facts!?!

QUOTES:
[Perna said,
So, who taught you to only bother them when you needed to borrow their phone to dial 911, that a simple, warm conversation wasn't a good enough reason to get in touch?



Damn Pern! I honestly have no freak'n idea who taught me this!!!!!!

But it is a concept that I seem to take to the extreme in MANY ways.

my t did charge for "extra emails". she allowed 5 pages a week by everyone. Then it was $5 a page to go over that. And people who wanted/needed a response had to put that in the subject line. Also, no emails on sunday or a $5 charge for that, too.

YES!! I've been thinking about this ever since. This statement hit deep, but I'm not sure where it comes from. I really don't know where this belief was ingrained in me.

When I look at the statement with regard to a therapeutic relationship, I have to say my initial response is that the need for a simple, warm conversation is not a good enough reason to get in touch with my T outside a session. When I think about it more, I'm not even sure if it is enough reason to justify going to a scheduled appointment. Its not her job to provide simple conversation. This is what friends and family are for. I have continually asked myself, if my problems are severe enough to warrant therapy? When it comes down to it, what really keeps me going is that I can justify it because I believe my therapy is ultimately helping my children.

Of course this also raises the question: In my mind is the need for a simple, warm conversation EVER a good enough reason for me to seek to connect with anyone? Again my initial response is... well, YES! But I'm not sure I really believe this.

Hmmm..

"Of course this also raises the question: In my mind is the need for a simple, warm conversation EVER a good enough reason for me to seek to connect with anyone? Again my initial response is... well, YES! But I'm not sure I really believe this. "

=( exactly what i was thinking. And i often end up not calling "friends" because of it. I call to check on them or care for them... but never when i am lonely or scared. I come here instead. I often wonder if i am wasting my t's time and energy. I decided to limit writing t emails because her last response to me (2 in the past 5 months of getting to know each other) seemed to be a mental struggle for her. I haven't written since. For a while i was writing antyhing i hadn't spoken or scary things that came up that i knew i wouldn't talk about. Last time i wrote to figure out what we'd talked about and make sure i was clear... But i think i am stopping for a while.
kiya

<font color="green">This thread is challenging to me. I never really thought about paying for telephone calls. I suppose if I had I would never have called.

Perna's question resonated for me too, but I know I have believed that I don't have any value and therefore don't deserve support. Eventually I learned to call when my kids were in crisis and that expanded to my own crisises.

I think the first time I ever called for myself, I was stuck in a flashback loop and panicking. She happened to pick up the phone herself and talked me out of it. We have talked a lot about what the rules for calls should be, she has 'given' me 6 calls a month if I have a need for her. I am also allowed to call or email if I just need to 'let her know something' but that is part of the 6. Funny thing is I have never gone over the 6, in fact I think the most has been 3.

Part of this has been a fear of becoming and acknowledging that I am this attached to her. About the time I begin to feel comfortable with my attachment something inside says nonononono!

I am glad she lets me call her when I really need to call her. If it was different I could deny my attachment and/or shut it down and out. </font>

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mckell13 said:
Of course this also raises the question: In my mind is the need for a simple, warm conversation EVER a good enough reason for me to seek to connect with anyone?

</div></font></blockquote><font class="post"> Exactly :-) And that's what it's okay to learn from T's!

A lot of therapy work isn't necessarily "deep" it's just difficult for us because it is simple, warm conversation (being vulnerable and telling somone about how we're not perfect and how disappointed we are about that, about our hopes and dreams, etc.).

My stepmother and I didn't "connect". We didn't share. I walked into the kitchen when I was about 20 and asked, "Hey, Mom, what's for dinner?" my T says (I didn't see it!) to start a conversation, it was an opening gambit, about food, love, and "Hello, how are you?" but my stepmother's response was to push me away, "If you were in here helping, you'd know!"

Think of conversations you have had or wish you'd had :-) with significant others? Did we ask our mother's "How are you?" and listen to the response, wanting to hear about their day? Does a warm, energizing glow start in someone's company, because we know they're going to ask us, "How are you?" and listen to the response with their whole being? When was the last truly personal one-on-one conversation you had with someone you work with? I worked 8 years at my last job because that was there and I got that validation and warmth and it greatly helped my therapy (as did the comments by my friends there that they'd seen a positive change in me in that period of time because of therapy). The bosses weren't great, the job got to be boring (when it wasn't frustrating) but I stayed even when I got in an impasse with my boss and my T said I should either quit or I'd get depressed because there was the possibility of simple, warm conversation from my friend:

See here what is confusing me about about this warm conversation concept. Some how I feel like I don't deserve it, or that I am a burden on someone if I call them up and want to talk about something that is bothering me. I won't call friends up just to talk, I usually have to have a specific reason to call. As for therapy, I feel like I need a specific problem to solve. Some how the idea that it is OK to want something just for purely selfish reasons or for simple pleasure is NOT OK for me. Therefore unless I am in a complete crisis I feel guilty about contacting my T. Honestly, I feel guilty for even wanting 1 hour every two weeks with her.

Perna you simply asked ...who taught you this? And I really don't know. I'm not sure if it is something that I was taught in really early childhood and just stuck with me. Or if I just created this distortion some how myself. I don't think it was my parents, at least not directly. My father had problems, but I always felt he loved me and don't recall him not thinking I was important enough to spend time with. Mostly what I remember is that it was ME who did not respect or want to be around him. As for my mother, she was very burdened by his problems, but she would have bent over backwards to have a relationship with me. But for some reason, this relationship never developed. I do not remember ever talking to my parents about anything (boys, sex, problems with friends, fears, wants, personal goals). It was always, hey what's up...see ya later. Even when I try to remember back to earlier times, I can't remember running to them when I was hurt, seeking a hug when I was lonely,.. nothing.

This makes me think, maybe my inhibitions and fear of intimacy is self generated. I don't recall seeking comfort and being rejected. It is really weird!

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dalila said:

Part of this has been a fear of becoming and acknowledging that I am this attached to her. About the time I begin to feel comfortable with my attachment something inside says nonononono!

</div></font></blockquote><font class="post">

I think this has a lot to do with me getting upset with myself after sending an email or letter.

I don't think anything bad has to happen to one, "benign neglect" happening to a child when adults are preoccupied with their own lives will teach the child they have to take emotional care of themselves. That's just the way things are. But that's not the way things have to be and the child doesn't learn to "connect" with others in a intimate way and that intimacy can be wonderful. Because it's not what someone is use to for the past 30 years, it can appear quite frightening because it requires a different skill set, the connection and expectation of warm conversation set, and anticipation of how good that can make one feel. Such closeness is eyed with suspicion when we haven't ever had it.

I think that is what therapy is for, to teach us other, rewarding ways and skill sets. I wouldn't take from my T for fear of being consumed by my stepmother and losing myself. I suspect you aren't comfortable because it is strange to you, you haven't had connection in any depth with someone else. It's like putting your toe in the pool to test the temperature and other tactics kids use when they're expected to get in and learn to swim. But swimming doesn't happen in one lesson. It took me nine years to finally do the simple, warm, human conversation thing with my T; to trust that when I tell my stories others will welcome them and I will be okay because I know me and my stories so everything else is just gravy (the warmth and connection from telling others). I suspect you have stories, McKell, but just haven't yet learned to access them or tell them to yourself or others.

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Perna said:
Because it's not what someone is use to for the past 30 years, it can appear quite frightening because it requires a different skill set, the connection and expectation of warm conversation set, and anticipation of how good that can make one feel. Such closeness is eyed with suspicion when we haven't ever had it.

</div></font></blockquote><font class="post">

This sounds accurate to me.

At this moment in time I think I write my T outside our scheduled sessions because a small part of me has "tasted" or has realized some benefits being connected with others more deeply. This part wants more.

I just haven't been able to convince myself this is OK yet.

I think it's something to discuss with your T and hopefully you both come to some agreement. It is a professional as well as personal relationship and they are providing a service. If we make them work "overtime" by using them off hours more than necessary, I think that they need to be compensated, as we would, in our jobs if we were working more than we got paid for really. Although yes it's not a 9-5 job but if we are using them a lot after session then compensation might be helpful to bring up.

I agree we need to have realistic expectations for the services our T's provide. They are not going to be there for us 24/7. They have the right to have a personal life. They should be paid for services rendered but they should clearly state their fees and what services are included which are extra.

For me it would be very helpful to have specific rules established so that I don't feel like I am imposing on her time or wondering if I am expecting too much. Since I have never been in therapy before, nor have I experienced this level of interaction before there have been issues arise that I totally did not anticipate. I'd like a Therapy Handbook that clearly defines our relationship, things I am expected to do, things I can expect my T to do, outside session communication, etc..

I want a Handbook dammit!

Having said all of that....I have to also consider the possibility that working all of this crap out as it comes up ...JUST MIGHT BE PART OF THE PROCESS of establishing an intimate relationship :-)

Is my heart growing???

I go back and forth on how I feel about contact. I certainly have contacted my T between sessions.

It never helped me though because I would read too much into his calling or not calling. I've emailed and faxed too. The last time I faxed he handled it very well. We went over the fax. He took the initiative. I loved that.

I am trying so hard to do the hardwork with no landing. He and I have talked about this over and over and I know his position on going more than once a week or calling etc.

He did take me once a month ago twice in one week which was cool. It helps me to have that occassional back up for the very hard sessions.

I think that is why two sessions ago I apologized to T and made sure he wasn't mad at me before I left.

I am afraid to be left hanging like I was one time after a very bad session ending. Long story short, I almost ended it the pain was so bad of him not returning my two calls.

I guess I'm realizing that I don't feel 100% safe with him and part of it is because of this. I need to respect his boundaries though and he doesn't want to encourage dependency.

Anyway, I think if I had to do over, I would have addressed this topic in the beginning of therapy. I had no idea what therapy was really about though two years ago.

I think this should be discussed by all clients to their T's and it should be outlined clearly to avoid inconsistencies and more hurt for us and our T's...

Oh and definitely T's should get paid for their extra time. That should be part of the discussion I think.

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almeda24fan said: Anyway, I think if I had to do over, I would have addressed this topic in the beginning of therapy. I had no idea what therapy was really about though two years ago.

</div></font></blockquote><font class="post">

This is a key point.. I think. Most people are totally clueless about how therapy works and what issues might arise as you go through the process. If you said to me the 1st day of therapy. Look at some point you may feel the need to call or contact me outside of the session... I would have looked at you like you were freak'en nuts. But if you posted a FAQ or had a new patient for folder or something I would have taken it. Then pulled it out if something came up.

I hope if there are any psych students lurking around PC, that they see this thread and consider it. I'm not saying it has to be a detailed road map for handling interpersonal relationship. It just needs to be some basic info on how a T or a Group Practice handle common situation that arise in therapy. After all if I was knowledgeable and skill at communicating and resolving interpersonal issues, I wouldn't need therapy in the first place. A little guidance would be helpful.

McKell, could you make an outline for a "therapy handbook" and take it in with you next time and have her help you fill in the blanks? You could have different questions: can I call between sessions? Only in emergency situations? How long can phone calls be? Can I email you? etc. I do think they should spell out this stuff when you first start. Are you sure it doesn't address any of this on the consent form you signed the first day?

Recently, I started seeing a financial planner and in between our first and second meetings, I needed to send her some information. I wanted to email it to her. I did not have her email and it was not on her website. Only her secretary's email was provided. I did not want to email this confidential financial information and communication to her secretary. So I actually sent it all to her in a letter. At our next meeting, I asked her how she preferred to be contacted, by phone, email, snail mail, direct meetings only, etc., and I mentioned I noticed she had not provided an email. I was so proud of myself for just asking her these questions directly! (Now, sunny, was that so hard? Why is it so much harder with a T?) She answered all my questions and now I am very clear on how I can contact her. It's wonderful to have it all spelled out.

My daughter's T had on her consent form that calls can be made to her answering machine and she will return the call within a day. There is a fee for phone conversations over 10 minutes. I thought this spelled it out nicely. She does not do email.

I do agree that if T's spend substantial time on us out of session, they should be compensated. But their policy should be clear.

My own T had on his consent form that a message could be phoned in to his answering machine and he would return your call. If it was an emergency, you should call the crisis center, etc. It says that on his phone message too. My T is really bad with the phone. The first time I called him to see if he was available to see me as a possible client, I waited over a week but he never returned the call. I figured OK, he has enough clients, move on. But my sister pushed me to call him again, since she had heard he was so good, and do a little name-dropping, which I did, and he called back within a day that time. After that, I've only called a few times to change appointments, and it is not uncommon he does not return my call for a few days. And he gave me no email. He has told me not to depend on the phone as he doesn't check messages often. Also, in session a few times, he has told me he will call me later that week with certain information or news, and he doesn't. I think he forgets he says that. So I have come to realize my T sucks when it comes to the phone. I now have his cell phone number, but it is not really for use. One time, I was in a really bad spot and emailed my lawyer with the subject heading, "help." She responded immediately and then T called me up. My L had told him I needed his help and to call me, so he did. He wanted to know why I hadn't called him? It just never occurred to me to do that. What good does it do when you are needing help to leave a message on someone's voicemail that they don't return for 3 days? I didn't tell him that, but sheeesh, duh! So he called me that day and the following day when I was so needy and provided some phone support. It was nice. But I would never initiate that kind of thing.

As our relationship changed/expanded, he gave me his email. Sometimes he emails me out of the blue. It is nice. Just brief notes, but I love them. He uses lots of smileys. Sometimes I email him, usually about switching appointment times, but I am always brief. I don't want to take up his time or be a burden. One time I did email him a longish email with substantive concerns. I wondered what the response would be, as I had never done that before. I wondered if that was crossing his boundaries. He did not respond to that email or ever refer to it in session. So I got my answer--he does not do email therapy, keep the messages short, don't step across the line! I really try to respect his boundaries.

One time I did ask for a second session in a week. I really needed it to deal with a specific issue. He told me that wouldn't be possible as he was all booked up the rest of the week. I have never asked again. I interpreted that to mean he does not do 2 sessions a week.

That's my saga with the out of session contact. I am not demanding, and he doesn't offer to provide what he cannot. I am respectful of his boundaries.

My pdoc who I initially began therapy with in 2005 had a promotion and job change so that she only sees me for med visits now. She referred me to a psychologist in her clinic (so my pdoc is my therapist's boss).

Well pdoc took emails and I did write her quite often, and she always wrote back, even if a short reply sometimes. I continued emailing pdoc even though I had switched to the psychologist. The PhD refused to take emails (she only works part-time at the clinic), but does call back if you leave her a voice mail at the office, eventually.

To make a long story short, I had emailed a complaint or two to my pdoc about the therapist (who she supervises) and my pdoc who is overworked forwarded my emails to the psychologist!!! It ended up with a very bad session between me and my Phd, and I cried and felt horrible and also felt attacked! Now here is an example where email came back and bit someone in the butt!! I can still email my pdoc who sees me for med visits only, but I choose not to for now. I don't think she intended to cause trouble; she was just trying to help somehow and was too hurried to stop and think of the damage it could do.

I said nothing horrible about my therapist, but it was enough to cause me to consider giving up therapy now. I may just go to see the pdoc for med visits. My therapist says she still cares about me and respects me! I am not sure I feel the same. She railed on at me for an entire session and I cried the whole time. She said I was hindering her ability to help me, etc. But since then we have talked about the whole relationship issues and she says she feels fine with it now; but I can't tell her I don't! I have not emailed or phoned anyone outside of my weekly appointment since the 'incident'. I have learned an important lesson and yes I was stupid to trust my pdoc would not tell my therapist.

I don't know that all T's are going to want to give cut-and-dried information at the beginning of therapy before they know a client at all?

When I saw my T for the second 9 years, she and I pretty much knew one another and I was shocked and offended when she told me she doesn't "chase ambulances". It's a perfectly good rule and I understand why T's have it but I was offended that she said it to me when I'd never given her any problems like that in 9 years worth of therapy before.

She didn't have e-mail and never gave me any phone boundaries because I rarely called her and when I did she directed the conversation to "see you in our next session", wouldn't get into material on the phone other than a sentence or two or reassurance. She didn't mention paying for sessions that weren't cancelled within 24 hours until after I did that two or three times and even when I explained why I hadn't been able to and she agreed they were good excuses and backed off, I still paid her for one as I'm fond of moral high grounds But I can't imagine her just straight out coming up with a bunch of rules, that wouldn't go well with me.

Oh, Olivia, what a rough spot to be in!

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Perna said:
I don't know that all T's are going to want to give cut-and-dried information at the beginning of therapy before they know a client at all?

</div></font></blockquote><font class="post">I think it's often in the consent form, which is signed by the client the first day of therapy. Some go into more detail than others on office policy. As time passes, the T can refine policy to better fit the client, if need be. I think some flexibility is important. There is not necessarily a hard and fast rule that fits everyone.

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OliviaC wrote:
To make a long story short, I had emailed a complaint or two to my pdoc about the therapist (who she supervises) and my pdoc who is overworked forwarded my emails to the psychologist!!!

</div></font></blockquote><font class="post">Olivia, I am so sorry that happened. That was a breach of confidentiality by your pdoc. They are not supposed to do that unless the client has signed a release form authorizing them to consult with another professional (your T) and it needs to specifically give their name. If nothing else, you should discuss this breach of confidence with your pdoc and make clear that a release is required in the future. If your pdoc believes emails do not require a release, do not email anymore, but always speak in person or over the phone. (I am wondering, could it be that emails are not afforded the same confidentiality protection that other interactions are?) At the very least, you deserve a bowing down apology from pdoc.

I think in OliviaC situation the sharing of information among professionals operating out of the same clinic is not necessarily a breach of confidentiality. My GP and neurologist work out of the same medical group but are actually located in different buildings and have different office and nursing staffs. I have one medical chart that is sent back and forth between the two physicians. When I first realized this I did not like it at all. However today I saw my GP for a general check in, It was nice to know he was interested and taking responsibility for making sure I was getting complete and coordinated health care. He even politely made a general inquiry about my therapy and if I felt like I was getting what I needed. Luckily my therapy is done elsewhere :-)

I think OliviaC's case highlights a disadvantage of a clinic arrangement where physician's and therapists work in the same office. Nothing is private in that situation.

If confidentiality is waived due to the pdoc and therapist sharing the same office, OliviaC, perhaps you could put special instructions in your chart that information is not to be shared among the other clinic staff as per your express request. And have the pdoc and T both sign it, so no further breaches are made. The breach already caused this rupture between you and your T (and was just plain rude in my opinion). Maybe you can prevent further problems by taking a measure such as I suggest.

This situation does make you wonder... Can the stuff you put in writing come back an bite you in other ways? Like... say you have children, get into a custody battle with your husband or ex-husband and it gets ugly. He has your therapy records subpoenaed and brought under review in court. Your therapist notes are likely incomplete, general statements, dx, misc notes, that only make sense to her. HOWEVER, in the file are also these freaky very disclosing documents that YOU wrote. Could what you write be used against you in court?

I asked my T once about my therapy file and if it could likely be used against me in court. She said judges usually protect people's privacy and wont all it to be brought to court. She said they usually view a person seeking therapy as a positive thing not a negative thing. The optimal word here is "usually".

Gosh, I couldn't imagine ever wanting to contact my therapist out of sessions.

I found it very unsettling when she sent me a text message inviting me to ring and schedule an appointment. Ringing seemed WAY too invasive, so I just texted her. Now that I have her mobile number I would still call reception and leave a message if I were running late or cancelling.