Email Vs Calls Vs Text...

[xena21]

Hi everyone. I am wondering how therapy works for people as a majority. Its not a pol per se but I'd like to see how many therapists let their patients email them throughout the week.

My reason being is, I signed a contract recently with my psychiatrist that I wouldn't email her because they were afraid I would say things like I was suicidal or things to that effect.

As of Friday, my therapist decided to change the contract to allow me to email her as long it wasn't about suicide or anything to that effect.

Can anyone tell me how their therapists work in this type of environment? I am uncomfortable with the entire thing.

Thanks!!!

 

[Deleted member 1860]

I think if you are uncomfortable with email then you can tell your therapist this and take this option off the table. Honestly, I wish more therapists who deal with trauma patients would stick to weekly/biweekly therapy sessions and phone calls.

There is SO much that is lost when you go from the spoken word to the written word, and then you throw in a population of patients that tend to have a higher rate of boundary issues, and this can spell a recipe for disaster. Also, many avenues of communication can lead to over-dependence, and independence from therapy/your therapist is the ultimate goal.

All of my therapists had strict communication rules, and it all worked out for the best as it forced me to do much of the work on my own without being in constant contact with my therapist. That is, I wasn't given more crutches to use.

 

[Justmehere]

My therapist allows texts and phone calls, but not emails because they technically are not a private form of communication unless they are encrypted.

My old therapist did encourage me to email her, but with the understanding that she would respond in session. She said it helped her help me better. Over the long run, I think it came with some big draw backs.

I like being able to text my therapist now instead of email because it's short and we can quickly decide if I need a call, and extra session, or just to tell her what's going on. She responds every time, which I'm not used to. I never call or text in between sessions as much as she encourages me to, but I do find it helpful to know I can, and to do so about anything. I do get much more out of phone calls than texting, and I have a huge as version to the phone... Therapy is about more than just telling our Ts stuff, but in the relationship and how it is revived and the feedback they give. So much of that can be lost in the written word on text or email. At they same time, being able to text her (which I do 2-3 times a week) helps me feel like less of a burden as it is easier for her to respond, and it helps me stay connected to her. I have a very avoidant attachment style in therapy though and she is trying to help me work through it and says all the time, soon you won't need to reach out anymore to me, it's just for a season.

I have texted her about suicidal thinking and she called when she had the chance.

If your therapist and doctor are saying no to emailing about suicdial thoughts, but are ok with you communicating about suicidial thoughts through other means, then it may just be due to their inability to access email as quickly as other means of communication. I don't know... I am sorry it is all feeling uncomfortable to you now.

 

[xena21]

Thanks for both of your messages. Yes it is very uncomfortable for me.> they don't want me to let them know I'm suicidal. I have to call the suicidal chat line which is so demeaning. I would never do it. They don't take calls at night and don't take emails at night so it wouldn't mater anyway. I have a VA crisis line if I really need it. They would call EMS if I was going to to do something. I have no connection with my therapists at night or on the weekends. Its tough.

 

[blackswan]

@xena21 , you would need to clarify with your therapist, but from my perspective the reason they would have asked you to not email regarding suicidal thoughts is not because they don't want you to let them know that they're suicidal. It will be, in my opinion, because they don't want you to reach out for support via email and not get a response because no one has checked the email account that day.

It's likely that your therapist attended supervision or a professional development session, or consulted with a colleague, and has updated their practice guidelines. If a therapist has email available as a communication method but doesn't specify how clients can/cannot access support regarding suicidal thoughts, and a client sends an email saying that they're feeling suicidal and then follows through with those feelings, they will be legally (and probably feel morally) responsible for not intervening even though they may have not read the email yet. As I said, please clarify this with your therapist though. It would have been better that they explained why they asked you to sign this form when they provided it, so perhaps feed back to them about your feelings of confusion and rejection as well so that they can do this better next time.

I used to work on a suicide line - give us a call :) we're very friendly and understanding and are there to help. There is a surprising amount of wiggle room when someone is feeling suicidal before emergency services need to be called in as well, so just calling a suicide line and saying that you want to suicide is not going to mean that a fleet of police cars and ambulances will rock up at your door. You could try doing a practice call when you're feeling ok just to see what it's like, (I expect) they would be very happy to talk you through the experience so that you can feel more comfortable calling when you're not ok.

As a supporter, I encourage my partner to use all available tools when things are tough (including phone lines). I'm going to pass on the same encouragement to you :) but yes, only do what you are comfortable with.

 

[Justmehere]

I'm sorry this is hard. Surviving suicidal thoughts and all the pain behind them is really difficult work. Are they working with you on other skills that you can do other than calling the crisis lines? I'm glad you feel ok enough to call the VA line. Some lines are better than others.

If what you want is for your therapist and doctor be able to be there for you at night and on the weekends if you are struggling with suicidial thoughts ... well no one in any profession can be on call 24-7... That's why crisis lines exist. It's an important boundary for therapists and doctors to be able to have time when they are not reachable, so that they can recharge --- and yet I know very much that it is a deeply painful boundary to hit up against, especially when the pain is so great.

It sounds like you know they can't be reached for quick response on email... and in the case of sucidial thoughts, they have to be clear all the same. It's just a professional boundary. It has nothing to do with how much they care about you or not.

When I have had very long deeply dark nights, I have had things my therapist has written that I will literally hold on to. It helps me feel a little more connected to her until I can connect again with her.

Have they been working with you at all on how to reduce the sucidial thoughts in more ways than calling crisis lines or alternative ways to hold on to the connection to them? It does sound like they are allowing email, but they are holding a boundary that almost all therapists hold. I haven't ever heard of any therapist that can be on call 24-7 on nights and weekends. When things were bad enough for me that I needed that level of support through the night and weekends, I went inpatient to a trauma speciality center where they had staff around the clock there that I could reach out to.

If they did agree to being open to you emailing them about sucidial thoughts in the middle of the night, or even during the day when checking email is slow, they could end up with a huge liability issue on their hands. In the state that I live in, most therapists say on their voicemail that if someone is in crisis they should hang up and call 911. That's on the voicemail of my own therapist. They leave that on their voicemails to protect their butts. It's not because they never want to know about a clients crisis, but that they want to be very clear that they can not be available quickly all the time even by phone to intervene in sucidial thoughts. They can't have some automatic message that reminds you before you email them about sucidial thoughts that if you are in crisis to call 911 before emailing them. And when people in general get very suicidal, thinking in those moments is not always clear - so therapists do have to be clear.

Their boundary is not because you are bad for having this struggle. It's just them keeping common professional boundaries and really trying to redirect urgent nighttime and weekend needs to other resources when they can't be there for you. It's common. And I know it still sucks and is painful to deal with all the same.

 

[Leah123]

I have unlimited email access to my therapist. She encourages me to write to her as much as I'd like. I pay for my email sessions though, so she's compensated for all her work. My email sessions are long, indepth, back and forth exchanges.

Her approach is less common in my experience but I love it and wouldn't trade it for anything. The ability to email her during tough situations and give her a play by play view of what's going on and work through that has been invaluable and accelerated my progress a lot.

 

[Deleted member 1860]

but @Leah123, don't you do Skype therapy? I think this is worth mentioning as it is a completely different format for therapy.

 

[Fadeaway]

I have never had a therapist that was open to e-mail. Phone calls only. I can see a lot of legal problems arising with e-mail. Even if I could, I am not sure I would.

 

[NovemberStar]

My T allows (and welcomes) my emails. I'm able to email her prior to our weekly sessions out the things I'd like to / need to talk about. I've been able to tell her SO much via email that I might not have otherwise been able to bring up.

I can only see her once a week as she only works where I see her, once a week. We haven't discussed it but I'm pretty sure it would be a no to phone calls (she hasn't given me her phone number other than the recognition and as she only works there on the day I see her - no point phoning!).

Email can work - we both acknowledge it's limitations. She has been clear that she cannot promise 100% reply rate to any email I send; she can only write a very short, response. She will usually acknowledge what I've shared, offers some encouragement and will always say she hopes we can talk more about it in our session. It is not therapy in itself.

It might also be a couple or more days until she gets my email and / or replies.

Key thing is recognising its limits - you cannot assume it will be a therapy session via email. Like @Solara said - you can't tell tone etc; so major misunderstandings could occur if you send an email with expectations of a lengthy response / answers to your questions.

I like the clear boundary your T has set - NO talk of suicide. My T hasn't spelled that out to me, but I think it's pretty clear given the limitations of email that would be completely unacceptable. Not that it's something is ever do anyway (send an email saying I was going to harm myself).

@xena21 I am in a similar situation in that I cannot access my T inbetween sessions. I know I can not reach out to her if I was feeling suicidal. That's actually ok I think. There are always other options - helplines etc. I think the US is very different but where I live it's the norm to NOT call your T in an acute crisis - there are emergency psych services, a GP, your psychiatrist that would be more appropriate to contact in a crisis. I will be honest with her at our session if I have struggled with the thoughts etc. But the expectation is I need to reach out to someone who can immediately help me if needed. My T can't be 'on call' for crisis - and it would be unethical if she promised or offered something she couldn't offer (ie immediate response to a crisis).

I encourage you to come up with a crisis plan with your T; one you can access 24/7.

I also think many T's don't do the 'on call for acute crisis' thing because all too often it can lead to unhelpful dynamics where some clients act out rescue fantasies - which can quickly spiral out of control and end very badly (with the client indulging in more severe self harm / suicidal acting out.) It's the same reason many have their clients make contracts regarding NOT self harming, and terminate therapy if the client does so.

Lol @Justmehere - I'm on call 24/7 in my job ;). But I do have regular time off call (every second weekend when a colleague covers my caseload - one of us is always on for our clients at any time). But you're right in that a T can't be on call like that. Mainly for the reasons above - an unhealthy dynamic can occur AND I don't think it's the purpose of therapy - and I also think not being able to contact our T's all the time leads us to foster our own strengths and abilities in coping - isn't that after all, one of the end goals of therapy?

I've read also it's why T's don't necessarily phone their clients inbetween sessions - to do so kinda implies they do not have faith in us to cope and manage. For me it feels SAFE that I know deep down my T does TRUST me to cope and survive :)

 

[Leah123]

I have had misunderstandings using email, but have had them in other situations too. It does depend partly on one's ability to communicate in writing, I suppose, but it's also about having a solid relationship. The longer I've worked with my therapist, the smoother our communication has become, regardless of format because we understand each other better.

I do actual sessions, not just one-way messages, via email as well as other formats, including phone calls and text chats, but I've never self-harmed or been actively suicidal. I can understand therapists having limits around those topics. Most of my therapy has been face to face, years ago, but my current round is the most effective by far and is done online.

I've found the most important element of therapy, more than setting or style, is finding the right practitioner, which for me is someone experienced with PTSD, who uses a relational approach, has lots of availability and a maternal sensibility. Given that I have the right therapist for me and we have an understanding of what works for us, email works great in combination with live sessions.

As for the possibility of frequent access enabling rescue fantasies, well... it depends on the client I suppose. I haven't found that to be the case in my therapy or expected my therapist (or anyone) to be able to rescue me, I don't want or need rescuing. (Though I do occasionally enjoy the fantasy of having her life, lol: she's semi-retired, living alone quietly with a dog, I'm working 60 hours a week with a rambunctious kiddo and a household where quiet is as rare as platinum!)

I have however really progressed because I've been able to work things through in a more hands on approach while conflicts and behaviors are fresh in my mind, and I've also been comforted during distressing episodes, like being triggered, to know my emails would be read sooner than I might be able to see her for session.

Some espouse therapy as being about increasing independence, and state the goal of therapy is to be able to quit therapy, but that's not a universal or immediate goal for everyone. It's a very personal journey, and somewhat different for each client/therapist pair.

There are many goals and many paths to success.

 

[Leah123]

There is SO much that is lost when you go from the spoken word to the written word,

Actually, as I writer, I find much is gained through print. It's a trade off, not at all a clear loss for me.