Communication/therapy between traditional in-person sessions.

The one I see isn't a huge fan of outside contact. She tolerates occasional text messages from me and will provide a brief response so long as she doesn't perceive me to be acting out towards her with an angry text (I can express anger in session but she isn't willing to go back and forth over text). She once said something along the lines of usually not texting with clients other than for scheduling. She does not do email. If something was really urgent, I could call her and she would call me back.

I guess having non-urgent out of session contact can probably be both helpful and harmful. Seems like a ton of people are more stressed out by it than helped, but are also unable or unwilling to disengage from partaking in the behavior. It also sounds like many therapists act like outside contact is welcome and ok for a while then end up revoking or reducing outside contact, sometimes with explanations that don't help and sometimes without any at all. While I don't have much in comparison to many people, I have found what I do have to be helpful to me and for the benefits to outweigh the annoyances. It is probably good for me that the therapist doesn't tell me she loves when I text her because then I would take that to mean it would be ok for me to let loose and text her all the time. In reality, I know that the person I text most often in my personal life doesn't even like receiving all the texts she receives and doesn't read all of them.

I don't see the point in hiring someone and then letting them dictate to you the terms of contact and communication.

It's all so controlling and punitive. It's not a feature of normal healthy relationships. Seems like a recipe for regression.

People talk about healthy attachment to their therapist, and then describe how the therapist refuses to interact with them outside of a one hour time slot.

It's essentially a business relationship though -- a fee for service. I know of very few, if any, business relationships where clients have open access to communication with the service provider without any limitations on that contact, be it time constraints or extra fees/costs for that additional time.

Yes, it is personal because it is a business relationship built around talking and sharing about ourselves, but it is their business, too. That's complicated, and most therapists do have circumstances in which they will make themselves available for their clients, but I don't particularly fault them for setting some limitations as to the extent of that contact. Seems within their right to set their practices as they feel best for themselves, and seems within the rights of the client to choose a different therapist who has practice routines that meet their needs if necessary.

I, personally, wouldn't see a therapist who had an absolutely no contact outside of session policy, particularly in the case of emergencies, yet I've read here of therapists who practice that way. That may work for some clients; not every client lands in emergency situations so that might not be a problem for them. Another person wouldn't see a therapist who didn't offer 24/7 contact via text messages or email, and I would assume they ask about that kind of availability early on and hopefully move on to find a therapist who offers what they want if a therapist doesn't offer that kind of access.

It's not controlling to set one's limits in any relationship. I have a friend who isn't comfortable speaking on the phone, so we don't speak on the phone. I have another friend who doesn't respond to texts for several days. It's annoying sometimes, but what right have I to lay claims on when she responds? She's got her life to lead. Yes we 'hire' a therapist, but they have a right to their life/family throughout the week and don't have an obligation to be available 24/7 to a client. Some therapists say they can be contacted anytime but that can quickly lead to burnout, which isn't fair on T or client. They're not an emergency service. Many Ts, mine included, actually talk about contact with the client and come to an agreement about how often and how etc depending on the client's need and the T's right to a life, rather than dictating TO the client. The therapy relationship is far from ideal but it can work well in many instances.

I think it is really a nonsense if a T says they are available for clients 24/7 or anytime. I don't believe anyone is (or can be) available in that way, not even a parent to their child... let alone a professional service. Unfortunately, sometimes clients take this for granted and get intensely disappointed when it turns out not to be true (it will come to that sooner or later). Of course it is easy to see that such a statement should not be taken literally but if someone really desires that level of contact, they will often hang onto the promise. The kind of compromise many Ts seem to make is to let clients email/text whenever, but they only respond when they want, or not at all. My last T used that with me, and it worked well for me because I wrote not for support or actual contact, more to have a channel to get my thoughts out. It wasn't so important for me that he even read it, although hearing it was nice. But, from what I have seen from this forum, that form of communication stresses out more clients than satisfies. I don't think that's a bad compromise if a client's reasons for contact are similar to mine, but is certainly not a natural form of communication and mark of a normal relationship.

The second one I hired told me to call her any time and gave the example of even at 3 a.m.
I did not call her in the middle of the night - but she did specifically and repeatedly make the offer. I did not find calling her at any time of the day particularly useful, although I gave it a shot a couple of times to see if it would be (she seemed very convinced it would). To me it always seemed they were overly excited anytime I tried to have more contact with them rather than less (I know they were acting but they did put on a show).

Seems like a therapist being pushy like that points to their own issues and some sort of obsession about being needed. I would suspect a therapist who suggested of her own accord that I contact her in the middle of the night to be trying to use me to gratify some sort of unhealthy addiction involving codependency of some sort.

Like Artley, I recall a time before text and email and would get on the phone. And even then the "message" could be misunderstood!! :-)
My current T encourages emails. Lately she has been saying that if I get a work email or setting that makes me feel overwhelmed I should email right away. I somewhat miss the days of phone calls. Current T will say, occasionally, that she is available on FaceTime, but whenever she says that, via email, I'm doing okay. But if I am not doing okay, then she never offers!

I agree with other that this helps with healthy attachment. (I know what bad attachment and transference is from experience, and this is not it). I don't think she is offering email contact to build codependency.

I also see that she has a varied clientele, lots of short term clients, like 3 to 6 sessions. My guess is that she doesn't do lots of email with short term clients.

My therapist and I have always emailed about scheduling, but recently he's started encouraging me to share more substantial content that way. He's always responded with a brief but supportive message, so it's not like we're doing therapy over email, but it's also not a totally one way street. I find it useful but I still use it somewhat cautiously.

One thing I do find concerning, perhaps as someone who has worked in healthcare IT, is that I very much doubt all these therapists accepting email with very sensitive and private content are paying due attention to client privacy. I am skeptical in the extreme that they are at all familiar with HIPAA requirements or that the vast majority are using HIPAA compliant platforms. Honestly, this goes for texting as well depending on the carrier. This lackadaisical approach seems really lazy and disrespectful of clients.

HIPAA grants clients the right to opt to receive less secure emails if they want to, if they're aware of the risks. All of the specifically HIPAA compliant email platforms I've seen were awful to use from both the provider and patient side of things, so I'm personally glad to avail myself of that right and happy to communicate with my therapist the same way I communicate with my primary care doctor and my other doctors. I'm sure there are people who feel differently and therapists who don't take the whole thing as seriously as they should. Personally though, my emails to my therapist aren't anywhere near the most private messages I send over email.

Most people talk about this in terms of what their therapist "allows". It's usually framed (by clients and therapists) as a privilege that is granted by the therapist and can be revoked by the therapist. So from what i've observed, it's very top-down and controlling. The therapist is the boss or parent, and the client is expected to comply. And the therapist's "policy" on this is usually self-serving, putting their needs above the client's well-being.

In my experience the main issue with between session communication wasn't the content, it was this insidious subordination.

HIPAA actually doesn't say anything about it being ok to do what you say, although I think the argument can be made that it is allowable under HIPAA. As for the sensitivity of things people send, I wasn't making a commentary about you personally. However, many people on this forum and elsewhere have mentioned disclosing things they felt too ashamed of, for example, to disclose to their therapists in person. For example, I have seen people mention emailing their therapists details of sexual assaults. I have also seen people who felt angry when they realized that their therapists who worked in agency settings did not have ultimate control over their emails and that said emails might be read by others.

ETA: There are actually ways to make email HIPAA compliant (I'm not talking about horrible portals or anything), but I doubt therapists are doing that.

It really actually does. With the 2013 HIPAA Omnibus Final Rule, HHS clarified explicitly that patients can consent to less secure communication of PHI if that's their preference.

The whole problem is that these lunatics have made human emotion and human attachment into a business, and try to conduct it as such. That's precisely why it's so destructive, and it's why you have this conundrum around contact between sessions. People aren't wired for this loony see-saw and when clients freak out, everyone makes excuses for the therapist and for therapy.

Sure, therapists need to put up walls to keep needy and disregulated clients from intruding too much, but let's not kid ourselves that this is for the client's benefit.

That's actually not what it says, that is an interpretation of the still very broad specifications and that's my point. Have you read the section on this in the actual 2013 HIPAA Omnibus Final Rule? It never explicitly states that it is ok for providers to transmit PHI in non-secure formats. It says that they may reproduce PHI and provide it to patients when requested in an electronic format if it is not unduly burdensome (for the provider, in this case). However, that does not necessarily translate to the electronic PHI being transmitted in an insecure fashion. This is what happens when you have technologically illiterate lawmakers coming up with these things.

Overall, I do agree that it's nice to have the option as a client. However, the less stringent the built-in privacy safeguards, the more client privacy relies on the individual therapist to a) know what the hell they are doing and b) not get complacent about maintaining client privacy. I don't think that's ideal.

The problem is that many clients go to therapy because they are emotionally damaged and need the therapist to set boundaries around contact. Many clients have never been taught what safe boundaries are. There is a power inequality in this situation which is unavoidable. Some ts deal with the difficulties by not allowing contact at all, but obviously others do but it means being clear about what is acceptable and what is not if the client is in a place where they need to contact T a lot...but ideally this is done with the client's wellbeing in mind.

I accept you've had some really awful therapy experiences though. I know there's some therapists who really shouldn't be practicing.

Thanks for all those responses, really insightful! Reading all that I'm even more questioning traditional dogmas and boundary "issues". Hopefully, in the coming years, we will see more research about the integration of texting/calls in traditional in-person therapy.

I am all for debunking old-fashioned, misguided dogmas. However, one problem with the between-sessions contact is how to handle it appropriately, in a way that satisfies more than stresses out the client. I don't think it is realistic or fair to expect a T to communicate with clients between sessions if they are only paid for sessions. If they are willing, fine, but then there is the frequency and extent of it. It still needs some boundaries IMO, like every healthy relationship/communication and expectations can be quite unequal between T and client.

I am not really in favor of it, unless maybe for emergencies. Maybe the T can allow a client to email or text but I do not think they should respond until the session. I think therapists might consider some sort of crisis protocol where if there is an emergency they will contact the client but I do not see how being available whenever is really in the best interest of the client. You know how when someone wears a uniform to work and sits at their desk they go into "work mode" and they are in that mindset, focused and ready to tackle the tasks? I kind of look at sessions in person the same way. A stable environment, same rooms, furnishings, knick knacks.. seating arrangement puts the client into the frame of mind ready to do some deep soul searching processing. I dont know maybe I sound stupid. And therapists have lives and families. Just like someone from the office will choose not to check and respond to work emails until monday morning, I think therapists should be able to set aside their work. Just because their work is highly personal and sensitive doesnt mean they should be available whenever someone wants. And I agree with others who talked about boundaries. Boundaries are a big issue for most clients and I do not know what the best course of action would be in that regard.
I do believe it can foster dependence. We have threads here devoted to these issues. I dont know, I think I have soured on therapy lately....