Should you call your therapist outside the session?

It hasn’t happened yet as a therapist, but as a college counselor, I’m often contacted by students and parents outside of our scheduled appointment time. This is especially true during the peak of the college application season. From September through November I will receive many panicked phone calls, text messages, and emails at various hours of the day. Most of the time these exchanges are quick and don’t interfere with my life. If any of it becomes too much, I talk about it with my clients, and when it does get unmanageable, I charge a fee. Typically, when I start to do that, those calls or emails slow down. I charge the fee not so much to make money but more to establish a boundary.

Now that I am expanding my practice into mental health, I have the challenge of figuring out what communication will look like outside the session. What I do know so far in these three years I have been in practice as a therapist is that when it comes to mental health care, conversations outside the session typically are with other providers to coordinate care and those don’t necessarily take long and they are essential with clients who are in crisis. However, while it is important to be able to have that communication outside of therapy, it is even more important that this type of communication have clear and definite boundaries regarding time.  

As a consumer of therapy, when I have been in crisis, it has been imperative that I have access to my counselor. Once, many years ago, when I felt very anxious and scared by the intensity of my symptoms, a very quick phone call remedied my worry that I was actually going to make myself have a heart attack (which is impossible!) or “make myself go crazy” (also not possible!). The exchange was all of 10 minutes, and it really helped me make it through the rest of the week before my regular appointment.

At the same time, it also has been a saving grace that every therapist I worked with over the years always established firm boundaries about outside the session contact. That particular counselor told me that if the phone call was under 15 minutes, then there would be no charge but if it went over, or became something I needed on regular basis, there would be a fee. This forced me to slow down and ask myself can I manage this on my own and if not, what do I need from this phone call? It was those boundaries in therapy, especially early on in the relationship, that helped me to figure out how to handle whatever was happening to me and also to accept responsibility for my symptom-management—both of which are vital to recovery. 

This is all assuming one very important thing: your mental illness is manageable with outpatient treatment. If you notice that you are frequently leaning on your therapist outside the session, it is a sign of two possible realities: you need a higher level of care OR you are avoiding getting better. Either way, it is important—on both sides of the couch—that boundaries for communication are established and respected.

Introduction!

I've created this blog in order to contribute to the #buststigma movement within the mental health community.

So here it goes...I am a mental health counselor...who knows therapy from both sides of the couch.

I first went into therapy around the age of 15 over a bad break up with a really bad boy. The second time was because of a crippling panic attack that rendered me agoraphobic for a quarter of my senior year of high school. The third time was insomnia in my mid twenties. The fourth time was prepartum depression with my second child. And the fourth, I refer to as an almost-mid-life break down.

With each bout of anxiety and depression, I sought treatment upon the first sign of symptoms, and with each round of therapy, my goals were the same—to get better, to get my shine back, to feel like "me" again.

I was (and am) a hard worker in therapy (and in the rest of my life) and so for all the years that I wasn't a therapist, I assumed anyone who went into therapy worked just as hard—if not, what's the point? I would later learn that is not always true...but more on that in another post.

Starting in high school when I was elected to be part of the Natural Helpers program, and all the way through my adulthood, I have always been a resident therapist of sorts. I tried different careers where I could use those skills: high school teacher, college counselor, and writing coach. Eventually, I had to admit to myself that I actually was a therapist already; I just needed the letters after my name to make it official.

So back to school I went, finishing up in May of 2017 and adding more letters to my name:

Hannah Goodman, LMHC (licensed mental health counselor—most folks have no idea what the letters stand for!)

The rest of my credentials are:

M.Ed (master of education in School Counseling)
CGS (certificate of graduate studies in Mental Health Counseling)

I have another bunch of letters, MFA, master of fine arts in Writing for Young People. My own forays into therapy also include the struggles of being a writer and dealing with failure and self-worth.

For this blog, I plan to cover topics like:

• the pros and cons of going through insurance for behavioral health,
• the importance of knowing what your therapist diagnoses you with and why that matters
• why you should do your homework in CBT
• on "tune" ups and maintenance
• why therapy isn't worth it if you don't do the work 
• to take meds or to not take meds
• ...and many others!

If you would like to know more about my practice, please visit me on Psychology Today or my website hannahgoodmanlmhc.com .