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.