Texting clients

[Lurn2Regul8]

What are everyone's thoughts about providing individual therapy clients with your personal cell phone number, texting clients, and/or allowing clients to text you?

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[Rivi]

There are very, very few circumstances where this is a good idea.

 

[VeggieDelight]

Absolutely not. There are crisis lines for emergencies.

 

[edieb]

is this a joke?

 

[Lurn2Regul8]

Nope, it's not a joke. I am asking because a doctoral-level colleague of mine does this frequently. I find it very questionable, so I wanted to see other's thoughts on the matter. Thanks for the responses.

 

[Pragma]

Nope, it's not a joke. I am asking because a doctoral-level colleague of mine does this frequently. I find it very questionable, so I wanted to see other's thoughts on the matter. Thanks for the responses.

Personally I find it to be ridiculous to give out your personal cell phone number, unless there is a specific purpose for it (like DBT). That being said, I know more than one person who has done this. To be honest, texting almost seems more benign than having them call you up when you are at home.

An exception could be when people have a dedicated cell phone for these kinds of contacts. I have know of therapists in private practice who prefer to do things like scheduling over text or email, as it ends up taking up a lot less time. I recall getting into unwanted conversations that I couldn't bill for or get any significant training credit for when I always had to communicate with clients over the phone about even some small scheduling change.

 

[Psychadelic2012]

I am asking because a doctoral-level colleague of mine does this frequently. I find it very questionable, so I wanted to see other's thoughts on the matter.

Yes, it's a BIG NO as far as I'm concerned. Your colleague will be complaining of the excessive calls/texts from his/her clients in no time, trust me. You just sit back and watch while he/she tries to unravel that mess.

 

[PerhapsMaybeOk]

It is fine if you have a work cellphone. It's not much different than emailing them. However, using a personal number, no way.

 

[futureapppsy2]

It is fine if you have a work cellphone. It's not much different than emailing them. However, using a personal number, no way.

I agree.

 

[eudaimonPsyD]

It is fine if you have a work cellphone. It's not much different than emailing them. However, using a personal number, no way.

I agree as well, although because I am still in graduate school I haven't had to have clients call a number specifically for me very often, they most often call the central location and leave a VM for me there. But what I did is signed up for a free internet phone number (Google voice) that could be forwarded to my smartphone. So I basically have two phone numbers on one phone, but that are not connected to each other. And it has lots of features like it doesnt take phone calls after a certain time (I could see being a plus!). That's one way to possible solve the personal phone number problem.

 

[Psychadelic2012]

It is fine if you have a work cellphone. It's not much different than emailing them. However, using a personal number, no way.

What's the difference, really? A cell phone is a cell phone--it rings and receives texts at all hours just the same. The client won't know the difference, they'll call/text it if they have the number.

 

[Marissa4usa]

What's the difference, really? A cell phone is a cell phone--it rings and receives texts at all hours just the same. The client won't know the difference, they'll call/text it if they have the number.

Yeah, but giving out your private number means that you'll never be able to pick up if you don't recognize the number (unless you don't care dealing with a client during your Sunday afternoon with your family).

 

[PsychPhDone]

It's actually dependent on the therapist and supervisor in my program. My clients have my cell number. It's the most reliable way to reach me. I am fine with occasional texts as long as they only deal with scheduling concerns.

 

[PsychApps2009]

My program has an in-house clinic that has a DBT program, so giving high-risk (i.e., suicidal) clients therapist cell phone numbers is actually pretty common practice for us (even for clients not in DBT). A lot of the therapists are actually very open to it (over and above what I would expect)... I was a bit reserved about it myself when I started and set up a separate phone number (google voice) for that purpose. Overall, we've had minimal issues with cell phone and texting in terms of client contacts, as our clinic director is very clear that if we do so we must have a discussion with our clients beforehand and set up boundaries/rules/expectations. In relation to this, we are also instructed to only have clients in our phones via their initials and take other steps to protect client confidentiality if taking a client call on a personal phone (while you're at home or outside of the clinic).

I don't text mainly because I find it inconvenient in general (I hate trying to have conversations/contact over text message) and could imagine it becoming annoying to record every text contact with a client in progress notes. I know some therapists who do text on occasion but even then it's minimal and a conversation must be had where both sides agree to it (as one would never want to text a client who doesn't have those services and have their cell company charge them... or vice versa) and the boundaries related. A good technique for a client who texts when you've given them your cell phone number (but not permission to text) is to call them right back as soon as they text instead of replying via text (and then obviously make your boundaries clear). [Note: Confidentiality concerns also exist with texts and e-mails; my phone is password protected partially for some of these concerns].

In regards to being available 24-hours a day (which I am - unless I were to set up different boundaries for contact hours), I personally haven't found it to be a problem at all, and am more open to it now than when I first started. I still prefer to have my google voice number (or I'd have a work cell phone) instead of giving out my personal number. I've had my personal cell phone number for a while and would not want to change it in case of a rare case of contact-abuse. But mostly, a separate number is a huge benefit because I know that when I get a call on that number it is a client (and high-risk) so I make it a point to answer or return the call asap.On my personal cell phone I typically ignore unknown numbers unless they leave a voicemail. (I find it funny that this is essentially opposite to the reason another poster detailed above).

 

[aventurine]

I was surprised to find that most of my colleagues who have small private practices do use their personal cell phone with clients, though most don't text.

I only do a little private work, but got a Google phone number, which is routed to my mobile phone. So, I don't need to pay for, carry and manage two separate phones, but I have the option to not be disturbed by calls to that number.

One thing to be aware of...unless you turn off the feature, Google Voice will transcribe voicemails. Due to privacy concerns, I recommend disabling that.

Email also seems pretty common.

 

[Pragma]

I was surprised to find that most of my colleagues who have small private practices do use their personal cell phone with clients, though most don't text.

I only do a little private work, but got a Google phone number, which is routed to my mobile phone. So, I don't need to pay for, carry and manage two separate phones, but I have the option to not be disturbed by calls to that number.

One thing to be aware of...unless you turn off the feature, Google Voice will transcribe voicemails. Due to privacy concerns, I recommend disabling that.

Email also seems pretty common.

This Google Voice option seems pretty nice, particularly with the turn-off option. It probably is a great tool for people that do want to be available to clients/patients.

Personally, I am of the mind that boundaries are really important unless a particular mode of therapy (e.g., DBT) is calling for more frequent/unpredictable communication. I like having an office VM that let's folks know when I am in and when I am not, and who they can call if there is an emergency.

While it represents my opinion that this is the proper way to manage these things, I also view it as important for self-care (i.e., having non "on-call" time) as well as important for not allowing our field to get out of control with non-billable time.

A dedicated email or office cell phone (including texting) for scheduling purposes also seems reasonable. If it were me, I would only respond during the hours I have stated I am available for these types of inquiries as well.

 

[G Costanza]

Many therapists give out their cell phone number. Many clients understand and respect when and when not to call. I can see how some think that's crazy but it happens frequently in the circles I'm around. It's not that big of a deal.

 

[aventurine]

This Google Voice option seems pretty nice, particularly with the turn-off option. It probably is a great tool for people that do want to be available to clients/patients.

There is also a "Do Not Disturb" feature, which will send calls directly to voicemail.

Using Google Voice doesn't necessarily mean you want or have to be available (at all times) to patients.

 

[AcronymAllergy]

Many therapists give out their cell phone number. Many clients understand and respect when and when not to call. I can see how some think that's crazy but it happens frequently in the circles I'm around. It's not that big of a deal.

I would agree that many/most clients aren't going to test boundaries or call at inappropriate times. However, it's the one or two cases when it does happen that become problematic, and is the reason I generally don't provide my cell phone number to clients (that, and because most of my work is neuropsych and/or rehab inpatient currently, and thus there's really no need for my number).

Most faculty with in my grad program, as well as the the two private practitioners I worked while there, also shied away from the practice. But I've heard of it happening enough that it doesn't come as a surprise or seem odd/unusual when it happens. Mostly it's just an issue of wanting to deal with the potential headaches that could arise. Google Voice, as mentioned above, can provide an excellent compromise.

 

[deleted176373]

What are everyone's thoughts about providing individual therapy clients with your personal cell phone number, texting clients, and/or allowing clients to text you?

Hugely bad idea... Start with your borderline clients and let us know how that works out. (I understand having access for DBT clients, but there are better ways to do this as others have noted.)

 

[Psychadelic2012]

many/most clients aren't going to test boundaries or call at inappropriate times. However, it's the one or two cases when it does happen that become problematic

Yep. All you need is one client who seems to be constantly in crisis, or who calls/texts incessantly, to totally f*** up your life. It all seems exciting and fun to help at first, but when it doesn't stop and meanwhile you can't pay your bills from your salary and you can't get through a social function without that client butting in?? Not so much.

 

[PhishGirl]

Even for DBT it doesn't seem appropriate. The clinicians at my work who do DBT explain to clients that they can call and expect to receive a call back with 24 hours, but to my knowledge no one gives out 24/7 contact info to clients. That seems like a tremendously poor way to set boundaries.

 

[AcronymAllergy]

Even for DBT it doesn't seem appropriate. The clinicians at my work who do DBT explain to clients that they can call and expect to receive a call back with 24 hours, but to my knowledge no one gives out 24/7 contact info to clients. That seems like a tremendously poor way to set boundaries.

I'd thought the norm for standard DBT groups was to provide at least the equivalent of a pager? I can imagine it would vary, but from what I remember, the 24/7 access to a therapist is one of the aspects of the treatment.

 

[Pragma]

Even for DBT it doesn't seem appropriate. The clinicians at my work who do DBT explain to clients that they can call and expect to receive a call back with 24 hours, but to my knowledge no one gives out 24/7 contact info to clients. That seems like a tremendously poor way to set boundaries.

Yeah, I thought access "in the moment" was kind of the point. Calling back within 24 hours sounds just like your run-of-the-mill access.

 

[cara susanna]

It is supposed to be in-the-moment calls. 24/7 phone support is one of the modalities of DBT. Remember that one Linehan video where her client is upset at her because she didn't answer her phone? You can set a "no call" time though, or at least I know one DBT therapist who did. This was at a clinic in Seattle, too, so I'm guessing it was pretty "pure" DBT.

 

[Psychadelic2012]

I am training in DBT and 24/7 instant access to a therapist is not ever implied. In fact, it would go against the whole idea of using DBT distress tolerance skills! Different story if the client is suicidal, of course--which is actually the original population that Linehan served. Normally, a reply is forthcoming within 24 hours.

 

[cara susanna]

Sorry, I thought it was implied that I meant when the client is feeling suicidal or the urge to self-harm.

 

[futureapppsy2]

I am training in DBT and 24/7 instant access to a therapist is not ever implied. In fact, it would go against the whole idea of using DBT distress tolerance skills! Different story if the client is suicidal, of course--which is actually the original population that Linehan served. Normally, a reply is forthcoming within 24 hours.

But aren't some BPD/otherwise referred for DBT clients pretty much in a continual sate of crisis? Admittedly, I have no DBT training, so I openly admit my ignorance outside of the very basics.

 

[JockNerd]

Seems like a mind-blowingly bad idea to me. Do you guys not have on-calls to handle this kind of thing?

The reality is that a therapist is NOT available 24/7 to handle emergencies (you're one person--your phone dies, you're on a plane, you're in a meeting). You can't reliably be available to handle emergencies. An on-call/crisis line/ER is. It seems to me ethically irresponsible to suggest that you can handle these things on your own. The appropriate place to deal with after-hours emergency is an on-call, crisis line/center, or the emergency room.

Things like this always make me wonder, to what extent is the therapist really trying to help and to what extent is he/she fulfilling his/her own desire to be needed by the client. To me, giving a client a personal cell number just seems to encourage dependence.

 

[PhishGirl]

I fail to see how giving a client 24/7 access is going to help develop the skills that they're supposed to be developing to cope with feelings of crisis. In fact, giving an instant response to calls that may or may not be actual life-threatening crisis would, in my mind, reinforce the behavior of seeking the clinician whenever the client is in distress, and claiming crisis in order to access the clinician at all times...and that, by logical reasoning, does not reinforce skills that the client is hopefully being helped to develop for themselves. And I think we all know that there are people who work the administrative staffs and mental health system in general by claiming suicidal ideation in order to get an immediate response. I don't want this to come across as callous, and while people who are in danger of self-harm absolutely need access to help in the moment, that's what crisis lines are for, and unfortunately some people abuse the system.

 

[Ollie123]

This is wayyyy outside my area, so take this with a grain of salt, but my understanding is that true "Linhenan-ian" DBT includes 24/7 support since there is a very specific way that these things are handled that is vastly outside the scope of something like a crisis line. These are obviously for crisis situations and not "I feel like talking to someone", but the nature of the disorder is such that those two are not exactly easily disentangled - one of the reasons for 24/7 support, since these are in vivo learning opportunities that can be capitalized on if you have a DBT-trained therapist answering calls instead of a college junior volunteering for a hotline. I won't get into the details (especially since I'm not trained in DBT and would likely screw them up) but from what I remember of my readings on it, its pretty integral to the overall approach and not handled the same way a crisis center would.

It is also my understanding that for this reason (and others) true DBT is always done by a team and not an individual, since it is both wildly impractical for an individual therapist to do, and would likely result in caregiver burnout 2 days into training. Obviously other models have evolved (which may or may not be as effective or meet criteria of EBP), so just like all forms of therapy there is not just "one" thing anymore. As for whether these are personal lines, work lines, etc. I couldn't tell you.

For what its worth, I would never give my personal cell phone number to a client for any reason. Mostly because I've had the number for years and don't want to risk having to "change" it. Having a second work phone makes sense and seems fine to me, though I would treat it like any other office line and not make myself available 24 hours a day nor attempt to serve as my own crisis center. I imagine that could get thorny legally, but to me it is all about how it is handled - whether its a landline or cell phone seems irrelevant.

 

[Psychadelic2012]

But aren't some BPD/otherwise referred for DBT clients pretty much in a continual sate of crisis? Admittedly, I have no DBT training, so I openly admit my ignorance outside of the very basics.

Well, yes, they certain come across that way, especially to get the therapist's attention. But that doesn't mean that they actually are.

 

[cara susanna]

Linehan says that they have "constant crises."

 

[Psychadelic2012]

Linehan says that they have "constant crises."

It's all subjective. She talks a lot about crises, so it doesn't surprise me. However, it doesn't mean that crises = life threatening emergencies (necessarily). It is the inability to regulate their emotions and tolerate the distress that characterizes those who benefit from DBT--so using the skills instead of using the therapist in times of crisis is what she teaches. She says herself that the goal is to get through a crisis without making it worse . I can't remember exactly what her definition of 'crisis' is, at the moment--my books are all at the office. Something about a situation you can't change.

 

[cara susanna]

Right, it's just that to your client it might be something that emotionally dysregulates them enough to become life-threatening.

I dunno, I can see both sides... if you gave out 24/7 access you'd probably go nuts.

 

[Pragma]

It's all subjective. She talks a lot about crises, so it doesn't surprise me. However, it doesn't mean that crises = life threatening emergencies (necessarily). It is the inability to regulate their emotions and tolerate the distress that characterizes those who benefit from DBT--so using the skills instead of using the therapist in times of crisis is what she teaches. She says herself that the goal is to get through a crisis without making it worse . I can't remember exactly what her definition of 'crisis' is, at the moment--my books are all at the office. Something about a situation you can't change.

I am not someone who does DBT, but from what I recall learning about it, the entire point is to help them "in the moment"

Until they have developed some skills over the long term, crises can actually be life threatening. Over time, they should rely less and less on the therapist. But before they get to that point, they have to experience the validation of their feelings as actual, real things. Talking to an available therapist can be a great tool early on.

So yes, I think there could be the potential to promote dependency, but I believe if the program is doing it right, they gradually make patients "leave the nest" and rely less on the therapists.

 

[Duck Duck Goose]

Having done practica at multiple sites with DBT programs, the 24/7 access is about coaching clients to use DBT skills when they feel the urge to self-harm or engage in other target behaviors. The calls are under 10 minutes and can be much shorter if the client seems to be abusing the system. Contacts like this are reviewed in the next individual session. Just my understanding. Usually, the understanding was that the therapist would call back within an hour (i.e., after seeing another client). Sometimes it wasn't the individual therapist who responded but a "coach" specifically trained in the DBT model whose job it was to respond to these calls. Most clients rarely used it and, when they did, they did so appropriately ("I had a fight with my mom, I really want to cut myself, I tried these distress tolerance techniques but I still really want to cut, so I'm calling for help."). However, one or two clients needed to have strong limits set around the contact because they were abusing it ("I'm stressed and I don't want to wait til our next session to talk about the fight I just had."). Despite the stigma associated with BPD, most people with the diagnosis appreciate/respect the rules of a process designed to help them. Again, just my understanding of the system.

I'd never give out my number (with the exception of my Google Voice number because it's free and so easy to set ring schedules or to block numbers) to any client... I also use my Google Voice number for supervisors, so...

 

[JockNerd]

Having done practica at multiple sites with DBT programs, the 24/7 access is about coaching clients to use DBT skills when they feel the urge to self-harm or engage in other target behaviors. The calls are under 10 minutes and can be much shorter if the client seems to be abusing the system. Contacts like this are reviewed in the next individual session. Just my understanding. Usually, the understanding was that the therapist would call back within an hour (i.e., after seeing another client). Sometimes it wasn't the individual therapist who responded but a "coach" specifically trained in the DBT model whose job it was to respond to these calls. Most clients rarely used it and, when they did, they did so appropriately ("I had a fight with my mom, I really want to cut myself, I tried these distress tolerance techniques but I still really want to cut, so I'm calling for help."). However, one or two clients needed to have strong limits set around the contact because they were abusing it ("I'm stressed and I don't want to wait til our next session to talk about the fight I just had."). Despite the stigma associated with BPD, most people with the diagnosis appreciate/respect the rules of a process designed to help them. Again, just my understanding of the system.

I'd never give out my number (with the exception of my Google Voice number because it's free and so easy to set ring schedules or to block numbers) to any client... I also use my Google Voice number for supervisors, so...

This all sounds fine; not the real cell number, on-call to handle emergencies, processing in the next session, identification of folks who abuse the process, theoretical consistency.

This, however, doesn't seem to me to be what the OP was talking about.

 

[Duck Duck Goose]

This all sounds fine; not the real cell number, on-call to handle emergencies, processing in the next session, identification of folks who abuse the process, theoretical consistency.

This, however, doesn't seem to me to be what the OP was talking about.

Yup, I agree, I was just trying to clarify the details of the DBT discussion spinoff.