One of the clients at my field placement has been using email to reschedule appointments and let me know about things she wants to talk about in our next session. This has been fine with me since it’s easier for me to read and answer a quick email than a phone message. However, her emails are getting longer and I don’t want to take the time to read and respond to them between sessions. How can I let her know this without causing a rupture in our relationship?
This is a good example of how communication in the therapeutic relationship can move quickly from simple and straightforward to complex and entangled. This can happen with conventional communication in person and by phone, but there are many more possibilities for complexity with electronic communication.
When communicating with clients by email, you need to be aware of security and privacy as well as clinical issues. Regarding security and privacy, email is not considered a secure form of communication under HIPAA, so you need to inform the client of the risk to her privacy for anything she sends you by email. In the future, you can include this discussion early in treatment, but you now have an opportunity to do so in response to the client’s expansion of her email communication with you. I recommend documenting your conversation about email security in a progress note so it is clear you have informed the client of the risk to her privacy and that she is making an informed choice to communicate by email.
There are also clinical issues related to email communication with clients, as you have found. Email is best used only for scheduling appointments. Some clients may also send information to you that is related to their treatment, in order to talk about it in the next session. Examples are a client forwarding an email from a family member or partner with whom she is in conflict, a parent forwarding information from a teacher about your child client, or a client wanting to tell you about something that happened or an insight she had during the week. It is safest to either let the client know you won’t respond directly to emails containing clinical information or to limit your response to these email to a simple acknowledgement and invitation to talk more in person in the next session. I recommend printing email exchanges with the client that contain clinical information and including them in the client’s record. Check with your supervisor about the policy at your field placement site.
At this point, you need to talk with your client about both security and clinical issues related to email. The conversation is likely to be less disruptive to the relationship if you begin by acknowledging your oversight in not talking about this sooner. You should let the client know about the risk to her privacy with email communication and ask if she wants to continue using email despite the risk. You can then move to a discussion of your preferences about the issues discussed by email, preferably by again acknowledging your oversight in not discussing it sooner. A straightforward description of the limits of email would be “I prefer to use email only for scheduling purposes and to save our discussion of other issues for when we meet in person. If there is something you want to let me know about, you can certainly send me that to me by email but I will wait to comment on it until we see each other.” You then can invite the client’s thoughts and reactions, again acknowledging that this is a change on your part if the client expresses confusion or worry about having done something wrong. This will relieve you of the burden of responding between sessions and will redirect the client’s communication to your sessions where you can talk about the issues in depth.
I hope you found this helpful in dealing with electronic communication. Please email me with comments, questions or suggestions for future blog topics.