I recently came back from a 10 day vacation and popped open my inbox prepared for an avalanche of emails.
Full disclaimer I have three main emails I use, but it feels like a million inboxes to check. Two are for my consulting and training side of my business and one for my private practice.
So I was right that my consulting and training inboxes were pretty full….but my practice inbox? 5 emails from clients. That’s it. FIVE!!
And they were pretty easy to tackle and mostly admin stuff - two for scheduling, one about balance payment, and one about an issue accessing the client portal. Done *dusts hands off* easy!
I wanted to talk about one of the boundaries I set in my practice that are both incredibly helpful for me as a clinician but also my clients as well! I start the conversation about how my clients can contact and access me at intake.
First things first - hop on over to this blog on informed consent and grab yourself a free copy of my informed consent checklist so you can start having these conversations and setting contact expectations at the first appointment.
Email can be complicated. Some email systems have full end to end encryption, which is the safest to use. Others only have encryption on the therapists end but not for transmission of the email or inside the client's inbox. I trust that each therapist has done their research on this and has communication covered in their informed consent and also goes over it verbally at the beginning of therapy.
Overwhelmed? Check out what HIPAA has to say about email HERE, including the excerpt below:
“Patients may initiate communications with a provider using e-mail. If this situation occurs, the health care provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual. If the provider feels the patient may not be aware of the possible risks of using unencrypted e-mail, or has concerns about potential liability, the provider can alert the patient of those risks, and let the patient decide whether to continue e-mail communications.”
Okay, so in my practice I encourage all PHI conversations to go through my secure client portal, talk about the risks of email at intake, and include it in my informed consent.
The reality is, parents still want to email me about symptoms or to give me information. It's easier, simple, and most of the time right at their fingertips (whether desk top or phone). There isn't a system to login to or password to remember. And although this could be a multi-blog series I wanted to focus in on boundary setting around emails to unclog your time at your inbox so you can refocus your clinical attention back to treatment and play!
I wanted to tackle boundary setting with the three biggest issues that often come into my inbox!
First are the parents that don’t want to “take up” their child’s time.
I completely get that parents don’t want parenting concerns, issues, or symptoms to “take up” therapy time. They want their child to have their independent time with you and understand the importance of therapy, and that’s great!
BUT it’s important to let them know that parenting support is part of the clinical hour and clinical treatment. Children can’t change in isolation, they are a part of a system. AND being a parent or caregiver is on of the most important roles in the child’s life, so they need to be involved in the process - including talking about symptoms, getting parenting support, or learning new skills.
And per their insurance all of this is part of the therapeutic time that needs to be focused on during session.
Psychoeducation about all of this can be helpful along with offering to set up an individual hour to meet with the parent outside of the child’s therapy time potentially on a less frequent basis.
Some parents are searching for help and support between sessions or in crisis.
For these families the struggle is real, and it’s NOW! And, for some types of therapy like DBT having communication with a therapist for crisis calls outside of therapy is completely within the protocol. Other clinics have crisis support directly at the clinic and can connect the client and therapist within a short amount of time.
Where this gets tricky is when an email hits your inbox 5 minutes after you walk out the door for the week and doesn’t get answered until Monday. Clients can be left distressed and it can have a hit to rapport.
For these clients creating a safety or crisis plan can be helpful along with reinforcing the places they can reach out to for 24/7 support. Resourcing is key along with a specific concrete plan and list of resources.
Lastly, many parents are so anxious they will forget that they need to get it out.
With these parents I will have conversations with them that I can read the emails but will not respond to them outside of session. For these parents we review the email content as part of the check in and we have a clear agreement that they will not get a response to clinical concerns outside of session and if it is a crisis or emergency to use the resources above. AND they are always welcome to set up a parent only meeting if the concerns are more than what the parent check in can handle.
So there you have it - the three most common emails I get in my inbox and my best troubleshooting tips of how to provide support and boundaries!
What about you? What common email categories (without PHI) do you see and how do you set excellent parent expectations?
I'm Ann Meehan, an LPCC,