I love these emails... or do I?

The use of emails in psychotherapy and counseling


By Ofer Zur


I checked my emails the other day and saw that a client wanted to change his appointment for the following week. I swiftly responded affirmatively. Next I shot off an email to a client asking her whether or not she could change her appointment the next Monday from 10 am to noon. Within seconds she responded with a one-word response, “Yes.” A couple of months ago I discovered that I needed to be out of town the following week due to a family emergency. In one swoop I sent a single email to a couple of dozen people (using Bcc not CC so their identities and email addresses remain private), telling them that I would be out of town the next week, I would neither be available by phone nor by email during that time, giving them names and phone numbers of my emergency back-ups, and asking them to let me know if they could make the same day and same time appointment for the week after.

Don’t you like these emails? I do! They are simple, quick and effective. Long gone are the days where we play phone tag with clients; when we need to start the phone conversation with “How are you?” only to listen to a long winded response; hear long back-and-forth scheduling messages; get busy phone lines, get put on hold, deal with overworked, low-paid, irritated receptionists or operators. These emails have saved therapists time and energy so we can focus on what is important. Many therapists love the flexibility allowed in receiving and sending emails from our computers, Blackberrys, or iPhones, during working and non-working hours, from the office, living room, beach, boat, another country, or from whenever or wherever. Realizing how helpful emails can be, many therapists have started giving their email addresses to their clients, including them on their business cards and posting them on our professional websites. After all, they can save time and spare us from long, wasteful phone conversations.

Then, I woke up the other day to a short email from a depressed client: “Doc, I cannot take it any longer!!!!!” I noticed it was sent at 2 AM. Now what am I to do? Send an email, call the patient back, call her listed emergency contact (not a good idea, it’s her toxic mother), call the local crisis team or 911, or …?

Another morning, I got an email from a client who was so excited about her "break through" dream the night before, how it relates to our therapy, and apparently I was in it. Scrolling down the email I noticed it was several pages long. Even though I was aware of the clinical significance of the dream, I did not have the leisure or desire to spend half an hour reading her dream that morning. She felt deeply offended when, during the next session, she realized that I had not taken the time to read her "break through" dream analysis.

Later on that very night, I checked my email and saw an email from a client which started with: “I know we ran out of time, but there was just one more important thing I wanted to tell you.” He proceeds to write an insightful email, in essence extending the session by about 20 minutes. We neither have an agreement that he would pay for reading time nor would it fit within his rather tight budget.

A young woman had gotten into a fight with her best girlfriend, who is the topic of discussion during many of our sessions. She wrote: “I am so upset, can you believe that she told me ……” She went on to express her distress and rage in a long-winded email. She got furious with what she called the “dismissive” response of “I am so sorry about the fight with your friend. Let’s discuss it further when we meet this week.”

Many therapists report that clients often ask them “quick” questions via “brief” emails, such as “My mother is coming over tonight, should I bring up with her what we discussed in our last session about my brother molesting me?” or “I met this girl, she seems perfect and I am panicked. Do you have any quick advice? We have a date later on tonight.”

Email, like any technology, has at least two sides, if not more. Like a hammer, it can be constructive and helpful or can be misused and be destructive. In our MySpace era, where social networking takes much of many people’s leisure (and often not-leisure) time, there is an expectation that anyone with an email address is instantly available and responsive, 24/7, therapists included.

We used to check our phone messages regularly or have phone message services page us. Now we need to be on the lookout for emails from depressed, suicidal or homicidal, or existentially depleted or spiritually lost clients. Emails were supposed to make our lives easier, not harder. Then come the obvious questions, what if the client committed suicide a day after she sent her “end of the rope” email to me; how to deal with the disappointed client whose elaborate description of her dream went unread; or with the furious young woman who felt dismissed because I did not reply with a lengthy, supportive email, like her best girlfriend would have done.


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