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Caring is a central component to your work, which is why it can be easy to assume clients already know you care about them. However, evidence suggests it’s the unexpected communication between clinician and client—outside of routine weekly contact—that can actually strengthen the therapeutic relationship.
This may be especially true during unusual circumstances, such as the current upheaval of everyday life caused by the coronavirus pandemic. Out-of-session contact with clients shows that they’re in your thoughts even if they may be out of your sight.
Why There’s a Need for Balanced Connection
The existing research exploring this topic suggests that occasional, irregular contact outside of normal sessions can improve therapy in a meaningful way.
For example, a 2012 study showed that therapeutic alliance was strengthened by a single phone call between sessions, where the therapist encourages their client to take a proactive role in treatment.
Studies that analyze more frequent text-message support have shown mixed results. This 2014 study showed that clients who received routine text-messages as an accompaniment to therapy actually attended therapy sessions less often, though the key word there might be “routine.” A 2017 study that examined text messaging as a support to cognitive-behavioral therapy showed that clients receiving the texts stayed in therapy longer.
The Right Way to Make Client Contact
While many therapists contact clients outside of sessions for billing and scheduling issues, it’s less common to reach out and ask about a client’s wellbeing unless they’re worried about a possible crisis.
In some cases, this is a question of time—a full caseload may leave little time for additional contacts. In other cases, it’s a billing issue—therapists typically can’t bill for a quick message, so they don’t do it.
Unscheduled contact has the power to strengthen the therapeutic alliance even if they’re brief. These types of communication may even improve treatment outcomes.
There are many different ways to reach out. It may be as simple as sending a message saying, “I know times are tough right now, and I hope you’re doing well.” If you want to keep communication directly linked to sessions, you might say “I hope [specific task planned in the last session] was a success” or “I hope [something learned or accomplished in therapy] remains helpful.”
Of course, emailing and texting should be done with client permission to address security responsibilities. Secure Messaging may be a better option for some practices. Regardless of the method of contact, communication between sessions, in both directions, is something to discuss during the initial informed consent process. That way clients have a sense of what to expect and you know what they prefer.
Why Unexpected Communication Works Despite Concerns
Some therapists understandably express concern about boundaries, fearing that by initiating communication with clients outside of session, they may open a door to clinical exchanges outside of the therapy room they don’t necessarily want opened.
These concerns are valid. While most clients don’t use communication outside of sessions to test boundaries, some do, and you need to be prepared to hold boundaries well.
Equally true is that these types of contact may not help much if a clinician’s standard operating procedure is largely automated. Automating your work can be a powerful way to facilitate administrative tasks, but it should never occur at the expense of human connection.
How to Find the Appropriate Cadence
Between-session contact with clients seems to make the biggest impact when they’re unusual, perhaps because they’re unusual. Even though this approach can be perceived as an annoyance—or worse—an invasion of client privacy, occasionally reaching out with intention and purpose has shown to be preferential.
As all of us continue to adapt to the changes brought on by COVID-19, some therapists and clients have moved to Telehealth while others are reducing or suspending contact. If you have clients whose therapy routine has changed this year, it may be worth sending a quick message of support.
You can remind them that you’re thinking of them, show that you understand the stressors they’re facing, and share your availability if they need your support in these next few weeks.
The lesson here? An occasional message of support outside of the therapy routine can strengthen the therapeutic bond. If nothing else, it shows the client in a very clear way that they don’t leave your thoughts when they—or you—leave your office.