Monday, September 03, 2012

The Doc and the Cell Phone

I debated calling this The Shrink and the Cell Phone, but I don't think the cell phone problem is unique to shrinks.  Maybe it should be called The Person and the Cell Phone.

Oh, I remember the good old days, before cell phones, before answering machines, before texting, chatting, Facebook, email, and even call waiting.  Okay, I remember black and white television with three stations and you stood up to change the channel and there were no curse words.  I remember rotary phones.  Oh my, just saying this, I feel a million years old.  

Unlike some old folk, I don't think many of these new-fangled inventions are a bad thing.  I remember waiting by the phone for calls, not wanting to leave the house if I was hoping a boy would call, missed connections where I was in one place and my friends were in another, and the general anger that one felt toward a parent or sibling who wouldn't get off the phone when there were important social engagements to be honored.

Almost everyone I know over the age of ten has a cell phone now.  They have their own numbers and you can text or call them and the expectation in our world is that one is available.  Unless of course they don't want to be.  Don't charge your phone? Perhaps you're passive aggressive.  Forgot it again, maybe you've a touch of ADD?   Harry picks up for everyone but me....could I be getting a tad paranoid?

So cell phones have replaced pagers and every doctor I know has a different relationship with theirs.  Some give their numbers out freely, others do not tell their cell numbers to patients.  So the first question is Who Gets the Number?  Is there a line of defense to screen calls and protect the doc from patients who might interrupt them with trivial concerns while they are with patients, sleeping, or simply don't want to be bothered?  Many doctors direct patients to an office number where staff decide what might warrant calling the doc's cell phone.

The second question is what to do about the calls that come?  Is the phone left on at all times, so that it interrupts patient appointments, bubble baths, dinner with the family?   This, I believe, depends on how crucial the doctor is (or perceives himself to be) and his/her individual personality.  If you're the only attending coverage for the ICU and the housestaff is to call you with emergencies, you probably are obligated to leave it on when you're on call.  I know plenty of psychiatrists who leave their cell phone on as an emergency number around the clock, take calls during sessions, and when they are busy with social obligations.   I also know plenty of doctors who don't return calls even if they are identified as being important.

I don't think there is an exact answer to this.  Individual psychiatrists are often their only coverage, besides the obvious, "If this is an emergency, call 911 or go to the nearest ER"....and while many docs feel obligated to take emergency calls, it may not be reasonable to assume a psychiatrist is never going to leave the phone in the other room, go for a swim, or turn it off in a movie theater.  

I think I have the ultimate love-hate relationship with technology.  I like all of it, but I feel compelled to check so many things, so many times.  My sanity hangs in the balance.  I give everyone my cell phone number, but if I don't recognize the number, I let it ring to voice mail -- I get lots of spam calls, I seem to be on every shrink head-hunter's list.  I also don't answer the phone during sessions, while I'm in the shower, when I'm asleep, or when I forget to turn the phone from silent to ring.  I don't answer when I'm at the movies or swimming laps, or in the grocery store, or in a restaurant or anywhere I can't have a private conversation.  I usually listen (except in the movies or if I'm submerged) to make sure it's not an emergency, in which case, I return calls sooner rather than later.  It's a mix, I hope, between being available, and having some control over my life.

I know shrinks who take all their calls immediately because they worry that a patient might be calling when they are on the verge of doing something bad -- and maybe the shrink can persuade them not to? -- or because a patient might be having a crisis or emergency.  Is any given shrink, I wonder, really able to alter an outcome, to talk a patient out of doing something horrible and irreversible, by being available immediately, 100% of the time?  Is immediate availability a standard we should set?  Does it set the stage to say that if only you'd answered the phone, then bad things wouldn't have happened?  

What do you think?  


SteveBMD said...

This is a really great post. But in response to your question about.... oh, wait a minute, my phone's ringing, I'll get back to you.

Anonymous said...

my cell phone is my only phone. If I don't recognize the number, I let it go to voicemail. If it is important enough, they will leave a message. But I also don't text or call incessantly.

My psych never takes calls or checks phones during our appointments. All time is spent on me... woohoo!

Every phone call that I do get from them is usually from the office phone. however, I have never called at night - so who knows what phone number would be used then?????

The only time they did call me from a phone other than the office phone was when I had lithium toxicity and they were calling to check on me the day after.

I was touched that they actually cared.

Anonymous said...

Therapists keep giving me their phone numbers and expecting me to call them when I'm feeling suicidal. I never do. Actually, I think I've only ever called a therapist once and that was by his request while I was in hospital because I guess having someone inform him I wouldn't make it to our next session wasn't enough.

I get the point to calling, but I don't necessarily understand it. As far as I'm concerned there's other, better ways for me to deal with my issues than to add on guilt for calling my therapist during his private time. There's going to the hospital if I'm so bad that my therapist is needing to verbally pull me off a cliff. There's the main office line if I accidentally run out of meds or show new, highly bothersome symptoms. At no point does anything seem urgent enough to me where I would need to call someone on their cellphone.

Having said that, if a therapist gives me their email address I'm quick to use it in the ways that they request. For check-ins between appointments this was a much more viable option to me. It meant that the therapist could read when he wanted to, I didn't have to feel guilty, and I still got whatever support I was supposed to be getting from it.

My psychiatrist hasn't given me a cellphone number to contact him at. I simply call the main office line. It works for me.

Lisa G said...

Fantastic post! I come at the cell phone thing from two angles. First, I'm a Director of Nursing for a large skilled nursing facility. It is expected that I am on call 24/7, and believe me, they DO call. I call my cell phone "the Leash". I carry it from place to place.

Secondly, I would be PISSED if my provider stepped out of a session or took a call during a session with me. I have made an appointment, left work to be there, and expect that the time I am there is devoted to me. Period. If calls come in, then they can be returned between sessions. It's just plain rude to take a call during a session.

I have my provider's email and cell phone number, and email her on occasion with questions but have never felt the need to call her cell. I know how irritated I feel when my personal life is constantly being interrupted by work calls. It's part of the job, but I don't have to LIKE it.

Looking forward to more interesting comments on this one. Again, great post!

Anonymous said...

A shrink can talk a patient out of a bad outcome.That is possible. It has happened. Still, no one should be chained to their phone. If the shrink is not available, it is not their fault that they were not able to talk someone out of something. It is a bit like winning a lottery. If it happens it is nice and if it doesn't, no one promised a lottery win. I do not think a shrink should answer the phone 27/7 365 days a year. They need breaks too. From a patient's perspective, a shrink who takes calls in session is not someone I would want to see. So there are professional and personal reasons for not always being available. The problem is no the cell phone or needing to have it off at times. The problem is that the only options for a person in crisis is to try calling the shrink and failing that, go to a hospital. Ideally, there would be an in between solution for people who can still be talked down but need some help quickly. If someone is not frightened by suicidal urges, it can wait and they do not need to call a shrink's cell or go to a hospital.I know we have no money for community services to help people in crisis but it could keep more people alive and fewer people admitted to hopsitals.

Anonymous said...

24/7 I wish there were 3 more hours in a day and I wish I could use them to sleep.

Liz said...

my last psychiatrist wanted me to call if i wasn't doing well. one time i felt increasingly depressed and wanted to self harm, so i did actually call him. he ordered me to go to the hospital and get admitted and said if i didn't, he wouldn't be my doctor anymore. i went to the hospital. it was a nightmare. i NEVER called him again. this was during a very, very unstable part of my journey.

flash forward a year or so: my counselor had a cell phone and a pager. i had both numbers. i was encouraged to call her pager if i ever thought that would be helpful. if i left my number, she'd call back sometime that day. if i left my number and 911, she would call back as soon as she possibly could. i never did it, except for the one week when that was my homework, but it was a comfort knowing that if things got bad, she was in my "line of defense".

i am about to start with a new counselor, to help me ensure that i stay stable during my transition into graduate school. just like before, i plan for my husband, family, and friends to be my first line of defense (this is something we have discussed). and we'll see what her "call policy" is.

btw-- this "prove you're not a robot" feature is very difficult. i can't read any damned one of them! hopefully this one works!

Anonymous said...

As a psychiatrist who works with a clinic population, I have had "bad outcomes" occur. None of these patients called me to let me know that something bad was about to happen. Being on call 24-7 does not prevent bad things from happening. It may, however, prevent SOME bad things from happening.

Sarebear said...
This comment has been removed by the author.
Sarebear said...

I know him as a therapist, and the last thing he'd want to do is make me feel less than, not worthy of his time and attention, disrespected, etcetera. He never shorts me on time, and apologizes on the very rare occasion this has been necessary.

I expect that my time will be important to him, and not to be shorted (unless, say, a family member calls to say a family member has died, or his kid got hurt at school and got sent to the hospital, or some other such thing like that). I expect that he is a human being like everyone else, who does his best to keep interruptions to an absolute minimum.

I'd rather have a real person, who is compassionate, with the rare interruption, than to have someone who is too perfect to relate to, and stuff. I am not trying to say those who never take a call in session aren't real or relatable; it's a matter of personal preference, of what type of therapist you feel you can connect to.

I am not trying to tell anyone what their attitude should be, but I also feel like I need to defend my psychologist, a bit. During 8 years, you develop a deep, abiding respect for each other, and I feel he has NEVER treated me in a way that is disrespectful of me, my issues, my thoughts, feelings, etc. or my time. Since he (rarely) goes over time with someone, if they are sobbing or in a bad place at the end of the hour, he helps them get to a better place before ending the session, rather than just harshly cutting them off. Some therapists will do this, some won't. If you are an on the dot person, all the time, and have no flexibility of 3 or 4 minutes ever, then another therapist is for you. For me, this compassion appeals to me. I know my first psychiatrist also did this.

Also, who knows if some of the very rare phone calls he's had to take, were a suicidal patient, or someone on the edge of doing something self-destructive? I'd rather he helped them. Not even considering the fact that someday that could be ME. He always keeps it as brief as can be.

These are a very rare occurrence.

I don't have to prove he's a thoughtful, considerate psychologist to anyone. I KNOW he is, and that's all that matters for me, I suppose. I'd rather have him err on the side of being too compassionate, than being too stiff.

Jane said...

I don't work in mental healthcare or any other branch of healthcare, but I was thinking that you could always give patients the number to suicide hotline if you are not immediately available. I won't act like suicide hotline is amazing and I don't know what docs think about it, but at least that is something. Docs should not be forced to be immediately available all of the time. I have found suicide hotline to be very comforting in the past.

I've never had a pdoc give me his or her cell phone number. I was actually shocked when my therapist gave me her cell phone number. I haven't called it, but I guess it's good to have it. It's good more because it shows she cares. I don't know that I would ever call her...even if I was suicidal. She has also said that if she ever thought I might try to kill myself that she would call me.

Anonymous said...

if the doc should take a phone call from a suicidal patient during a session with another patient, the doc should also take the suicidal patient's phone call during the doc's own therapy session or maybe even during their kid's wedding or in the middle of sex or when they are sitting on airplane and cannot use their cell phone? i have never held it against my doc that i cannot reach them when they are in session. and i have suicidal thoughts and urges but to be very honest, the times i have acted on them and ended up in icu were those times that i did not call the shrink.

Anonymous said...

patient perspective: I have had drs who preferred to not be contacted and drs who encouraged contact freely. i think what worked best for me was understanding that it was okay to call, but also being very clear that he might not be available all the time -- and that if i called and he couldn't return my call until a few hours later or the next morning, it was as good as an obligation to not kill myself until he did. i think i also was pretty respectful as far as not calling at night or on the weekends. but knowing that i could if i needed to was essential. this dr was in private practice and did not have a main line to a covering agent. i don't think a dr should be tied to a cellphone all the time, but i do think that if s/he knows a patient is in severe distress, it might make sense to be a little more available (if possible). at those points, my dr as suggested calling him at specific times or has called to check in on me at specific times. i do not think it's appropriate to take calls during session. my dr. keeps his phone on vibrate or silent and keeps it turned over so that he doesn't even see if and who the caller is. yes, it might be a suicidal patient on the other end, but far more likely it's your dentist or your maintenance man or the new york times calling, and every break to look at who's calling is a break in the dr's attention - and not fair. seriously, you're paying for 50 minutes. what did people do before cell phones? they waited 50 minutes. it was okay.

Me said...

My primary care doc - answering service that ideally will get in touch with the covering doc if after hours response is needed (more and more I'm seeing "go to the ER" for everything)

Therapist/pdoc: Pdocs had answering service I think (never called after hours so I'm not exactly sure)

Current therapist: office number always goes to vm and the message lists the hours she returns calls and provides a local crisis hotline. She is available as she can be (meaning she wont interrupt sessions, sometimes she is teaching and sometimes it other/family time)

It is clear she will not be there every minute of the day. But that is okay as she has worked with me to build and use other support in my life. Instead of being a single point of failure if she cant answer the phone she becomes one of the tools in my toolbox.

I'm also pretty sure if she assessed that I was unable to use any of my other support and was in bad enough shape that it was risk if she didnt answer the phone that she would talk with me about hospitalization until I could stabilize and be safer.

Anonymous said...

The only M.D.s I know who EVER answer their cell phones during office visits are psychiatrists.
I have been to two psychiatrists who did this. Neither one of them even said "excuse me" . It put me in a difficult situation. I felt angry, but unable to express my anger. I was able to express myself to one, who actually like there was something wrong with ME,
that I was upset.
A ringing cell phone during a therapy session interrupts my train of thought, and messes up my session.
One of them did not even make up the time that he took up from the session.
I stopped seeing him shortly thereafter.
I am in therapy with a WONDERFUL psychologist. He leaves his phone on vibrate, unless he forgets. The only time he ever answers his cell phone during session is when he makes a "home visit." When it comes to "home visits" he will answer his Cell phone ONLY if it is his service calling regarding an emergency.

Anonymous said...

Call me old fashined but, unless it were a family emergency of some sort, I would be offended if my psych. accepted phonecalls during session.

I briefly saw a therapist whose phone went off a couple of times during session and, on another visit, he stepped out to take a call. Each time it rang, it was very startling to me and disrupted my train of thought. It was annoying enough that I would not have continued to see this person if I had decided to stay in therapy.

Jane said...

I'm reading a book right now by a psychiatrist who has ADD. He has to be super organized because he is so forgetful and gets side tracked easily.

Well, he actually has a rule that he does not answer the phone while in session. So, he turns down the volume on his phone, so patients can leave messages without people knowing. But sometimes he forgets and the phone will ring and he has to rush over to the phone while in session so that the patient he is with does not hear the private message left by his other patient. So he took a stuffed animal (rhino) and he puts it on the phone whenever he turns down the volume. If the rhino is not on the phone, that means the volume is turned up. But he is so ADD that he would forget to put the rhino on the phone and turn down the volume. So he got inventive again and made a rule that he could not listen to his messages until he moved the rhino to the very end of his desk. This put the rhino right in his line of sight and it stuck out like a sore thumb. If he sees the rhino at the end of the desk, that means the volume is still up. 99 percent of the time, this formula works so that he doesn't have to rush over to his answering machine while in session.

I thought I would share that story because doctors can always remember to get inventive about how they handle their phone calls. They don't all have to follow the same formula for returning calls. Whatever works for you and the patients! It was really interesting reading about how a super ADD doctor had to find innovative ways to deal with the responsibilities of being a doctor and realizing that he had to do what worked best for him.

Anonymous said...

It's not just a shrink thing. It's not just a cell phone thing. One of my college roommates was the daughter of a doctor. If I wanted to talk to her over the summer I had better keep track of the phone number she gave me (the days before cell phones when you actually had to remember phone numbers!!!) because her family number was unlisted. She seemed to think that all doctors had unlisted numbers -- otherwise their patients would call them at home! How horrible would that be!

I was rather confused because when I was a kiddo, our pediatrician's home phone number was posted by the phone on our kitchen wall. I don't remember ever using it, but it was always there and available. I thought that's what everybody did.

Sarah said...

My shrink silences his phone during appointments. Only once has he forgotten but he just turned it down instead of answering it. He has voicemail during the day while he is in appointments and the receptionist can also take messages. After hours during the week I have his pager number and he will respond fairly quickly. On weekends someone is on call but I can still page him if need be, though there is no guarantee that he will be near his phone or how long you will wait to hear back.

I've seen a few different shrinks in my life but he is by far the best and I feel lucky to have found him. We also have some things in common, so that helps our rapport.

pdf doc said...

I'm a day late in posting, but I also think that this is a great post. In my (non-psych)practice, I give patients my e-mail address - I find that this is more reliable and gives me a record. The nurses on the floor have my cell number and do call with problems. I leave my phone on while in clinic and OR (I don't have a nurse to take messages), and in clinic will glance at the number but usually not answer until between patients, in the OR I answer between cases. Remember that old adage from residency - never answer a page right away, as nine times out of ten the problem will have solved itself when you answer in 5 minutes! (OK, I don't live by that one! - I do usually answer floor calls - we do have PE's and MI's post op!)

My own psychiatrist has his phone on answer, although so that he catches the beginning of the call on speaker and then switches it off. In 7 years with him, he's only answered it once. I have his office number and e-mail, both of which I've used only twice - follow ups on lithium toxicity. I don't call him otherwise - I figure if it's bad enough, I won't call and I'll be dead, and if it's not that bad, it can wait!

Anonymous said...

Shrinks get to pick when to answer the phone on their time but a session is not their time. someone else is paying for their time. if you think about it. plenty of people other than shrinks do not and cannot take calls immediately all the time. once upon a time cell phones did not exist. did more people kill themselves because they could not get through right away?
If my shrink took was worried about their cell in a session, i would quit and find a new shrink and i bet that if i called my shrink at 3 am the cell phone would not ring. if we are not infants, it is silly to think that someone will answer the second we cry. even babies have to wait most of the time. my shrink is not at my beck and call but he needs to be there in my appointment if i am going to stick it out.

Anonymous said...

I absolutely hated it when my therapist took calls during our meetings. I felt that I was paying him for the time and he really shouldn't be spending it taking other people's calls. Plus, it's difficult enough for me to open up and talk about things and then right in the middle of that, his phone would ring, he'd answer it, talk to whoever (lots of times it was obviously a pharmacy calling), with no apparent concern about me hearing his side of the conversation. As far as I was concerned that was the end of the session. I could never really get back into whatever difficult thing I'd been in the middle of describing.

He also occasionally texted during our sessions and checked his email.

I did ask him once not to take calls during my time with him. He brushed me off, said it wasn't a big deal, and to get over myself.

I'd also never call his cell phone because I figured that whatever I was calling about was going to get discussed in front of some other poor soul.

I didn't have a choice about seeing this guy and as soon as I did, I stopped. :)

Anonymous said...

I would hope that the psychiatrists who take calls during a patient's session are either reimbursing the patients or extending the session so that the patient gets the time they paid for. I would not go back if a psychiatrist took calls, checked email, texted, ate lunch, etc during my appointment. I pay for the appointment and I expect that time. If it's an emergency call (and they happen), fine but you need to make up the time or reimburse the patient.

EastCoaster said...

I work in a case management role and am supposed to use my cell phone as my work phone with a forwarding number. A lot of my coworkers use a personal cell phone and block the number. I don't think this is fair to the clients, so I have a separate phone.

I refuse to answer calls when the number is blocked--except when it's a work line, so why should I expect my clients to.

Eliza Kendall said...

A teacher of mine said: "Your clients do not exist after you stop seeing clients for the day. You WILL get burned out because you will be answering your phone constantly."

Prior to that class, I always had the sense that answering the phone during the session and after the end of the day would make shrink work grueling. Considering the sheer masochism needed to get through shrink-school, there is absolutely no sense in continuing that masochism into one's career.

One thing I have done with those who sit across from me is repeatedly shove crisis plan forms in their face until they filled one out. I'm not really the pushy type, but having some sort of list of people to talk to when you're going to lose it is something everyone on the planet should do. Considering all of this technology, you can probably find at least one person somewhere to spend some time talking you off the ledge. For the record, I've gotten all but maybe two people to do it.

As for my shrinks, I did have a pair who answered their phones during sessions and spent time talking outside of, "Uh huh, that's nice, in session, bye." The psychiatrist was a commute and the therapist was a one man show. Therapist's intentions were good, but I would have been fine with a 45 minute session versus an hour if she would have turned her cell off. Not assertive enough back then.

Current shrink is stuck answering desk phone as his coworkers will continue to call until he picks up, which I imagine irritates him immensely. So he does the, "Yeah, uh huh, that's nice, in session." Phone calls last a minute at the most. Works for me.

By the way, I remember when cell phones were gigantic and tended to only be used by business folks. Not sure if some of those people would have imagined the future existence of Bluetooth headsets and smart phones.

Anonymous said...

If anyone shoved a crisis form in my face I would write down a few bogus numbers because I have no one to call to talk me off the ledge. I doubt I am the only one. One reason I see a shrink is due to the fact that I do not trust or get close to people so what phantoms would I call? I have trouble trusting the shrink which I have to work on. Unless I am supposed to write down that I would call 911 there are no names. and if a shrink shoved a form in my face I would be very upset and not work with them at all. Maybe they can talk to patients about what types of calls are emergencies and when to contact them and when to just try to get admitted by going to emergency room. The part about your clients don't exist at the end of the day? I have seen several shrinks and several other types of doctors and none of them had a policy that their patients did not exist at the end of the day. They just had boundaries in place or back ups or some other way to make sure clients or patients could get some help in a crisis without making the doctor go nuts. If becoming a shrink is so masochistic, try becoming something else that might suit you better.

Dinah said...

I am surprised at how many people are miffed at docs who take calls during sessions -- presumably it means that if you're having an emergency, the doc will take your call -- and I'm surprised at how many docs are taking non-emergent calls during sessions.

Some of it (as in all things) may depend on the doc, so one who was trained that it's essential to be available at all times may approach the issue differently than one who was trained that the session is never to be interrupted. Or a psychiatrist who has had a patient who has committed suicide (or a family member) may feel differently than one who hasn't. I won't speculate on what it does for your thoughts about how available any given psychiatrist should be if all the papers broadcast that a patient attempted to call you only 9 minutes before shooting 70 people, but I'm guessing it might change how one practices.

Anonymous said...

If my Dr. routinely took calls during sessions that are anywhere from $200-400 a pop, I would fire them. Most of us who need mental health services are not rolling in money. So call me old-fashioned, but I think it is rude to take a call during session. The Dr. is supposed to be there for the person that is present! If there is that much of a worry, schedule in 10 minutes between patients to return those calls. You cannot be a superhero all the time. Go into practice with other psychiatrists so you can cover for each other.

Anonymous said...

Dinah, what is your suggestion for the doctor who does not have a secretary or a call service to screen calls, in order to help them determine which calls to puck up in a session? You seem to have a similar practice to my doc. You take your own calls and do your own bookings etc. How do you know when to pick up the phone in the middle of a session? Is there a special ring to indicate an imminent suicide attempt? I really doubt your insinuation that any doc would be held responsible for not being able to answer a crisis call and avert a mass murder.It is huge stretch and I can also hear you arguing that no doc ought to assume that sort of responsibility. If a doc feels that degree of responsibility, they need to hire someone to screen their calls so that they can focus in a session and only ever respond to true emergencies. If a doc operates in a certain way because a family member has suicided, the doc needs some therapy to make sure it does not interfere with their practice. If I am your patient, how far are you going to go to save me? That is the real question. If you are honest with yourself you will admit that you are not that powerful and if you are helping your patients, you will not turn them into babies whose cries you answer always and all the time, around the clock no matter what else. One more question--if you have a family member who has just made a suicide attempt and a patient who calls right then in a crisis, what will you do? I will lay odds that you will say the patient can wait.

Dinah said...

I have no suggestions. My phone is silenced during sessions, no way to reach me but to knock on the door (and years ago, the locked-out babysitter did that with my kid in tow, I handed them a house key). You know, shrinks swim laps, shower, forget the phone in the next room.
My point was that people have different styles and how they approach things may be influenced by what they've been taught or past bad outcomes.

Eliza Kendall said...

The upset Anon -

I was being flippant. I actually do stick to Therapy 101 Guidelines On Not Being a Jerk Therapist, as taught in Shrink School for Masochistic Students. I found school to be very rough emotionally, and it had nothing to do with the clients. The clients are what kept me going in between reading stacks of journal articles on things that I know are useful but just was not/am not interested in.

I think what Dinah and the guy I quoted have brought up is setting boundaries in a world where it is so easy to get in touch with someone while continuing to provide the best service possible. If I hadn't turned off the stories of decades of sexual assault or cancer or deaths for a few hours while I went to the park with my kid, I would not have lasted and instead had ended up an accountant. The intent of clients not existing wording is allowing oneself to focus on something that may feel selfish, even if you have put in as many hours into work as you can.

I am not the type to hand people crisis forms in the ream of paperwork you're stuck filling out, nor do I turn them into paper airplanes it be launched into the face of the person who sits across from me. There are going to be times when you get the on-call worker you don't like or the intern at the suicide hotline isn't remotely helpful or therapy sounds like BS and Why am I doing this anyway? I'm not a fan of insisting on having the names and numbers of everyone in the neighborhood as I'm far from a social butterfly and think having a list of your twenty closest friends to call when you want to end it is ridiculous, but just setting up a back up or two can't hurt and thinking about it is really all I suggest. Especially if your insurance company decides against authorizing more mental health appointments...

My attempts at humor don't always go over so well as pointed out recently by my husband, so I will be more mindful of that when doing posts. I like what I do a lot,and it wasn't my intention to be insensitive.

Eliza Kendall said...

Dinah -

When I first started seeing a therapist and a psychiatrist several years ago, I was advised against working for a few months. My husband and I didn't have a lot of money to begin with, and we did end up going through all of our savings in order to pay for copays. That would be one situation in which having a therapist pick up the phone would be difficult to tolerate. Crisis calls make the feeling a lot worse. As does feeling all around horrible that day while feeling obligated to tolerate the crisis call because what you have going on isn't life threatening.

Or the drug rep call, when you're dependent on samples. That's a fun one.

Phone situations are not easy, though. Ideally the therapist has hammered out a time frame for returning emergency calls (if there is no on-call person/administrative staff/etc), but emergencies sometimes pile up. There also may be delusions of multitasking which may or may not include thinking that answering the phone during a sessions must happen unless something really-really-bad happens. Or office policies that require the phone be on. Having not felt good about ringing phones in my own sessions, I don't want that for others. But I think sometimes therapists don't get as much choice in how they work as what is ideal.

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Lisa researching answering services said...

Ahh, the good old days. When, if you weren't home, someone would just leave one message and assume you will return their call when it's convenient for you. I miss those days.