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Weird.  Many of the therapists I know (especially those under 60) use email to communicate with clients.  I use it with some to schedule.  Then I had one start sending me dreams, and something stopped me from saying, “Let’s wait and talk about those in our sessions.” 

This raises some hair-raising questions.  Sure, my email is secure (although it’s not encrypted), but is his?  Where does this fall in HIPAA?  What if he sends me a message that communicates an emergency, and it sits in my IN box for hours.  (Actually, I check my email CONSTANTLY on my iPhone, it’s become a bit of a problem, but that’s another story.)  Do I want to have an email conversation throughout the week as a part of the therapy?   In this case, I do!

Another way that email plays a role in my practice, a lot more nerve-wracking: two of my men’s groups have set up email listserves, restricted to them and me.  A lot of very personal stuff goes out across the wire, and ends up sitting in the IN boxes of every one of those guys.  How often does a wife or a kid walk by and take a peek?  On the other hand, for both groups those listserves have become a dynamic part of the process.

I don’t want to give it up.  But it worries me.

One Response to “Email Therapy – The Unsettling Extension to the Container”

  1. Berne says:

    This is a problem. It falls somewhere under and between ethics, law, and evolution.
    ETHICS: It’s an ethical issue under APA code sections 4.02 DISCUSSING LIMITS OF CONFIDENTIALITY, 6.02 MAINTENANCE….OF CONFIDENTIAL RECORDS….and 10.01 INFORMED CONSENT. Seems as long as the client-patient is clearly aware that no matter how secure the email-chat-etc. digital information is transmitted, there is no way to guarantee that someone else can’t look at it. It just is impossible in the cyber-world. That conversation itself is a very valuable one for those who use Facebook, etc. and have no clue how much of their personal internal life they are exposing. The ongoing discussion of the container itself with clients is so valuable in and of itself.
    LAW: Unfortunately, in this world you can always be sued or subpoenaed. This is part of the culture. So it is important to remember that whatever you right down (even in your personal records) can be used in a court of law. So it is important to be attentive to what you right down (thank goodness for the privacy of our minds).
    EVOLUTION: The world of communication is becoming so digital. It is amazing to be able to communicate with the ease we do. There are some people whom we can reach with email-text-etc. that may not be reachable otherwise. Therapy will evolve in these areas of digital transmission. Cisco just bought Tandberg, a company with some of the best TelePresence products. Soon, very soon every TV set will have internetworking built into it (LAN or WIRELESS) with a high-end video cam and microphone. You’ll easily be able to talk to your friends-family and even clients over this link. You can do it now with skype but the quality is spotty.

    Anyway, this is going to be a long ongoing discussion. In the beginning, I would be very cautious with whom I extended the therapeutic container into digital space with. An informed consent tailored to the insecurity of this medium would be a minimum.

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