Why you don’t want your therapist to be endlessly available
by Peggy Haymes, MDiv, MA, LCMHC
The ads pop up with some regularity on my Facebook feed. They have different names but all extol the benefits of therapy by text. Some of them offer glowing reviews from clients whose pictures look suspiciously like stock images. (Incidentally, using client reviews is a practice frowned upon by licensing boards, for very good reasons.) All of them extol the ease and benefits of using their services.
Today it was DoMental. A search of one of the images on their website “reviews” revealed that it was a free stock photo. (If you’re interested in seeing it for yourself)
Misrepresentation (also known as lying) isn’t a great place to start with a therapeutic relationship, but let’s keep going.
On their website they present the third step of their process as:
Chat with your therapist throughout the week and get the help you need whenever you need it, wherever you are.
In the ad that popped up on my Facebook feed, “Billy Carson” (whose handle doesn’t exist on Twitter or Instagram) said,
“I used to see my therapist once a week… I would spend all week depressed and only on that day I feel like I can open up. With the DoMental app, I talk to my therapist every day and I don’t have to wait long for her to respond (emphasis mine.) It’s like having a therapist in my pocket!”
Sounds great, right?
Well, only if you don’t want to get better. One of the selling points that these services promote is 24/7 access to your therapist. That kind of access is actually counterproductive for healing and change.
In my career as a therapist, I’ve talked with a client every day once or twice, for only a few days when they were in the midst of significant crisis. The emphasis was always stabilizing them and helping them find their own tools for getting through a tough place. I have had, on occasion, clients who came more than once a week because they had a limited time to see me before moving out of state or because they were dealing with such a deep volume of work. That’s the exception, not the expectation.
As therapists, we always want to work ourselves out of a job., We want you not to need us anymore because you’ve discovered the tools you need and nurtured your own network of support. One of my goals for my very first session with a client is that they leave with one tool they can use to help them self-soothe or get through feeling whatever they’re feeling.
Part of therapy can be filling in the gaps, helping the client learn healthy patterns that they did not learn as children. One of those lessons is being able to tolerate uncomfortable feelings. When you are talking to a therapist every day (and you don’t have to wait long for her to respond!), you never have to find your way through those feelings. You never have to strengthen the muscle that allows you to keep breathing even when you feel awful. It becomes a self perpetuating cycle where you have to keep relying on your therapist because you’ve never learned that you can bear it on your own.
Like many other therapists, I work with clients to unwind painful feelings and discover what’s feeding them. Is it old grief long ignored? Is it anxiety from having been a child with adult responsibilities? Is it faulty beliefs about what you should be able to do, including keeping everyone happy? Is it a combination of emotional factors and lifestyle factors? Are the painful feelings pushing you to make changes in your life?
When you’re able to reach out to your therapist every day, it keeps you from having the space to listen to those feelings. While walking a dog or through writing in a journal or by making art, my clients find ways to listen to what they’re feeling. They start unearthing the feeling that’s beneath the feeling on the surface. They also learn that it’s just a feeling, and as painful as the feeling is, the only way it will harm them is by what they might do to make it go away.
The beauty is that they find what works for them, and they can keep using that tool long after our work together has ended. Every time we come through a difficult and painful time, we strengthen our belief in our capability of doing hard things.
Sometimes a client needs to touch base with me in the space in between sessions. They want to tell me that it’s a tough time. Or that they made an important connection and want to be certain that we talk about it in our next session. I’ll acknowledge it, but they know that we’ll wait to talk about it until we next meet. They know that I believe that they have the capability of waiting, of tolerating that painful feeling.
As therapists, we sometimes have to work on boundary setting with clients. No, we’re not going to schedule your regular appointment on the day that I’m off. No, you can’t come by my house to visit. No, your appointment cannot go as long as you want.
While this gives us a measure of protection for our own emotional wellbeing, it also serves a therapeutic purpose. Children who grow up in families with poor boundaries learn that any sort of boundary setting is a rejection of them. As an adult, they have a string of blown up relationships and failed friendships.
As they work with a therapist with healthy boundaries, they learn that a boundary doesn’t mean that they are not cared about. It means that the therapists cares about themselves as well as their clients, and that kind of modeling can be powerful. They learn that “I cannot see you on Sunday morning” doesn’t mean “I never want to see you again.”
It’s no secret that we have significant issues in the United States with accessibility of counseling and other resources for mental and emotional health. Even if you have insurance, you may have a large deductible that makes it cost prohibitive. Many therapists have practices that are full.
Many therapists are trying to find creative ways to meet the need. I have colleagues who offer services to children through their schools. Some have done online groups (as I have) and some are starting to offer in-person groups again. Many of us offer at least one or two reduced fee slots, or work hard to find ways to make it possible for a client to do the work they need to do. Some of us who reluctantly incorporated online therapy during Covid are continuing to see at least some of our clients that way as a way of offering greater access.
And I know that all of this is a drop in the bucket.
We need to continue to have both serious and creative conversations about how we support mental and emotional health. When people get the help they need, we all benefit from the gifts they are now freed to share. The answer, however, isn’t replacing one system with another one whose very structure works against its stated goals.
