Counseling Today, Online Exclusives

Voice of Experience: A not-so-simple question

By Gregory K. Moffatt October 21, 2021

I have a feeling some of you will stop reading after the next paragraph. You could be excused for thinking, “This is so basic.” But even if you are a seasoned professional, I ask you to hang with me for a bit. The question I pose might not be as basic as you think.

Here is the not-so-simple question: Should counselors contact their clients by email or text to confirm appointments?

It is common practice to send such messages, and perhaps they are even necessary. After all, for every no-show, we often lose money. And forgetfulness and disorganization are sometimes part of our clients’ dysfunction, so reminders might be in their best interest.

As subtle as it may seem, a reminder/confirmation message is a boundary crossing. There is nothing inherently wrong with a boundary crossing (as opposed to a boundary violation). Still, we should always carefully examine the possible ramifications of any boundary crossing.

Let’s ask another question: Should we call our clients on the phone to confirm their appointments? I suspect most of you reading this would say no.

And one more question: Should we drop by our clients’ homes or workplaces to remind them of their appointments? Surely no one would think this kind of boundary violation is ethical.

Brett Jordan/Unsplash.com

So, what is the difference between an email and dropping by someone’s home? Don’t get me wrong. By no means am I proposing that these three scenarios are the same, but I am suggesting that they have something in common. In all three cases, we are crossing a boundary. Even with a simple text or email, we are figuratively stepping into our clients’ private worlds, potentially without invitation (I’ll come back to this in a minute). In this way, a text message is similar to standing at your client’s front door.

When that text or email goes through, we don’t know who might have access to it besides our clients. We don’t know what potential problems that might cause or what potential embarrassment or intrusion our clients might feel.

Would they feel obligated to explain who you are as a counselor? What if there are difficult relationships, jealously, distrust or other powerful and emotional dysfunctions in operation? Or what if our clients simply choose not to make others aware that they are seeing a counselor? This is why the question isn’t so simple.

When anyone — another professional, another client, a friend, a relative — comments about one of my clients, my response is always the same: “Who my clients are or are not is no one’s business but theirs.” This simple piece of information should be guarded as carefully as any secret our clients choose to share with us.

I’ve often thought about past clients and clients who dropped out of therapy without closure. I’ve wondered whether I should reach out to check on them or to ask if they would like to reschedule. But I never do, even when the urge to follow up is powerful.

If I reached out to them, a host of things could happen. They might feel obligated to come see me. As in the scenarios mentioned earlier, I might complicate their lives or embarrass them. Maybe they didn’t like me as a counselor but didn’t want to confront me by saying, “You haven’t really helped.” We protect all of that by not intruding into our clients’ lives.

But this doesn’t mean that we can’t send reminders or follow-ups. The easiest way to manage this is to include this information in your informed consent. At the end of my informed consent is a section where clients can check off the ways they approve for me to communicate with them. These options include phone (landline or cell), email, video (Zoom), chat and text. I note which options are HIPAA compliant and which are not.

I also include a section regarding clients’ preferences for receiving session reminders and messages about missed appointments. “None” is an option. This section of my informed consent is where clients extend me the “invitation” that I referred to earlier.

Thus, I’m not suggesting that we never send follow-ups or reminders. It is a reasonable and commonly used business practice that is not inherently unethical. But it would be very easy to never even ask the question regarding its effects because it seems so innocent.

If you decide to use these tools, keep three quick rules in mind.

  • Rule No. 1: Keep it short.
  • Rule No. 2: Keep it professional.
  • Rule No. 3: Keep it vague so that your client will know who you are, but it won’t be so obvious to others. For example, “Reminder of our meeting, Wed., Oct. 10, 3 p.m.”

In this way, we can protect our clients.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

2 Comments

  1. Frederick M. Avolio, LCPC

    The obvious answer is establish ways of communication at the first or before the first meeting. Clients sign off on email, texting, and or phone calls. These things are established at or before our first meeting.

    Reply
  2. Lucy

    What the actual hell. Its 2021 and its yhe PROPER and perferes way for ALL people to communicate. It is not a boundary violation when you add it to your informed consent and have the client sign for approval to be contacted via email and text message. It’s not 1951 where everybody sitting at home waiting for a phone call. As technology increases we have to adapt our practice to do it’s best for our clients. The lack of using text message and email is what keeps a lot of clinicians from feeling to practice and being productive at four capacity. As times change we as clinicians need to do so as well. Sounds like most people you’re referring to are probably over the age of 65 and on their way out. Clients I work with love the fact that they can text me on a personal secure HIPPA cell phone to cancel an appointment rather than waiting to speak with a secretary. As far as I’m concerned centered as long as you’re providing informed consent following HIPPA doing what’s in the best interest of the client it’s not a boundary crossing.

    Reply

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