Your phone buzzes with a client message at 9 PM. Another client emails daily updates. A third never reaches out, even in crisis. Between-session communication is one of the most challenging aspects of modern therapy practice. Get it right, and you deepen therapeutic relationships while protecting your wellbeing. Get it wrong, and you risk burnout, boundary violations, or clients who feel abandoned.
The good news? With clear policies, the right technology, and consistent communication, you can create a framework that serves both you and your clients. This guide walks you through everything you need to know about managing between-session contact effectively.
Why Between-Session Communication Boundaries Matter
When you started your practice, you probably imagined deep, meaningful sessions with clients. What you might not have anticipated was the constant stream of texts, emails, and messages that can blur the line between your professional and personal life.
Between-session communication exists in a gray zone. Some contact genuinely supports the therapeutic process. A client sharing a breakthrough insight. Someone reaching out during a genuine crisis. A quick question about homework assignments. These interactions can strengthen the therapeutic relationship and improve outcomes.
But without clear boundaries, that gray zone expands until it swallows your evenings, weekends, and mental peace. Research consistently shows that therapists with unclear communication policies experience higher rates of compassion fatigue and burnout. Meanwhile, clients often feel anxious about whether their messages are appropriate, leading them to either over-contact or avoid reaching out when they genuinely need support.
The Research Says
A 2023 study in Professional Psychology found that therapists who communicated clear between-session policies during intake reported 45% lower burnout scores and higher client satisfaction ratings than those who addressed boundaries reactively.
Creating Your Between-Session Communication Policy
An effective policy answers four key questions for your clients: What channels can they use to reach you? What types of communication are appropriate between sessions? How quickly should they expect a response? And what should they do in a crisis?
Defining Your Communication Channels
The first decision involves which channels you will use for between-session contact. Each option has trade-offs in terms of security, convenience, and boundary management.
Most therapists find that offering too many options creates confusion, while too few can feel restrictive. The sweet spot typically involves one primary channel for routine communication and a separate crisis protocol.
Recommended Channels
- ✓ Secure client portal messaging - HIPAA compliant and documented
- ✓ Practice email with encryption - Professional and trackable
- ✓ Scheduled phone check-ins - For clients who need extra support
- ✓ HIPAA-compliant video for brief check-ins - Visual connection when needed
Channels to Avoid
- ✗ Personal cell phone - Blurs professional boundaries
- ✗ Standard SMS texting - Not HIPAA compliant
- ✗ Social media messaging - Inappropriate dual relationship risk
- ✗ Personal email - No audit trail, security concerns
Setting Response Time Expectations
Nothing creates more anxiety for clients than uncertainty about when they will hear back. Be specific and realistic. If you check messages once daily on weekdays, say so. If you do not check messages on weekends, make that clear.
The key is consistency. A longer but reliable response time creates less anxiety than unpredictable quick responses. Clients adapt to whatever timeline you set, as long as you stick to it.
Response Time Policy Checklist
- Specify business days vs. calendar days
- State your typical response window (e.g., within 24-48 business hours)
- Clarify weekend and holiday availability
- Explain what qualifies as a crisis requiring immediate action
- Provide crisis resources for after-hours emergencies
- Set an auto-reply that reinforces your policy
Understanding Different Types of Between-Session Contact
Not all between-session communication is created equal. Understanding the different types helps you respond appropriately and educate clients about what warrants contact.
Administrative Communication
Scheduling changes, insurance questions, and paperwork requests fall into this category. These are straightforward and usually require brief, factual responses. Consider delegating administrative communication to an intake coordinator or virtual assistant when possible.
Therapeutic Updates
Clients sometimes want to share breakthroughs, setbacks, or insights between sessions. These messages can provide valuable information for your next session, but responding in depth can inadvertently conduct therapy via text. A brief acknowledgment that you look forward to discussing it in session usually works best.
Support-Seeking Communication
Some clients reach out when struggling, looking for support between sessions. This is where boundaries become especially important. While you want to be supportive, extensive between-session counseling can undermine in-session work and create dependency patterns.
Crisis Communication
True crises require immediate attention and should bypass normal communication protocols. Your policy should clearly define what constitutes a crisis and provide specific instructions for clients to follow, including crisis hotline numbers and emergency services information.
Important Distinction
Distinguish between clients who need crisis support and those who have learned that framing requests as urgent gets faster responses. Track patterns and address them therapeutically when you notice escalation that does not match actual crisis criteria.
Communicating Your Policy Effectively
A policy only works if clients understand and remember it. The intake process is your primary opportunity, but reinforcement throughout the therapeutic relationship matters too.
During Intake
Include your between-session communication policy in your intake paperwork. Review it verbally during the first session, checking for understanding and addressing questions. Frame it positively, explaining how boundaries protect the therapeutic relationship rather than presenting it as a list of restrictions.
Ongoing Reinforcement
When clients contact you appropriately, acknowledge it. When they step outside your policy, gently redirect without shaming. Use boundary violations as therapeutic material when relevant, exploring what need the client was trying to meet and how to address it more effectively.
Effective Boundary Language
- "I check messages once each weekday morning and will respond within 24 business hours."
- "For scheduling changes, please use the client portal rather than email."
- "I appreciate you sharing this. Let's explore it more deeply in our next session."
- "This sounds important. I want to give it the attention it deserves when we meet Thursday."
Language to Avoid
- "I am too busy to respond to messages between sessions."
- "You should not be texting me about this."
- "This is not an emergency, so I am not going to engage."
- "You need to wait until our scheduled appointment."
Technology That Supports Your Boundaries
The right technology makes boundary management easier. Practice management platforms with built-in messaging create natural separation between work and personal communication. They also provide documentation, which protects both you and your clients.
Look for platforms that allow you to set office hours for notifications, create auto-responses, and route different types of messages appropriately. The goal is to create systems that enforce your policies without requiring constant vigilance on your part.
Features like secure messaging, automated appointment reminders, and client self-service for scheduling reduce the volume of between-session contact while improving the client experience. When clients can check their next appointment time or complete intake forms through a portal, they do not need to message you for these routine requests.
Essential Technology Features for Boundary Management
- HIPAA-compliant secure messaging portal
- Customizable notification schedules
- Automated out-of-office responses
- Client self-service scheduling
- Message threading and history
- Separate work and personal device access
Handling Special Situations
High-Risk Clients
Some clients genuinely need more support between sessions, at least temporarily. Rather than abandoning your policy, consider scheduled check-ins, safety planning protocols, or coordination with higher levels of care. Document your clinical reasoning for any policy modifications.
Vacation and Leave Coverage
Plan ahead for absences. Identify a colleague who can provide coverage for emergencies. Communicate your absence to clients in advance, providing specific dates and coverage information. Update auto-responses and voicemail with this information.
Termination and Transitions
When ending treatment, clarify that between-session communication also ends. Provide referrals and resources for ongoing support. For planned terminations, discuss this transition in advance so clients can prepare.
Remember
Your boundaries model healthy relationship skills for your clients. When you maintain consistent limits with warmth and clarity, you teach by example that boundaries and caring can coexist. This therapeutic modeling often benefits clients far beyond the immediate communication context.
Maintaining Your Boundaries Over Time
Creating a policy is the easy part. Maintaining it consistently, especially when you are tired, when a client is struggling, or when your schedule is packed, is the real challenge.
Build systems that make compliance automatic. If you said you respond within 24 business hours, set a daily reminder to check and respond to messages. If you do not check messages on weekends, remove work email from your personal phone or use app scheduling to block access.
When you slip, repair it. If you respond immediately to a message one time, that exception becomes the new expected standard. Address pattern shifts directly: "I notice I responded faster than usual last week. I want to reset expectations that my typical response time is within 24 hours."
Frequently Asked Questions
What if a client threatens self-harm in a text message?
Take all safety concerns seriously. Respond immediately to assess current safety, regardless of your usual policy. If you cannot reach them or determine they are in immediate danger, follow your crisis protocol, which may include contacting emergency services. Document everything and address the incident therapeutically in your next session, including discussing more appropriate ways to communicate crisis needs.
Should I charge for between-session communication?
Many therapists include brief administrative messages in their standard fee but charge for substantive clinical communication. If you bill for between-session contact, specify this in your policies. A common approach is billing in 15-minute increments for any communication requiring clinical expertise or taking more than 5-10 minutes. Whatever you decide, communicate it clearly upfront.
How do I handle clients who repeatedly violate my boundaries?
First, ensure your policy is clear and was communicated effectively. Then address the pattern therapeutically. What need is the client trying to meet? Is there anxiety about the relationship? A history of unavailable caregivers? Use the boundary violation as clinical material while maintaining the limit. If violations continue despite intervention, consider whether this indicates a mismatch in treatment fit.
What about using text messaging for appointment reminders?
Automated appointment reminders via text can be HIPAA-compliant when done correctly, with minimal PHI and appropriate consent. However, this is different from interactive texting. Using a practice management platform that sends automated reminders while keeping clinical communication within a secure portal gives you the best of both worlds.
How do I balance accessibility with protecting my personal time?
The key is predictable availability rather than constant availability. Clients need to know they can reach you when it matters, not that you are available 24/7. Consistent response times, clear crisis protocols, and reliable session scheduling provide security without sacrificing your wellbeing. Your sustainability as a therapist serves your clients better than burning out from endless accessibility.
Key Takeaways
- 1. Create a clear, written policy that defines channels, response times, and crisis protocols before you need to enforce it.
- 2. Communicate your policy during intake and reinforce it consistently throughout treatment.
- 3. Use technology that separates work and personal communication while providing HIPAA compliance.
- 4. Distinguish between different types of between-session contact and respond appropriately to each.
- 5. Address boundary violations therapeutically rather than punitively, exploring underlying needs.
- 6. Your consistent boundaries model healthy relationship skills for your clients.
- 7. Predictable availability protects your wellbeing while meeting client needs effectively.
Between-session communication does not have to drain your energy or blur your boundaries. With thoughtful policies, clear communication, and the right tools, you can stay connected with clients in ways that support their growth while protecting your own wellbeing. The therapists who thrive long-term are not those who are always available, but those who are reliably, consistently present within sustainable limits.
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TheraFocus provides secure, HIPAA-compliant messaging with customizable boundaries, automated responses, and client self-service features that protect your time.
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Practice Management Experts
The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.