BFFs with smartphoneHow do you talk when you type your texts?

The question of appropriate language in texts and emails is long-discussed and fraught with angst. College and high school teachers lament the intrusion of “texting speak” into formal papers. And some professional organizations have discouraged clinicians from using emoticons or emoji in professional text messages, despite their heavy use by clients.

Besides the language of texting, there’s also the question of the therapist’s availability. Mobile phones have all but destroyed the concept of having to wait for someone to become available before you can speak with them.

Let’s explore some perspectives on these issues.

Watching Your Language

I want you to try something with me:

Think about the most formal written essay language you can imagine. There’s probably a lot of passive voice. There’s a dearth of contractions, conjunctions, and parentheticals. It’s generally very formal.

Now imagine talking like that during your sessions with clients. It makes very little sense to do that, right?

On the other hand, emails and texts are written, and provide an opportunity to use formal written language. But should we do so?

There is room for argument on this point. One perspective says that because these messages are written, we should use formal written English. That argument tends to work better for email than for texting, however. Text messages are short by design, and provide little space and comfort for formal English.

Linguists have identified that the language we typically use in text messages is much more like spoken English than written. (Chiad, 2008) Emoticons and emojis are essential to making this work, since tone and expression are integral to spoken English. How can you properly express yourself in a text message without them?

On the other side, there is a perception that excessively informal language in text messages and emails appears unprofessional. Regardless of cultural norms, these communications are written down and forever available to be dug up during a licensing board investigation or court case. Careless language could come back to bite the therapist that wrote it.

There are numerous perspectives on what to do about this, so we will simply offer ours. We suggest that therapists consciously foster their own voice(s) for these communications mediums, and base it on the professional voice(s) they use when speaking verbally with clients.

The exhortation that informal text messaging language can cause problems for a therapist is also true of our verbal interactions with clients. We are generally very intentional with the tone and words we choose when we speak. Our recommendation is that therapists do the same when they write emails and texts.

We recommend that emoticons and emojis get used! But they should be used intentionally and for the purpose of accurately expressing the therapist’s intentions and message.

It’s good to be careful of excessive emoji or emoticon usage, just like it helps to be careful of reactively over-emoting in your verbal interactions with clients.

Also be careful of avoiding the use of emojis and emoticons and coming across as having a kind of textual flat affect, thus potentially appearing uncaring or leaving your expressive intention open to interpretation.

If you aren’t accustomed to using emoticons and emojis, you’re in luck: text messaging gives you extra time and space to think about what you write. You can use that time to practice and develop your style. And that leads us to…

Turnaround time

The ACA Code of Ethics, the American Telemedicine Association’s 2009 guidelines on telemental health, and several other professional guidelines, we are sure, all recommend that informed consent include declaration of the therapist’s expected turnaround time for responding to messages that clients send in between sessions.

Not everyone in the modern world expects instant feedback when they fire off a text or email, but many do. When therapists don’t set expectations up front and make sure they’re on the same page with clients, the resulting impact on the therapeutic relationship will depend on how well therapist and client happen to already agree on proper texting and email protocol.

Where disagreement occurs, the potential for a relationship disruption arises, depending on the client’s and therapist’s skill in managing it.

Another potential negative outcome is that a client may send an important message expecting — or possibly needing, if in crisis — instant response that the therapist is not a position to provide.

Good informed consent and planning around between-session communications can help prevent these bad outcomes.

Even therapists who instantly respond to their own friends’ and family’s messages often prefer to take their time when responding to clients. Such therapists usually wish this for two reasons:

  1. They want to maintain healthy boundaries with clients. This is usually for both the therapist’s health and, in many cases, for the client’s health.
  2. They want to employ what Suler calls the “zone for reflection” that arises when using asynchronous communications like email or texting (“asynchronous” means that you don’t have to be messaging simultaneously, and that each person in the conversation can respond when they feel ready to do so.)It wouldn’t do to react to a client’s message without careful consideration. When you add in that a huge clinical advantage of email and texting is their asynchronicity, it makes perfect sense that therapists would want to leverage that extra thinking time to ensure that their responses to clients are as helpful and as balanced as they can manage.

In order to keep up healthy boundaries and happy client expectations, we recommend that informed consent include a declaration of expected turnaround time for messages from clients. At Person Centered Tech, we like to do this through providing a Communications Policy at intake. We supply a sample Communications Policy form as a bonus for our free newsletter readers, and also include it as a resource with some of our CE courses.

Of course, discussing communications policies at the first session can add a lot to an already big pile of informed consent items. We recommend using layering to help manage all that. You can get great advice about layering from the recorded replay of our webinar with paperwork expert Maelisa Hall, PsyD. It’s openly available to the public on our site, with an option to purchase CE credit if you wish. Watch it here.

Conclusions

Email and texting, like all Internet-dependent tech, is challenging decades-old preconceptions about boundaries and communications styles. The basic ethical and clinical principles remain the same, however: be helpful (or at least don’t be hurtful) and maintain healthy boundaries for you and your clients.

With some forethought and planning, that’s completely doable in the world of email and texting!

References

Find references for this article here.

Learn more about texting with clients in mental health practice:

2 CE Credit Hours

1 Legal-Ethical


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