Of course, there are numerous exceptions. Some patients, for example, need very brief occasional contact to confirm the reality of the therapist. Others need various kinds of brief contact to avoid overwhelming anxiety. Under these circumstances, therapist and patient can arrange for limited telephone conversations. Specific agreements regarding phone calls need not come up at the beginning of treatment, unless an obvious problem is anticipated.
Discussion can wait until after the first or even second call.
At that time, the rationale for any limits can be stated and discussed. Limits set in a reasonable way can make the difference between virtually no phone calls or daily phone calls. To set these limits well, the therapist needs to have good boundaries regarding the therapy hours, plus the belief that therapy is best carried out when it is confined to well-defined sessions. Dr. Goldstein is a teaching analyst and director of the adult psychotherapy training program at the Baltimore-Washington Institute for Psychoanalysis. Additionally, he is clinical professor of psychiatry at the Georgetown University School of Medicine.