I am providing DBT therapy on an individual basis for a client referred to me from a psychiatric inpatient facility, dx Borderline Personality Disorder. Dr. Linehan, who developed DBT for BPD, recommends offering clients contact in between therapy sessions, and with this one client, I have made this available. She recently lost access to cell phone service, and she also prefers to communicate by e-mail. Normally, I have limited this to discussions about appointments and such, but with this client I have allowed her to communicate in between sessions. She has been seeing a therapist for several years, and they have a longstanding agreement that she seek help when feeling suicidal so that the therapist doesn't become a 24 hour crisis center. The client has upheld the agreement over the years, and seems highly motivated for DBT.

I find the e-mails extremely helpful, both for my understanding of the client's particular schemas, and also for the client to receive support and guidance between sessions. I also prefer e-mail over phone as a means of contact, as I can read and answer on my own time, the client has a written response they can keep going back to, and for me, on a sensory level, it's just easier.

We have talked extensively about the limits of this, and her responsibility for maintaining safety, and I continually review this with her. I respond briefly with validation of the client's experience, and a suggestion of how to use the DBT skills. It seems to be helpful and I think from an attachment disorder perspective this helps correct the anxiety/nurturing/trust function. I recognize the capacity for transferrence in this (we have discussed this also), and though she is contemplating leaving her other therapist (feels she has reached a plateau), she has agreed to seek out another therapist and I have provided her with several referrals.

I believe the benefit of this strongly outweighs the risks. My computer is always in a locked place, and I am the only one who ever uses it. I have virus protection with a firewall. I have a close friend that does maintenance on my computer and I am present when he works on it. I maintain limits that don't consume much of my time (reading and responding might take 15 minutes) and gently let the client know what my limits are so that my not responding in an expected amount of time doesn't result in a crisis on her part.

Anything else here I should be aware of?