no sheep

I just called a psychotherapist colleague and listened to her voicemail greeting with the now-ubiquitous message, “If this is an emergency, hang up and call 911.” 

My professional voicemail will never include such a message. Here’s why.

The 911 message is not a legal or ethical requirement or even a guideline. Therapists who think it is haven’t done their homework. They’re just following the herd.   

It conveys that our patients are idiots. Do we really think they wouldn't know, without special instructions, when to leave a message for a therapist and when to call 911? In more than 20 years of practicing and supervising therapy, I have never encountered an adult patient who didn’t know the difference.

It is at cross-purposes with therapy for patients who are prone to feeling helpless and incapable. Therapists should not collude with such self-perceptions. But the message says, in effect, that we agree with them. Why else would we leave instructions appropriate to a 6-year-old?

It conveys that our fear of liability trumps our respect for our patients’ intelligence, judgment, and common sense. That’s not a message I want to send.

It’s not the way to handle suicide risk. If a patient is a suicide risk, this should be addressed during office appointments. There should be a clear, well-thought-out, mutually agreed upon plan about how suicidal crises will be handled and exactly what patient and therapist will do when they occur. If such a plan exists, the 911 message is superfluous. If not, the message is not an acceptable substitute.

The subtext of the message is that we are not on call for the patient 24/7. Of course we’re not, nor should we be. We have other patients and other responsibilities, not to mention our own lives. Therapy should begin with a clear understanding of the roles and responsibilities of both participants (this is part of the therapy “frame”). There is no need for a voicemail message restating the obvious, unless the therapist conveyed false expectations in the first place.

I used to just tune out those “call 911” messages. Now they leave me wondering whether the therapist is an expert professional or a sheep.
 

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Jonathan Shedler, PhD practices psychotherapy in Denver, CO and online by videoconference. He is a Clinical Associate Professor at the University of Colorado School of Medicine. Dr. Shedler lectures and leads workshops for professional audiences nationally and internationally and provides online clinical consultation and supervision to mental health professionals worldwide.

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