The Asynchronous Frame: Patient Portal Messaging Between Psychiatric Visits

Asynchronous patient portal messaging has become a routine part of psychiatric practice, yet its impact on the therapeutic frame remains poorly defined. Unlike telephone calls or e-mail, portal-based communication is embedded into the electronic health record, extending care beyond scheduled visits. Although patient portals may improve access, transparency, and satisfaction, concerns have been raised about their effects on therapeutic boundaries, the therapeutic alliance, and clinician workload. The authors introduce the concept of the asynchronous frame to describe the explicit and implicit expectations governing between-session communication. Defining this frame collaboratively may preserve therapeutic integrity, support clinicians, and promote safe, patient-centered psychiatric care.