My T and I finally had to get really clear about what he means by certain terms like "emergency" and "crisis." We are always in touch (though when he goes on vacation, I do give him space, that is voluntary on my part). We've decided to use "in danger" as a code word for SU and intense SI that I don't think I can avoid without help. When that stuff is going on, and it takes a lot of work to control it, but I'm not to the point of being unsure I can do it on my own, then we call it "crisis." Having that defined for me, so we can understand each other and I know what to tell him and when was really helpful. He wants me to keep him updated when I get to crisis level and to promise to contact him and/or others immediately if I'm "in danger."

I would notify her that you may receive an answer about the insurance stuff while she is on her vacation and it's possible a negative outcome will cause some intense ED behaviors...then just ask her if that is the sort of thing she is talking about by emergency, and, if not, if she could give an example. I don't think she'd be offended on you asking to clarify, because it shows you are trying to be respectful of her personal time and the boundaries she is setting, by making sure you understand them well.

I'm sorry your T going on vacation coincides with such a stressful period. I'm in the middle of a six month (eight if you include open enrollment) struggle with my insurance company, currently at the state appeal level for two months. I can totally understand how stressful it is, how hard not to think about it (though I've had a lot of practice, lol), and how easy it is for their responses to trigger messages from the past about what you do or do not deserve, etc.

I don't really know anymore.

My T has said that she would rather I call her than hurt myself in any way (ED, self-harm, suicidal action all included here). If it's during a time she's not available (vacations and weekends she is 100% NOT available) then I do whatever else I need to (and have my P and adjunct T as backup).

I'd probably be dead for 2 solid minutes before I'd ever call 911 for a medical emergency. There are times I've called my P or Drs on their regular line and been told to call their crisis line next time (about med or physical issues). So I'm not a real champ at this stuff... but knowing very clearly when my T is okay hearing from my helps. She's never really "sorta not there" she's either there, or not. I did run in to this grey area with my T who would let me e-mail/call and I've tried to err on the side of if I'm debating I should call and I'm allowed to... I should probably just call.

So if you can contact your T, and it would help you not to hurt yourself, it can be "emergency enough". The best way you'll learn what is/is not an emergency/crisis is just to call and if there is a problem you and your T can talk/clarify later, but since you haven't had a chance... calling my not be so bad.