She wants to know how I handle it when I really like a patient. Don't I want to be friends, seriously, with delightful people? Technically, she reminds me, after a two-year break in the therapy, I'm allowed this legally, can have this
friendship with a client.Or I can use an "ex" patient as a plumber; I can commission an artist to paint me a picture.
The problem is that I don't ever really, hardly ever, terminate the therapy.
With people I see professionally, there's no terminating, not really, although I'll go to weddings if I can. That's part of a therapy, going to a wedding. But basically, when all's going splendidly in life, and there's no need for my services, it becomes:
See you next crisis. Call me if you need me.Life is all about the next developmental crisis waiting to happen.
And I feel it's a disservice, a dilution of the relationship, almost a perversion to take it out of the office. It's not possible to give a relationship, always the third person in the room, its due any other way.
All that said, I'll help friends as a professional, do the therapy, literally, or provide referrals. But I'll offer them advice. I couldn't have done that as a younger doc, but now keep my legal pad ready for them, a 5 X 8 in my bag. Or sometimes will doodle on a napkin. I'm nothing if I can't write or diagram.
Not that we won't do this over dinner, but there's little time for dinner, so it's really better if a friend comes to the office.
I know other docs who do it, too, help out friends. Some even do it at home. I know a psychiatrist, who treats his entire community, . He treats people that his wife invites over for lunch or dinner, people he goes to basketball games or movies with on a Saturday night. But he does the therapy in his home office. You sometimes see people leaving with paper bags of samples.
It's all about how well a therapist can detach emotionally from people, and some of us are amazingly good at detachment. Therapy is really an intellectual exercise, you know. Although it helps to have heart.
So boundaries are a personal choice. A person has to be comfortable with the perforations, and by default, therapists are taught to keep a nice solid line to protect the patient. But nothing is written in stone, and I personally have learned, by watching people's lives in my community go to ____ without intervention, that if I don't step in when I can, I'm going to feel guilty.
With friends, crazy though it might seem, I expect a certain amount of therapy back. At least I should be able to talk to my friends like I'd talk to a therapist, spleen about my life when it's not damaging to someone else, report a decent nightmare. I tell my friends,
You're not to try to fix anything here, just shut up and listen.
And they do, and I feel better. They feel worse, but I feel better.
Just kidding, just kidding.
More on termination when I have a minute. The truth is, there are times when it really has to be a termination, and we should talk about that a little.