Thursday, June 11, 2009

Friendship and Professional Boundaries

In the last post Porcini asked me a question in the comments section. You can go back to that to see how I answered her there.

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.

therapydoc

therapydoc

74 comments:

Lisa Marie said...

I have to admit that I have thought about a few questions you pose here, mainly "Does she like me?" Namely, would I be someone she would like if she met me off the street. I like to think that if that were true, then our relatinoship as therapist and patient is stronger than if the answer was no to that question.

therapydoc said...

Now THAT'S interesting. I don't agree. I don't think it matters how much we like our patients. The job is the job, and like I said, it's an intellectual challenge, just deciding what to say in therapy. Liking doesn't enter into it at all. Not for me.

The job for the therapist is always to think, What's this person need right now? Not, Do I even like her?

Syd said...

I think that sponsoring is a bit like this. I may not necessarily be friends with the person that I sponsor in Al-Anon but I can be a guide for them through the steps. I have worked with a couple of people that I actually found difficult to be around but that taught me something about myself--detaching, my own character defects, etc.

wendy said...

I think that I've talked about this before, a horror of a termination story.
The therapist with the ego so big he couldn't admit that HE couldn't help me. Then the night he snapped and nearly pushed me over the edge, fullying knowing that I was suicidal and alone, he demanded that I say the words, "I'm terminating therapy" - he couldn't stand his failure anymore - me.
He at least had the decency to have a therapist that I had seen for EMDR call me the next morning. She talked and talked and would NOT give up. It seems now that when we come to a patch in therapy that terrifies me, I try everything to quit. She won't let me fire her! Yea, let's talk about terminating, the good, the bad and what we have here, the ugly.
Thank God for the ones that hold on for my dear life. (And her biggest lesson - boundaries - Yea!)
Wendy

porcini66 said...

Thanks so much for answering my question - and with a full Blog, no less! It's an interesting topic, no doubt. In my field, maintaining that professional distance allows my students to know that I am fair, equal, not gonna have favorites, etc. It also gives them confidence that I have their end goal in mind - I want them to be better at what they do. If I am focused on their personality, I can't be focused on their technique. Principles before personalities. And, what a gift to watch someone grow under my tutelage.

My own T and I were discussing our jobs one day long ago - comparing, contrasting. I love what I do. I respect my profession, I can manipulate my product to do just what I need it to do because I understand the theory behind it all. Best of all, I can show OTHERS how to do that as well and my best students are the ones who are better than I am. We got to talking about how HIS job is like that too, really. He plies his craft and nurtures people to bring out their best flavors b/c he knows how to work with them. I laughed at that point and told him that his work was infinitely more important since he was working w/human psyche and me? I work with spinach and potatoes. LOL

I think that, at the end of the day, the perforations of those boundaries teach us a lot about those with whom we work, regardless of the profession. We learn the most from relationships that grow and change and deepen. I have learned a lot by pushing boundaries; I have learned about not having enough of my own. Boundaries create respect, in my opinion. And, not to bring up the honor thing again, but I am always honored when someone lets me in.

Thanks again for the response - I am definitely curious to read about termination - such a cold, hard word, in my mind...

therapydoc said...

Syd, I imagine sponsoring is really hard primarily because a sponsee knows the sponsor has been there, so blurring boundaries, projecting is going to be a major source of error and miscommunication on both sides. But it's such a wonderful thing, this mentoring aspect, when communication is clear, when you get a clear channel. I'm so impressed with the system.

therapydoc said...

Thanks Wendy, for reminding me. As much as I talk about the intellectual process, that emotional piece is what saves lives.

Still Dreaming said...

I want to read this again and again, until I've fully processed my thoughts. I've always completely believed that we can't be friends with our clients and we can't do therapy with our friends. Of course, that's never stopped me from using the occasional CBT with my friends, or asking a solution focused question with a group of people I'm trying to do something with, but that's just working with my strengths.

I think my 1 therapist and I could have been friends... I'm glad we're not. I wasn't when we terminated, but I am now. Another therapist I saw, I could never have a relationship outside of therapy with. And my clients now? Well, I haven't come across it yet, but I'm sure it will happen. Something to keep thinking about!

Lisa Marie said...

I totally see your point. It's harder to distinguish that when there are so many emotions that are hashed out in therapy, but looking at it from my perspective as a teacher... I don't do my job any different if I don't like a student. It's my job to teach them. Sometimes you just have to give me a good analogy ;)

Retriever said...

Great post, td. I tend to think that the boundaries can be a little more flexible only as a person gets healthier in therapy. For example, when the friendship element is part of the therapeutic relationship, it can certainly add warmth, and compassion. But sometimes if one is really in pain or suffering thru the effort of facing a demon or six, knowing that the therapist is also a friend can make it that much worse. One feels more embarassed, ashamed, and envious of the therapist who is not such a basket case. When one thinks of them as only one's shrink, one doesn't have to worry as much about angering, upsetting them or feel such a loser. ON the other hand, to the extent that a shrink can tell a well timed friendly joke or offer genuine friendly sympathy at times (instead of cool therapeutic insight) that can help. And, given how isolating mental illness can be, sometimes small pieces of friendship can be a bridge for someone back to a more social existence. For example, to chit chat two minutes with one's shrink in a friendly way isn't a waste of time or a boundary violation if it points a person outwards again "I can make someone laugh, someone is glad to see me, I do care what happens to another human being, I will make an effort to be agreeable even when miserable, etc.

cb said...

There is a big difference to being friendly and being friends. I can't imagine being in a situation where I would cross the line but coming from a government setting, we have very strict boundaries set for us that become ingrained into working practice.

In some ways, I find it harder when I don't like the person I am working with.. which happens and in some ways I may overcompensate and make more effort because I know I need to and it comes less naturally.

Dreaming again said...

I left a therapist because it began to feel like too much of a friendship rather than a therapuetic relationship. I needed a therapist, not a friend. (At the time, I had more friends than hours in the day could support ... I really didn't need to be paying to see a friend!)

Also, when the relationship morphed into a friendship ... it was really not as comfortable talking about deep issues.

therapydoc said...

This all makes so much sense to me.

Anonymous said...

I love my doctors and sometimes sad when they have to leave --I had a psychologist who was alos a college professor and I love him as a doctor and I wished (and told him so) i could have him as a friend as well as a doctor--Alas, that was not to be. However, I still think warmly of him always and I talked to him many years ago and told him how well i was doing -he seemed really happy to hear it--he is private practice now. Same is true my intern doctors -i have a great batch of them and i wish the same thing-which i can't really have either but my current doctor made it a point to come to my art show which made a world of difference in my self esteem levels.

Jack said...

This was really interesting.

Glimmer said...

This reminds me of issues in another aspect of life. I will hear someone say "my daughter is my best friend" etc. and think, well, different strokes. Because my son has plenty of friends and only one mother. It would be easier to be his friend, frankly. But that's not my role. Maybe when he's much older, a parent himself, and I am ancient, God willing, I'll think about it then.

So, I agree, Therapy Doc. Maybe when you retire the legal pad you can change your roles about. Or write books about it all.

therapydoc said...

Oh, that's the best part, writing about it.

The problem with me is that there is no way to cut off the part of me that thinks in terms of diagnosis or treatment. I don't tell anyone, of course, and never say, wow, you have GAD! But it's impossible for me not to see stuff this way, or forget diagnosis, not to see family or relational systems.

So most people, probably knowing this, stay away :)

therapydoc said...

Most people who don't want that, that is, in a friend.

Barbara said...

Hi,

As a therapy client only, I am currently struggling with this issue. I can't reconcile simple statements such as, I like you from my therapist to me or vice versa.

I think what has both assisted me in bolstering and confused the heck out of me is this relationship I have with my therapist. She claims however there is no way for me to do this work, break patterns without this confusion/constant questioning. In my surface moments that makes perfect sense, but seldom otherwise.

There are many of my own issues that have smacked me right in the face, including boundaries of which you speak. It turns out, in a surprising therapeutic revelation, I don't much like women in general and wouldn't you know my therpist and I are both women. I guess much telling in my choice to work with her. And more to reconcile.

I'm not sure i would want to see my therapist outside of therapy. The dificulty however is all inside the work. I'm not sure it makes a difference, at least in my view.

Thanks for a good post. And like other readers, I think I'll have to read again.

Still Dreaming said...

I agree. I can't turn off the part of brain that wants to ask things like "are you experiencing this?" or "how are you coping with that?" I always see things in terms of family systems and internal family systems.

therapydoc said...

Barbara, I tend to learn a lot from patients, and over the years it's become very clear that most of them don't want a friend, they want a therapist.

But saying "I like you" could be her thinking you need to hear that (hypothetically, I don't give advice on the blog, not knowing the full situation).

So it's something to talk about. In general, this is all something to talk about.

STILL DREAMING, it's probably universal. I'm amazed that people can divide themselves, separate the therapist from the person. For me, it's impossible.

But the art of friendship is talking about yourself, sharing about you, and hearing your friend, too, and asking questions that are sensitive enough to not make a friend feel he/she is being analyzed. Cuz that has to feel pretty awful. The beauty of seeing therapy in as people in relation is that there's no individual focus.

Wendy said...

Wow, all these comments and different views have really opened up a lot of emotions for me.
I see how it is more important to have a therapist in my therapist vice having a friend in my therapist.

She couldn't do half as much for me if she were a friend. The way she insists that she will continue to walk beside me, and gives me the room and space to make it about me and not about us, makes it so much better than a friendship.

She worries sometimes that I think of her as a mother figure, but I see her more of a teacher, a mentor, or guide - she has made me so much more of a mother than I ever was. And when I say "I don't like when you do that", she is so open to finding a way that works, where as with a friend I think we would end up hashing out "your way" vs "my way".

Thanks for all of your comments.
I will be reading this one over and over again!
Wendy

Midwife with a Knife said...

Ah, so not so different from being an ob-gyn. It doesn't really bother me at this point to provide ob or gyn related services to my friends, but I would never ever sleep with a former patient. That just seems so wrong in so many ways.

therapydoc said...

Wow Wendy, everyone wants to know, Who IS she?

therapydoc said...

So wrong, Midwife. You're so right.

Glimmer said...

Also, therapists aren't the same people outside the treatment room. Years ago, a woman I know described a therapist at a party at his home acting like a youngster, silly jokes, innuendo, very immature. It really bothered her, she was surprised and disappointed. The therapist was known as a genuine healer. But she had a hard time getting past this. I thought it was very unfair and harsh of her. But, it illuminates some of the problems with blurring the boundaries.

JJ said...

You always get the best comments, TD. Fascinating.

I'm interested to hear more about termination. What is your perspective on a client you've been seeing for awhile that terminates by canceling an appointment and never rescheduling? What is the "right" way to terminate, in your opinion?

therapydoc said...

Now this is a great observation, and I can think of reasons that the healer felt she could let loose.

A therapist's personality is often muted in the office, because after all, it's not about us. And then there are people, not going to mention any one by name, of course, who are even more muted in public, for all kinds of good reasons, personality included in that, too.

Believe it or not, a lot of therapists, like a lot of people in general, can be pretty shy.

rabbi neil fleischmann said...

As an MSW a lot of this resonates for me. I like the idea of leaving things open, "see you next crises."

You reminded me of the joke in which a woman talks to a rabbi for an hour. She tells him, "When I called I had a terrible headache and now it's disappeared." He replies, "It didn't disappear - you gave it to me."

Keep up the good writing.

therapydoc said...

JJ, I KNOW!

There are better ways than that, for sure, cancelling and not even a So long, been nice to know ya'.

That type of term could be designed to make the therapist think about what he/she said that wasn't salubrious.

Or the person who cancelled and termed might be in a really bad place, too bad to even have to talk about it.

Or the person may feel, based upon his or her read of the therapist that the therapist could care less.

When the therapist calls back (and this should happen, of course, to rule out suicidality) the therapist should address all of the above and not make ANY assumptions about the behavior.

Whenever I get paranoid about having upset a patient, maybe, it's usually some kind of transference, or my issue (I'm always thinking people are angry at me).

Yes, I'll get to the post as soon as I can. But these things take time, I'm not gonna' lie, to write. So be patient with me.

Wendy said...

Are you kidding? Give out her name and her schedule will be so booked there won't be time for ME!!

I work for the Army, and she does therapy mostly with military members/family members - her husband is in the Air Force and her father was a general in the Air force. I do a lot of research for her on what programs are going on, what conferences are coming up. You know - make yourself indispensible - but it's working for me! Ok, enough clues...

This post on boundaries and therapists/friends has been so good for me, and all the comments have been great. I've sent it to just about everyone I know and we've had some great emails going on.

Good work, Therapy Doc!

pinky said...

You can interpret dreams? I have had this reoccuring one that bugs the crap out of me. It is always that I have inherited or bought an old house that needs work and it is full of junk and I don't know where to begin.

ANy thouhts?

therapydoc said...

I can only do this with confidence if I know someone, and even then, will add, But it might be the pizza you had for dinner.

It's probably a fear dream, from the tone of your comment, and my guess a fear of suffocation.

But it could also be a wish dream, if you like old stuff and don't mind spending a lifetime de-___ifying.

The blank starts with a c, rhymes with 'tap," is Yiddish for a word that rhymes with "bit."

Reas Kroicowl said...

I haven't read all the comments here, but darned if that ethics training I'm forced to attend every year isn't sticking with me.

What I hear, again and again, is that as a therapist you will always have more power in the relationship, even after termination. Always. Because you have all their personal stuff and they have none of yours.

Friendship is about reciprocity, among many other things.

therapydoc said...

Right-o, Reas. Thank heaven for school.

Ally said...

This is a great post and set of comments! Very timely for me. I agree so completely with what Retriever said.

I thoroughly enjoy and value seeing my therapist; she has seen me through the absolutely most difficult time in my life. I am eternally grateful that I had/have that one safe place to go.

Unless I have something really pressing on my mind, which thankfully isn't the case nearly as much lately, we make a little small talk for a few minutes before we truly start the session. Far as I can tell, we genuinely enjoy our little chats and have a good bit of common ground.

Lately, we have been spending up to 10 minutes after each session chatting (initiated by her). Which makes me wonder if she genuinely likes me. That would mean a lot!! But it is confusing too, for someone who is not a pro at relationships.

I find it so interesting that I am completely honest and uninhibited in what I say...and she is (presumably) so careful in crafting her responses to me. As you said TD, it is an intellectual exercise to her and one in unbridled emotion to me!

Keep the great posts coming!

Ally

therapydoc said...

I had no idea this would hit such a chord, glad it did. And I'm pleased everyone got the message, that it's clear that it is a two way street. A therapist can't take a patient to lunch, but a friend can take a therapist to lunch. If you start out friends, whacha' gonna' do? Refer everyone on and hope for the best?

Maybe. Surely. At least until you've been doing the job for thirty years.

Dr. Deb said...

As usual, well written and informative.

jumpinginpuddles said...

We recently had to leave a therapist that became too much of a mother and less of a therapist, we wish we had read this long before we started therapy with her we might have saved ourselves a whole heap less stress.
Nowdays we see a new therapist whose life doesnt enter mine outside of hours, its been working just fine.

Nainja said...

This post came just right as I had my last therapy session this week and this kind of considerations are pretty much going through my mind at the moment.
I think I could have become friend with my therapists if we would have met first outside of the session. On the other hand that’s already quite difficult to say for me. As a client, I only met the therapist not the person, while as a therapist you actually meet the real person in the client (More real than sometimes desirable probably). So, maybe the therapist could decide if he or she would like the client, I don’t think, I as the client can.
On the other hand, if we would now try to become friends, where to start? I don’t know anything about my therapist or at least not very much and she knows a bit too much about me. So, should we now start with small talk again? And after such an intense relationship as it can develop between therapist and client, would we really want to start at that level again?
It is quite sad in a way, when this relationship comes to an end. But it would anyway, even if we would meet again afterwards outside of the office. And finally, who would do my therapy when I have a crisis again and need somebody, and my therapist is now my friend instead?
So, I am a bit sad that I can’t go and talk to my therapist again but I can’t see how there could be any other way.

therapydoc said...

JUMPING and NAINJA, great, just great, and thanks so much.

These comments bring up yet another point, one I forgot to mention, which is that

although I leave it open for people to call me "next developmental crisis", there may not be one.

But that doesn't mean I don't ever want to hear from people again, and I know it's a double standard, so don't expect it.

But I'll say, anyway:
Please drop me a line, shoot me an email or a postcard once in awhile, or a picture of the baby, if you think about it, if you have a minute and want to reconnect with me, but can't, don't need or don't want to be back in therapy.

Which brings up yet another piece of this, which I don't like to say, but sometimes feel I have to say to people, which is that there are hundreds, literally thousands of people who have walked through my life as patients.

That's a lot of birthdays for me to remember, so I never send cards, not during treatment, not following a "termination."

So I don't send pics of me, either, on vacation, or gardening (since I don't garden that would be weird anyway).

It's not what you paid me for, it's not what this is about. It's not about me.

But that doesn't mean I don't think of you.

Unforgettable, every one.

Anonymous said...

Ah dreams, got to love 'em. The house in a dream is you.

Aura said...

When I was a teenager, I was undergoing therapy for an eating disorder. I don't think my therapist even liked me. She used to go on and on about how much skinnier she was when she was my age and just make stupid thoughtless comments. I was being managed as a team approach and she was the contact person who I saw (Govt social worker.) I asked the leader of the team (the consultant psychiatrist - supervisor of my previous psychiatrist before the social worker) so many times if I could see someone else but it was out of the question. I ended up going private and 14 years later I still see the private therapist.

When I graduate from my nursing degree in a few months, i'm beginning my mental health training - you can bet I'll be thinking before I open my mouth!

Moral of the story - if you don't like the patient, at least act like you do. If you can't, refer them on.

therapydoc said...

AURA, What a story! Thanks for sharing it.

I have another moral. Just LIKE them, like all of the people you see. If you're a therapist it's your business to like people.

I guess how to do that would be another post, but it would be looking into yourself and your projections and why you do that, first and foremost.

Tempy said...

I have often wondered about this, mostly because it terrifies me to think my Therapist would even consider it (even though I know she would not) Interesting perspective as always, thanks!

Laurie-Ann said...

therapydoc...what a great blog! I too, am a therapist and have been asked many of the questions you have.

Its interesting to ponder, but not difficult to answer for me. Boundaries..boundaries boundaries. lol...many times I have had to work with my own therapist to ensure lines were kept clear.

I have had clients that I adored. Did we become friends? No...I may have wanted to, and they may have wanted to, but I had to be the big girl in that decision and have always been proud of how I handled myself. I was never afraid to assure a client that I cared deeply though...because I did.

On the other hand I have had clients who I did not like as people. Again...my own training and my own therapy assisted me in ferreting out the reasons. Sometimes the person reminded me of someone...sometimes there was something about them that was similar to a part of my personality that I would rather not have to have had. Sometimes it was just a clash.

If we could work together effectively, with the client getting optimum care....it would be ok. There have been times, where I have talked with said clients, and referred them to someone who could better meet his/her needs. It was the best situation I could come up with.

I just found your blog, but I will be back. Just wonderful!

Laurie

therapydoc said...

Thanks Tempy, and Laurie-Ann, this is what captured me:

Sometimes the person reminded me of someone...sometimes there was something about them that was similar to a part of my personality that I would rather not have to have had

It's SO true!

Alice said...

"You sometimes see people leaving with paper bags of samples. "

Samples of what? Therapy??

therapydoc said...

No, he's a psychiatrist. He prescribes medications.

Wouldn't it be nice to bag therapy?

Alice said...

I'll have 10 kilos of person-centered, and a small packet of Gestalt, please!

therapydoc said...

Ha!

My guess is you can get this on Second Lives (I think that's a virtual reality place just ripe for a new biz)

linrob63 said...

Great post. I, too, am eager and I think moving close to saying thank you and goodbye to my therapist.

It seems to me that clients who wish they/we could be friends with our therapist have grown fond of them. I have become fond of mine.

Things I like about her: she is unfailingly generous with her time; she is focused on my challenges when we are together; and gives thought to helping me make my way in the world without regular visits.

That is her job. And while she may or may not be fond of me as well, it is unreasonable for me to expect that once we have severed our client/clinician relationship, that focus and generosity would endure.

Seems to me also that a casual and informal relationship would make returning -- in the event some old challenge asserts itself again -- more complex and difficult. I would rather have the option of returning than asking for a referral.

Would have been cool to meet her in another context. But truthfully would not have been likely. That probably says something about differences in our values and lifestyles -- something worth remembering.

Thanks for offering yet another post that generates so much valuable discussion.

therapydoc said...

We like the people we serve more than our friends, sometimes, is the truth. I'm sure she likes you a lot.

Anonymous said...

Israeli Gal
well I dont thing Ide like to be my T's friend as there is quite an age diff between us(Im 30 something & she's 60 something ;-)
)
We live in the same suburb so we do see each other sometimes (Friday shopping and such)

And sometimes she does try cross the professional boundries when she gives examples from her own life but I then ask her not to.

Antway boundries are a delicate issue when working with people and emotions .

Shabat shalom

Anonymous said...

Here's a hot question:

A client asks his/her therapist out after terminating therapy because of a real or imagined connection. Therapist says she/he can't cross that boundary but says if they'd met under different circumstances would have gone out. Ethical? Leading the client on? What are your thoughts on this?

therapydoc said...

Very inappropriate to say that. Shrugging would be better than that. I'd say,

"We professionals look at you in only one way, one way only. You have a problem and we're supposed to help you, in some way, cope with it, or pass you on to someone else who can.

And there's no way that being a part of your personal life is remotely on the list of ways to help you cope. Sorry."

And smile when you say it.

jumpinginpuddles said...

but making sure you keep all professional boundaries as a client can also stop good therapy because you are constantly checking you are keeping your therapist at arms length

therapydoc said...

JP, it's really the doc's job to keep up the boundary. You can lapse into whatever transference you want, you can think the 2 of you are best friends. It's up to the doc to catch that and go, "So how do you feel in this therapeutic relationship we have going?" (one of the questions we ask along the way)

And you would say, "Well, it feels more like a friendship."

And the doc goes, "Uh, we better talk about that."

Maggie May said...

I've never been 'terminated' but I'd be highly upset if I was!

Ally said...

I know it's off topic and I apologize but... is it weird to have imaginary "sessions" with my therapist in between real sessions? She doesn't talk much during the imaginary sessions but is a compassionate presence so...maybe it's good that I have internalized a compassionate presence somehow??

therapydoc said...

Why wouldn't you talk to the bird on your shoulder. 200% normal. I wish everybody did.

Ally said...

Thanks for your answer, therapydoc. Now I am thinking perhaps my question was not off topic.

Why do I want my therapist to be my friend? Well, I think she's really great and we have a lot in common, I would like to get to know HER better but, let's face it, the biggest reason may be... that it would be nice to have her available to me any time of the day or night.

Soooo, if it's fine for me to "talk" to her whenever I want...maybe it's enough to have her to help/advise/nurture me when I am physically in her office. That is the place where our actual relationship does and should take place.

Ivory said...

Oh, man, all this about boundaries and terminating therapy has made my head spin.

I would be in a bad way if my T terminated my therapy, tho there have been times, we discussed if he should refer me out. (sounds so harsh and cruel)

Here's a horse of a different color: Before my T was my T, I worked for him. His wife was fast becoming my friend and after I quit working for him to be his client, his wife and I became good friends. We even drove to school and back together. Following???

When I became he client, his wife and I set some boundaries. He and I discussed those boundaries and set some of our own in session. His wife had a few problems with the boundaries so I tackled them in session, with my T.

His wife and I had a major blow out. It was devastating, but my T handled it quite well. In session, he allowed me to discuss my anger, frustration, and my desire to scratch his wife's eyes out.

We live in a small town. I couldn't afford to go anywhere else and because I have DID, I was terrified of having to go over all the abuse, etc with someone I didn't know.

T's wife and I have moved passed our problems and are on good speaking terms, again. BUT! I will never again be her close friend until, or if, I stop therapy.

My T is definitely a different person at home than he is in the office. I like that, tho, because the few times I've been to his house, it made it easier for me to be with the family man, rather than the therapist. I don't want therapy 24/7 and he wants to shut it off when he leaves the office. (if I call him at home, tho, he is my therapist.)

Love your blog! (sorry if I posted this more than once, I had probs with sign in...)

therapydoc said...

See, I don't even think that's so unusual, either. For sure the less outside interference the better. Thanks, Ivory!

smartchic said...

interesting post. in my type of work (marketing), you need to set up a boundary between you and your colleagues. this way, decisions and work treatment are not biased and subjective. however, in your profession, i guess boundaries are a no no if you want to have a smooth and effective therapy session with a patient.

therapydoc said...

SMART There are different kinds of boundaries. We take them down, put them up when it makes sense. There aren't hard and fast rules, except, Don't even think about sleeping with a patient.

lisa said...

Have you written anything on transference/countertransference? I was taught that it is inevitable; that it is useless to try and fight, but rather must be accepted and recognized. I sometimes struggle with my adolescent clients with the countertransference. I often ask them to tell me if they feel like they are being "parented" by me, so that I can change my focus...How do you deal with such things?

therapydoc said...

Lisa, great question. I see myself as part of the system, and as small a part as possible, especially when I'm dealing with couples and families. And even if people see me individually, the couple-ness and family are in the room, so to speak, which helps keep me smaller, preferably the voice of reason.

With kids I try to see where they're putting me, which box, and more importantly, where I'm putting them, which box, and to keep myself straight, I ask as many questions as possible, not about me, but about people like me, in my age group, that they have contact with outside of therapy.

It's way too big a topic to tackle in a comment, but if you give me more precise situations then maybe we can flesh this one out in a bigger post. Thanks for bringing it up.

Erin Merryn said...

Nice blog! I just stumbled upon it and like what you have to say.

From a fellow social worker who just joined the field.

Erin

Cheryl said...

I was meaning to reply to this earlier but I went to (of all places) Chicago. I find it particularly interesting that you mention you WILL go to weddings. I took a class once taught by a full time shrink (part time prof) who said she would NOT go to weddings. She also said if a client asks a direct question and the therapist answers it that this is ALWAYS countertransference. And I'm talking about if I like had an issue w/someone and I asked you if it was better if I called the person or emailed them in order to hash it out. Where is the countertransference in answering that? But now I'm going off on a tangent.

I find it very uncomfortable that my shrink knows quite A LOT about me and I know NOTHING really about her after 2 years. I don't want any tidbits that are deep dark and personal from her, but other past shrinks have shared SOMETHING when appropriate to the conversation. I find nothing wrong with that. FINALLY though (I think it might have something to do w/a blog post I wrote & had her read) I found out she's origionally from rochester, NY and you know what? That was enough. That'll satisfy me for the next few months. Not to mention I'd been trying to place her accent this whole time and I have no idea why I was getting so hung up on that, but I was. There I go off on a tangent again.

What I find most interesting is where each individual shrink draws his/her lines and I often want to ask them why they chose to draw theirs where they did. My mom's DID just come to her wedding 4 weeks ago (must be why I have weddings on the brain). I think knowing this would help me so much in being able to develop my own boundaries after things are calmer in my life and I go to SW school. I've never had the guts to ask anyone though. I feel like it might come off as if I'm attacking their personal choice.

It's hard, I feel, having "issues" and wanting to help other's w/theirs. I said once in a post of mine how much I think I'll want to tell clients I'm bipolar, be very upfront, but that after I'd thought about it, I'd never want my shrink to tell me if s/he was. I'd be too worried about their ability to do their job, whereas if I never knew... but therapists w/their own issues is yet another post entirely. I've sure given you alot to think about TD, haven't I?

therapydoc said...

Marvelous.

When I say I go to weddings, it means the ceremony, or pre-ceremony reception. Unless there's a good reason to stay for dinner, I'm usually out of there after they tie the knot.

Sometimes the reason to stay for dinner, however, is that the family needs to know I'm there, crazy as that may sound, in case something untoward within the family system pops up. It can.

In general it's my feeling that professionals take themselves way more seriously than they have to. We can be people, not uni-dimensional systems of protoplasm that nod and fall asleep half the time because we're not "required" to be alert enough to answer questions with anything other than, "WELL, WHAT DO YOU THINK?"

As a psychoeducational doc, the reigns for me are knowing when to be psychoeducational, comforing, and confrontational, or quiet. So your professor who says, If you're answering a question, you're responding to your conter-transference is right on the money. Unless you have thought about your answer and know that what you say, will indeed be helpful, or psycho-educational, why say it?

For me, that rule, the one about zipping it for people we call "patients" is the same I use when speaking to everyone else, too.

Except for the jokes, which a person like me has to keep a lid on, obviously. But that's for another post.

Cheryl said...

Yes, "What do YOU think..." It drives me absolutely BONKERS. Needless to say when I went into my shrink for the 1st time that's the only thing I asked of her, if she'd actually answer a ? w/an ANSWER. Somehow I managed to stumble upon someone who almost thinks it's as stupid as I do. It's kind of hard to get as annoyed at that as I do... I got into a full out arguement w/that prof that day right in the middle of class.

therapydoc said...

And nothing to show for it, either :(

Thanks, Cheryl

San Diego Therapist said...

This is so true.