How Would a Friendship with Your Therapist Work?

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The fantasy of having a closer relationship with one’s therapist occupies the mental space devoted to imaginary things. It must, because few counselors permit such a connection. Professional ethics generally prohibit the dual role of therapist/friend and therapist/lover. Yet, there is value in fleshing-out what this double-bond would look like in practice.

Responses to my recent post, Being Excluded From Your Therapist’s Life, suggest the fantasy dies hard. What follows is an effort to describe how the relationship would function if brought to life — the day-to-day lives of a shrink and his patient. I invite you, dear reader, to think along with me. Let me know if my concerns are off-base. Even more, once you finish reviewing my ideas, I’d love to read your own notion of how to create the connection some of you want with your therapist: an outline better than the current prohibitive model you say is frustrating.

I will use myself as an example. First, were I to lower therapeutic barriers, I’d accept only unsolicited volunteers for friendship. No direct invitation would be addressed to patients. I’d then need to consider who I’d enjoy having as a friend from among those who expressed an interest. Let’s assume three people both want this and seem a good fit for me. Any number I might choose would be arbitrary. Pick a different one if you like. Remember, however, the bigger the numeral, the harder it will be for this system to work.

FIRST PROBLEM: Even without an announcement, I assume some folks would become aware of my possible willingness to pass time with them informally. This might happen by word of mouth, within a written statement of clinic policies given to patients beginning treatment, or due to a general change in the ethical guidelines applying to all clinical psychologists.

A therapist is human. He finds some people more compatible than others. This doesn’t mean the potential chums are better than anyone else, only that they possess the kind of personal qualities the doctor enjoys socially. Unfortunately, “no” would be the message delivered to some people. Imagine how those “blackballed” might be affected, including the negative impact on the therapeutic alliance. In effect, my partial openness to friendship necessarily establishes a three-tiered clientele:

a. Those clients who do not request friendship.
b. Patients who become friends.
c. The unfortunates who get rejected.

Might some occupants of the lowest tier infer I offer them professional services only to make a buck, since I don’t want to socialize? While not true, any alternative explanation sounds hollow, at least to me.

SECOND PROBLEM: How might I differentiate between time spent as a therapist and hours passed as a pal? That is, what if a client with me at Starbucks begins to talk about personal problems? How should I respond? I’d need to choose among three roles:

a. A sympathetic friend.
b. A therapist doing an unscheduled session out of the office.
c. A doctor who thought he was off-duty.

If I react as the doctor I must then remind my coffee-partner I am not at work. Indeed, I might emphasize that we are having a non-therapeutic relationship at his request. What do I do, however, if my friend ignores the boundary or gets emotionally overwhelmed in the restaurant? In addition, how do I deal with the question of a fee for my service if I find myself doing lots of therapy outside the office?

THIRD PROBLEM: I am the proud owner of a good social life, as complete as I’d like it to be. In our example, it has suddenly been enlarged by three people. My downtime instantly becomes “jammed-up.” My freedom to enjoy family and personal connections already present, many of long-standing, is now reduced. Disappointments among both chums and loved ones are inevitable. This will be predictably stressful. How do I choose which relationships to honor? Would arguments or resentments follow? Would some of my patient/friends experience surprise or worse when their expected access to me is less than they dreamed? Might this add to the history of rejection that triggered at least a few of them to enter counseling in the first place?

FOURTH PROBLEM: As noted in “Problem Three,” the abrogation of my former ethical restrictions leaves me trying to find time to do what I want, including contact with children, spouse, old buddies and recent dual role chums. Perhaps you’d advise me to limit new patient/friends from the start by saying to volunteers, “Yes, I’m open to being your friend, but I can’t because I just don’t have the time.” I doubt this would satisfy them forever and might seem phony.

Remember, too, I am introverted by nature. Were I to add the three newbies and try to keep the rest of my social network unchanged, I imagine draining myself. Might I become resentful about this? If so, would anger and fatigue intrude on all my relationships, as well as diminishing my competence as a psychologist? The answer would be “yes” to both questions.

FIFTH PROBLEM: Let’s assume the new ethical guidelines still prohibit sex, broadly defined. In other words, kissing, fondling, and everything more. Further imagine I have a fulfilling marriage (which I do). Now, however, I am spending time as the “friend” of a woman (or women) I find attractive. Age is not important, type is not important, whether you’d be attracted to them is not important. The only consideration of consequence is my susceptibility to the allure of such a person or persons. Yes, perhaps I could screen out those whose magnetism I felt from the start, but this wouldn’t prevent attraction from developing in the course of the friendship. Nor do I assume that both of us would experience the same beguilement, but I’m expecting sometimes we would.

You all know nothing stops two people who begin a relationship (casual, professional, or otherwise) from becoming sexually intimate down the line. All of us are the offspring of ancestors who had intercourse. Lots of it. We are built to reproduce. Oscar Wilde put it best, “I can resist anything except temptation.” Under my new rules, however, I’d have to do just that. Had I maintained the previous metaphorical moat between myself and my patients, those ethical principles would have helped in cementing this boundary. Avoiding temptation is far easier than resisting it. Our hypothetical scenario puts me pretty much on my own, doing enjoyable activities — as one does with platonic companions — a few of whom happen to be “hot.” The slope is slippery and my skis are on. If I begin this downward adventure I will destroy my patient, my family, and myself.

SIXTH PROBLEM: The decision to permit friendships with clients rests on an implicit assumption: I have something to offer as a friend no one else can provide. This is absurd. No practitioner I know, including myself, is unique in his capacity for understanding, affection, loyalty, wit, and all the other qualities present in a good chum. It only seems so to the client.

Moreover, by becoming the buddy of the person to whom you are ministering, you reduce his incentive to develop healthy connections outside of the office and to take the risks necessary to do so. Stealing the initiative of the people you serve harms them.

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By now you’re either on board with my concerns, believe I’m unnecessarily worried, or think I’m just plain wrong. What I hope I’ve done, however, is to make it clear that an extra-therapeutic relationship with a mental health professional can’t measure up to an imaginary nirvana. It holds enormous risk for the parties in the consulting room and dares causing permanent damage to each of them, as well as to others. By giving in to a client’s idealized dream of having MORE time and tenderness, the chances are increased of making a nightmare of complexity and disappointment for patient and doctor alike.

I know I have not dealt adequately with the depth of heartache experienced by those who suffer unrequited affection for their therapist; or perhaps I should say “unrequited access” instead. I can do no better than refer you to a wonderful, but exquisitely painful post written by such a person. Indeed, her blog is called Life in a Bind — BPD and Me, the first four words of which serve as a stand-in for both her topic and mine, examined from different perspectives.

You might not like the rules I chose to live by when I practiced, the same rules about which the American Psychological Association gave me no choice. Those ethical guidelines simplified my life and benefited my patients. They permitted me to focus on the most important responsibility my career demanded: helping people. Yes, they limited me and limited those on the other side of the therapeutic moat. We — both of us — needed some boundaries.

Perhaps it is too much to call the doctor’s office a “sacred space.” Yet, the external regulations enforced on patient and therapist are designed to protect each from the other; and, to safeguard each party from the injury he might do to himself if the barriers were lowered. As a therapist, you are therefore unable to assist people in the fulfillment of their dreams about you. As compensation, you have a chance to guide them safely to a healing place. We cannot permit you everything, but in our prohibitions perhaps we can enable you to find everything elsewhere.

In the end, if you don’t like the obstacles erected by all responsible therapists, I invite you to describe a more perfect system. Ideally you will design a new set of ethical principles superior to those psychologists use, less fraught with the problems I’ve described and others just as bad.

Good luck to you. I look forward to reading anything you fashion.

The first photo is called Joy in Arm Wresting by Bernd Schwabe. The second picture is Two Interlocking Braided Hands by M. Koenitzer. Both are sourced from Wikimedia Commons.

 

84 thoughts on “How Would a Friendship with Your Therapist Work?

  1. Reblogged this on Tales of a Boundary Ninja and commented:
    If you’ve ever wondered why you can’t be friends (or more) with your therapist, I refer you to this excellent explanation by Dr. Stein.

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    • Thank you for the compliment!

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      • It was well deserved! 🙂 I just had a major breakthrough in therapy, getting to a memory I have been trying to approach for many, many years. The trigger to accessing it was the deprivation inherent in the therapeutic relationship but the means was the deep trust and intimacy that occur within the boundaries. They are vitally important. Sometimes blindingly painful, but still so necessary. I love that you have laid out the complications so clearly. There is comfort in understanding how this works. ~ AG

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      • First: “Brava” on your breakthrough! Second, I’m very pleased anything I have done has provided you with comfort. Keep up your own good work in therapy.

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  2. I really liked Robert, my therapist, but there was no way that I would consider having him and his wife over for dinner, heading out for a drink, coffee, etc., let alone entering a friendship with him. If he suggested it, I’d be telling him no thanks.

    Rebecca my first and most current therapist is beautiful and arousing (to a flaw), but having romantic or even sexual is so far from my thought. It actually sickens me to consider. Perhaps I am crazy? 😉

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    • Not at all, Will. That said, the Freudians might wonder if you are being open enough within the therapeutic process. A cognitive behavior therapist probably wouldn’t be troubled by your report, unless he detected some resistance.

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      • I am always resisting what I don’t like. If I sense danger, I am prepared to make a hasty exit. If I have no option, I am ready to take defensive measures. See? Openness! My therapist knows this already. Robert, the one I did get help from, saw the defense with extreme clarity.

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      • Self awareness, Will. Always precious and always in short supply for every one of us.

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      • I wish that I possessed less self awareness. For some reason, it seems that there is bliss amongst the ignorance.

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      • Indeed. I wish I could think of the name, but at least one famous person has said that in order to truly happy you have to be a bit stupid.

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  3. There is an organisation here where its the therapeutic model to be a “friend/support” outside of therapy. It was the best thing to happen to me. Its personal to the therapist offering it and not something you can blanket rule with “not good”.

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    • I’d be very interested to find out the name of the organization. In particular, if you have the URL for this group, I’d be grateful to receive it from you. I would like to read a description of what they do and the rationale for their model. If it is as good as you say, I suspect other readers of your comment would be interested, as well.

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      • Its not something I will share publically due to the fact it will give my location away ! Email me if you want to chat about it though. I can understand the interest

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      • Thanks. I have emailed you.

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      • I’d be interested in this group as well, as my approach to therapy is more of a coaching role. Therefore my patients with ADHD can tell me what’s happened as its happening, and not have to rely on fault executive functions to recall days or weeks later. All of this is documented; however, I’ve received some criticisms from older therapists. I’d love to have a reference point from which to work from and possibly research, as saying ‘I just see it working well for my patients’ isn’t a very strong argument.

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      • Thanks for your two, slightly different comments. As noted previously, “Bourbon” is the source if the information about this group. I still don’t have it. Best wishes.

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      • I would be interested in knowing about this community, as my style is more Coaching than Therapist with my ADHD patients. It’s helpful for them to let me know what’s happened and their feelings as its happening, rather than rely on faulty working memory systems and executive functions. I’ve caught some flak for this from older practitioners, and I’d like to have more than ‘it works for my patients’ in my bag of responses. If you could post this group, I’d really appreciate it!

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      • Can you please give me this information too? What is the best way to connect?

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      • As I indicated earlier in this thread, the individual with the information has declined to provide it.

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  4. I said once before on your blog that I don’t seem to have these feelings/thoughts towards my Therapist. Of course, I do question my reluctance to form connections, so I’m not altogether sure if my approach is a good thing. When I was reading your post, I couldn’t help but think I might not like the Therapist if I got to know him on a more personal level and the guidelines you guys are bound to, gives me more security than frustration. Another excellent post!

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    • Thank you, Cat. Yes, I think you are right. We can’t possibly measure up because, as much as we can sometimes do for 45 or 50 minutes in our office, we can’t do full time outside the office. Anyone we treat sees, I hope, a real slice of us, but only in a very particular role. Indeed, the ethical guidelines are designed to help you feel the security you describe. They were created to assist in treatment, not to help anyone find a friend or lover in the doctor’s office.

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  5. Interesting post.. My first therapist, I really wished to be friends with her but in hindsight I realised that it was (at the time) an unconscious wish for a mother figure. In reality, her being a lot older than me and our lives not having that much in common would have meant it was unlikely an organic friendship would have developed had we met outside of the therapy room. My wish for her to be my friend was me wanting more of the caring that she gave me in that hour a week. Now, I do still wish for my therapists to somehow magically be in my life at the end of therapy but not during. I recognise that this has something to do with the fear of endings and loss. Hopefully that will resolve itself as my therapy progresses. We’ll see.

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    • Thank you and good luck with your therapy. Yes, the “transference” of feelings from someone in one’s life outside (often a parental figure) is part of what Freud expected to play out on the (relatively) blank screen he advised psychoanalysts to provide to their patients. If the shrink becomes a real-life part of the patient’s life, Dr. F. believed it would interfere with “working through” the patient’s unresolved emotions concerning that person. You probably have heard or read this before, but I’m including a bit of explanation here for anyone who might not be aware of this. Thanks again for commenting.

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      • I have thought about wanting to continue my relationship with my therapist as a mentor after therapy ends. Which I hope isn’t for a few years. We have some significant overlapping professional interests in social activism, He has more experience and I’m excited about the things we could accomplish. Is a mentor role out of the question? I will easily admit that I also like him as a person from what I know, and I respect his love for his wife and children. It’s one of the reasons I trust him. I have also had some fantasies about him based on our work on my sexual abuse by male relatives when I was a little girl. I told him about them so that we (or I) could get passed it and he was very professional and firm in his response. I didn’t proposition him, I just told him about the thoughts and that I knew it was not a good idea so how do I get over it. I was going through an acute crisis situation at the time. Soooo Is it possible to have a more semi professional relationship sometime after therapy ends?

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      • This is a tough one, Patricia. I’ve written several posts on the question of friendship with therapists and you are free to search for them. Here is a link to one that deals specifically with a relationship that occurs after therapy has ended. This hasn’t pleased everyone who reads it, but it is the position I found best. I hope this helps.: https://drgeraldstein.wordpress.com/2014/07/27/friendships-with-ex-patients-why-i-say-no/

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  6. Since I am neither therapist nor client, I have simply been watching these two threads with detached interest. However, I had an interesting revelation this morning. My best friend is a well regarded MFT with a busy private practice. I met her 15 years ago through professional connections and we have laughed and cried our way through an assortment of life’s challenges and adventures. I am sure that she has pulled out her therapist hat in conversations with me much as I have been the best listener and confidante that I can be with her. The thing is, had I been in search of a therapist 15 years ago, I would have certainly explored working with her. I imagine, given how well we connect as friends, that it would have been a valuable therapist/client connection. I then would have known her in that therapist role (which would have been valuable) but I would never have had the whole wonderful friendship that we have developed.
    I guess it speaks to the second problem that you referenced above. She has never been my therapist but there have been times when she helped me get through some dark moments. Therapist? Friend? No question to me really – friend trumps therapist. And , for me, an interesting nod to the notion that sometimes life gives us what we need.

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  7. Your past several posts have been incredibly helpful. I recently returned to my therapist after a break of several years. Upon returning I experienced some strong emotions which were hard to sort out. I wasn’t craving a friendship in which we would hang out but maybe more contact than the 50 minute appointment and possibly conversations that were not quite so one sided. Your posts offer perspectives that would have never occurred to me and give me peace and confidence in the therapeutic relationship and process. Finding your blog could not have come at a better time for me. I look forward to your future posts and the amazing insight you provide from a therapist’s perspective.

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  8. Thank you for another incredibly helpful post 🙂 And thank you immensely for your very kind words and reference to my own 🙂 It’s a privilege to share thoughts, ideas, comments with you – to have your words as inspiration and your feedback as support and building up. There is absolutely nothing I can offer by way of a more perfect system – I only wish I could! There is nothing I can argue with or dispute – unfortunately, it all makes perfect sense and I can absolutely see how all of those reasons contribute to what are very sound ethical guidelines, of benefit to all parties. But as one of your readers commented on your previous post, it’s the age-old difficulty of turning that head-knowledge into heart-knowledge so that it actually affects how we feel….

    I think the only thing I would add, is the whole idea of ‘uniqueness’. That desire so many of us have, that manifests in so many different and sometimes strange ways (even to the extent of ” I believe my therapist cares about her clients, but uniquely, not for me”! – thankfully not a belief I subscribe to any more…). However, it’s an enduring fantasy though of course at heart we know it cannot be true – how much we hope to be our therapist’s more interesting, more enjoyable client. The one they most enjoy spending time with. They one they would _really_ like to be friends with, if they could. The one for whom an exception is made, so that the therapist is not swamped with client-friends, but just has one or two. However, that notion is either completely unrealistic (if it were ‘allowed’ why on earth should the therapist choose only a single client with whom to be friends) or very worrying. Even with my intense desire for ‘more’, the idea of my therapist breaking boundaries and doing ‘the wrong thing’ sends out massive danger signals and freaks me out. I would love for her to feel it was within the ethical boundaries of therapy to give me a hug, and for many practitioners (though mostly outside the UK I think), it might be. However, I wouldn’t want a hug at the expense of her conscience, her integrity, or my ‘safety’.

    I’ve just re-read your post (for the third time!) and a few more thoughts struck me…with regard to reason 6, I think that perhaps what the client is also assuming, is that they will have a unique combination of ‘therapist-friend’ and not just a friend who is a therapist, or vice-versa. Although the client may recognise that others can be understanding, or witty, or have the most wonderful laugh, perhaps they assume that the therapist will have those qualities while also maintaining the ‘therapist’ aspects of him/herself at all times. Which of course is unrealistic. As mentioned in your previous post, therapists give their clients a unique kind of attention and attentiveness during session- perhaps the client is hoping for something just like that, at all times, in combination with those other qualities of friendship? And yet, as you also mentioned in that post, the therapist does not, cannot, always wear his or her halo or indeed maintain that level of ‘perfect attention’, and so perhaps what the client _actually_ wants, is based on an illusion.

    I find your ‘problem 5 ‘ extremely interesting – I think because I have a lot of sympathy with it and yet I think it flies in the face, in some ways, of many people’s way of thinking. My comments here are based on my own experience, and not any assumptions at all about your own – I think the slippery slope is easy to underestimate if you haven’t been there, or seen exactly where it leads. I think it’s easy to assume we all have a right to friendship with either sex, attraction or not, because we *should* have the necessary moral restraint and we should expect to be trusted and to trust others. But I think there is also such a thing as a need (or even duty, if that is not putting it too strongly) to protect a relationship that one is in, and occasionally, that may involve giving up what seems like an obvious ‘right’ to a friendship. If a friendship threatens my marriage, perhaps I need to do without it – but unfortunately, the seriousness of that threat is often not apparent until it is too late to avoid. Having said all of that, we all (at least strive to) know ourselves, and our own susceptibility, particularly in this area. I know that, at least partly if not largely due to my diagnosis, I am extremely vulnerable in this area – my need for caring, understanding, merging, can, if I’m in the right (or rather ‘wrong’) situation, completely take over anything else and leave me literally powerless. Which is not an excuse, of course, but is something for me to be very much aware of. So I guess all I’m saying is that I found your viewpoint and acceptance of the this slippery slope and statement about ‘nothing stopping two people…’, very interesting indeed….

    Apologies, ramble now over! 🙂

    Many many thanks again for another excellent excellent post 🙂

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    • No apologies. I love to read what you write. In fact, I have meant to communicate that before now. It seems as though you are able to generate a large number of beautifully crafted, properly arranged, and flowing thoughts in a short time. Quite a gift. I, too, have benefited from our “conversation” and only came up with the idea of this post, I think, because of it. I believe you are also right about the “therapist-friend” combo and enormously wise with respect to Problem #5 and the sexual possibilities in relationships. I’ve heard so many people tell me how they weren’t initially attracted and were surprised by what developed (especially women), some of whom even “gave in” to a relentless approach by a man because they felt sorry for him! I heard very religious, upstanding people describe what happened when they had a congenial working relationship with someone they found attractive. What “should be” often overestimates what we, as fragile humans, are capable of. Another very bright friend used to say he thought people who couldn’t withstand sexual temptation were “weak.” I have a more forgiving view, having observed people succumb who never intended an extra-marital affair to occur. In my own practice, I had (as virtually all therapists do) some pretty frank “come-ons.” One from a woman who began to describe how she would please me, another who brought an assortment of condoms to a session, a few who dressed to arouse in an obvious way, etc. I never came close to giving in to such enticements, but I’m glad the ethical guidelines made it easier. Again, if I haven’t made it clear, I enjoy our very distant (literally) connection.

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      • Thank you so very much – your words mean a great deal to me, and I am so thankful that you have taken the time to pass them on, and to make things clear (without something being stated explicitly I often find it very hard to believe or remember – something I sense you probably realise about me). I am grateful for your words about my writing but much more grateful for your words about enjoying reading my posts, and enjoying our interactions. Those words have a special place for me, particularly because in my therapy I have come to realise how much I have missed out on, and continue to miss, that sense of being enjoyed or of bringing pleasure in some way, whether that is a child just being herself, as an adult-to-adult companion, or in any other of the many ways in which people can bring joy to each other. Needless to say, I very much enjoy our ‘literally distant’ connection as well! Speaking of which, if you ever find yourself in the UK, and happen to be passing, it would be an honour to be able to shrink the distance – you seem to mention Starbucks in your posts a few times, and I would offer to buy you a coffee but I have no idea where that suggestion stands in the realm of the ethics of blogging ex-therapist, client-in-other-therapy interactions!

        On a separate point, I completely agree (sadly, through having seen it in myself), that withstanding temptation is far from easy – I think I have come to believe that one of the biggest risks for falling into temptation is believing that one is immune or that it simply takes strength to withstand it. We are _all_ susceptible, I think, to many things, given the right set of circumstances or emotions. And those circumstances or emotions are not always ‘negative’ – I have recently come to realise that some of my moments of temptation occurred when I was feeling otherwise happy, but my inability to bear a break in contact very well and to be alone, makes me vulnerable during those times. I feel very fortunate for being in a life situation at present, where temptations are few – because I know how absolutely rock-bottom my ability to withstand that temptation would be. I am glad and not surprised either that you resisted enticements from clients, or that you received those enticements in the first place! And I apologise if that is somewhat cheeky, that was not my intention 🙂

        I love to be honest, but also have an absolute fear of over-stepping boundaries and of saying or doing the wrong thing. I’m conscious that I have been a bit effusive in my words, and I hope that if at any time I don’t navigate this tricky realm of human interaction in a ‘proper’ manner, as far as you’re concerned, that you would set me straight, either by comment or by email! I think I better end there before I get myself completely tied up in knots. Sigh – self-awareness is one thing, but over-thinking and over-analysing is another!

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      • Yes, when we think ourselves above it all, the distance for a fall and the ease of that fall, are all the greater. As to a cup of coffee, since I’m not your therapist and never was, there is not a restriction, and I’m sure it would be fun. No ethics issues, so long as I don’t intrude on your therapist’s domain. There is a terrible irony here, since I wouldn’t and haven’t agreed to this with my own ex-patients. In any case, for now it is hypothetical, since I have no trips to England planned at the moment. Something to look forward to, though. Be well.

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      • I did notice the irony and it gave me pause for thought and made me wonder whether indeed to be so bold! It is indeed both a hypothetical and a fun notion and your response, should the opportunity ever arise, is much appreciated….!

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      • I meant it. And, I should mention one other factor that would reduce the irony: the physical distance (Chicago vs. UK) make it almost certainly a “one off.” We would necessarily both enter it without the expectation of ongoing, face-to-face meetings.

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  9. I understand boundaries protect all parties involved, yet transference has evoked Intense feelings of rejection. As therapy progresses, my desire for friendship lessens since I’ve divulged more embarrassing details. I feel vulnerability & shame that would not survive a friendship. However, as I wrote in a previous post, I wish my very thoughtful, kind, amazing psychologist would have said something similar what I titled the “Sweetest Rejection”:
    “”If we had met any other way or if it were possible to be friends without it being a conflict of interest, I could see us becoming friends. I really like your personality & think I may have enjoyed hanging out with you. In order to make sure I provide therapy in your best interest, it would be unethical & unprofessional for me to maintain a dual relationship with you or any patient of mine.”

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    • The “Sweetest Rejection” is a fine and proper way of setting the limit. I’m glad you wrote it here, since I know some therapists read my blog. Perhaps, along with your own writing, you will influence a few practitioners to improve their practice.

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    • My therapist actually shared something very similar to “the sweetest rejection” with me and I believe her. It was brutal to hear but also helpful.

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  10. I would never want a friendship with my therapist. I know for certain I am no near her league. It wouldn’t be any fun because I would have so many anxiety around it. I do though fantasize about being employed by her after she retires. I do general lawncare jobs as a side occupation and thought as she is getting older she might want to hire this job out. Is it ethical after a therapist has been retired for awhile, to have some form of marginal contact with a former client? Again, no friendship but employed.

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  11. Wow.  So, I was going to say that I fell down the blog rabbit hole to find this… but I guess when you blog about therapy as often as I have, and follow / are followed by a number of other blogs which also do so, it’s not surprising I stumbled across this.

    I’m not usually short on words, but when I am it’s generally because something resonates deeply with me.  A blog I read re-posted the “Life in a Bind” post, which led me to this and your “reasons” post.

    Ok, so I guess it wasn’t *that far* down the rabbit hole.

    Anyway, I want to have something profound to comment here… but I’m really struggling to get past the word, “Wow.”  Very well written, and I really appreciated both of those posts.

    Heh, it’s made me want to share your blog with my own therapist, who I have definitely experienced a wide spectrum of emotions at… and, of course, I’ve tried just about everything I can think of to poke holes in his blank screen (unsuccessfully).

    Thank you for sharing. 🙂
    ~Dee

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  12. […] Being Excluded From Your Therapist’s Life: Reasons You Haven’t Heard Before, and How would a Friendship with Your Therapist Work? both from a wise retired therapist, Dr. Stein, and finally, this post (of a similar title to the […]

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    • Thank you for linking to my posts. I thought the essay in which they were included had the gift of lightness, something most of us writing about therapy are usually a bit short on.

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  13. Unfortunately for me, the problem is that when I started therapy, I had no idea what I was letting myself in for. I had no idea that I would form an attachment to my therapist. I certainly had no idea of the immense pain that this would cause me. I wonder now; armed with this knowledge, would I undertake such a relationship again? It is difficult to say. I am where I am. But that doesn’t make it hurt any less.

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    • A great shame, Lorraine. These days therapists are more likely to make disclosures and, depending on their particular discipline and ethics guidelines, may be required to. I hope there was something of value to the treatment, but, as you say, the hurt remains. All the best to you.

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      • Thank you for your kind words. Yes, the therapy has been very beneficial in lots of ways, but it has been a bit of a shock and not at all what I expected. I don’t think my therapist expected it to take the direction it has either, so couldn’t have prepared me for it in one sense. I think I wish I’d had a better understanding of what therapy in general could be like before I started- so it might have been less of a shock. Thanks for your great blog posts.

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      • My pleasure, Lorraine. Thanks for reading my work!

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  14. This is such an elegantly written and insightful post ( as always , Dr S) and the discussion is so very helpful . Therapy is so wonderfully healing l and heartbreaking at the same time. Thanks again for a masterpiece of wisdom.
    Jill

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    • You are too kind! “Kind” was a word my mother used to play with. As she put it, “People say I’m kind, but what I want to know is, what kind?” Seriously, thank you.

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  15. Reblogged this on Life in a Bind – BPD and me and commented:
    Another very interesting post by Dr Stein, using a ‘thought-experiment’ to elicit the difficulties inherent in the notion of friendship between therapist and client. This follows on from both Dr Stein’s original post on the reasons behind clients’ ‘exclusion’ from their therapists’ lives, and from my own post on how that feels, from the patient’s perspective.

    As with Dr Stein’s other posts, I believe his points are very well-made and hard to argue with, and are put forward both carefully and compassionately. In common with many, I think, the challenge for me is to somehow turn this intellectual knowledge and acceptance of ‘how things must be’ into an emotional understanding and acceptance. It will come, with much work and with digging deep; but in the meantime, every time, as clients, we come face to face with feeling excluded and ‘bump up’ against the boundaries of therapy, we have an opportunity to talk about how it feels, to discover the origin of those feelings, and to start to heal from them. It’s all ‘grist for the therapy mill’, as a friend of mine would say….!

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  16. I really appreciate these two blogs you wrote. I have been in therapy for 21/2yrs to try to resolve my childhood trauma and am very attached to my therapist and it is very painful at times but i am in agreement with the boundaries and the protection they provide. I resolved with myself in the beginning that no matter what i was going through that I wouldn’t try to increase my once a week sessions and limited outside contact to one email a month if needed. its been very difficult to stick to this, but i have and it has helped me immensely to build up resilience and to maintain a life and relationships outside of therapy. When i do have my moments of wondering what he is thinking and if he cares about me i look up blogs and sites like yours because i dont think he can be much different from anyone else. And it really helps reading what other therapists think and feel through their blogs, I can see that my therapist probably feels the same way to. And by reading from other therapists who are willing to discuss these difficult and painful issues for clients, I can and have maintained the boundaries and got stronger and appreciate the immense help that i get from my 55mins a week from an incredibly skilled and compasssionate therapist. So thank you Gerald for your contributions it helps me get through to my next appointment.

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    • drgeraldstein

      You are welcome, Claire. Your comment points to a crucial quality within the patient: strength of will. Indeed, your words have prompted me to write something about that. Thanks.

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    • Well, my feelings for and about my therapist along with how close I’d like us to be, and what that would entail in real life really span a great if territory. I’ve been in long term therapy for CPTSD, and we are almost done, except he has said I can return whenever I feel a need to do so. The many varied feelings I have felt, including varied degrees of intensity were painfully very real, sometimes scary, sometimes embarrassing, and sometimes healing. Some were the best feelings I’ve ever had. Others were the worst. We have traveled a long journey from childhood trauma to the here and now. A part of me hated my therapist, a part was fearful of him, and the inner child part fell in love with him because he protected her, was there for her, and understood her, and saw her behind the wall where she was hiding. He was not afraid of her fear, and he understood her shame. I have loved him, hated him, ran away from him, moved towards and away from him, wanted to merge with him, wanted to have nothing to do with him, and wanted to go home with him. What amazes me are the intensity of some of these feelings. His boundaries are in tact, but pliable, and that in itself has helped me so much! He has hugged me, I have leaned on his shoulder and cried, he has held my hand when praying. I have been totally upfront with him about all of my feelings, except in the beginning of therapy when I acted them out instead of talking about them. The hardest things to tell him were how I felt about him sometimes, things I wanted to do with him, and things that happened to me. At times I felt like crawling underneath the floor in his office. But what helped me so much was how he explained these feelings and how normal they were for me to have them. He helped to diffuse my shame.

      I guess now I know we can’t be friends, and I understand most of that at least in my head. The problem I have is that my little girl wants him to be her father, and she wants to live with him. While the adult part of me knows this is not practical, and can never take place, she is in love with him. I am hoping before our therapy is over that these realizations will happen to the little girl, and she will know in her heart why things have to be this way, not just know them in her head.

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      • drgeraldstein

        Thank you for sharing as much as you have. I’m sure your words will enlighten many people.

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  17. My personal opinion is that if two people, regardless of how they met, who feel a real connection with each other then they should have the freedom to act on it. The thought of opening up to someone about my personal issues who would not even consider having “coffee” with me is demoralizing. It reduces my personal issues and the compassion and empathy shown by the therapist to a financial transaction. It objectifies both parties and is unethical. I have to wonder if the psychiatric community ever considered how their clients would feel.

    Liked by 1 person

    • I think I’ve said all I can say with respect to your concern. We do consider how patients feel, all the time. That said, one cannot have everything one wants in this world and I have tried to describe why there is a greater chance of a downside to the patient community generally than an upside. As to ethics, the mental health community, where it has put things in writing, is pretty clear on where it comes down.

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  18. Very well written!!! I ´m working with my therapist for almost a year and the idea to leave her one day is bothering me a lot. According to this thoughts I ´ve started to thinking how to be a friend with her cause our meetings are very friendly now and we are most of the time just chating during my appointments, i can say that i know few stories from her private life but i ´m not sure if the friendship after my therapy wouldn ´t change my oppinion on her as a person but still I want her to stay in my life in the future. Probably it ´s just a transference feeling and thanks to your blog I realized it.

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  19. I really appreciate your post. I fell so hard for my therapist but when I tried to talk about it he seemed evasive and anxious. Ended up terminating therapy abruptly and with no real closure. I was so upset and depressed over this apparent rejection that I became suicidal. Now I’m just drinking my feelings and I miss him so terribly. I’m trying to keep going but it’s hard.

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    • drgeraldstein

      You are welcome, Maria. I’m sorry to hear of your experience with your therapist. Time and your continued effort to grieve and move forward should help. Keep at it.

      Like

  20. Really appreciate your post!!! But I would like to ask you… My therapist is the only person who I thrust and I couldn ´t speak with anyone else, but I think I ´m bothering her a lot, just because i can call her in crisis or text her (son ´t mentioned that she is not answering from time to time)… How ever, is it normal during the therapy that the client has the feeling of being a friend with therapist but from the opposite side to bother the therapist?

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    • drgeraldstein

      You are welcome, Kate. I’m not sure I understand the last half of the last sentence. I would say, however, that feelings of affection for the therapist are quite normal. As to bothering her, much depends on what she considers a crisis, as well as what “too much” extra phone or text contact means to her. Only she can answer those questions. My answers are more general and not specific to her. Good luck with this and thanks for reading.

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  21. […] How Would a Friendship with Your Therapist Work? […]

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  22. I haven’t ever seen a counselor before. Then almost 2 years ago I got the courage to go and try. Lots of bed things have happened when I was younger and my mother was dying when I first went to counseloring.
    My couselor is the pretty much the only man who has ever been nice to me. I wish so much he could be my friend. I don’t have a lot of friends and I kinda thought maybe we are friends. Reading this, I guess we aren’t. More than just a friend I kinda wish he was my brother. It’s embearssing but I wish I could see him everyday. I can’t really describe how hard it was for me to even try counseloring. I almost wouldn’t go so many times. Then one day I just was able to finally talk to him. I kinda remember his face when I said, can I ask you a question. He practically leaped out of his chair and said really excited, yes! Everything! I felt dumb but it was funny. Now, it’s been almost 2 years. Lots has happened. My mother died from the cancer and just other things. I guess somehow my counselor went from being scary to being someone I don’t want to not have in my life anymore. I wish I could see him everyday. I don’t want to ever stop seeing him. He is the only person who cares about me. Unless he is pretending? Do counselors do that? Do they trick you? I don’t think he would do that. I was in a play and he came and saw me. Does that mean he is my friend? It meant so much to me that he came. I have no family really so in a weird way I pretended in my head he was my brother coming to see my play. I guess I’m wondering if he isn’t my friend, why does it seem like we are when I see him every week? I think I really love him but not in a gross way. He is married and has children. I cannot imagine doing anything like that with him. But sometimes I get nervous and scared at night. And I imagine him sitting next to me though. He is just sitting there and sometimes I imagine him touching my head. Again nothing gross or wrong. And it’s just my thinking anyway. It is embearresing but at the same time thinking about him makes me fee better. Is this ok to love him and wish he was my brother? Is there a small chance that maybe he loves me to just a little? Again, not in a bad way. But in a nice way. Let how he is when I come and see him.

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    • drgeraldstein

      You have shown great courage to be in counseling. There is nothing in what you are feeling that is “wrong.” It certainly sounds like your therapist has affection for you, too. The process of therapy often is one in which you process the kinds of feelings you are having in such a way that you gradually resolve the hurts that have contributed to being wary of people. Eventually, though you continue to have good feelings about your therapist, as you start to take risks with other people, you discover he (the counselor) isn’t the only person with whom you can have a good relationship. I imagine you are on the road to the point where good social contact and intimacy is possible for you outside of the doctor’s office. Keep up the good work! Best wishes.

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  23. Your post is interesting, but I find some of the problems you present not to be problems at all, and at times some of the statements you made feel as very patronizing of the client. Somehow it assumes that every client who wants a friendship with their therapist doesn’t know what they are getting into, or that inevitably something horrible will happen. Also, how can someone have a limited ability to add others to their life? Can a person have “enough” friends? What makes you think once friendship begins that new person is going to expect all the attention and expect the new friend to be all for them? Because only in that scenario I can see someone struggling to fit time for all their friends. Transference issues aside, you somehow left out the real possibility of a unique and genuine friendship between a therapist and a client. Yes, you might now say that every patient wants to be that special person. However, by your own admission not everyone would be interested, that would certainly exclude a good number of people. Then those who once they start a friendship realize is not what they wanted: isn’t that part of real life with the rest of the world? And maybe less than 1% would be represented by that someone who genuinely clicks with the therapist as a person, and respects them, and genuinely cares for them and is not after free therapy, nor is going to use every opportunity to overwhelm them with their problems, because a friendship is supposed to be reciprocated. Maybe they are both runners and can go share a run in the woods, or they both play tennis and meet at the municipal court for a game. I would understand it could harm the client if therapist created an unreal world for them. But why question that it could be a free and genuine choice? Are there other people out there? Sure. But the same can be said of any friend we have. We choose people with whom ideally we have some sort of connection. Ethical rules are not exclusive to psychotherapists. The rules clearly state that as long as the relationship doesn’t hinder the ability of the therapist to perform and it doesn’t harm the client a relationship outside of therapy is ok. Only the therapist can decide if their ability to perform is impacted, and if so, client would have to respect that. But client should also have a saying on whether they are or not being harmed.

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    • As I have indicated previously, the duty of a health care professional is always, “first do no harm.” Lots of possibilities exist outside of the therapist for someone to generate friendship. The APA ethics state the following: “A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.” All of us are safer — especially the client, who is in a weaker position by definition — if the complexity of an attempted friendship with a current or former patient is minimized. I won’t say such relationships couldn’t possibly work, only that the annals of counseling history are littered with failed attempts at this, sometimes with great injury to the patient. The client only gets the say as to the harm done to him when it has already happened, as you indicate in your last line. Unfortunately, no one can then unring the bell. “First due no harm” is the wisest guideline, even if it causes both parties to miss something that would have been nice. Thanks for our comment, Sali.

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  24. Been seeing my therapist for 2-1/2 years. It was apparent almost from the start that my therapist was mentally unbalanced. We became friends (strictly platonic) outside of the therapy room while I was still in therapy and the depths to her mental imbalances became more and more obvious as time went on, as displayed by her sometimes odd behavior as well as what she disclosed to me. There were some great, healing times, which is why I stayed so long. I grew to deeply care for this person. There were also so many things wrong with what was to be MY therapy, therapy I paid for, I could write a book. Basically, she exploited me — she used me for her own personal gain. She has been unethical in so many ways, looking back it blows my mind. Within the last couple of months, she has been gaslighting me. I finally found the strength and courage to leave her. I am confident in saying this older woman has no business being a therapist. It is not my desire to seek revenge or payback on this therapist but given what I know about her, she is going to continue to cause harm to other clients. Where can I go to find out if I can file a report against her, or take some sort of action against her?

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    • Thank you for this, Jessica. I’m sorry you had this experience. The courage you displayed is commendable. In answer to your question, there are two possible places, at least if you live in a place like Illinois. First, in Illinois there is a governmental department that licenses most therapists. Within that department there is a section to deal with ethical violations. The second place to look, assuming your ex-therapist belongs to a professional organization, you can file a complaint with them. For example, since I belong to the American Psychological Association, someone who wished to file a complaint could appeal to them. Good luck with this and be sure, before you get into it too far, that you learn not only what forms you might have to fill out, but also whether a personal appearance before an ethics board might be required of you. Best of luck.

      Like

  25. Josephine Bloggs

    Hi, Sorry to be re-opening an old post! I found your words to be helpful. I have always been aware of the guidelines around dual relationships and took them seriously (since I began training as an Occupational Therapist, I really understood why this was an issue).

    I have been in therapy now for 4 months. I have BPD and along with the issues which caused that, I am working through some pretty major engulfment/isolation fears (being afraid of being swamped by and/or swamping my therapist so keeping her at arm’s length while at the same time being terrified of being isolated from her). So far I have successfully managed to walk the middle line and neither become too close nor too isolated. My therapist said that this was actually very clever. Last week I handed her a letter and she said ‘I get the impression you want to get closer to me?’ I can’t recall my response, I was dissociating badly and in emotional turmoil. She is relational developmental/integrative therapist so uses a deep and meaningful relationship with me to ‘model’ relationships on the outside. The idea being I am supposed to treat her as I would treat anyone else so that the issues I have in relationships can be dealt with in a place of safety and support.

    I also have a real issue with object constancy with her. I see her on a Tuesday. Wednesday and Thursday I can hold onto how warm, caring, kind and lovely she is. By Monday, I am shutting down, overwhelmed by the feeling of there’s so much I want to share with her but I can’t. She becomes distant and aloof. I become isolated and alone, I shut down emotionally so on Tuesday the first thing she has to do is re-establish that connection and redress the imbalance in my perception of her.

    Later in the same session (last week), she said ‘you look hopeless?’ I nodded. She said that she wanted to reach me in that hopeless place. She said she had this vision of a marble and she wanted to roll it over to me. She asked me what I would do with it. Again, I don’t really know what I said. But this week I have been thinking I’d like to pick the marble up and put it in my pocket as a reminder of that perfect way she balanced my need for space and my need to connect with her. Just a tiny gesture, unintrusive but it meant so much and was far gentler than a hug.

    So now I have some questions. I came to this post because I googled ‘how close is too close to my therapist?’ (I’m not sure where the boundaries are, if my degree of affection, warmth and trust is bordering on unprofessional?) I don’t want her to be my friend, it’s not that… I just want to connect with her in a…professionally intimate manner…. is that OK? I cannot see her as I do my plumber or my GP but I recognise she’s not my friend. She exists in the middle. That’s where she should be, right?

    Would it be too much if I were to take some marbles in and ask her to pick one? So that for those times when I cannot hang on to the feeling that she cares about me, I have that physical reminder of what she said? I think I would need to actually take them to her and ask her to choose one, so that I felt it was OK, there was no secrecy in carrying around a marble with me. Also, it would show her what it meant to me, that I was trying to find ways of coping when she’s not around… is that OK? It’s not bordering on idealising her or being sycophantic is it? She has a BUSINESS twitter account with her picture on it which she allows clients to follow and my husband asked why I couldn’t just look at that… I said a) because it’s secretive, it feels wrong, like I’m stalking her (which is an issue for me since I have been stalked and harassed twice… anything bordering on googling or cyber stalking feels VERY dangerous to me) b) because it is not unique to our relationship… anyone can look at it so it is not as meaningful as taking a marble in. I bet she says this to most of her clients though… I bet the marble is not actually unique? She did say though before she said it ‘I don’t know why but I just had an image of a marble come into my head…’ so it didn’t sound rehearsed… I don’t know.

    Like a previous poster, I have issues with knowing if I am being a burden. My therapist does not have the issue of contact outside therapy in her contract. So rather than actually ASK about them (I’ve been in therapy on and off for 20 years, I know in the UK most therapists don’t do contact outside session) I needed to assume that the answer would be a ‘no’. We have discussed this (without ever actually directly asking or answering the implied question) and while I am getting closer to believing the answer would be ‘yes but with certain restrictions in place’ I still cannot quite get there. I’m not afraid of rejection, I’m afraid if she says ‘yes’ then I will become a burden, I will engulf her and cause her to reject me. So is my marble idea a good one? Is it a good and healthy way of coping with separation from her (when I will not allow myself to contact her)? Is it a sign of mutual affection which is appropriate or is it a sign that I want more than I should and I’m bordering on being a burden?

    I guess I have read too much on BPD. I have heard it said many times that therapists don’t really like working with Borderline clients, like ‘Life in a Bind’ says – I believe(d) that my therapist could care about all her other clients but not me, because I was the Borderline one. I was the dangerous one who would become a sycophantic stalker. I hate this. I never know what to believe – that feeling she gives me that she genuinely cares or all these other therapists online who state categorically that anyone with BPD is basically a horrible client, manipulative, draining and found of creatively breaking boundaries. I don’t want to be that way. I only want to have affection for someone who has affection for me, is that wrong?

    Thanks

    JJ

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    • You needn’t apologize for reading an old post, JJ. They remain available for just that purpose. The idea of transitional objects like a marble is an old idea and many therapists use it to help maintain the connection with patients. More broadly, you might know that the only empirically validated treatment for BPD is Marcia Linehan’s Dialectical Behavior Therapy, about which you can find out more here: http://www.linehaninstitute.org/ Having affection for a therapist is not at all unusual, but, as I’ve written about elsewhere on my blog, be careful of the extent to which you expect that affection to be equally reciprocated. The therapist must always maintain therapeutic boundaries and a therapeutic distance. Thanks for commenting and best of luck.

      Like

  26. This was a great read. I know it is a very old post, but it was such a wonderfully enlightening article, not just for engaging with a psychiatrist, but any doctor really.

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  27. the main issue in this scenario is that clients have a fantasy of who the therapist is, and that is not who the therapist is. Secondly, friendship implies a give and take, which is not the dynamic that we want in therapy. Also, i don’t agree with the piece about avoiding temptation. Temptation is part of life, and we all have to face it at some point.

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    • drgeraldstein

      Just to clarify, there is a give and take in therapy, but not of the kind identical to a friendship. With respect to temptation, my view is that unless one wishes to live in a locked room all one’s life, there will be plenty of temptation. If a person, in this case a therapist, enjoys the thrill of walking the high wire, or thinks he is impervious to all temptation, then all I can say is that I wish him luck. It only takes one fall from the tight-rope to damage your patient, create a trauma to your family, and end your career. I’ve seen too many good people succumb to temptation to recommend that others put themselves in harm’s way because they believe they won’t give in to it. Thanks for your comment, Lila. I enjoyed the conversation.

      Like

  28. I very much enjoyed reading your thoughts on this & found it interesting how difficult a situation this potentially is. I’d not looked at it through the eyes of the therapist, but only through my own selfish wants! I have had discussions with my T about never ever wanting to end therapy, but only because I could never imagine my life without him in it. We have talked about what the ‘friendship’ might look like & how it would work. Clearly from my point of view, it would be ‘perfect’ I would catch up with him maybe once a month for a coffee or a drink. He has asked me how I might feel outside our therapeutic space, with him knowing my inner thoughts, trauma & past? I told him that it wasn’t an issue. However, reading your post just brings to mind that not even my closest friends know so much about me & actually, would I not feel a little vulnerable?
    Mt T tells me that my feelings are purely transference & as time goes by & I heal further, I will not need to rely on him quite so much. (at this moment in time, I can’t imagine ever getting to that position) What I do find confusing is, I am a very loyal person & cherish the people I meet & like & those people become my friends. How can I not look at my T in the same way. I know he’s my T, but I can’t just ignore the amazing impact he has had on me & how my life has changed for the better because of him. I won’t just walk away & forget all about him.

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    • drgeraldstein

      Is the choice between forgetting about T or having a friendship? I imagine you will be thinking about what you might or might not want as time passes. Thanks for sharing your thoughts, Joanna. I am pleased you enjoyed it and thought about it.

      Like

  29. Thank you so much for responding. I perhaps didn’t make myself very clear, but my T has never suggested having a friendship outside of therapy, but we have had discussed it a few times (because I’ve brought it up) He has just allowed me to talk about it, I guess, appeasing my inner children? There is no choice for me to make (unfortunately) only, that I struggle with the concept of one day, never seeing him again. I think I wanted to run the idea past him! I think the ‘adult’ me knows it’s really not realistic, but my ‘little person’, my 9 year old desperately want it, or something, at least! My angry teenager couldn’t care less! I just can’t understand how I am supposed to ‘switch him off’.

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    • Perhaps the child and teen will grow and have less need for the friendship. In any case, your therapist is holding to a proper limit. I hope time makes all this easier for you, Joanna.

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