Finding friends as an adult can be strangely difficult. So if you really get in touch with someone, you can hope to connect to "I'll definitely write all my thoughts during the Big Little Lies " friendship. But … what if that person you feel connected to is your former therapist? In my time as a psychiatrist on a campus, more than a few patients have asked me if we can stay in touch regularly after we have ended our formal therapeutic relationship. I understand why. My job is to be a good listener who respects and empathizes with the person sitting opposite me. As a patient and therapist, we work hard for months, sometimes for years. We share deep conversations and maybe even a few laughs. Normally, I am also close to my patients because my preferred population is college and doctoral students. (Basically, I understand a lot of pop culture references from my patients, Big Little Lies and others.)
Even though I see after our sessions why some of my patients want to be friends, I would not allow it , and most of my colleagues do not either. Therefore, the prospect of making friends with your former therapist is so much more nuanced as "I like you, you like me, let's hang out."
There are no official guidelines for therapists.
You may wonder if your former therapist may be your friend at all, considering how strictly the field of mental health is ethical. The answer is technical yes, but generally not advisable. (To be fair, I'm not talking about sending an update to an old therapist from time to time.) Many former therapists greatly welcome these updates, including I. I'm talking about them friends friends truly sharing the ups and downs of life.)
The Psychology professional societies (the American Psychological Association (19459025)) and the Psychiatry (the American Psychiatric Association (the ) do not provide explicit rules on friendships with former patients Their instructions on "multiple" or "dual" relationships, as they are called, examine friendships with current patients (do not do it) as well as sexual relationships with current and former patients (again Don) do not do it).
Friendships with former patients are more of a gray area, so I made a few calls for clarification. Dual relationships are "not prohibited unless the client is harmed," said David Palmiter, Ph.D., a professor of psychology at Marywood University and Ph.D. Rebecca Brendel, MD, JD, Chair of the Ethics Committee of the American Psychiatric Association and Director of the Master of Bioethics program at Harvard Medical School, had a similar attitude. "While there is no hard and fast rule … it is important for a psychiatrist to think about anything that could be exploitable for past or current relationships," says Dr. Brendel opposite SELF. "It's not unethical that a relationship has more than one dimension, but the primary focus must always be on the patient's interest."
Okay, that's not expressly forbidden. So why can not you just do it? Job? Well, there is the great and unpleasant fact that the former relationship between patient and therapist is quite incompatible with the dynamics of a good, healthy friendship.
Therapeutic relationships are based on differences of power.
I asked colleagues for mental health professionals to share their thoughts about being friends with former patients, and wow, have they ever done it? The consensus? Most people who responded to my social media views said they would never consider it and instead follow the rule "once patient, always patient". That may be disappointing, but listen to us.
"Therapy has elements in common with friendship, such as positive consideration and the desire for the other person to feel good," said Aditi Ahlawat, Ph.D., a human resources psychologist at Washington University in St. Louis says SELF. "The customer and his well-being, however, are still the focus. In a therapeutic relationship there is a significant difference in power that is not a problem in organic friendship.
For the Therapy to Work you need to be so vulnerable that your therapist can research what makes you tick, usually on a much deeper level than a new friend. "We have the privilege to experience the most intimate details of other people's lives," says Erin Fulchiero, psychiatrist at Case Western Reserve University, to SELF. In the meantime, your therapist retains all his dark and twisted personal belongings, does not expect much more from you than payment, appears on time and is ready to work. You give them your soul and they react from a professional distance.
This is an inherently unbalanced power dynamic that, in most cases, does not easily translate into a balanced, healthy friendship – even after you & # 39; I've finished the therapy, even though you've only seen it a few times, even if you've seen it for something that seemed insignificant, or whatever the case may be, a sense of duty for you, about one thing typical friend goes out. "I would always feel obligated," says Anna Borisovskaya, MD, a psychiatrist at the University of Washington, SELF. "I would have to respond to any worrying status message on Facebook. I would have to worry if I did not call them often enough – they might consider that a rejection on different levels. "
If your former therapist were a friend, you could be grateful and admiring. Make it hard to stand up to them, refuse a favor they're asking, or weigh yourself in on Lives off.
The therapy should also have a beginning, a middle and an end] Of course this is generally the case. In most cases, however, the goal is to end the therapy so that the patient learns to process the loss in a healthy manner. Many patients start the treatment to cope with some kind of loss. If they properly end the therapeutic relationship, they can practice using the new skills they have learned to deal with new losses. Even if you are not in therapy to cope with the loss, it may always be helpful in the future to have a practice run to deal with it.
confidence. You may find that you have indeed put a lot of work into this process and do not need the constant presence of your therapist to achieve happiness or success. If you keep your therapist as a friend, you can not get away from it. And over time, this distance can help you recognize that you have not even fully engaged with this therapist.
The transmission may blur your feelings towards your therapist.
Transmission occurs when you unconsciously divert feelings toward someone else, usually someone from your childhood, to your therapist. These can be positive or negative feelings, but the positive ones can help explain why you are itching to invite a former therapist to happy hour. For example, the way your therapist interacts with you is really like you, because it reminds you of your mother without you realizing it. Or you are easily annoyed by the way your therapist asks questions because … she reminds you of your mother.
Therapists can also transfer their unconscious feelings towards someone else to their patients, which is referred to as countertransference. In "positive" countertransference relationships, a therapist may really like you and have the desire to overly support, share more about yourself than they should, or cross boundaries to support you in any way. The thing is, as professionals, we are trained to identify those feelings for who they are while still maintaining therapeutic boundaries. Without training, you can not easily figure out how much your therapist likes them.
That does not mean that you do not like a therapist or a former therapist for whom you hold him. (Remember that they are likely to get their most authentic self and you get them at work.) However, it can be harder for a patient to tell the difference between a true preference for a therapist and a transference.
You too may need your therapist again someday.
Your mental health will dwindle throughout your life, so you may be able to benefit from the therapy in the future. Between the difficulty of finding a new therapist and the exhaustion of informing them about your entire life story, returning to an effective former therapist may be a good option if possible.
"Every week I have at least one patient who wants to go back to treatment with me," Dr. Naureen Attiullah, a clinical professor in the Department of Psychiatry and Human Behavior at Brown University's Alpert Medical School, told SELF. If you are a close friend of a former therapist, you will be blocked quickly for future treatment.
As always, there are a few exceptions.
In general, it is advisable to keep your friends and former therapists in separate categories. But sometimes it's not always that easy.
My social media appeal opened my eyes to a few special cases of unavoidable duplication. They all depend on social interaction. At the beginning of your therapy sessions, it is always wise for you or your therapist to show what you are doing in these situations. Do you ignore them, casually acknowledge them or do you actually stop talking to them? If you agree that you both enjoy talking when you meet, you may want to be friends in such situations, especially after you have stopped your therapy sessions:
- There is only one therapist in your little one. The rural community that will take out your insurance so that you will inevitably end up in social situations.
- You are a psychiatrist yourself, so contact a colleague or someone in your network for therapy. That means you often see them at work or at work.
- Your child or teenager is undergoing therapy and you get along well with your therapist. This may still be a difficult border, but in some areas there are very few mental health professionals in children and adolescents, and this dual relationship can be more ethical as you are not technically the patient.
- You see a therapist who shares an important facet of your identity, such as belonging to the same race, religion, culture, or ethnicity, so you can meet them in many of these community events. It's natural to want to be friends with a former therapist. This will always be on a case-by-case basis, but unfortunately it is most useful for a former therapist and patient to keep any kindness on a fairly level ground. Ultimately, Palmiter says, "It's easier to find a good friend than a good therapist." I would have to agree.
Jessica A. Gold, MD, MS, is an assistant professor at the Department of Psychiatry at Washington University, St. Louis. Find her on Twitter @drjessigold .