05/27/2010

Dear Patti,
My husband Reginald sees a psychotherapist for individual therapy and also attends a weekly men’s group headed by the same counselor. The whole group — including the therapist — often goes out to dinner after their meetings. They’re now planning a men’s weekend that will involve therapy for half the time and hiking, golfing and having fun for the other half. While Reggie thinks it’s fine to associate in different contexts, I’m a little uncomfortable that his therapist engages in extracurricular activities with his patients. My former therapist, whom I highly respect, would never have crossed those lines. What are your thoughts?
—Bianca

Dear Bianca,
While I agree with you that it’s generally not a good idea to see patients outside of a therapeutic setting, I can’t comment on any individual private practice or a particular psychotherapist. In a similar vein, there are ministers and social workers who believe that certain situations justify interactions extending beyond the parameters of their professional roles. If Reggie feels comfortable with his therapist and doesn’t react with jealousy, resentment, inappropriate emulation, or by putting him on too high a pedestal, I’d say — with caution — the benefit might outweigh the negative. 
 
However, most psychotherapists — including myself — adhere to a strict code insofar as seeing patients outside a context of counseling. This code is predicated on the critical need for a therapist’s office to be a safe, private and nonjudgmental place to explore, experience and confront the deepest, darkest parts of yourself in order to move toward the goal of a healthier mental state. To accomplish this requires that the therapist witnessing these feelings and supporting your courageous steps to become whole is someone you only see in that confidential, therapeutic environment.
 
It’s also common for patients to engage in transference — the act of transferring onto their therapist the positive/negative repressed feelings they hold toward their previous and existing relationships with family members, spouses, friends and teachers. It’s difficult enough to process and understand these emotions without confusing the issue by seeing the therapist in a social venue. A patient, for instance, who expresses mild jealousy because he perceives the previous patient received a few extra minutes of attention might then be encouraged to reflect on how a sibling always seemed to be favored by their parents during his childhood. What happens, though, when that same patient on a weekend outing like the one you’ve described becomes hurt and angry because he perceives the therapist plays more golf with another patient? Is it truly transference or is there a possibility the therapist has allowed his personal feelings to be nudged toward displays of favoritism?
 
That therapists are often regarded as both nurturers and authority figures can lead to invitations which, if accepted, can set a messy precedent if other patients find out. What starts as an act of respect and warmth can quickly spin out of control if to turn down other patients’ invitations — or to have gift costs compared as a measurement of your real feelings — makes them feel less worthy. There’s also the problem of how to interact with their guests and artfully deflect questions of how you met. In tandem with this is the protocol of acknowledging patients if you accidentally run into them in a public setting. My own rule is to offer a private, warm smile and let him/her take the lead in whether or not to greet me or make introductions. The most important issue is that a patient never feels invaded or violated.