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Dr. Bob is Robert Hsiung, MD,
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Posted by alexandra_k on May 3, 2005, at 23:06:25
In reply to Re: Is it really harmful to be friends with T ? » Dinah, posted by pinkeye on May 3, 2005, at 22:06:29
Forbidden????
Linehan has a section on termination. One of the issues she deals with is how to handle it if a client requests to keep up contact with the t.
She says that the client should understand that it is a privaledge not a right - and accept that the therapist may not want to.
She said that it is perfectly fine to be friends if both parties agree.
I wanted to keep up contact with one of my t's who I liked very much. She seemed happy to give me her address. She muttered something about not being able to remember her new home address - and I said her work one was fine. I figured that she would get to see over time that I was thinking of her more as a friend than a therapist and trust that I wasn't going to send her stuff when I was in crisis or expect her to interveane or anything like that. Then if she wanted to give me her home address then that would have been fine with me.
I wrote to her a couple of times.
She then wrote to me and said that she didn't realise it when I asked initially, but because she was still employed by the district health board even though she was in a different city she was required to put my correspondance on my file.She said she was sorry about that. That she wouldn't put the previous letters on there - but any future ones would have to be. She also said that she was thinking that it could be useful for me to write for up to a year to help me say goodbye because she understood that goodbyes can be hard.
I really think... That she mentioned it to someone off hand and they frowned upon the idea. That she rethought that and the clarification was done in hindsight.
I accepted that.
Never wrote again.But I do think it is only sexual relationships that are prevented.
Friendship is up to both parties.
It might be helpful in some cases.
Harmful in others.
It may be hard to get a grip on the role transition.
Posted by pinkeye on May 3, 2005, at 23:20:43
In reply to Re: Is it really harmful to be friends with T ?, posted by alexandra_k on May 3, 2005, at 23:06:25
I sometimes wonder, if people in ethics committee and other people who enforce such strict ethics and prevent friendships between people who are both adults are somewhat cruel and don't have any human value.
It is perfectly understandable for the T to decline a friendship offered by a patient. Same way for a patient to decline a friendship offered by a T. But why on earth would that be anybody else's business but these two parties?
After a therapy relationship is over, nobody has any business whatsoever interfering in a relationship between two adults. At the max, they can enforce a time line - like 2 years. But making it ethical requirement is really not up to the ethics committe to enforce.
Posted by alexandra_k on May 3, 2005, at 23:29:20
In reply to Re: Is it really harmful to be friends with T ? » alexandra_k, posted by pinkeye on May 3, 2005, at 23:20:43
> I sometimes wonder, if people in ethics committee and other people who enforce such strict ethics and prevent friendships between people who are both adults are somewhat cruel and don't have any human value.
Hmm. I think they are well intentioned... I'm not sure about the friendship thing... It might be okay for some people, but it might not be okay for others. 'Do no harm'. I think it might be more about that. Easier to refrain from things (like keeping up contact) when there is a risk of harm with continued contact.
You wouldn't be able to ever see them again as a t. It would be unethical to go to a t who you know prior to therapy as a friend.
I don't know. I can see the sense in it. But to the best of my knowledge there isn't anything to prevent friendships - other than the disapproval of other t's who may not think it is a good idea.
> It is perfectly understandable for the T to decline a friendship offered by a patient. Same way for a patient to decline a friendship offered by a T. But why on earth would that be anybody else's business but these two parties?Sure.
I don't think it is.
Sex is different though.
And there we seem to want to say that it is other peoples business..
> After a therapy relationship is over, nobody has any business whatsoever interfering in a relationship between two adults. At the max, they can enforce a time line - like 2 years. But making it ethical requirement is really not up to the ethics committe to enforce.
Well... Making it an ethical 'requirement' is what does make it up to an ethics committee to enforce. I guess what you are questioning is the ethical requirement.I don't know.
I sort of think each case should be decided on its own merits...
But in general...
Friendship seems okay.
Sex doesn't.
Not unless you happen to meet in a different context after the two years.
But 2 years of no contact.But I should probably leave this topic
because I have gotten into trouble on this one before and I have pretty strong feelings about this one.IMO
It is a betrayal of trust.
Despite what a client may think they want.
And therapists should damned well know better
And if they don't then they shouldn't be allowed to practice.
Just my 2 cents and now I'll shut up.
Posted by pinkeye on May 3, 2005, at 23:45:05
In reply to Re: Is it really harmful to be friends with T ? » pinkeye, posted by alexandra_k on May 3, 2005, at 23:29:20
I actually think it is a betrayal of trust to cut off all contact with a former patient, (if a therapist personally decides it would actually benefit the client and not harm the client), and acts against his/her own judgement and just tries to stick to the ethical principles for the sake of it. A therapist who does that, goes down drastically in my esteem and he/she is the one who is not fit to be a T.
It is the thing that I don't like about modern world - that people seem to sacrifice common sense in favor of sticking with guidelines and are more afraid of lawsuits and disapproval of other thearpists than they are concerned about the patients well being.
As a favourite quote of mine says - "Science must ultimately obey common sense - its own root from where it came from". Ignoring common sense, and protecting science is what most people seem to do in the world nowadays. They kill the meaning and preserve the structure. They just ignore the purpose and follow the actions. It is like killing the root of the tree and watering the leaves. What is the use?
What good would it be and how ethical would it be, for a T to cut off contact and follow the rules, and it destroys the client? It is like doing a perfect operation according to the books, and letting the patient die because the Dr didn't have common sense to apply his own logic in an emergency.
Sorry if it came across strongly. I feel pretty strongly about it, that any professional should value his/her own common sense more than anything else. (Apart from the necessary legal requirements)
Posted by alexandra_k on May 4, 2005, at 1:35:09
In reply to Re: Is it really harmful to be friends with T ? » alexandra_k, posted by pinkeye on May 3, 2005, at 23:45:05
> I actually think it is a betrayal of trust to cut off all contact with a former patient, (if a therapist personally decides it would actually benefit the client and not harm the client), and acts against his/her own judgement and just tries to stick to the ethical principles for the sake of it.
But the point of termination...
The point of termination...
Is that the person is not your therapist anymore.
It isn't about your welfare anymore.
Otherwise they would still be being your therapist - do you see?
That is why I am a bit dubious about whether a friendship would work.
Therapy is not an equal relationship.
Think of the sort of transference feelings you feel toward your t.
Do you feel those towards your friends?
Would you be able to have an equal friendship with someone you had all those transference feelings for?
A friendship is supposed to be an equal relationship.
Don't you think you would be way more invested in the friendship than the x t?
They can't be a t to you on their own time.
Not without going crazy themselves.
They need to get their needs met in a friendship too.
Not just maintain / sustain - or even act to encourage a dependency relationship.I know it sounds harsh.
But IMO it is actually much kinder.
Besides which, there isn't a legal requirement to the best of my knowledge. It does seem to be true that most therapists frown on it. I am just trying to figure out and relate why that might be.
Posted by Tamar on May 4, 2005, at 3:42:35
In reply to Is it really harmful to be friends with T ?, posted by happyflower on May 3, 2005, at 10:35:29
I struggled with this one a lot. I liked my T very much and I really wanted his friendship.
I think it is certainly possible to be friendly if you happen to run into your T, which is quite likely if you live in a small town. Or even in a big city, if your T lives within about ten miles of you.
The problem with a real friendship is that you have a therapeutic history. It would be very difficult to make the transition from a professional relationship to a friendship, even if you both want to. It’s different from relationships with other professionals, like doctors and teachers, because of the transference involved in a therapeutic relationship.
The other thing to consider is that, like Alex said, you can never go back to a therapeutic relationship. That was the deciding factor for me. I figured: if I become friends with my T, then if I ever need therapy again I’ll have to find a new T. And the new T might not be as good. My T was brilliant. And if the friendship didn’t really work out I’d have lost a good T for nothing.
In a way, I felt it would be almost an insult to his skills as a therapist if I decided I’d rather have his friendship than his professional expertise. I have lots of friends already; I don’t have lots of therapists!
According to the theory, friendship is discouraged because the transference that takes place in therapy doesn’t disappear after termination. It stays with you. In my experience, this has been true. I still experience the transference, and it’s still useful to me as a means of exploring my feelings.
But, but, but... If I’m honest I still hope that one day, five years from now, I’ll bump into him somewhere and we’ll go for a cup of coffee and talk about politics and sport and books and movies… I love my fantasies!
Posted by fallsfall on May 4, 2005, at 7:40:22
In reply to Re: Is it really harmful to be friends with T ? » alexandra_k, posted by pinkeye on May 3, 2005, at 23:45:05
>I actually think it is a betrayal of trust to cut off all contact with a former patient, (if a therapist personally decides it would actually benefit the client and not harm the client), and acts against his/her own judgement and just tries to stick to the ethical principles for the sake of it. A therapist who does that, goes down drastically in my esteem and he/she is the one who is not fit to be a T.
In this case, the ex-therapist is acting as a therapist, and not as a friend. I believe that you are advocating for gentler terminations - for either decreasing contact, or the ability to reestablish contact if the need arises.
Posted by Dinah on May 4, 2005, at 9:04:37
In reply to Re: Is it really harmful to be friends with T ? » pinkeye, posted by fallsfall on May 4, 2005, at 7:40:22
There's a fair amount of thought out there that says once a therapist always a therapist. Because whether your therapist is currently acting as your therapist or not, he's supposed to be acting in your best interests. He's not going to breach confidentiality. In many cases he'll ba available for further therapy. A lot of duties don't stop with the actual relationship.
There are also a lot of sub-categories based on the nature of the therapeutic relationship. Did you go three times to learn breathing techniques? Call once for a consult? Have a long term relationship?
But in the case of a long term therapy relationship, I think the ethical guidelines are spot on. Once a therapist always a therapist.
Think of the complications.
Disapprobation from colleagues.
Having to remember what was said in a therapy setting and what wasn't. Because what was said in therapy is still confidential.
The friendship would really have to start over from scratch, and it would be heavily burdened.
It just doesn't seem like a good basis for friendship.
Incidentally, while supportive therapy does discourage transference (and while it happens anyway) my understanding from the literature is that it in no way equalizes the therapeutic relationship more than exploratory therapy. Maybe the opposite. If you ever read the books on supportive psychotherapy...
Well, I have. And I'm in supportive psychotherapy (long term). And I'm under no illusion that my therapist considers me an equal.
Short term CBT and the like would be the least power differential because it's more like teacher/student.
Posted by Susan47 on May 4, 2005, at 11:18:15
In reply to Re: Is it really harmful to be friends with T ?, posted by octavia on May 3, 2005, at 18:55:46
Hmm. Irvin Yalom claims to have treated a friend, something that went on for several years, and he managed to stay friends with her afterwards as well, mingling in the same social circle with their spouses and such. I believe if he can do it can happen and why on earth not? Everything is relative to the people involved and their degree of maturation - always. IMO.
Posted by Susan47 on May 4, 2005, at 11:26:10
In reply to Re: Is it really harmful to be friends with T ?, posted by alexandra_k on May 3, 2005, at 23:06:25
What you're writing about here in your post, that's the reason this therapy relationship has to be done in a completely different frame of mind, and why I couldn't ever be a therapist. I'd be always denying myself, always denying my real feelings, so much of my life's journey would be spent alone in my head, or having the necessity to rehash things constantly, take every dynamic in a relationship and turn it around until I've viewed it from every angle possible, to make sure I wasn't hurting someone or being hurt myself. And when I wasn't doing that adequately, then there'd be the guilt of not wanting to, wondering, well what is it about this person that bugs me so much? And then, if I couldn't work with someone for whatever reason, having to tell them that, somehow.
And then there's the necessity of having the respect of my peers. That's another story entirely. Because no matter what, I need that. That would be my biggest probable need.
In many ways, therapist is a lousy profession. IMO.
Posted by Susan47 on May 4, 2005, at 11:36:18
In reply to Re: Is it really harmful to be friends with T ? » alexandra_k, posted by Susan47 on May 4, 2005, at 11:26:10
And add to all of that stuff the fact that psychotherapy is evolving rapidly (???)
and there're always new considerations, new circumstances, it's like law, you know, there's always a new precedent, isn't there? New case law, and of course if you don't do your research you don't know it exists, so you argue your case without the benefit of the knowledge and you lose. Or you go in well-prepared and you might win.
I don't know.
I just don't really know anything about so much of this stuff.
Posted by Shortelise on May 4, 2005, at 12:12:01
In reply to Re: Is it really harmful to be friends with T ?, posted by happyflower on May 3, 2005, at 21:20:49
Am I nuts (well, yes) or didn't you say before that you are very sexually attracted to your T?
ShortE
Posted by happyflower on May 4, 2005, at 12:22:35
In reply to Re: Is it really harmful to be friends with T ? » happyflower, posted by Shortelise on May 4, 2005, at 12:12:01
> Am I nuts (well, yes) or didn't you say before that you are very sexually attracted to your T?
>
> ShortEIf you are talking about me, than yes I thought their was some mutual sexual attraction. But I feel I have moved on from that, yes he is attractive, but do I want him, no. I want my DH.
Posted by pinkeye on May 4, 2005, at 12:34:06
In reply to Re: Is it really harmful to be friends with T ? » happyflower, posted by Shortelise on May 4, 2005, at 12:12:01
Ok Guys.. I see all of your point.
I guess that is why it is generally not encouraged for a T to be friends with a former patient.But actually what I was getting to, was the fact about cutting off ALL contact after therapy is over. Even this, in most cases, (like short term therapy, specific issue related therapy etc) is probably advisable not to encourage any contact after Termination.
But what I was getting to is, above and beyond all these rules and regulations and quesiton about power dynamics in relationship, at the end of the day, both the T and the patient are human beings. And they just have emotional needs. To tell a patient that after termination, he/she has to completely cut off contact with a T (who during the course of therapy serves as the most closest person to this patient) is wrong. If the therapist decides personally, that further contact with him/her is most likely to damage the client further, or if the therapist doesn't like to see him/her in the role of a friend or detested the patient to startwith, by all means, he/she should'nt encourage contact, ie, if the patient was being a complete nuisance to him/her, or he/she personally didn't like the patient and was just waiting to get the therapy over with. I don't advocate the therapist playing a role of a therapist in the name of friendship. But what I am trying to say is that the decision should be left to the therapist's common sense and the patients common sense and not make that a rule.
To my mind, it is incredibly cruel, to have a patient completely open up and get attached to you, and then one day just ask the patient to stop contacting you and forget that you ever existed in his/her life. It is just not human.
Actually, the whole therapy model is based on religious and other social models which take humanity into account and are more humane. In church, people go to counselling to the pastors, and they go to make confessions. And that is what served as a starting point for this whole therapy business. To just take that part of it and apply it half way, but without understanding the deeper meaning behind it is wrong. The deeper meaning in therapy, is the relief that the client gets from bonding closely with another human being. That is what helps. That is why more humane therapists are always more successful than brillian and sharp and otherwise un empathetical therapists. What the patient really needs is the love and care and afffection and the bond. In my mind, the current western model of therapy, takes the humanity out of the picture.Just my 2 cents.
Posted by happyflower on May 4, 2005, at 12:40:41
In reply to Re: Is it really harmful to be friends with T ? » Shortelise, posted by pinkeye on May 4, 2005, at 12:34:06
I think in almost all relationships of all kinds there are different levels of power. I also believe we trasfer our feelings to other people all the time. I think most relationships there is not equal power all the time. It changes all the time.
Posted by gardenergirl on May 4, 2005, at 14:00:37
In reply to Re: Is it really harmful to be friends with T ? » Shortelise, posted by pinkeye on May 4, 2005, at 12:34:06
>But what I am trying to say is that the decision should be left to the therapist's common sense and the patients common sense and not make that a rule.Actually, there is NO rule that says a T must cut off all contact with clients after termination. It IS left up to the T within whatever constraints may be in place due to a situation. For example, it might be the policy of the agency, in which case the T has no choice. In other cases, the rule is that copies of all correspondence or contact must be placed in the client file, and that might lead a T to discourage contact.
But a T in independent practice, or one who does not have agency policy limiting them, can certainly choose to allow contact after termination. We actually discussed this in one class, and the professor stated her own policy. She tells former clients that they are free to contact her in the future, but that she may not necessarily respond. She frames this as how she always likes to hear how former clients are doing, but she is not always able to respond in a timely manner due to her workload. So with this knowledge in place, she leaves it up to the client.
And I have received emails from former clients in the past. I deal with them on an individual basis depending on the nature of the email.
But at any rate, there is no rule in the APA ethcial code that says contact MUST end at termination. Most states ethical codes or state laws are based on APA.
gg
Posted by Susan47 on May 4, 2005, at 14:08:42
In reply to Re: Is it really harmful to be friends with T ? » Shortelise, posted by pinkeye on May 4, 2005, at 12:34:06
Add into the mix you've described the fact that if a therapist really doesn't like a patient or can't handle his or her behaviour, s/he hasn't dealt with it very effectively if s/he has to terminate therapy in order to feel better. Sounds like a therapist who gives a termination that's hurtful to the patient, isn't very good at the job s/he just did. So there you go, more for him or her to feel angry about. It must be a relief to be rid of troublesome client. Yes, I would hate the job. Hate it.
Posted by pinkeye on May 4, 2005, at 15:35:26
In reply to Re: Is it really harmful to be friends with T ? » pinkeye, posted by Susan47 on May 4, 2005, at 14:08:42
i actually don't think that a T would necessarily have to be bad to terminate.
in lots of circumstances, that may end up doing long run good for both of them.
I think Ts should get equal privilege - just as we as patients get to choose, they also should be able to choose.my next 2 cents. ignore if it triggers please.
Posted by Dinah on May 4, 2005, at 17:48:33
In reply to Re: Is it really harmful to be friends with T ? » Shortelise, posted by pinkeye on May 4, 2005, at 12:34:06
Well, you won't get me to disagree with that.
It's incredibly disrespectful of the relationship that therapist and client have worked to build together.
But there's a big difference between keeping contact and starting a friendship.
Besides, I always figure I get the best part of my therapist anyway.
Posted by JenStar on May 4, 2005, at 18:21:36
In reply to Is it really harmful to be friends with T ?, posted by happyflower on May 3, 2005, at 10:35:29
I think it hurts most of all to realize that the T may not WANT to be our friend after therapy is over. Even if it's not explicitly forbidden, and even if WE want to be friends, the T just may have no desire to do it.
Part of the process of good therapy is becoming dependent and trusting the T, which are things we normally do with good friends. It's very hard to come to terms with the fact that for the T, the relationship isn't really "friendship" the way we like to define it -- it's something else entirely. (Without the $$....no therapy!)
We have only one T, but the T has many many clients...to us, the T is a huge part of our world. But to the T, we are just one of many. I believe that good T's do care about each patient individually, just the way a good doctor cares about each patient in a practice or hospital. But how draining it would be, how impossible, for the T to form a 'real' friendship with each client who wanted it.
Anyway, I think in VERY special cases a friendship may develop on its own. But in that case, the T would easily figure out a way to stay "friends." If we have to ask this kind of question, I think it already means that the T is just not interested in such a relationship.
Just my 2 cents! Hope it didn't offend...
JenStar
Posted by Dinah on May 4, 2005, at 18:36:06
In reply to Re: Is it really harmful to be friends with T ? » happyflower, posted by JenStar on May 4, 2005, at 18:21:36
I know I'm not one of many to my therapist. I'm the one and only Dinah. Special down to my toes.
I imagine that's true of long term therapy relationships in general.
It's hard for me to comprehend friendship being better than therapy.
Posted by pinkeye on May 4, 2005, at 19:37:49
In reply to Re: Is it really harmful to be friends with T ? » happyflower, posted by JenStar on May 4, 2005, at 18:21:36
I think it is true.. The thing that hurts the most is the fact that your T does not want to know you after the termination. That is the hardest part - more than the fact that you could not be friends, is the fact that your T doesn't want it that is hard to digest.
In many cases, it is not really about money. My ex T didn't charge me for any of the services. So I know it is not about money. Maybe it has to do with interest.
Posted by JenStar on May 4, 2005, at 20:21:40
In reply to Is friendship supposed to be better?, posted by Dinah on May 4, 2005, at 18:36:06
I'm sure you're special to everyone in your life, Dinah, not just your T . :)
I think friendship isn't necessarily better, as long as you have good boundaries, which you def. seem to have with your T. I've never heard you express sexual/romantic feelings for him, and you seem very clear about expectations on both ends. So for you it seems that the relationship is very healthy and solid, and you like it the way it is.
It seems that some people have a much harder time setting up those kind of groundrules in their mind. I know a lot of people really seem to desire a closer relationship with the T, maybe the kind where they get to offer advice/support in kind, get and are are given affection, and share the kind of emotional bond that seems to come with friendship. Maybe it's because it's hard to "get" that someone who sees the "real us" isn't magnetically drawn to us; doesn't go crazy trying to find a way to be with us all the time. After all, if we're so great (which we're learning to feel about ourselves), why isn't the T breaking down doors to be our friend? Anyway, that's the way it would go in MY mind, I think!
I admire the kind of relationship you have with your T. I think it's really a good role-model of what the healthy client/T relationship looks like!
take care,
jenStar
Posted by Dinah on May 4, 2005, at 20:32:03
In reply to Re: Is friendship supposed to be better? » Dinah, posted by JenStar on May 4, 2005, at 20:21:40
> Maybe it's because it's hard to "get" that someone who sees the "real us" isn't magnetically drawn to us; doesn't go crazy trying to find a way to be with us all the time. After all, if we're so great (which we're learning to feel about ourselves), why isn't the T breaking down doors to be our friend? Anyway, that's the way it would go in MY mind, I think!
Ahhhh. Ok, that I understand. I guess I assume it's because he's so darned delighted to be my therapist (wink) that he couldn't bear to leave that behind. :)
>
> I admire the kind of relationship you have with your T. I think it's really a good role-model of what the healthy client/T relationship looks like!
>
> take care,
> jenStarThanks JenStar. I've always thought it works so well precisely because I have no further desires from him. So I do understand that.
I suppose I'm a bit hampered by the fact that I'm very skilled at wanting what's possible to have, and pretty much never noticing if on the odd chance I actually want something more.
Posted by Shortelise on May 4, 2005, at 20:41:14
In reply to Re: Is it really harmful to be friends with T ?, posted by happyflower on May 4, 2005, at 12:22:35
Yes, Happyflower - I was talking to you. I did remember correctly that you had written about a strong sexual attraction to your T, and wondered how it would translate into friendship. I have found that mutual sexual attraction to men outside my marriage, esp. the men in couples my husband and I frequent socially, has meant Trouble.
But as you say, you've moved on. It would be great to live in a small town where seeing my T out and about, talking about the weather, watching his children grow, etc. was a part of things. I would like that, I think. But I don't think I could be friends with him, nor could my husband. But long term therapy is different. I could probably be friends or at least socialize with the woman I did art therapy with for six months.
Not so weel today so can't read what everyone else has written but will do so later.
ShortE
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