Psycho-Babble Social Thread 10908

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Question about pdoc/therapist protocol

Posted by Mair on September 6, 2001, at 21:39:59

Can someone tell me if the proclivity of pdocs and therapists not to acknowledge patients when they see them outside of the office is strictly for the benefit of the patient (and thus the patient's call). Is this just to spare the patient the embarrassment of maybe having to explain to someone else how it is that you know this person who's just spoken to you, or is there a boundary issue here?

Thanks

Mair

 

Re: Question about pdoc/therapist protocol Mair

Posted by kazoo on September 6, 2001, at 23:30:28

In reply to Question about pdoc/therapist protocol, posted by Mair on September 6, 2001, at 21:39:59

> Can someone tell me if the proclivity of pdocs and therapists not to acknowledge patients when they see them outside of the office is strictly for the benefit of the patient (and thus the patient's call). Is this just to spare the patient the embarrassment of maybe having to explain to someone else how it is that you know this person who's just spoken to you, or is there a boundary issue here?
>
> Thanks
>
> Mair

^^^^^^^^

There's no "boundary issue" here, as you so put it, because no boundaries exist when this so-called professional deposits your check in their bank account for services rendered.

"Boundary issue," my hiney!

It's just plain rude on their part.

This has happened to me on a number of occasions, and a simple "Hi, nice to see you" was the perfectly proper thing to say from either them or myself. Nothing more, but nothing less either.

This obviously happened to you, so don't get bent out of shape from their bad manners. Ignore it. And it might be best to ignore them as well. There's no place for arrogant stupidity except with British Royalty.

kazoo

 

Re: Question about pdoc/therapist protocol

Posted by sar on September 7, 2001, at 2:22:50

In reply to Re: Question about pdoc/therapist protocol Mair, posted by kazoo on September 6, 2001, at 23:30:28

dear mair,

i had a therapist who promised me she would not acknowledge me in public, and i felt kind of offeneded. i think she sensed my shyness and protectiveness-of-self, so she thought that was the right thing to do...but she thought wrong.

i saw a former therapist at work a couple of months ago, and she greeted me with a big smile and by name (which was discreet because i wear a nametag) and asked how i was doing. i saw the look in her eyes--i knew she cared--she was my "former" therapist only because a family tragedy had halted her career and i needed immediate attention.

i think ignoring therp/patient/pdoc is totally weird. seems suspicious to me, lke something to be ashamed of. a smile and nod, a "how are you?" "good for now, i'll see you soon," seem appropriate to me.

jeez, you share the most intimate details of yr life with this person, how can they just breeze past?

on the other hand, i saw an psych evaluator at work the other day. during our interview he seemed distracted, senile, either constipated or hungry, and when he showed up at my jobplace and saw me he smoothly moseyed away...and i was grateful, 'cos i thought he was an idiot, i really had some vitriolic feelings for him, and had no desire to wait on him.

and good on him for realizing that.

i think that psychs probably think they're being polite to not acknowledge you, like "hey there, crazy patient! how are ya?! i know you feel like hell, we'll talk wednesday!" especially if you're with someone who might question how you know this particular person.

but i think at least a handwave/smile/knowing-look is the *least* they can do...

on the optimistic side, they don't want to embarrass you...

sar

 

Re: Question about pdoc/therapist protocol sar

Posted by Craig on September 7, 2001, at 4:17:37

In reply to Re: Question about pdoc/therapist protocol, posted by sar on September 7, 2001, at 2:22:50

> on the other hand, i saw an psych evaluator at work the other day. during our interview he seemed distracted, senile, either constipated or hungry,

===========================================
I've never laughed this hard at 5 AM before. In the future, if the guy looks like he might approach you, you could head him off at the pass and cheerfully say, "Oh hi...how is that problem with your bowels working out?" ;-)

 

Re: Question about pdoc/therapist protocol - LOL! (nm) Craig

Posted by Marie1 on September 7, 2001, at 7:19:39

In reply to Re: Question about pdoc/therapist protocol sar, posted by Craig on September 7, 2001, at 4:17:37

 

Kazoo Sar - how this feels

Posted by mair on September 7, 2001, at 16:30:05

In reply to Re: Question about pdoc/therapist protocol, posted by sar on September 7, 2001, at 2:22:50

> Sar and Kazoo - it's nice to know this affects others as it does me. I have a pdoc now who's looked right through me the last several times our paths have crossed. She is not my therapist. My therapist does acknowledge me on those rare occasions when we end up in the same place. This was also never an issue with my previous pdoc because i knew him pretty well before I ever became his patient. So I guess the apparent cold shoulder I'm getting now is the first time I've really had to deal with this issue. My feeling about it is that i live in a relatively small area and because of my job and the length of time I've lived here, I have occasion to cross paths with lots of people in different lines of work including doctors and therapists. I guess this means that I could easily know this woman in another capacity altogether and I feel no need to explain to anyone I might be with just who she is or how it is that i might know her.

I'm assuming that she's doing this because she assumes that it's what I want, and when i next meet with her I'll try to clarify that in as nice a way as I can. In the meantime, it does have a demeaning feel to it which bothers me probably more than it should. Unfortunately, because of some activities our kids are involved with, these encounters are likely to become more frequent.

Mair

 

Re: Kazoo Sar - how this feels mair

Posted by sar on September 9, 2001, at 2:39:44

In reply to Kazoo Sar - how this feels, posted by mair on September 7, 2001, at 16:30:05

dear mair,

i thin people are usually satisfied by a simple explanation if they even bother to ask--i.e., "we spoke in a long grocery line last week," "we met at the dr's office" (not a lie, hee hee), "my husband knows one of her friends"--whatever. in my experience, ppl generally aren't as curious/suspicious as i'd thought they were.

would definitely discuss this with yr pdoc, in simple terms: "it somewhat offends me thsat you ignore me though i'm you're patient"--and assure her that you're not going to like, accost her, but a nod and smile--some form of acknowledgement would make you feel better. i would imagine that pdocs/therapists might harbor a fear that patients they run into on their free time might lodge intosomesort of pseudo-phychiatric/therapist session sight there in the street. after all, they do treat loonies, you know? :) i would imagine that they're trying to protect their own personal privacy as well.

i would address it directly: hey doc, it kind of hurts me when you ifnore me...i don't expect you stop and chat, but give me some eye contact and a smile, hey?

i would feel really weird if any of my regular docs ignored me on the street. i'd expect a smile/nod at the least or a brief meet & greet. your doc may just need to know that yr not gonna be like "Omigaw! guess whats going on today!" or totally mortified that (s)he acknolwdges you.

just my floundering thoughts...
sar

 

I am the total opposite!

Posted by JennyR on September 9, 2001, at 18:11:52

In reply to Re: Kazoo Sar - how this feels mair, posted by sar on September 9, 2001, at 2:39:44

I have run into my therapist a number of times. I have seen him and he didn't see me, and I then avoided him. Other times I initiated a wave. I asked him what he would do if he saw me first outside. He said he would wave or say hi. I told him not to unless I acknowledge him first. I don't want there to be any possibility of anyone knowing the connection or figuring it out. I told him not to ever greet me first but take my cue. this was once discussed on here and someone said it is illegal in some states for a therapist to greet you first on the outside, like a breech of privacy.

 

Re: Kazoo Sar - how this feels

Posted by Mair on September 9, 2001, at 22:14:22

In reply to Re: Kazoo Sar - how this feels mair, posted by sar on September 9, 2001, at 2:39:44

>
> Sar - you mean my inclination to say something like "is your habit of not recognizing me in public for your benefit or for mine because if it's for mine don't bother because i don't care about stuff like that" carries with it too much an an edge? (particularly when stated with barely concealed annoyance) You're young but wise beyond your years. I think it bugs me that she is only my pdoc and not someone with whom I have a therapeutic relationship. She doesn't know much more about me than my internist does and she's (my internist) very friendly when we cross paths. I think I'm also bother by the inference you raised that I'm going to try to get too close. My last pdoc used to periodically call me to check up on me, so uncertain was he that I'd ever initiate any contact with him even in the worst emergency. ( I am also the same person who was forced to consume at least 2 sessions with my current therapist being convinced that there were times that it was appropriate and necessary that i call her at home. I had told her, after all, in total seriousness, that I couldn't see calling her unless i actually was pointing a gun at my head, because why should I bother her if I wasn't actually going to hurt myself) Disrespecting boundaries is so not me. Also if someone's really trying not to acknowledge you, it seems like they're looking right through you which is disconcerting to say the least. I don't want anyone to have an "oh shit" reaction just because they bump into me. It seems so childish. Ah well - I'm sure i'll work this out with her.

Jenny - I guess there probably was a time when I would feel like you do. I've been very secretive about my illness and my treatment. Maybe the fact that i've been faking it with people for so long gives me the confidence to feel that i can easily fabricate a story for whomever I'm with as to why I know this person.

Mair

 

Re: Kazoo Sar - how this feels Mair

Posted by sar on September 10, 2001, at 0:25:45

In reply to Re: Kazoo Sar - how this feels, posted by Mair on September 9, 2001, at 22:14:22

> >
> > Sar - you mean my inclination to say something like "is your habit of not recognizing me in public for your benefit or for mine because if it's for mine don't bother because i don't care about stuff like that" carries with it too much an an edge? (particularly when stated with barely concealed annoyance)

well, i think this is a strange situation. it's an odd thing to discuss with a pdoc/therp--discussing terms/bounds of relationships is weird in *any* situation. i wonder if someone is my boyfriend. i wonder if someone is my best friend. but i can't ask...it just works itself out...you know, if it were *me* being ignored, i'd just waved, grin, say "hey you!" and breeze right by.


You're young but wise beyond your years. I think it bugs me that she is only my pdoc and not someone with whom I have a therapeutic relationship. She doesn't know much more about me than my internist does and she's (my internist) very friendly when we cross paths.

mental issues are so touchy. it's getting better culturally, but discussing depression is much different from discussing like, a heart murmur...

I think I'm also bother by the inference you raised that I'm going to try to get too close.

no, no i wasn't inferring that at all! i am sorry you misunderstood. all i'm saying is that they don't know *how* you're going to be. you know how when you initially make a friend, and you don't know whether they're the type to call once a week or 5 times a day? you can't tell about those things sometimes! i'm the same way, i've always been rather reserved, and would feel intrusive for calling my psych up to just talk, and i certainly never would just in the street. what i'm saying is, psychs deal with other types--how could they possibly know how you'll react when you see them?

i will tell you something very personal yeah RIGHT HERE ON THE INTERNET (i feel comfy and kindof anonymous here)--i was a stripper at 18 and 19 and saw customers in public somewhat regularly--i *still* see them somewhat occasionally, and i avoid eye contact and walk by as quickly as possible, because when i'm on the street i'm *me,* not my job--and though they deal with you on a very intimate level, i can see how they might want to do some damage control, even if none is needed. i didn't mean to insinuate anything; i'm sorry you took it that way.


My last pdoc used to periodically call me to check up on me, so uncertain was he that I'd ever initiate any contact with him even in the worst emergency. ( I am also the same person who was forced to consume at least 2 sessions with my current therapist being convinced that there were times that it was appropriate and necessary that i call her at home. I had told her, after all, in total seriousness, that I couldn't see calling her unless i actually was pointing a gun at my head, because why should I bother her if I wasn't actually going to hurt myself) Disrespecting boundaries is so not me.

i feel exactly the same way. my favorite psych gave me her home # when she had to take care of her sick son, but i couldn't bear to call. she had this cute family photo perched on her desk and i didn't want to be some loony calling while she was trying to take care of a sick toddler, or eating dinner, or reading a book, etc etc! i was just saying that not everyone is like that, and i can see why docs feel they might have to protect themselves (the same way lots of women carry pepper spray though most men aren't muggers or rapists). do you see what i'm saying? i'm trying to explain myself in detail because i feel you misunderstood what i wrote.

Also if someone's really trying not to acknowledge you, it seems like they're looking right through you which is disconcerting to say the least. I don't want anyone to have an "oh shit" reaction just because they bump into me. It seems so childish. Ah well - I'm sure i'll work this out with her.

talk to her about it...if you feel comfortable enough to get it off your mind for awhile, maybe you could just be the social smoovie next time and graciously acknowledge her without conversation, keep moving...

please let us know how this turns out.

sar

 

Sorry Sar - I didn't misunderstand sar

Posted by mair on September 10, 2001, at 15:55:03

In reply to Re: Kazoo Sar - how this feels Mair, posted by sar on September 10, 2001, at 0:25:45

> > >
>Sar - When I said that about the inference "you raised" I didn't mean an inference that you were making about me. "issue" would have been a better word. I read your post to mean that my pdoc might be concerned about my breach of boundaries, NOT that you thought I was so inclined. I'm sorry to have inadvertantly pointed an errant finger. I really appreciate your feedback. Whether you appreciate it or not, you have alot common sense which you manage to very graciously dispense.

Mair

 

Re: Question about pdoc/therapist protocol Mair

Posted by shelliR on September 10, 2001, at 23:54:40

In reply to Question about pdoc/therapist protocol, posted by Mair on September 6, 2001, at 21:39:59

> Can someone tell me if the proclivity of pdocs and therapists not to acknowledge patients when they see them outside of the office is strictly for the benefit of the patient (and thus the patient's call). Is this just to spare the patient the embarrassment of maybe having to explain to someone else how it is that you know this person who's just spoken to you, or is there a boundary issue here?
>
> Thanks
>
> Mair

Hi Mair.

You've got a lot of good feedback already, but I'll add my 2cents. My therapist told me she would not acknowledge me unless I make the first move. And she gave me no sense that she would not appreciate responding at that point. I think it is simplier for therapists (and pdocs) to decide to possibly err on the side of rudeness, than it is to possibly cause a breach of confidentiality. I can understand how you feel, since you are an equal community member. She is a physician; you are an attorney. (or a truck driver, whatever.) But remember, seeing a pdoc might not be something that someone wants to reveal, perhaps even more so than a therapist, because of the inference of medication. So the next time, maybe try to acknowlege her first, or else bring it up in a session. If she explains quite simply why she hasn't acknowleged you, you don't even have to leave yourself vulnerable (like saying you feel rejected) unless you want to. Just let her know that you would feel more comfortable acknowleging each other.

Shelli

 

Re: Kazoo Sar - how this feels Mair

Posted by Jane D on September 11, 2001, at 1:38:24

In reply to Re: Kazoo Sar - how this feels, posted by Mair on September 9, 2001, at 22:14:22

Mair,
I'm also coming in on this thread a little late. I wanted to think about my response for a while but I'm afraid I'm just going to end up rambling.

I've never had to deal with meeting outside the office but I definately feel constrained inside it. I have a friendly and casual manner with my internist and with other doctors and feel that I am on a fairly equal footing with them. I never worry that kidding around will be misinterpreted. I ask about their children and where they go on vacation just as I do with any casual business acquaintances. I feel that if I behave that way with the pdoc it will be interpreted as an attempt to become inappropriately dependant (that red flags will go up like 'I'm dealing with a disturbed person who can't be trusted to act appropriately' or 'Is this a stalker'). It's a bit insulting. It's also on ongoing reminder that this is not just like going to the internist. In short it makes me feel even sicker and even more outcast. I end up feeling that no matter what they say about this being just another illness with no more shame than diabetes it isn't, and even our doctors don't really believe that it is.

My doctor is rather formal and distant and I take my cue from that. In this I treat her differently than I do other doctors. I am afraid to try and set the tone myself. Once in a while I do wonder if she thinks that she is taking her cue from me and that this has become a ridiculous circle. I imagine that it might be frustrating for the doctor - afraid to initiate a more informal relationship and therefore cut off from the kind of social interaction on the job that everyone else takes for granted. I can't imagine feeling unable to greet someone I worked with in any capacity on the street. Or to know that even if I did a great job my clients/patients were unlikely to go around announcing it.

I know that I would have no problem with her greeting me on the street. I hope that I would also not have any problem with admitting the context in which I knew her but I'm not sure about that one. With personal friends I'd be happy to make a full introduction (with endorsement) but I think that I still need the option of keeping my illness a secret from employers, clients and coworkers.

Jane

 

Re: Kazoo Sar - how this feels sar

Posted by Jane D on September 11, 2001, at 1:59:26

In reply to Re: Kazoo Sar - how this feels Mair, posted by sar on September 10, 2001, at 0:25:45


> no, no i wasn't inferring that at all! i am sorry you misunderstood. all i'm saying is that they don't know *how* you're going to be. you know how when you initially make a friend, and you don't know whether they're the type to call once a week or 5 times a day? you can't tell about those things sometimes! i'm the same way, i've always been rather reserved, and would feel intrusive for calling my psych up to just talk, and i certainly never would just in the street. what i'm saying is, psychs deal with other types--how could they possibly know how you'll react when you see them?

Sar,
I think what bothers me is being a part of a group that is thought to be more likely to misbehave. I feel that I have to prove myself in this context where in others I would have the benefit of the doubt until I actually became a problem.

Jane

 

Re: I am the total opposite!

Posted by Elizabeth on September 11, 2001, at 12:09:17

In reply to I am the total opposite!, posted by JennyR on September 9, 2001, at 18:11:52

Funny topic...anyone see the _Sopranos_ episode (1st season) where Tony runs into Dr. Melfi in a restaurant? (He tells her that the "decorating tips" she gave him are working great, and he gets her and her date a table which was supposedly unavailable.)

When I was in Boston, I would regularly run into former [individual and group] therapists because I regularly went to McLean and was seeing a pdoc at the place where I'd been in a day program for a while. It's different in that kind of setting, though. I still keep in touch by phone and email with some past treaters.

That's so funky that it's *illegal* for them to say "hi" in some places.

-elizabeth

 

Response to Shelli and Jane

Posted by Mair on September 11, 2001, at 21:01:25

In reply to Re: Kazoo Sar - how this feels Mair, posted by Jane D on September 11, 2001, at 1:38:24

Shelli - everything you say is true. I'm quite certain that my pdoc will be fine with another arrangement if i request it. I see her next week and I think this is something I can raise. Even though I can intellectualize that she thinks she's doing this for my benefit, it still rankles a bit. Maybe you're right about feeling on some equal footing. I'm way beyond the days when I used to mythologize people like this.

Jane - you raise a very interesting point - that no matter how much people try to treat depression as just another treatable biological illness, it really is different in that you do sort of feel that mental health providers feel they need to be protected from you. I doubt many regular doctors feel this way about patients. I've been seeing my therapist for about 3 years. In that time, she never offered me her home phone number until I crashed somewhat last winter. I had always taken her omission to mean that she really didn't want me calling her at home. If need be, I could have found her number in the phone book (she is listed), but since she hadn't offered it to me, hell would have frozen over before I'd have ever called her. I do think the inference is there that we might try to get too much access and I do really resent that since i know it's never going to be a problem with me.

Thanks for all your feedback

Mair


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