Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Thursday, March 11, 2010
Let Me Tell You About My Friend
Hypothetical situation (with a little ring of possibility)....
So a new patient shows up at my door, referred by a friend. The patient used to be in treatment with my friend, but the friend is moving to another state. The patient is sad, she will miss her old doctor who helped her so much, and while we hit it off just fine, it's clear that I can't fill my friend's shoes.
Now here is the thing I'm wondering about: the friend who used to treat the patient is my good friend, someone I talk to all the time --Are we thinking along the lines of a Camel? Perhaps, but I'll never tell. After the move, I'll still talk to her all the time, and I'll still see her socially, even if it means a bit of planning or trekking. Should I tell the patient? My initial thought is "yes" that this will be a connection, that I can relay regards and that the patient (and the doc) won't feel so cut off. But then I wonder if maybe it will be hard to know that I am seeing the old shrink when she can't, if somehow this might be frustrating?
I'd ask here, but clearly this is one where the answers may be very individual,--oh, but why not? Go for it!
Posted by Dinah on Thursday, March 11, 2010
Labels: friendship, private practice
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I'd avoid bcoming the "middle man". If they choose to maintain some contact, that's their issue. Might make it harder for new pt to bond with you if old therapist remains in the shadows
Having been in somewhat similar situations before, I take the easy way out- use the connection to form an initial bond (the first few times patient ask about ex docs, I tell them where they went and what they're doing- if I'm allowed, that is); keep it short and sweet and then gradually taper it off.
With most patients it tends to be a brief period of transition- then it comes back to the two people in the room.
Unless Camel is trying to avoid the patient for some reason there'd be no reason the patient could not occasionally go have a session in the distant town or have a phone appointment with Camel. In the mean time it might be OK to make a brief mention of Camel to the patient, but really what can you say? Camel's personal life is not what the patient discussed with Camel, and sharing that would be inappropriate. It will be better for the patient to develop a relationship with you and move on.
Focus on this new patient doctor relationship. If the patients asks about the well being of the old doctor answer. You really don't know the future w this patient. There could be med changes and improvements. Her perspective on the old doctor might change with time.
(i probably wrote about him before, however), i was in therapy with a fourth year Psychiatric resident and the connection we made was amazing. We discussed things i have never told anyone, let alone a Psychiatrist before. He was very good at therapy as well as being kind, funny, and very supportive. i only got to see him for 10 months, as he was finishing his residency and going on to do a Fellowship.
At present: i am seeing another, fairly young Psychiatrist who "knows of" the other doctor. i miss "My Resident" (Dr. k) soooo very much, but am getting along well with the present one. We have never discussed how much i miss Dr. k. Sometimes i just want to ask if he (Dr. K) is alright, how he is doing, but am afraid on several levels. And talk about opening the Proverbial "Can of Worms".......anyhow....don't know how to handle the situation. it's almost as if the former relationship overshadows the current.
AND, then there is the Psychiatrist before either, whom i a l s o miss very much (who lives in another state)...sigh.
Do we see a trend here...? Oh, yeah...
BPD in VA
I have a dietitian who is friends with a former therapist. My therapist moved away, though it was long after I had stopped seeing her. When I wrote my senior thesis about oppression in mental health care, I gave a copy to my dietitian and she said she asked if she could tell my former therapist about it because she would be proud of me, so I gave her a second copy and a letter to give to my former therapist. I don't know how she reacted or anything, which is fine.
I don't know if that is at all helpful, but there's my experience as a patient.
As a patient, my feeling is you should err on the side of letting sleeping dogs lie, to be amended in future according to your instincts. I do think I would find it frustrating and a little sad to know you were seeing the beloved (or esteemed, or whatever the particular feelings are) ex-therapist when I couldn't. But then again, that is more grist for the mill, isn't it? Do you explore and try to resolve transference issues when they partly relate to a third party? Hmm. And I also agree with Ann--if the person asks, you should answer. Sometimes a therapist's discretion looks like unnecessary withholding and becomes an issue in itself.
As a patient, I would be curious, and want to know. But, I would also be really sad to hear more about my old beloved therapist -who was just that, my therapist, not my friend - who was your friend and dear to your life. it would be really hard to hear casual comments about someone so important to me with whom i couldn't have any sort of continued connection.
i think it would also be incredibly difficult to keep things focused on the present therapy. i know i would be thinking about the old beloved therapist and what she would be saying/thinking/expressing when i said whatever i was saying to you, rather then what you were saying. i think it would be really detrimental in the formation of a relationship with the new therapist. ... though i would still want to hear anything you had to say about my old well-loved therapist.
what can i say - sometimes what we want isn't what's really best.
It would be like eating candy in front of a diabetic.
This sounds more like social networking than treatment of an illness. Can you imagine a dermatologist or cardiologist worrying about this? I was taught as a family systems psychotherapist the patient-psychotherapist relationship should be the least important, and if it has become this important a major goal of treatment should be to help the patient build more important relationships, or repair the damaged ones.
I agree with Ann and Lu: grist for the mill. The patient has a right to ask or say anything they choose. But the doc gets to maintain personal boundaries, too.
It may be like eating candy in front of a diabetic or drinking wine in front of an alcoholic, but that's reality. We have to learn how to confront temptation and deal with the feelings. Should the psychotherapist protect the patient from that or respect that the patient can handle it on his own?
The patient is a human being who had a human connection with the prior therapist. So I would respect that too and not be too "blank-screeny".
And use it. What were other transitions and separations like for the patient?
Otherwise it is the elephant in the room.
No way. The client has experienced a loss and needs someone to help facilitate their grieving. The fact you have an ongoing relationship with the person (or Camel) they lost is irrelevant. To try to mitigate their pain by passing messages or giving updates not only prolongs their suffering, it prevents them from having a well-facilitated therapeutic closure to the relationship.
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