We've been having a great discussion over on the post Tell Me.... An Ethical Dilemma. The post talks about a young man who wants to know if he can check "no" to a question about whether he has a psychiatric disorder if his illness is not relevant to the situation. The comments have been fascinating -- do read them-- and very thought-provoking.
One reader asked, " If a patient asked if they were boring you, and they were, would you say yes?"
This is a great question, and of course the right thing to do is to explore with the patient what meaning the concern has to him. But is that all? I'm not very good at doing the old psychoanalyst thing of deflecting all questions, and mostly I do answer questions when they are asked of me. This can present a really sticky situation because one can not think of any clinical scenario in which it would be therapeutic to have a therapist tell a patient, 'Yes, you're boring, OMG are you boring,' or 'No, in fact, I don't like you.' And not answering could be viewed as negative response by the patient --if you liked me, you'd tell me, so clearly you don't like me. So if the exploration of the question doesn't take care of the issue, and the patient continues to ask, what's a shrink to do?
I'm not in favor of lying to patients, therapy is about having an honest relationship, but our readers have given some great examples. If a gunman asks for your money, is it okay to lie and say you have none? Is it okay to lie about whether you've been the victim of sexual abuse on a job application (one reader saw this!). Just because someone asks, do you need to answer truthfully? Of course, you can be truthful and say you don't plan to answer that question, but so many times, the assumption is that the answer must be Yes because if not, you'd have nothing to hide.
Psychiatrists don't owe it to their patients to be totally transparent. Shrinks have the right to their privacy, and professional boundaries dictate that it's wrong to share your problems with your patients (even if they ask).
That being said, it still can feel very uncomfortable on the shrink side of a couch when a boring patient asks if they are boring. What would you say?