Comments on Shrink Rap: My Friend, My Shrink

This site is great.I think that in a small town, y...

2010-10-12T03:44:31.470-04:00

This site is great.I think that in a small town, you may have sometimes to treat a friend. Or a friend's kid. But it may become the stuff of much of the the therapy and involve a lot of discussion setting up boundaries. So the person feels safe that this therapeutic relationship really is separate.Thank you for bringing such nice posts. Your blog is always fascinating to read.

Mulling through the eyes of the patient: I wonder...

2010-10-08T21:06:14.400-04:00

Mulling through the eyes of the patient: I wonder if having a friend become one's psychiatrist might make it harder to disclose the hard-to-disclose things? It would be for me. There have been things that I finally told my psychiatrist I doubt I would ever tell a friend. If a professional relationship were established, would one then feel uncomfortable socializing with the shrink considering the shrink perhaps knows everything that others do not? I know my shrink talks to his partner and sometimes his friends about his patients. I suppose he would not do that if the patient was part of that group. In my case our lives are completely separate.

Anon: Just as I was thinking of the blogger as Iro...

2010-10-07T01:31:10.859-04:00

Anon: Just as I was thinking of the blogger as Iron Dinah... Nah.

Wasn't this already discussed as "friending" on Facebook? Either way it's a bad idea. It cheats the patient. We like to think of psychiatric disorders as medical, but that model fits variably along a spectrum with schizophrenia at one end.

The exception might be in a rural area with no other psychotherapist. And it might be less of a problem with CBT than with a psycho-dynamic approach.

Interesting post. Reminded me of some seminary fl...

2010-10-06T23:30:25.925-04:00

Interesting post. Reminded me of some seminary flip flopping roles many years ago... Will link to it. But the example Small gives (haven't yet read the book) is of being a shrink to an authority figure not a friend. A friend would not boss one about, dictate, call the shots. If they do, they should expect it to become the subject of therapy.

Although I could imagine that with a friend one might also miss a diagnosis because one might treat a person gently , cushion blows, make excuses, look for the most socially acceptable explanation: eg: he isn't an alcoholic, he just appreciates fine wine because he grew up in wine country.

I think that if you live in a city, you should refer a friend to someone else. Especially if it's a university community with many psychiatrists and psychologists. But several names.

I think that in a small town, you may have sometimes to treat a friend. Or a friend's kid. But it may become the stuff of much of the the therapy and involve a lot of discussion setting up boundaries. So the person feels safe that this therapeutic relationship really is separate. Not everyone can handle it. It would depend on the friend.

If you were just writing a prescription and giving some encouragement to keep taking meds, probably no different than being a GP. But if you were treating a truly dreadful mood problem or a life threatening crisis that would take a long recovery and need long term therapy, a lot would depend on your own training. I'd be inclined to say that the needs of the patient should take precedence. There are so many places where there are only a couple of shrinks in an area and one is a jerk and the family knows the other one from the kids' school. In that case, the shrink who knows them from school should probably be the one.

I could also be flip about this and say I have a personal stake in this: we have a family house in a rural area and I have a kid with serious issues currently in remission. Should he suddenly go ballistic, the only mental health professional I know for fifty miles in the area is a blogging friend. I think I know what I would do if I were up against the wall...:)

make that irony

2010-10-06T21:44:31.614-04:00

make that irony

"such arrangements are not kosher"A touc...

2010-10-06T21:44:05.522-04:00

"such arrangements are not kosher"A touch of iron from a site that offers bacon on the side.