Psychotherapist and patient relationship manager

psychotherapist and patient relationship manager

Clients often develop a close relationship with therapists but is it of all the reactions that take place between the therapist and patient. Second, managing closeness in the treatment relationship itself is seen as one of the expression by the patient to which the therapist responds with empathic. The therapeutic relationship is not a friendship because the therapist and patient have no relationship outside the consulting room. That doesn't.

It would depend on the context.

'Til Death Do Us Part: Does a Client Ever Stop Being a Client?

However, when a therapist and long past patient enter into a relationship separate from the therapeutic one, is that actually a dual relationship? Would it be more accurate to call it a sequential or serial relationship?

Is there a difference? If one believes that our patients grow mature and sometimes surpass us in knowledge, wisdom, and power, then it is a significant difference. Of course, of all the dual or sequential relationships that are potentially possible with patients and former patients, when the issue of sex comes up, most all therapists of all disciplines react forcefully.

Examining the Therapeutic Relationship and Confronting Resistances in Psychodynamic Psychotherapy

Having sex with a current patient or even a recently discharged patient is not only unethical—it is illegal. It is truly a betrayal of the trust the patient places in us. However, over time as in yearscan that change in some very special circumstances to allow exceptions to the rule? If a therapist and former patient meet some 10 or 15 years after the last therapeutic session and develop a personal relationship, get married, and have children, can we say that an ethical violation or a crime has been committed?

Washington State is one exception. However, assuming the former client does not file any complaint, how enforceable would such laws be? For example, what if the former therapist and patient got married, were in a committed relationship, and had children?

Would or should an ethics committee have the authority to interfere with a marriage or union among consenting adults? What about our belief in the right to free association? What is the rationale for the prohibition against sex with patients?

Many believe it is the power differential. Behnke points out that many relationships have significant power differentials, including partnerships and marriages, and that we often do in fact put our own interests above those of clients when we charge fees, for example. So, neither a power differential nor putting our own needs first is in and of itself unethical. Rather, Behnke says, it is because we have a fiduciary relationship that is compromised and creates additional risks that are not a necessary part of the therapeutic relationship, making psychotherapy impossible.

But fiduciary relationships are not static and change with time and circumstances. Some would argue it is based on psychodynamic theory, and perhaps those who practice psychoanalytically have a higher standard.

psychotherapist and patient relationship manager

But interestingly, there is nothing in psychodynamic theory or psychoanalysis that would state such. This would include taking patients on vacation and conducting analysis in hotel room beds. We tend to forget that that was a different time with different standards. Therefore, perhaps, our reactions could possibly be a way of denying and reacting against the behaviors of a previous era we find frankly embarrassing and indefensible.

Another possibility is that, whereas all of us require structure of some kind, some of us need more structure and clear inflexible rules more than others. Some fear that if they bend the rules just a little, they may go down a slippery slope and cross all reasonable bounds.

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To therapists who believe they are just one rigid rule away from harming their patients, I say maintain all the rules you need. However, not everyone requires such inflexibility. Attempting to impose such rigidity on everyone is not good practice. It is not good for our clients or the field. If we hold that belief to be literally true, then it would not apply only to sex. We are responsible to protect our clients from harm to self and others. But if we make no distinction between current and long past, can we in this litigious society be sued for the actions of a long past client?

Our clients grow mature and often leave us behind. In this case he or she may be exploring scary emotional and romantic feelings in a safer environment. Thanks for participating in a venue to help people understand some of these complex psychological problems!

My purpose here is not only to answer the student but to help people understand the complexity of psychotherapy and the human mind.

There are many definitions of transference. To keep the concept as simple as possible for our purposes here we will use the following definition of transference: Transference refers to the repetition of childhood experiences with parents, redirected onto the therapist today.

In other words, feelings and desires felt towards the parents during childhood are redirected and placed onto the therapist. The transference is important for the therapist to understand, as it gives him a picture of what this patient experienced during childhood. First, we must understand that there is very little we know about the individual who wrote the E. We have no way of knowing why this patient attended therapy in the first place. What we can deduce from what she writes is that her experience of love for the therapist, and her wish to be with him, is painful.

The painful nature of her experience is surely due to the fact that she feels that it is hopeless to have her wishes realized. Perhaps and most likely, this is a depressed woman.

psychotherapist and patient relationship manager

In terms of transference, it is possible that she experienced her love for her parents as frustrating and hopeless. Perhaps they did not love her? Perhaps she was not allowed to love them or her love of them went unacknowledged and unappreciated? Perhaps she was made to believe that her love for her father was "inappropriate?

Children blame themselves for problems and not their parents. All of these and more are possible explanations but we do not have adequate information. What we do know is that this patient now has a powerful transference relationship with the therapist. She loves her therapist and wants to be with him. She states that she knows that she "cannot be with him.

If this is true then the experience of painful rejection is a repeat from the past. Similar to her thinking and feeling during her childhood, she concludes that she is not loveable and that is why the therapist "rejects her.

In other words, it is not that the patient "knew" she was unlovable, but that she unconsciously experiences being unlovable when she is in relationships that end in disappointment or failure. The problem becomes "her fault," and not the fault of other people.

'Til Death Do Us Part: Does a Client Ever Stop Being a Client? -

She does not "know" any of this because the feelings of depression and self hate she experiences have unconscious causes rooted in her early past. The therapy provides a chance to work through and correct this self concept.

It is also true that if the patient was abused as a child, then the transference could be her expectation of repeated abuse at the hands of other people and of the therapist. When that does not happen, she comes to feel safe with the therapist. The therapist becomes a good object. However, he continues to refuse to "be with her," and she finds this intolerable.

psychotherapist and patient relationship manager

In this intolerable situation, she concludes that he does not make love to her because she is not worthy. Worse than that, he does not even beat her as her parents did when they abused her. Freud talked about this in his famous essay, "A Child is Being Beaten.