The relationship between a psychiatrist and patient must be different from that between two friends. Friends share problems and concerns with each other because of the mutual give-and-take foundation on which friendships are based.
A psychiatrist-patient relationship is very different. A patient comes to and pays a psychiatrist for professional services. While a psychiatrist is probably going to be more effective by showing some human qualities and not being a completely blank slate, there is still a necessary professional veil that the psychiatrist must wear.
What I was always taught and still believe to be solid advice is that a psychiatrist should not disclose any significant personal information to a patient unless the intent is for that disclosure to help the patient. That’s been a great barometer that I’ve used with myself over the years. If I find myself beginning to talk about my own life, I stop myself and double-check my intentions.
Why must we keep it mostly one-sided? To ensure that the visits are for the patient and not the therapist. I’ve seen too many patients who’ve complained that past psychotherapists spent much therapy time talking about themselves. I’m embarrassed when I hear these stories.
So, while it may be necessary for many details of a psychiatrist’s life to remain a mystery to his or her patients, one drawback is that the patients may not appreciate that psychiatrists are people, too. We have our own lives, families, hopes, dreams, disappointments, fears, good days, and bad days.
Psychiatrist, Gordon Livingston, recently wrote an article, “Even your psychiatrist has a life, and all of it’s problems,” in the Baltimore Sun discussing this issue. He mentions:
So when our patients touch on situations that we ourselves have faced – divorce, rejection, loss of a loved one – it is not unusual for us to experience our own emotional reactions. Because I am a bereaved parent and have written about it, it is not unusual for people whose children have died to seek me out. It is hard sometimes to listen to their stories dry-eyed, though how can I help them if we are both in tears?
So, our own experiences may increase our ability to relate to our patient’s problems even if the situations hit a little too close to home. These may be opportunities for appropriate self-disclosure.
I think it’s fortunate that over time it has become more culturally acceptable for psychiatrists not to be such perfect-appearing blank slates. But, it’s still vital that we keep some personal information to ourselves.
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You have a very difficult job. To remain quiet and be a blank slate has to be very difficult at times? I think it is the correct path in this profession though. I once had a therapist whom i liked very much, but as soon as i learned more about her personal life and personal opinions it deterred my trust in her because we had different belief systems. How can i trust someone to help me if we had a difference in opinion about life, period.
PS, but your not a therapist HERE, correct? This is just a blog-where you should be able to express anything you want and still be anonymous to most of us? My first impression on your blog was that we could discuss anything and get your perspective as a person and therapist-psychiatrist.
@Toni
That’s an interesting question–and, you’re right, my relationship with those who read this blog is different. There is no doctor-patient relationship here, so I will definitely voice my opinions about things that I would not in the context of a treatment relationship. I have enough patients as it is, and I don’t need this blog to be yet another patient interaction!
Locup Doc, very good post. I am sorry for the loss you have endured. Life is hard at times, and these horrible moments shape us; they change us. With that depth of pain though, comes understanding of those that come to you with such a heavy heart. The most painful patient encounters- that stir your own memories and emotions, are probably the ones you can help the most. You are having to compartmentalize as you help them, but you still have access to the information of true knowing. “Really” knowing what they are going through. It’s different than just “understanding” it. You can feel it in your private moments.
I am not a physician or a psychiatrist, but I would think letting them know you are human is okay, but distance is also essential for your own protection as well as the patients.
“So when our patients touch on situations that we ourselves have faced – divorce, rejection, loss of a loved one – it is not unusual for us to experience our own emotional reactions. Because I am a bereaved parent and have written about it, it is not unusual for people whose children have died to seek me out. It is hard sometimes to listen to their stories dry-eyed, though how can I help them if we are both in tears?”
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I am also so sorry to hear about this. I think crying is OK with another parent who has loosed a child and is in your care. Part of therapy is caring & sharing is it not? I think crying is a part of healing and it shows you are a human being as well. I think religion-politics-etc are the things a Doctor should keep to themselves unless they want to only accept like minded patients? But sharing an experience such as this loss is perfectly OK in my book and think it would actually be beneficial for the patient.
Thanks for the comments. Just to clarify-I did not lose a child. That was a quote from an article written by the other psychiatrist.
I think it is helpful to the therapeutic relationship between patient and psychiatrist when he/she offers some personal information on a shared issue of concern. In my experience, it was very helpful to me when one psychiatrist empathized with me regarding the trials and tribulations of dealing with young adult children who seem to know everything (when they don’t). Another psychiatrist shared the frustrations and time consuming nature of caring for elderly parents. Neither shared a huge amount of information but just enough to “share” the common experience and to underscore the human side of the person on the opposite side of the couch.
My mistake. I was reading too fast. My apologies for the misunderstanding.
This begs the questions of what constitutes significant personal info and the type of treatment provided. Marital status would seem to be significant, but hiding it would require you to wear gloves so the patient cannot see whether or not you wear a ring. This issue would seem more critical in the context of psychotherapy than in pharmacotherapy or rTMS. And in the realm of psychotherapy analytic vs family systems or CBT. Regardless of the context the boundaries must exist, but different boundaries may apply in different contexts. Too often the justification for such refers to analytic concepts like transference which have no place outside of analytic/dynamic psychotherapy, but it is not necessary to refer to such concepts to justify boundaries that keep the patient’s welfare at the top of the priority list.
@moviedoc
Great points. I particularly agree that revealing personal info to patients is very context-dependent. I definitely reveal less about myself in the correctional setting than I do in the community outpatient setting.
[...] Lockup Doc discusses the conditions under which a psychiatrist might discuss his private life. Example fitting our theme: when a psychiatrist and patient are both mourning the loss of a child. [...]
[...] Lockup Doc discusses the conditions under which a psychiatrist might discuss his private life. Example fitting our theme: when a psychiatrist and patient are both mourning the loss of a child. [...]
[...] 1. When should psychiatrists discuss their own lives with patients? [...]