Therapy and Friends - June 24, 2008

Dr. Rob,

My best friend is a therapist and I talk to her about my problems with men. She often has helpful things to say but sometimes she'll say I have "deep-seated" issues regarding my father and the men I choose to be with. She thinks that I should seek professional help. She says that because she and I are friends she doesn't want to do therapy on me. But she's not really acting as my therapist, is she?

Jill

I have a fair number of friends who ask me for advice or to just sit and listen to them so I can relate to your friend's ideas. One of my friends created a list of "100 Reasons why I Hate my Mother" and asked me for feedback on it. Some of them were quite valid (e.g., She disowned me when I married a Jewish man); others not so much (e.g., She wears Crocs). But I digress. The issue is when, if ever, do shrinks cross the line from acting as a good friend to that of doing therapy? This is a really tough call without a clear answer.

The standard rule is you cannot engage in a formal therapeutic relationship with friends, family members, past or future sexual partners and pretty much anyone you know personally. The question then is what does formal mean? If a friend comes to the office, spends 45 minutes discussing and working on a psychological problem, then pays for the session -- that would qualify as formal. But does calling a friend and asking for advice on men, while this friend happens to be a mental health professional, qualify as a formal relationship? Probably not but the lines start to get blurred. Part of the problem is that therapy is, in the most basic sense, just a conversation. As I've mentioned before it's very difficult to completely turn-off your therapy mind when talking about problems. If you know something that might be helpful, do you withhold it simply because you're a therapist?

As an example of a blurred boundary between helping a friend and acting as a shrink, consider Dr. Pete's Social Phobia. His music therapy had not been helping so Dr. John decided to stage his own intervention and convinced Pete to let him help out. John arranged to do Exposure Therapy which is probably a better choice for Social Phobia anyway. This is a behavioral therapy approach that is predicated on the notion that if one can be in the presence of an aversive stimulus (in Pete's case, people) for enough time and talk through the anxiety-producing thoughts, the anxiety will subside. In other words Pete's anxiety is a false alarm: he meets people and his mind and body assume that he is in a threatening situation. So dragging Pete to a loud bar with lots of people, while extremely anxiety-provoking, can ironically be therapeutic if Pete can just sit there long enough to let his anxiety ebb and flow and ultimately dissipate. The thinking is that the false alarm will learn to correct itself when the person's mind and body realize that there isn't any inherent danger being in the presence of others. Most of the time this treatment takes more than one session but occasionally very positive results can be seen quickly.

Many people would help a friend overcome an anxious situation, quite possibly by spending time with him in bars and trying to talk down his anxiety. Does the fact Dr. John is a shrink make this intervention inappropriate? I would say no (although Pete could have easily gone to see an expert in Social Phobia for this) but others might argue otherwise, stating that because John and Pete are friends, John's objectivity is compromised. As a side-note on the efficacy of John's work, he started drinking pretty heavily upon arriving at the bar and began hitting on every woman there. Nine single-malt scotches later John was virtually passed out on his barstool and Pete was still a nervous wreck from having no one to talk through his thoughts and feelings. So much for objectivity.

Maybe your friend has a valid reason for suggesting you see a therapist. I don't like to throw around the term "deep-seated" too freely but if this is recurring problem maybe you could benefit from a professional voice that isn't emotionally connected to you and is worried about your friendship being compromised. Or just stop dating altogether and be done with it. While shrinks are a strange bunch they do usually have a good intuition when someone needs more than just a friend's ear. Except maybe Dr. John because he's always drunk.

So what have we learned today:

1) As usual I have no definitive answers to the questions that come in. And I wonder why no one listens to me when I have something important to say.

2) Don't overtax your friends who happen to be shrinks.

3) Stay away from Crocs if you want your kids to like you.

You'll never find a site with gems of wisdom like that. It simply doesn't exist.

Posted by Rob Dobrenski at 12:05 PM

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Comments

Great post Rob.

You say we can't seek input from past or future lovers...does that imply current flings are okay for symbiotic physical and therapuetic needs?

Posted by: Rhett at June 24, 2008 01:46 PM

crocs are a valid reason to hate anyone

Posted by: Adam at June 24, 2008 06:17 PM

I would question whether a shrink would be more effective at troubleshooting a mental fuck-up than your basic garden-variety good friend. A formal therapy session is a very controlled thing, whereas the setting of a conversation between friends is so loose it is just as likely to be anti-therapeutic as it is to help. Therapists are trained for one environment only.

Posted by: Vincent at June 24, 2008 07:50 PM

The designer of Crocs needs to be shot. Analyze THAT! Hehe.

Posted by: Gabrielle at June 24, 2008 10:38 PM

2) sub (i), unless they are able to offer you free services in return.

No, not those kind of services! Professional services!

No, that's not right either...I give up.

Posted by: Yasmin at June 25, 2008 03:00 AM

How about the other way around? When your former therapist calls and wants to "hang out". I've said yes a couple of times but I've discovered that as much as he opens up about his life, he'll always have the power. Now that sucks. Any opinions about this Dr Rob???????

Dr. Rob Note: That is completely unacceptable. A shrink should not be soliciting friends, even if they are not current clients. I will post about all the subtle rules on this at some point.

Posted by: Nicole at June 25, 2008 02:40 PM

I suppose this will surprise few, but I really find some of the "rules" of therapy a bit annoying and doctrinaire. For instance, what if ex-patient and shrink happen to meet again many years into the future, when both are old and gray, something between them clicks...and, no relationship; sorry, no can do! Reason: One person once treated the other person. Now, this reason is a truly stupid reason. You therapists put So Much credence in your own specialness. It's assumed that the previous patient could never, Never, NEVER! comprehend the fact that one's shrink is just human, and flawed and needy and...(on the other hand, Nicole's shrink Does sound a tad creepy, but her example, like any example of a bad therapist, is not really germane to what I am talking about). Of course, I'm also not talking about a relationship w/a *current* shrink. It's like dating a professor. Some people see this as verboten, but, after the class is over for good, what is the big deal? It's said that a therapist would be "exploitative". Well, I think the 50-minute hour is worse. I'm much more harmed by the fact that I must leave ten-of, and yet the time is referred to as an *hour*, than by some overly paternalistic, therapist-ego-inflating rule like the no dating one. Personally, I also think Crocs are more harmful to me, too. :)

Posted by: Borderline Betty at June 25, 2008 03:30 PM

I hear you, Borderline Betty! A 50-minute "hour" indeed! And I have heard, mind you, that in some circles the hour is whittled down to 45 minutes.

As for the social relationship between therapist and client, I can say that my former therapist and I have exchanged holiday cards with warm--albeit brief--personal messages every now and again, and she even sent me an invitation to the opening of her first painting exhibition. She paints landscapes in watercolor.

Posted by: Olivia at June 25, 2008 08:29 PM

"And I have heard, mind you, that in some circles the hour is whittled down to 45 minutes."
Really? That's quite...annoying to me. (Unfortunately, I haven't had my coffee yet, Olivia, so my Excessive Indignation-Response is lagging this morning. I need some time to work up a bit of momentum...;)

Posted by: Borderline Betty at June 26, 2008 07:19 AM

I think croc wearing is a valid reason to hate your mother. Put yourself in your friends shoes (oh pun) and think about how you'd like it if you were to go over to your mother's with your new girlfriend and she's wearing those ugly things? See, valid reason.

Posted by: Jenna at June 28, 2008 04:31 PM