Monday, May 19, 2008

Bah Humbug Transference

On my post called It's My Life, I'll Blog If I Want To, one commenter ( green tea) wrote:

I would have a really hard time if my therapist had a blog. It would make them seem too "human" too fallible. I think part of the illusion of therapy is that the person sitting across from us brings their BEST person into the room. In the blog, it's hard to maintain that sense of bounded distance. That detachment that invites a client inward, and into themselves. As an aside-- why use the word "transference" when "relationship" is more apt?

Green tea, I have to say that I agree with you. Here's the issue though: it would be wonderful if every therapist was a wonderful, infallible, highly moral, human being who lived life on a higher plane than the rest of us, and if, barring that, the therapist could keep all skeletons, failures, incorrect or unplanned emotional responses safely locked in the closet and out of sight of any patients.

Sometimes this is so important to a patient that the patient goes to lengths to find distance in therapy: maybe traveling to a distant city, paying in cash so that a psychiatric diagnosis won't come around to bite, making every effort to avoid information about a therapist's personal life/blogs/writings/friends, whatever.

Here's my question: Where's the Line? The real life reality is that therapists have issues, they can endorse unseemly political opinions, have messed up children, icky public divorces, dirty secrets that aren't so quiet. Who wants to know that their therapist hasn't spoken to his own mother in 23 years? Or that he's a member of a church that insists all non-members (including said patient) are condemned to an eternity in Hell? That he buys kinky things in porn shops? What about that prison tattoo? I could go on and on.

At what point does one's profession dictate who one has to be in one's private life? If you think you may want to run for President or for the Supreme Court, well....we all want you to be perfect: pick your pastor wisely, don't inhale, never never never pay your nanny under-the-table, declare everything, deduct nothing, watch where you put that cigar, and don't have ECT. Try not to shoot the neighbors, even by accident.

If you're a psychiatrist, some things are clear: you can't be impaired by a mental illness or have an active substance abuse problem. Licensing boards ask about crimes (but not about tattoos). Direct patient boundaries are defined (or at least trying to be). But outside the office in settings that don't entail the purposeful inclusion of patients? Not many would criticize a doc for writing in academic journals. Novels? Blogs? A doctor who smokes but encourages his patients to quit? Take your lithium, but I've got to run to my hang gliding lesson now?

It's good to have a therapist who is a nice person, who is moral and ethical and kind and encouraging. It's good to have a psychiatrist who is well-educated about medications and up-to-date on treatment options (and kind and ethical and moral and encouraging and a nice person). Google your doc well if you want to be certain they don't have a blog or a strange hobby or affiliation, or crimes against humanity.

Why "transference" and not "the relationship?" Because that's how the question was posed to me. Sometimes my patients talk about the relationship, "transference" is not a word I tend to use in clinical practice, mostly because it's not a schema my patients bring to the setting.