Wednesday, October 26, 2011

Guest Blogger Dr. Jesse Hellman on "Acting Professionally."

Psychiatrists “friending” their patients or interacting with them on Facebook led to the discussion of professional boundaries on Podcast #62. I thought of expanding the discussion because the oft-advised “act professionally” is less than truly helpful: how does one know what is professional? That does not elucidate the underlying principles. I’m talking about one aspect of this below, and am posting this to see what ideas others have. If possible, try to look below the concrete example to expose the underlying principle. 

The psychiatric relationship is a special extension of what is considered proper in all relationships in which one engages someone for professional ends. A mechanic, accountant, electrician, each has access to certain information and he is to use it only for the purpose intended. When you invite an electrician into your home he is to concentrate on the task at hand, not dwell on your art or the design of the home, and certainly not on how beautiful you are. 

A psychiatric patient opens up extremely sensitive personal information, potentially much more embarrassing and intimate than that seen by other physicians. The psychiatrist needs to behave in a way that not only takes no advantage of the information but also keeps the focus on what will help the patient. 

The more the psychiatrist holds to this dictum not only is it easier for the patient to speak openly but the psychiatrist may learn of things that the patient has revealed to no one, perhaps information that he has had trouble admitting even to himself. 

Keeping to proper boundaries is very important in psychiatry. Certain remarks which are common in ordinary social situations would be quite seductive in a psychiatric session. We do not use our patients for our own gratification. That is the basic principle and it is essential if we are to help them.