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Professional Boundaries: Is It Okay For A Friend To Treat A Friend?

I just finished reading Dr. Gary Small’s book, The Naked Lady Who Stood On Her Head.

In the final chapter of the book, Dr. Small talks about his mentor, friend, and father figure who’s mentioned throughout the book. The mentor approaches him on the golf course, where they meet to talk, and says he needs psychotherapy and Small is the man to do it. The author is surprised, hesitant, and a bit uncomfortable with the demand (it comes as more than a request.) His wife likens it to the need for a plumber or a dentist, and Dr. Small takes on the task. The mentor calls all the shots: Where the meetings will be, what pastry they will eat, the form of his payment. The author initially misses the diagnosis and uses this as an example of how one can be blinded.

So is it okay for a friend to treat a friend?

I was in an institution where the resounding feeling is that psychiatric disorders are medical diseases like any other: The patient should go where the care is best. Obviously, our institution gave the best care, and so there was no taboo about faculty being treated (or even hospitalized) within the department. This is not to say that everyone treated their friends, but people might not move their care as far away as one might imagine (and sometimes people treated their friends).

At the same time, the standard professional boundaries suggest that friends should not treat friends, and that such arrangements are not kosher, especially after the fact if the treatment is called in to question.

Dr. Small talks about a delay in diagnosis. He doesn’t talk about the fact that the patient here is dictating the care in a way we generally don’t view as being helpful to patients — even VIP patients — or that the desire to please authority figures can be very powerful.

*This blog post was originally published at Shrink Rap*


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