New Therapist Feels My Relationship with Psychiatrist Might Be Unethical

Reader’s Question

I have been seeing my psychiatrist for 10 years. There were a couple of years in there that he stopped seeing me because of transference issues that got out of hand. But now that I am married with kids, we thought we could try this therapy again. I still have transference towards him, but we talk about it openly so that it doesn’t get to the point it did last time. But now I have started seeing a new therapist who thinks my relationship with my psychiatrist is inappropriate. She has even mentioned it being a violation of ethics.

She said that because I am allowed to text him, e-mail him or call his cell phone that this is against the rules. He clearly tells me over and over again that I am only supposed to contact him in crisis situations but he can’t help it if I break that rule. And there are times that I try to talk to him through text or emails or phone calls that are not emergencies. But most of the time he won’t even respond to my text or e-mails if that is the case. And sometimes with the phone calls, he won’t even answer or call back until I leave in a message what is going on. But I like the feeling of safety that I get from knowing that I have ways of contacting my psychiatrist any time of day or night when things get unmanageable.

But my therapist is telling me that because of this my psychiatrist and I have a dual relationship and that it is a violation of ethics. But the thing is that it is hard to not have some sort of other type of relationship when I have known him for so long and he has been there for me the whole time, and during the 10 years he met some of my family members and became good friends with them before he ever knew I was related to them.

He goes to the same church as my uncle sometimes, and the rest of the time he goes to my church. But we didn’t know that before he started seeing me. My biggest concern is that I don’t want to get him in trouble for some way that I am acting that is not his fault at all. He is not the one who gave me the e-mail address: I paid $5 for it on a search engine, but now that I do have it he does respond sometimes. And I have had his cell phone number for 10 years; he gave it to me when I was 15.

Because of what my therapist said I got extremely mad at her but did not tell her that. And I really don’t even want to go back and see her again.

She treats me differently because she knows that my diagnosis is Borderline Personality Disorder. She acts like just because of that diagnosis she should be scared of me because I will start stalking her too. I don’t know what to do or if what she says is right or what.

Psychologist’s Reply

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The concept of “dual relationships” has always been important in professional ethics. Over the years, ideas about dual relationships have changed, especially for professionals working in small communities or who have been in clinical practice for many years. For many professionals, dual relationships are impossible to avoid as one of your clients/patients may eventually be or also be a neighbor you haven’t met, a member of your church or organization, an employee at a business you frequent, or someone known to your family and friends. With this understanding, the concept has changed to now prohibit relationships that involve the exploitation of the client, as when the professional uses their relationship with the client for some selfish purpose or manipulation.

Ethical standards are for the protection of the public…not always the protection of the professional. Based on your description, while you are exploiting and using your relationship with the psychiatrist inappropriately at times, he is still operating in an ethical manner. If he feels exploited or mistreated by you, he is responsible for setting boundaries as he has done in the past. In these situations, if you become too inappropriate or intrusive, he will once again reset the boundaries of the professional relationship. Your psychiatrist is behaving in an ethical and appropriate manner, despite having a variety of relationships with your friends and family in the community.

Your new therapist may be concerned about your past behavior with your psychiatrist. The new therapist may have very firm boundary practices and beliefs and is now aware that you will purchase Internet searches if needed and contact professionals inappropriately. She will likely create firm boundaries with you, with some therapists providing a “do and don’t” list.

The establishment of such boundaries may be of benefit to you and may be very helpful. If you think about what you’re saying about her — “She made me mad…I didn’t tell her…I don’t want to go back” — that’s the behavior of that original 15-year-old, not of a mature mother with children. You’ve been struggling for many years with the establishment of “mature” and appropriate relationships and this is an opportunity to create one, with professional help. I’d recommend continuing with the new therapist.