Psychotherapy and Boundaries: Guess Who’s Coming to Dinner.

Holistic Psychotherapy With A Heart

The other day a patient told a story of how she got her first kitten. It wasn’t anything like what one might expect—found a litter in the alley behind the house, or a stray wound up on their porch. Her family doctor was over for dinner with his wife and he had found a kitten.

“Your doctor came over for dinner?” I asked.

“Yeah, he always did. He was like part of our family,” she sat back.

“He was your doctor and your parents’ doctor?” I asked stupidly.

“Yeah, why?”

The last time I heard about a doctor visiting a patient’s house to celebrate a socialoccasion was the last time I watched Little House on the Prairie.

When I went to graduate school and in every agency I’ve worked since, those boundary crossings were utterly verboten. I know of one social worker (who’s really an administrator, not a therapist) who won’t even acknowledge a patient in public unless the patient comes up to him first.

There are rules and regulations about these things now, privacy laws and confidentiality acts that can put a therapist or doctor in jail for saying the wrong thing at the wrong time.

So, the caution is understandable.
But it’s also lamentable.

Because this past week I left the cloister and went to see a client graduate.  She invited me to do so and there was no doubt it meant the world to her. In my mind and heart it was the healing and loving thing to do. I could have said no, that the regulations strictly interpreted limit our interaction to the office setting and that leaving those four walls could pollute the therapeutic relationship. But I didn't. I went. And we both wept.

To be fair, there are some good reasons for people being careful about leaving a traditional and "safe" setting. Many “healers” have taken terrible advantage of people by forcing unprofessional relationships on them with highly improper dynamics. And I don’t just mean sexual ones. I mean ones in which the therapist is the needy one. And people like that sincerely do need lines drawn around them that read: “so far and no farther.” But I suspect that we may have gone too far in our tentativeness and become fearful. In so doing we may be losing something truly precious—the healing relationship.

My father is a doctor. He no longer practices, but he is and always will be a doctor. When I was growing up it was not unexpected for the phone to ring and it would be his answering service.  I distinctly remember more than a couple of occasions when the call came in the wee hours of the morning and he picked up his leather medical bag (just like in the Jimmy Stewart movies) and left the house not to return until 4 or 5 in the morning.

In fact, one of our family’s closest friends—Aunt Irene and Uncle Harry, we called them—were his patients.  It was winter when I was an infant and Harry had contracted a bad flu which took a turn for the worse one night. They called in, my father went to their apartment on Decatur Avenue in the Bronx, where he sat with Harry as Irene paced until the fever broke. He sat there all night. Harry lived. Irene never stopped pacing, but she was eternally grateful and thought my father walked on water.

First they came to major family events—birthdays, funerals, the like. But then they started coming over just to come over. He still took care of them medically. And they lived into their 90’s, hale and happy.

It never occurred to anyone in my family–immediate or extended–that there was anything untoward or unethical about it. In fact, if that question had even been raised, they would have heard a resounding “Are you CRAZY?” from all of us.

I think the patient who got her first cat from her family internist would have said the same.

Doctors, therapists, priests, rabbis, pastors—healers and helpers of all sorts—used to be part of the community and a part of the lives of the people whom they served. Doctors didn’t have to find different churches to attend because one of the congregants came to see them for a yeast infection. It was confidential, the relationship was sacred, yes. But there was other life to live, too. And people did.

In one of my talks on Verbal First Aid, I make a point of bringing up the stethoscope as one of the inventions that truly changed medicine and the art of healing. Because where once the physician had to lay his or her ear on the patient’s chest to hear the heart beating, now there was over a foot of distance between them.

In our zealousness and fear, we have substituted machines for people and strict rules for sensible relationships. We have literally taken the heart out of healing. I think that is something we cannot afford to do.