Patients hugging you without warning?

[Ceke2002]

I'm assuming this has happened to most of you at some stage, particularly with some of the less inhibited or emotionally disregulated patient population. How did you react? Was it bewildering, disturbing, something you chuckled about after the fact ~ any funny anecdotes? Do you usually know if a patient is about to hug you without asking as well, or do some really manage to take you by surprise?

My Psychiatrist and I haven't so much as shaken hands in the past 5 years, but I had a random urge to give him a quick hug last session (for, let's just say, reasons that relate to a private matter). Of course I refrained, because I do have some semblance of self control, and did think it a tad inappropriate to just launch myself at the poor guy and have him wondering what in the blue blazes I was doing ~ But then it made me think of patients who may not have that sort of filter or are disinhibited in some way, and what it's like to be on the receiving end of stuff like that.

So yeah, me, curious, etc etc, the usual.

---

Members don't see this ad.

 

[smalltownpsych]

I have received lots of hugs from patients and all of them were very appropriate. Many times the patient will just ask and it is usually at the end of a session and it feels pretty natural and non -sexual
Last week I had a young 12 to 13 your old girl come up to me in a store and ask if she could give me a hug. I didn't remember who she was at first but afterwards recalled that she had been an ER consult a few weeks prior. She just wanted to express her gratitude. I won't forget that one.

Another hug was one that occurred in my first couple months of training. This was a 14 year old girl who was wearing very skimpy clothes and was quite well-developed and she gave me a hug in front of all of the detectives at the police station I was working at. That was a pretty uncomfortable moment.

 

[HarryMTieboutMD]

Case by case situation. Obviously if it's an intrusive/manic/borderline (good side of the split) it's a bad idea. When I was in medical school, the division chief of addiction medicine who ran the residential treatment center that was part of the psych dept would hug patients after they presented their 4th Step exercises and also after their last meeting with him before discharge. But these were brief, friendly, and very appropriate to the situation.

 

[PikminOC]

I don't like it when patients hug me or their relatives. Some patients have given me a card. I save that in the chart. Thanks Ceke again for posting!

 

[Ceke2002]

I have received lots of hugs from patients and all of them were very appropriate. Many times the patient will just ask and it is usually at the end of a session and it feels pretty natural and non -sexual
Last week I had a young 12 to 13 your old girl come up to me in a store and ask if she could give me a hug. I didn't remember who she was at first but afterwards recalled that she had been an ER consult a few weeks prior. She just wanted to express her gratitude. I won't forget that one.

Another hug was one that occurred in my first couple months of training. This was a 14 year old girl who was wearing very skimpy clothes and was quite well-developed and she gave me a hug in front of all of the detectives at the police station I was working at. That was a pretty uncomfortable moment.

Case by case situation. Obviously if it's an intrusive/manic/borderline (good side of the split) it's a bad idea. When I was in medical school, the division chief of addiction medicine who ran the residential treatment center that was part of the psych dept would hug patients after they presented their 4th Step exercises and also after their last meeting with him before discharge. But these were brief, friendly, and very appropriate to the situation.

I don't like it when patients hug me or their relatives. Some patients have given me a card. I save that in the chart. Thanks Ceke again for posting!

Sounds like everyone has different experiences, and points of view, which is to be expected. Just personally I don't mind a hug in therapy if it's something that happens naturally and is done appropriately, but doing the whole 'Oh, okay, end of session, er so it's hug time now I guess' type awkward vibe is just totally not my style.

As for being hugged by a well developed, skimpily clad 14 year old - yeah, I'm hearing you on the uncomfortably aspect there.

In terms of randomly wanting to hug my Psychiatrist out of the blue - I said for 'reasons', and without getting into the nitty gritty or anything, he's currently on leave due to a family member's health (he has told me what is happening, but only briefly and not in any major detail). Last session as he was walking me out to reception, I wished him and his family well, and said I hoped everything went okay, and he was like 'Aw thank you, I'm sure it will', all casual and no worries, but then he turned around and gave a caveat of 'I hope'. Now I'm fairly good at picking up on people's emotions, even if they're expressed subtly, so the brief puppy dog eyed look of concern that flashed across his face is something I just automatically noticed straight away, and for the same brief moment I was like 'OMG, quick let me give you a reassuring hug'. Of course as soon as that thought went through my mind I was like 'Holy inappropriateness Batman! How about we don't hug our non-hugging Psychiatrist'. Yeah, we don't really have the hand holding, hugging type of therapy relationship so that would have just gone down as being waaay awkward.

As for cards, I've never given my Psychiatrist one. I've given him a couple of small gifts, but I asked if it was okay before either card or gift giving actually happened. He does have a space on a shelf at home (I think it might be near a prayer shrine/altar, I can't remember exactly) where he keeps any small gifts or tokens that patients have given him. First gift I gave was actually something for him and his reception staff at the old clinic we had therapy at. The two women who worked reception there were really lovely, so I bought a box of Guylian Sea Shell chocolates for my Psychiatrist to share with them (I specifically picked chocolate sea shells, because we'd been talking about my hope to take up snorkeling again when I had the money to replace my thrashed out old equipment and had gotten all my dental work out the way, so I figured it was kind of appropriate). The only other gift I've given him was a little pouch of some semi precious stones that were taken from a larger portion of stones my husband and I had received as symbolic gifts (with corresponding wisdom) representing the four elements at our (combined Wiccan and Buddhist) wedding. I reconsecrated a small amount of the stones for blessings on him and his family, and that's one of the things he keeps on his specially set aside shelf space (I think other patients have given him small Buddha statues, or similar ornaments as well).

 

[PikminOC]

I like cards. I put them in the chart and then I don't feel bad that the patient spent too much money. It's the sentiment. Just my opinion.

 

[Therapist4Chnge]

I enjoyed my time in the VA system bc most of my pts were the "handshake and a nod" type...which was great bc I'm not a big fan of hugging. Back when I worked w. peds I'd pre-emptively offer the high-five, which worked well in most cases (assuming I had anti-bacterial soap around).

As for the gift thing...I worked a couple of years at a private facility ($$$), so occasionally I'd get families wanting to buy me a gift as a thank you. I'm pretty conservative with that kind of stuff, so I'd usually rec. a card/thank you note if they pushed me on, "we want to get you something." Admittedly, the coolest gift I was offered was to test drive a pt's father's new Ferrari. It was beautiful and he knew I loved cars, but I declined bc the family had a way of pushing boundaries that gave me pause.

 

[Ceke2002]

I like cards. I put them in the chart and then I don't feel bad that the patient spent too much money. It's the sentiment. Just my opinion.

Yeah I'd prefer to give something small and inexpensive, but that also had meaning or sentiment to it.

 

[Shikima]

I think hugs when concluding an encounter or terminating therapy can be very beneficial and therapeutic to the process. I never initiate them but always oblige, especially if my LoLs are requesting them.

 

[F0nzie]

Hugs are ok. I have received them every now and then. Mostly after breakthroughs or completion of therapy. Overall my experience with hugs has been positive. I never offer but I am sure it has some therapeutic value for the patient. If it happens all the time I will bring it up at the start of the next session...hasn't yet.

 

[Lysinee]

You should dodge hugs like Bush dodged flying shoes.

And say "Ain't Nobody Got Time for That!"

 

[Ibid]

What about winking..... out of the blue winking...... their is a lot that can be implied in a wink..... overtly or covertly sexual..... all out of the blue.... wink wink...its a mine field..... wink back.... don't wink..... pretend the wink didn't happen.... or write it all up in tedious detail in your notes just to be on the safe side.....

 

[Ceke2002]

What about winking..... out of the blue winking...... their is a lot that can be implied in a wink..... overtly or covertly sexual..... all out of the blue.... wink wink...its a mine field..... wink back.... don't wink..... pretend the wink didn't happen.... or write it all up in tedious detail in your notes just to be on the safe side.....

Well if it was my Psychiatrist winking at me back in our earlier sessions (before all the good stuff like implict trust and a therapeutic bond kicked in) the notes would have probably read something like:

Winked at patient, patient proceeded to throw a chair at me, before bolting from the room. Unsure at this time if patient is returning to treatment.

 

[Ibid]

Well.... now that you have the therapeutic superglue set hard...... you can wink away at each other safe to explore the worm holes of each others minds with out the implied threat of violence from you..... of course you can't be sure your psychiatrist won't do the dirty on you......

 

[Ceke2002]

Well.... now that you have the therapeutic superglue set hard...... you can wink away at each other safe to explore the worm holes of each others minds with out the implied threat of violence from you..... of course you can't be sure your psychiatrist won't do the dirty on you......

You do realise I'm the victim of previous abuse by a Psychiatrist, hence the chair throwing example As for my Psychiatrist doing the dirty on me...*falls over laughing*

Edited to add: {redacted - no use getting into a p**ssing contest]

 

[smalltownpsych]

Well if it was my Psychiatrist winking at me back in our earlier sessions (before all the good stuff like implict trust and a therapeutic bond kicked in) the notes would have probably read something like:

Winked at patient, patient proceeded to throw a chair at me, before bolting from the room. Unsure at this time if patient is returning to treatment.

I encourage my patients who have been abused to fight back with whatever means necessary. Sort of like the holocaust survivors mindset of never again. Of course, if he had something in his eye and you hit him with a chair, well that's the risk we take working with people. Oh I also wink when I am being humorous. (Dodges chair)

 

[Ceke2002]

I encourage my patients who have been abused to fight back with whatever means necessary. Sort of like the holocaust survivors mindset of never again. Of course, if he had something in his eye and you hit him with a chair, well that's the risk we take working with people. Oh I also wink when I am being humorous. (Dodges chair)

Haha, don't worry no chairs My Psychiatrist and I get into some friendly (appropriately friendly I might add) banter in session ourselves sometimes, keeps things flowing, builds rapport and connection. Mind you it took some time, and a heck of a lot of patience and gentle persistence on the part of my Psychiatrist to build trust. He twigged pretty early on that there might have been some sort of previous therapeutic abuse though, so I think that probably helped with his approach overall, and my subsequent ability to actually trust a male Psychiatrist again.

That's actually one of the anon questions I got via email - what the abuse consisted of, feelings/reactions at the time, long term effects, advice for therapists dealing with therapy abuse patients. I'm still working on writing an answer.