Do patients often develop romantic feelings for psychiatrist?

[carlosc1dbz]

I think that psychiatry is probably the only field where a true patient doctor relationship can be established. Some might argue that a lot of primary care does that as well, but in my opinion, I think its only psychiatry.

Psychiatry seems to deal with very vulnerable people, that have many times experienced some sort of trauma, whether it be physical or mental. Many times one deals with depression, and patients that feel very isolated from the world. Sometimes, the psychiatrist is the only person in their life that will sit down with them, listen to them, and truly ask them how they feel.

As a results many patients a truly grateful for service that is given, and might even consider the psychiatrist their friend. I would assume that some percentage of these people, might develop romantic feeling for their psychiatrist.

I want to hear if any of you have any experience in this regard this topic.

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[carlosc1dbz]

lol dude you ask a lot of questions

Well, thanks, and I hope you will be able to provide some great insight into the topic at hand. It is important for doctors to know about this topic because you can get into some serious trouble if you get involved with a patient.

 

[cat22]

Post your question in the clinical psychology PhD forum and you'll get a lot of responses.

 

[pingouin]

Google "transference and countertransference". You'll find more answers than you could ever read in a lifetime.

 

[peppy]

I think everyone in psych has had a patient try to "hit on" them or make a lewd remark. You don't have to even have a relationship with a patient for it to happen. Mentally ill people often have poor impulse control and don't have a normal sense of boundaries. Some will say inappropriate things when you're just walking down the hall past them on the psych unit.

In med school, we were taught that psychiatrists are the specialty that is most often disciplined for inappropriate sexual relationships with patients, so unfortunately I guess there are some people in this profession who have the wrong intentions.

 

[sunlioness]

I was just thinking that I would imagine that when these sorts of ethical violations happen it is probably less often because the patient developed romantic feelings for their provider and more often because the provider had terrible boundaries and manipulated the patient either consciously or unconsciously. Either way though it's the provider's responsibility to make sure that appropriate boundaries are maintained.

 

[carlosc1dbz]

What kind of great insight are you looking for? Don't have sex with your patients.

This isn't unique to psychiatry either, although in psychiatry you'll get patients whose pathology may make them act out sexually towards you. Hopefully by the time you're a psychiatrist, you'll have learned the requisite self-control and keep your noodle in your pants.

Why do you think I dont have self control? I never implied that. I just wanted to know if psychologist have to deal with it a lot, and how they confront patients about inappropriate behavior. Nothing wrong with asking people with experience.

 

[whopper]

I was just thinking that I would imagine that when these sorts of ethical violations happen it is probably less often because the patient developed romantic feelings for their provider and more often because the provider had terrible boundaries and manipulated the patient either consciously or unconsciously.

I agree. Even if a patient developed romantic feelings for a psychiatrist, the psychiatrist is in a position to position the patient against this from happening, and if it were to happen, there's still things the psychiatrist can do to enforce proper boundaries.

I've only had one patient to memory that made sexual advances on me. I wrote about it before--it's pretty graphic, well actually very olfactory.

If you, for example, laid out the ground rules to patients, e.g. "If you tell me you want to hurt yourself or others, or give me enough information to lead me to believe you will, I may have to have you hospitalized, even against your will. We cannot have any relationship outside this office..." It will likely prevent the patient's mind from going into that territory.

I have seen some exceptions to the rules, but in general, unless you have a cluster B patient, I wouldn't worry about it much. I do recommend that you interview anyone of the opposite sex with cluster B issues in a transparent manner. E.g. the door is open and other employees can hear the conversation. If the patient wants the door closed, you could do other things to make the interview transparent.

 

[Rabbit Hole]

I agree. Even if a patient developed romantic feelings for a psychiatrist, the psychiatrist is in a position to position the patient against this from happening, and if it were to happen, there's still things the psychiatrist can do to enforce proper boundaries.

I've only had one patient to memory that made sexual advances on me. I wrote about it before--it's pretty graphic, well actually very olfactory.

If you, for example, laid out the ground rules to patients, e.g. "If you tell me you want to hurt yourself or others, or give me enough information to lead me to believe you will, I may have to have you hospitalized, even against your will. We cannot have any relationship outside this office..." It will likely prevent the patient's mind from going into that territory.

I have seen some exceptions to the rules, but in general, unless you have a cluster B patient, I wouldn't worry about it much. I do recommend that you interview anyone of the opposite sex with cluster B issues in a transparent manner. E.g. the door is open and other employees can hear the conversation. If the patient wants the door closed, you could do other things to make the interview transparent.

What else would you suggest to make the interview transparent?

I have wondered about dress code for female psychiatrists, do they have to totally cover up and not wear as much makeup when they are at the hospital (as opposed to private practice)? Is it more difficult for female psychiatrists to work with patients - higher incidence of transference?

 

[whopper]

What else would you suggest to make the interview transparent?

Record the interview, and say it's for record-keeping purposes.

Don't be alone in the office.

The office door could have a glass window in view of other staff.

Insist that a chaperone be present, or you won't be able to see the patient.

I actually do see female patients alone in an office in my current outpatient gig. I would never see a patient alone where I ran on my all-female forensic unit last year.

Outpatient is a different game than inpatient. Several of the patients, you've seen consecutively for several months if not longer and you know the likelihood of being falsely accused of some type of inappropriate sexual behavior is extremely low. In my inpatient gig, almost all the females had a severe cluster B personality disorder. One of those patients, the second she didn't get something she wanted, she screamed "rape!, rape! rape!"

Point is you need to protect yourself, but there is some room for see patients of the opposite sex alone in your office. Just take proper precautions, and be extra careful with specific patients that may be at higher risk of making a false accusation.

Is it more difficult for female psychiatrists to work with patients - higher incidence of transference?

Don't know the answer to this one. The only female colleague I knew of that had a problem in terms of sexual boundaries had a patient stalk her. She is an attractive woman, and she demanded the patient stop the activity or she would refer him to another doctor. He complied.

 

[Rabbit Hole]

Record the interview, and say it's for record-keeping purposes.

Don't be alone in the office.

The office door could have a glass window in view of other staff.

Insist that a chaperone be present, or you won't be able to see the patient.

I actually do see female patients alone in an office in my current outpatient gig. I would never see a patient alone where I ran on my all-female forensic unit last year.

Outpatient is a different game than inpatient. Several of the patients, you've seen consecutively for several months if not longer and you know the likelihood of being falsely accused of some type of inappropriate sexual behavior is extremely low. In my inpatient gig, almost all the females had a severe cluster B personality disorder. One of those patients, the second she didn't get something she wanted, she screamed "rape!, rape! rape!"

Point is you need to protect yourself, but there is some room for see patients of the opposite sex alone in your office. Just take proper precautions, and be extra careful with specific patients that may be at higher risk of making a false accusation.

Don't know the answer to this one. The only female colleague I knew of that had a problem in terms of sexual boundaries had a patient stalk her. She is an attractive woman, and she demanded the patient stop the activity or she would refer him to another doctor. He complied.

Thanks for your comments. I know the name of the game is to document EVERYTHING. You mentioned recording the interview - for liability purposes, do you actually have to store these recordings in the patient's record? Can it be digitally recorded and stored or would you need a "cassette" (assuming it's is voice recording only).

The stalking thing..

 

[whopper]

Can it be digitally recorded and stored or would you need a "cassette" (assuming it's is voice recording only).

Yes. I don't see why not. I would recommend a digital recording only because it'll save space.

 

[masterofmonkeys]

I think everyone in psych has had a patient try to "hit on" them or make a lewd remark. You don't have to even have a relationship with a patient for it to happen. Mentally ill people often have poor impulse control and don't have a normal sense of boundaries. Some will say inappropriate things when you're just walking down the hall past them on the psych unit.

Very true. There's a running joke among people who've seen it about how often old men at the VA would make comments about my muscles and attempt to feel them when I was doing night float there. Like once a night at least. That's why I started wearing baggy hoodies. And I wasn't exactly wearing skin-tight shirts before that.

There was also a situation with an Axis II female patient who would have 'suicide attempts' or otherwise act out with factitious dissociative events frequently when I was working that night...but not on other nights.

And, as anyone who knows me will attest to, I am not exactly gorgeous. Or at all for that matter.

My own experiences notwithstanding, I do believe that a female psychiatrist is honestly less likely to have problems in this area than a male psychiatrist. Part of this is the power differential. Part of it is the role of the princess being rescued by her knight in shining armor who comes to rescue her from being locked inside the tower of despair. Part of it is the fact that so many females with mental health issues have a history of sexual abuse or simply dysfunctional relationships. *shrug*

 

[Rabbit Hole]

Very true. There's a running joke among people who've seen it about how often old men at the VA would make comments about my muscles and attempt to feel them when I was doing night float there. Like once a night at least. That's why I started wearing baggy hoodies. And I wasn't exactly wearing skin-tight shirts before that.

There was also a situation with an Axis II female patient who would have 'suicide attempts' or otherwise act out with factitious dissociative events frequently when I was working that night...but not on other nights.

And, as anyone who knows me will attest to, I am not exactly gorgeous. Or at all for that matter.

My own experiences notwithstanding, I do believe that a female psychiatrist is honestly less likely to have problems in this area than a male psychiatrist. Part of this is the power differential. Part of it is the role of the princess being rescued by her knight in shining armor who comes to rescue her from being locked inside the tower of despair. Part of it is the fact that so many females with mental health issues have a history of sexual abuse or simply dysfunctional relationships. *shrug*

I can't tell if you're serious about the 1st bolded section 😕

As far as your last paragraph - I don't understand what you mean by this princess in locked tower of despair syndrome? How does that relate to the difficulties female psychiatrists face on the job?

To be quite frank - the reason I think female psychiatrists would have a tougher time with a certain population of patients (males) - is because they would be staring at their chest the whole time. I know that is a gross generalization, but you know what I mean. That's why I was asking about whether females should dress down or wear less makeup while at work. Or is this a non-issue?

 

[masterofmonkeys]

I can't tell if you're serious about the 1st bolded section 😕

As far as your last paragraph - I don't understand what you mean by this princess in locked tower of despair syndrome? How does that relate to the difficulties female psychiatrists face on the job?

To be quite frank - the reason I think female psychiatrists would have a tougher time with a certain population of patients (males) - is because they would be staring at their chest the whole time. I know that is a gross generalization, but you know what I mean. That's why I was asking about whether females should dress down or wear less makeup while at work. Or is this a non-issue?

I am dead serious about my 1st paragraph. It has been a regular occurrence for me.

What I was trying to get across is that I really do feel that for all the reasons I stated above, a male psychiatrist is more likely to have issues with female patients and transference than a female psychiatrist.

As for whether female patients would have a tougher time...I think this is just an extension of an idea that has perpetuated throughout popular culture, that if women are pretty they won't be taken seriously, and that they are at risk of being sexually harassed everytime they breathe.

Which really just demonstrates our cultural bias about the unidirectional nature of sexual harassment. Men are regularly the targets of sexual harassment or otherwise inappropriate sexual attention. Maybe not as often as females, and maybe they don't get offended by it, or maybe they just don't report it as often. I have personally experienced plenty of it from both coworkers and from patients. I do regularly get my muscles touched and squeezed by female coworkers. I do mean muscles here, not a friendly pat on the shoulder. And its completely inappropriate. How would a female feel if I grabbed her butt? How is feeling me up any more appropriate? How is 'you have nice shoulders' any better than 'look at that rack! Are you wearing a water bra or is that all real?'

My point was that this is not a gender-specific issue, especially in psych where due to higher experiences of sexual abuse and the frontal release associated with mental illness, female patients may be just as impulsive as male patients.

I think a general rule of thumb for anyone of any sex is not to either hide or attempt to accentuate your attractiveness. I can't comment on the makeup issue because I am honestly not moved by it very much and have a distaste for anything beyond mascara and lipstick in women. But I don't think its appropriate for a female professional with a voluptuous figure to wear clothing that emphasizes and displays her attributes any more than it is for a guy with a great body to wear one of those ridiculously over-tailored dress shirts that shows off the curves of his arm muscles or just how flat his stomach is.

 

[sunlioness]

To be quite frank - the reason I think female psychiatrists would have a tougher time with a certain population of patients (males) - is because they would be staring at their chest the whole time. I know that is a gross generalization, but you know what I mean. That's why I was asking about whether females should dress down or wear less makeup while at work. Or is this a non-issue?

I haven't had a problem with this thankfully. And you know, I have to talk about such things as erectile dysfunction and inability to ejaculate with guys fairly frequently because of the nature of the meds I prescribe. And it's far more likely for guys to blush, look at the floor and mumble answers to my questions rather than behave inappropriately. I keep the questions matter-of-fact and clinical. I had one guy who had his own Axis II stuff going on make inappropriate flirty comments in what I sense was trying to intimidate me. He was called on that and he stopped. I do wear make-up to work most days, but not over the top. Never wear tight-fitting clothes or show any cleavage. As said above, I don't think dressing that way is appropriate or professional for either gender.

 

[toby jones]

>... any more than it is for a guy with a great body to wear one of those ridiculously over-tailored dress shirts that shows off the curves of his arm muscles or just how flat his stomach is.

lol. Girls are into broad shoulders and a 'triangular' frame. Curls aren't for the girls - they are for the boys :-D As is the obsession with abs :-D