Psychiatry & Psychology--General/Doctor-patient friendship


Hello, nice to converse with you. I'm a doctor working in psychiatry department of a hospital in Pakistan. During a night duty in department I was told about a verbal quarrel between 2 female patients. I called 1 of them and another patient in my duty room and talked to them both to counsel them and to distract them. Of the 2 patients I called in separate room and I talked to them, one patient said that I'm a really nice person and she said that she wanted to be my friend. She said she had a female friend who betrayed her about 6 months ago. She has done many unsuccessful suicide attempts and was saved by her family each time. I verified her story from her family. She says that her life would be a failure unless she finds some real friend to share her sorrows with. I personally feel she needs a good friend. She repeatedly asks me to be her long lasting friend.
She has also befriended a nurse there.
If she isn't a patent, I would have certainly befriended her too. But provided she is an admitted patient having few obsessive compulsive symptoms and depressive cognition, should I befriend her. From her history, I've realized that a good friend can save her from anymore suicidal attempts.

Hello Nasrullah

Standards of professional practice may vary from one jurisdiction to another, and I can speak only for what's accepted on my side of the world.

You know that psychiatric practice typically extends into intimate social topics. And that friendliness can be therapeutic. (There is a book titled "Psychotherapy: The Purchase of Friendship.") BUT:

1. Male practitioners dealing with female patients are admonished to consider whether they would think and behave differently if the patient were male and/or unattractive.

2. Friendship can lead to dependence, and one goal of psychotherapy is to foster independence.

3. Friendship and dependence can lead to intimacy, for which the clinician could lose his licence and even go to jail.

4. Practitioners should be acutely aware of practice barriers than must not be breached. The primary one is that the therapeutic relationship starkly stops outside of the designated time and place.

5. A few psychiatric patients can be manipulative and dangerous, and psychiatrists can be manipulated to their serious disadvantage.

6. When the practitioner finds that his resources are being used to resist intrusions into his life, it's time to transfer the patient to another, possibly female, colleague.

7. When in doubt, record the session and inform a supervisor or at least a colleague.

Thanks for asking us, and I hope this helps.


Psychiatry & Psychology--General

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Alan Auerbach


Taught psychology for 30 years, authored four textbooks. Specialize in introductory and industrial/organizational psychology, but will tackle wider range of areas.

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