I agree that there are a lot of views that probably can't be reconciled. Still there can be understanding among differences. I agree with you, and have said so, maybe more in another thread, that I don't believe the client should ever lose sight of the fact that the therapeutic relationship is not reciprocal. That doesn't mean there isn't mutuality or even affection. It just means that it is one way, not two way. And that makes the relationship safe so there is no harm and real work can be done.

In your specific case, I am sorry you experienced hurt. I'm not sure I would interpret it as about a boundary issue (favors). Rather I see it as a doctor's ethics, perhaps being overly cautious, but they sorta have to be that way. The reason I think so, without knowing your story fully, is that when training in assessment, we discussed the diagnosis and accommodations for learning disabilities and ADD. Some sort of testing is usually required to confirm the diagnosis so I don't think a shrink's letter would do it all by itself. He probably didn't realize that fully or became uncomfortable with having that responsibility, knowing it could be scrutinized. Just a guess, but offering a slightly different way to see it.