This is reminding me more and more of a relationship I had with one of my p-docs. (As such you should take what I say with more than a grain of salt, no doubt. You need to assess how much this fits for you).

> Yeah - I bruised his ego when I wrote him this letter about how we were spending too much time on him and not so much time on me in the appointments and I said we needed to get down to business.

Does he talk about himself a lot or do you mean that most of the time is spent talking about his deficiencies (e.g., him promising to do something and then not doing it?) If the latter... This is a situation that I got into with one of my p-docs. He would make promises and then not follow through on them with action. Repeatedly. And I'd pull him up on it every time and so our time together was mostly about that. Him getting defensive, and me trying to figure a way to get him to change... And not wanting to go on about this (wanting to get to the real issues) but going on about it regardless.

> And these days he feels I'm attacking his professionalism because I go on about how he doesn't return calls when he says he will etc.

I think it is fair to be able to expect that when someone promises they will do something that they will do it. *Expecially* clinicians. He does indeed need to learn to not make promises if he is unsure whether he can follow through on them. It can be as easy as saying 'I'll *try* to get back to you by xxx' instead of saying 'I'll get back to you by xxx'.

> I think I'm touching him in areas where he already feels inadequate because he is not yet working for himself so he can't do things the way he wants to.

That sounds right to me. The biggest bone of contention between me and my p-doc was his taking calls on his mobile and checking his pager when it went off while I was trying to talk to him. He would jump up and leave the room or he would check his pager and then leave the room to make a call. He promised he wouldn't do that anymore, but he just kept on doing it.

What took me a while to realise... Was that he was oncall for emergencies at the hospital. The registrars were keeping him updated by pager but they would call when they really didn't know what they should do. Basically... He didn't have the time to see me and he was overcommitting to seeing me. He never told me that but I realised one day when he didn't show because there was some emergency at the hospital and the receptionist explained that he was oncall there on whatever day of the week I was seeing him.

I'm sure things aren't *that* bad with your p-doc but it could well be that there are emergencies like that (unexpected ones) that waylay him from getting back to you when he promised. What he needs to learn to do, however, is to not make promises that he can't keep.

Why? Because it is hard to trust someone who repeatedly breaks your trust. I found it hard because p-doc was so wonderful to me in a lot of other respects and so I really struggled with this aspect of his untrustworthyness.

Maybe... You could say / write something to him... Something about how you understand that he is busy... And that emergencies etc can come up which waylay him... But that trust is an issue for you and you are doing your best to trust him but that it is hard to trust when he doesn't keep his word. Then give him an example or two of things he has said where he didn't keep his word and say that it is things like that that are hard. And then maybe provide a couple of examples of different things he could have said (Like 'I'll *try* and email you before xxx' or 'I'll do my best to').

That way... You won't have so much trouble with trusting him (and same goes for other clients). And that way... When he really does promise something... You should be able to trust him. But of course it will take some time to repair things.

I think that it was that you hit him where it hurts rather. And I don't think that that was your fault. Sounds to me like you can help him in this instant. I assure you that if you are having this trouble with him then others are similarly having this trouble with him. Offering him some concrete suggestions for change could help ;-)

> So I'm going to be brave and talk with my therapist about the relationship.

That sounds like a good idea.

> It's so hard for me to talk to her about my transference with him because I feel so embarrassed that it's this important and that he's important to me.

Yep. That is what is hard about transference...

> I think I've been shamed by being continually reminded that relationships with professionals can't go beyond the professional. But I think it's ludicrous to separate your life that way - especially when you have such a close relationship with therapists and psychiatrists - I mean could you share what you do if you didn't trust them and feel that they were your friends. You don't just turn that off and on.

Thats right. Especially since your relationship seems more 'friendly' and reciprocal than most p-doc client relationships (and that is okay). But yeah, I understand the desire for friendship.