[Greenleaves]

OK, I'm really hoping that it is!

Say there was a psychiatrist who was an administrator of a forum. There is a member who is in love with him, but he is really strict with boundaries. Oh and the love is not romantic, it is platonic. This pdoc meets up with the members of his forum sometimes and has met this particular member 3 times.

Now this member is hoping she can see this pdoc for real one day, for a second opinion, as a patient. But it wouldn't be all the time since they live far apart.

Would this be ethical?

[Rhapsody]

IF you are asking if it would be ethical for the doctor to see the forum members as one of his patients in real life - I say sure I don't see why not... he has not done any thing wrong where she is concerned, and well lets face it patients often develop crushes on their therapist.

[Greenleaves]

Thanks Rhapsody!

Nothing inappropriate has ever happened between the two and this pdoc is VERY strict with boundaries even for members of his forum. They've just had dinner three times (not alone, with other members) and went to some museums and stuff together (again not alone, with other members).

This pdoc isn't even friends with his members. They just get together once a year in celebration of the forum's birthday.

I was thinking that the crushing on your pdoc thing happens all the time and this is kind of similar so, it's probably OK.

[elliemay]

Oh! aren't you a star! Usually if you have to ask if it's ethical, it isn't. Some docs wouldn't, having met this person socially several times, accept this person as patient.

[Greenleaves]

I really hope that's not the case with this pdoc. This member would be really happy if she could see him both socially and as pdoc and just anytime really! Oh well, if he doesn't then they can always see each other socially every year.

What is unethical about it by the way?

[ECHOES]

To me, if you are talking about seeing the psychiatrist for medication, then it's not even an ethics question.
If you would be entering into a psychotherapy relationship, that might be different.
I guess I'm a little confused as to what the ethics issue is...

[Greenleaves]

I read about dual relationships, and how they are generally discouraged, but in real life it happens all the time and sometimes it is acceptable, depending on the circumstances. It happens all the time in small towns for example, where everyone knows everyone.

I am just wondering if in this case there is even a dual relationship. This pdoc is seriously private with his life, even while "socializing", so I wonder if it would really be a big deal.

[Greenleaves]

Yeah, the member wouldn't see this pdoc for psychotherapy, she would see him for meds, for a second opinion, as she doesn't think her current pdoc is that knowledgeable on meds. Her current pdoc does mostly psychotherapy.

I think it would be OK. I hope it is OK for them.

[ECHOES]

Again, it depends on what kind of treatment (Rx vs. therapy) the patient would be seeking from the pdoc.
Dual relationships usually refer to actual real friendships, not acquaintances. Therapists do not generally treat friends and they do not generally move into a friendship relationship with the patient/client after therapy ends.

Sorry.. edited to say that I though your first reply was to me. Thanks, and I hope it goes well for her too.

[Greenleaves]

Thanks for that info Echoes! The member and this pdoc are definitely NOT friends. The member would love to be friends with him, but alas this pdoc maintains strict boundaries and won't be friends with any members of his forum. This pdoc doesn't talk about his personal life to any of the members.

The member emailed this pdoc asking if it would be possible to see him sometime in the future. She hopes he'll say "yes"!

It wouldn't be for therapy as the member is pretty sure this pdoc only does meds.

[mlpHolmes]

Then sounds like a good possibility!!

Best of Luck!

There should be NO dual relationship. You are either client/patient or you have a social relationship. Mixing the 2 is a no-no. If they already know you from elsewhere, my vote, as a therapist, would be that you shouldn't be taken as a client.

[Greenleaves]

She wouldn't be a client though. She would be a patient and wouldn't be receiving therapy. It'd be a one time second opinion for meds.

I think the reason the question was posed is because it feels "off", and it is. It feels like you want verification that this is okay, and I'm sure some will say it is. I think if someone needs meds, keep the boundaries distinct and they can see someone else.

[ECHOES]

It'd be a one time second opinion for meds.

mmm, okay.... Sounds like it is about something else, from what you've said: more likely it's primarily a chance to get close to someone she's fantasizing about, but calling it something else.

[Greenleaves]

Yeah, for the most part she wants to see him because she is attached to him, but he also knows her a bit, maybe he has some ideas on how to help her.

[deliquesce]

i would suggest that she see a different doctor for a second opinion. if she thinks her current doctor isn't helping in the way that she needs, then she should be seeking a second opinion. psychiatrists need time to get a proper med cocktail worked out - if she does take this psychiatrist's advice and changes her regime, then it wouldn't be ethical unless the forum-psychiatrist knew she was receiving appropriate follow up with another psychiatrist. is this forum member letting her primary psychiatrist know she is seeking a second opinion? if she decides to change meds will she be going back to her first psychiatrist?

imo, there isn't a distinction to be made between "Therapy" and "medication" consultations. the psychiatrist's association in australia has a big ethical guideline against dual relationships and this does constitute a dual relationship.

[imapatient]

I don't see the distinction between it being a pdoc and a T. Either way it's a professional mental health relationship; it's not arthritis. The psychological dimension is still a big issue with a pdoc. Med therapy is still mental health therapy. And there are prohibitions against dual relationships for many types of caring professions, varying by type and professional assoc./licensing board. Massage therapists and chiropractors have prohibitions against dual relationships in my state.

Dual relationships are defined by legal and ethics codes, e.g. Amer. Psychological Assoc., state boards, as a whole slew of types. Landlord, buyer of goods/services, friend of someone, business partners, group memberships, etc. It many times is by acquaintance or by way of a 3rd party where that relationship is beyond the control of the T and would-be patient. I had a GF who wanted to see my T, without telling me this, but my T wouldn't see her because she was seeing me, telling me it would be innapropraite to be treating someone in a situation like that (unless it was for family/couples therapy and with my consent).

I think what's really being sought, as you wrote, is something social, with a professional dimension which just sounds like an excuse to have contact with the pdoc.

I doubt that any code would rule out for certain what might happen as you've laid it out, but it could very easily turn into something more, perhaps, and I think a decent pdoc would discern this and want to avoid setting up a situation that might veer off course.

On contacts with T's and pdocs, the rules are different the smaller the locale. In small towns, etc. it isn't always possible to avoid multiple relationships.

The question isn't really one of ethics--as you've spelled it--so much as a matter of what's best and wise--for the pdoc and would-be patient. The pdoc can veto it even if there is not clear ethical requirement to do so.

[Greenleaves]

She doesn't even know if he will say "yes" right now. It is very possible the pdoc will say "no".

Thanks for all the info. She will be happy just seeing him yearly for the social gathering if this doesn't work out.

[deliquesce]

ahh yes. i just wanted to add - it's the pdoc's responsibility to adhere to ethical guidelines and since you've mentioned he keeps very firm boundaries, maybe you can trust his decision to be what's best?

of course, if anything at all feels funny to you, i would encourage you to warn your friend to back off! she won't get in trouble for breaking "ethical guidelines", but she might get hurt, and that would really suck.

[Melbadaze]

If its DSr Bobs forum your talking about, then I'd run from that guy as fast as my legs could carry me!

[deliquesce]

^ yes. i have read some really suspect things about the owner of that forum, so i hope that is not the pdoc the original poster had in mind.

[bebop]

green isn't this the same one you talked about a couple of years ago here? hon I really think you should not try to keep this up hon. you are going to be hurt and you don't need that. I see a bunch of red flags on this.

[Greenleaves]

What are the red flags? How is she going to get hurt?

Green,

Whether or not he has shared anything personal with you, isn't the point, the point is you did go out with him socially several times.

It would be unethical for him to treat you because you already have a social relationship with him. (even if he acts anti-social) Now if you were to just ask his opinion (off the record) when you see him, that is one thing, (he may be unwilling to say anything in this way too) but to see you as an actual patient would be wrong and I am sure he wouldn't be willing to do so.

I hope you don't get hurt in wanting this and not getting this, Green, he is only doing what is ethical. ((((Green))))) Take care of yourself, okay.