Dual relationships with therapists and other issues

I have posted before about my continuing evolving relationship with my therapist, who is both a psychiatrist and an analyst. It is intensive therapy long term. It is not necessarily about symptom management at this point but more about growth and transformation though of course there still are issues that need attention.

My latest concern is that I am now developing a new professional identity as a clinician working with people with psychotic disorders, which I intend to continue to do. I am developing some apparently new ideas about how to see and understand some of the way people work, at least according to my supervisor and my therapist, both of whom have experience with this particular population.

My therapist has flattered me, which I posted about before. He has been a sort of mentor figure earlier but now I guess because I am coming up with different ideas and strategies, he is treating me more like a colleague, which is weird since he has 35 years of experience, has an MD from Stanford, where he also was a professor, plus went back into training to become an analyst, doing 5 years of his own analysis, course work, and a dissertation to earn a doctorate and is now a supervising analyst for that institute.

He has now told me that in his experience in charge of a locked ward, supervising residents at Stanford med in psychiatry, and then a supervising analyst, he still has not encountered the way I am thinking and handling this particular group, who might be characterized as chronic, low functioning psychotic patients.

That is kind of intense to hear. I asked about "dual relationships" since it is part of my ethical code, but not his, and he said he didn't think it was outside of his way of interacting with me in doctor-patient terms.

Still I wonder. And during this period he has been more personal and even suggestive. His masculinity and sexuality has come up. Compliments toward me of a personal or physical nature have come up. Then one morning when things were very personal, I texted him about something and I got a video of him, clearly not dressed. I wasn't sure why he sent it, but he did say that he sent it on purpose to let me see what he looked like early in the morning and made a joke about hoping it wasn't grotesque. I didn't respond.

I love the closeness between us. I don't believe that is harmful to me. We are not friends. We are not even colleagues, regardless of the collegiality. The boundaries are clear to me and I have no interest in overstepping them. I don't think he does either. I guess his shifts recently have raised questions though.

I'm a social work major and back when I was in therapy I my therapist was a social worker. I badly wanted to ask her sowk related questions but felt like it would be a dual relationship. Nevertheless I don't think this is a dual relationship. Being a clinician is a part of your life, plus a large part of you.
I think it would be any different than what happen if you both had the same hobby.

My T has been similarly complimentary in a professional way and it did not strike me as inappropriate. However, it is difficult for me to think of professional reasons for him to send you such a video.

Um...eew? I understand the dual relationship issue regarding your clinical work, but this really crossing a line.

Agree with the "ewwww" factor of him sending you a video of himself where he's not dressed. The rest of the stuff, you guys talking about your work and him complimenting you on it, that doesn't seem odd or abnormal to me. But videos of himself undressed? No no no. That seems pretty far over the line into inappropriate-land. Did you say he's married, or am I remembering that wrong? Either way, no... that's not ok.

Oh, and his comment about you not finding him "grotesque" - sounds like he's fishing for compliments or flirting, at least to me.

Did YOU feel like the video was inappropriate? You're studying this stuff - what do you think? Aren't Ts only supposed to share when it's for a therapeutic purpose and in the client's best interests? Do you think this was in your best interests? What would you think if this wasn't *your* T, but say... somebody elses' T? For example, if somebody else here had posted that, what would you advise them?

And, congratulations on your work! It sounds like you're really doing great in your career, and well on the road to making a difference in the world, and a place for yourself professionally! That's something to really be proud of! Good for you!

If I was uncomfortable, I would keep my own boundaries where I want them and not worry about the other person's = mine would protect me -would be my plan of handling such a situation.

The video thing would be odd between most people. I have very few friends I would do that with (or have them send to me). From a therapist it is completely unsettling and inappropriate.

I was fine with everything up until the video. What dud he say in the video? That just seems odd and inappropriate. It sounds like you have your boundaries, but he doesn't.

Thanks. I guess I can calm down about the dual relationship stuff, though occasionally there are reports in the journals I get of disciplinary action for dual relationships so that's what alerted me to it. He is not covered by the same legal and ethical standards that I am. Also we have openly discussed this aspect of change in our relationship and he has been very good about not wanting to influence me or otherwise affect me in ways that wouldn't be right. I have just said I have a mind of my own and other types of training and research that influence me so he doesn't have to worry about how his "mentoring" could be wrongly construed. I used to be a professor and already have a doctorate and another profession behind me so he knows that I'm solid that way.

The video is probably out of bounds. He said at first it was an accident that happened when he was trying to respond to my text, but then that he thought he'd let me see him in the morning hours. Yes, he is married. And yes, years ago there was some erotic energy that was worked through. No, I wouldn't tell anyone who posted here about such a thing that it was therapeutically okay.

But on deeper consideration I think something is happening between us that is changing our relationship and that is in keeping with this particular school of analysis which endorses self-disclosure and co-creation of experience, including the analyst's ability to transform along with the patient which is hardly even considered in most therapies. I think he may be feeling closer but not clear about how to express that since he may be experiencing at a removed level. He is a person who is very embodied, a former hippie free spirit type, and very masculine, proudly so. He has lived in alternative communities most of his life, including clothing optional communes and encounter groups, and even though so professional and aging now, he still acts as if he is in that lifestyle. I now think that even if inappropriate, I can understand that he is trying to express part of himself and that it is not intended to harm me or even by yucky, even if it seems that way. I don't think he has had a patient turn around so radically and become like an independent thinker about his own speciality. There is a closeness like we are inside each other right now that I actually think is okay as a transitional phase, and perhaps his way of handling that is to displace it to more physical things. But I'll keep an eye on it since it does seem out of bounds and I would never do that to a client or think it was therapeutic. I wouldn't even do that with a close friend, but then I'm very disembodied and not willing to be that open about physicality.

Um, jealous. So he sent you a nude pic of himself? Wowza.

He is not your T in order to express himself inappropriately (whether or not he intends to harm you).

Yalom speaks at length about how he himself was changed by his clients, and how he celebrates those changes.

If I told you that my T was a former hippie and lived in clothing optional communities and was proudly feminine, would you give her a pass on sending me such a video?

Why do guys think we wanna see pics of their junk? I mean, i like guys well enough, but that stuff - really not pretty to anybody but yourself and maybe your mother. Unless maybe you put a top hat and a bow tie on it (Like in king of queens ). Some airbrushing. Adjust the color. The only other time ive seen that color in nature is when i was in the emergency room and there was a guy there who died of a heart attack. Seriously is there people who like this?

I think the naked male body is pretty sexy, and I mean all of it, especially hairy manly men.

I speak to my T and pdoc about schooling both have said I can ask of talk about professional issues anytime. My pdoc let me use a session to do a mock T session for a paper I was writing. I see no problem with any of that part of your relationship with your T and I don't think it's considered a dual relationship in the code of ethics.

What is very concerning are the sexual comments and especially the video. Eww is right. I can't think of an instance where it would not feel weird to get a video like that unless I was dating the person.

I've often wondered the same. When I was separated and on a dating site I received pics like this from a couple of guys I considered dating. The pics put an end to that.

I really think too many men believe the things they've seen in porno movies. When I was separated and on a dating site I received pics like this from a couple of guys I considered dating. The pics put an end to that.

Have you thought about speaking to your supervisor about this? It may not be a breach of his ethical code but you are rightly mindful that you adhere to a stricter code and I would think that supervision would be a good place to raise those concerns.
I agree with others that the video is inappropriate and almost seems like he is testing the waters and gauging your reaction to his behaviour. Definitely needs keeping an eye on.
On a happier note, great to hear you are doing so well professionally!

It would be interesting to know whether this very masculine clinician feels threatened or overshadowed by the growth and success of a woman who was once simply a patient but now is breaking new ground in a field where he himself has extensive knowledge and experience.

That is an excellent point, Bill.

I might be off base on this but if this kind of relationship is not ethically wrong for your therapist, no one is going to hold you accountable for his activity, right? I mean, you're the client. No one is going to charge you with an ethical violation, even though you're in training to be a therapist. In this situation, you are the client; you are the one professional organizations are protecting by putting in a set of rules and guidelines therapists are suppose to follow while practicing. So if this was inappropriate behavior, it would be your therapist who was risking the possibility of being sanctioned.

That said, I do think that the video was inappropriate, even when his personality and lifestyle is considered. As for giving the excuse that it was initially a mistake . . . . uh, not kosher. Think about all the men who claim, "Gee, I hit sent by mistake!" when caught sending pictures of their junk (ala Weiner of NY fame). A truly strong, solid and well analyzed therapist would know when he was stepping over the line of too much "sharing". It's fine for him to share his state of mind, to stand in the spaces with you and allowing you to see as much of him as is therapeutically appropriate, but sharing a video of one in a state of undress is a bit over the line, imo. Perhaps the lines are blurring a bit to much for him and he needs to do some reassessment of his professional behavior.

I do think it is entirely appropriate that you are encouraged to talk about you work and your thoughts on how to perform your professional clinical work in new and different ways. These are all things that are important to your personal work in therapy. By-the-way, major congrats on thinking outside the box in your work . It's probably exciting and rewarding to your therapist that he is able to see you grow professionally as well as personally.

I hope you're able to share with him at your next session what your feelings were regarding this current situation. Great stuff to discuss!

I had a visceral reaction to this, particularly the part in bold. It may be that this is a new type of therapy, but it feels a lot more like grooming than a ground-breaking type of therapy. I don't know his caseload, but it's easy to think we're the only client, or most special, when in fact we're part of a line-up (not to diminish the quality of the relationship). I just don't see how a therapist can meld with 25-30 patients a week and still be sane, so this does seem particular to you, and that's what leads me to grooming. It just gives me the chills to read your rationalization when, at the same time, you agree that it seems out of bounds.

As others have said, you have a lot going for you. Good luck on your career. And keep a side eye on this guy.

I had another thought regarding this issue that will perhaps help you check internally as to whether his behavior is out of line and connected in an unhealthy way to your therapy. I mentioned in my post: I hope you're able to share with him at your next session what your feelings were regarding this current situation If you find yourself hesitant to talk about your feelings about this situation in your therapy, then you really need to consider that something is going off the rails between the two of you. You know well that when we hide ourselves and our thoughts in therapy it's usually something critical that needs to be opened up in the space between therapist and client.

If you feel the need to keep these feelings close to you and not open to both your therapist and yourself, then you need to ask yourself why this is the case? Are you afraid he might interpret your concern or hesitation in a negative way? That he might judge you as less "evolved" than he might want or expect at this point in therapy? Or that you are too conventional? If he is truly open to exploring the spaces within you and between the two of you, then he will welcome this conversation and your relationship will grow and expand. I'm not asking you to answer those questions here on the forum, just suggesting you might want to explore them for yourself.

I think theory can convolute something that is simply a straight line.

I would not call sending a client a video a dual relationship, I'd call it a boundary crossing. I understand he could be sanctioned for it. Likewise, his manhood and sexuality have no relevance to you or your treatment.

There are several books on sexual abuse in therapy:
Surviving Therapist Abuse Bookstore - Therapy, Therapist Abuse and Professional Misconduct

You can email them TELL. I'm sure they'd have opinions.
TELL: Therapy Exploitation Link Line

It sounds like a gray situation because you've had a long relationship. You recently wrote about his "fantasies" and effusive flattery. Are you in a position simply to tell him to "knock it off" like a peer might do in a sexual harassment case? If you can't talk like peers, then I hope you find some assistance, because I believe most therapists would view this is very wrong. (I know it's tougher when 1) you're inside it 2) the relationship is colored so much by analysis.)

I assume he's a little young for the disinhibition that comes with the onset of senility, but that might be a possibility. I've seen dignified men turn to dirty-talking adolescents when they get older.

There are a lot of good points here, most notably that you refer initially, and seemed more concerned about a possible "dual relationship" regarding his role as a mentor or peer rather than what is very clearly a boundary violation. Since you're in the field I think you've learned the ethics and probably know what this situation really is on an intellectual level. Emotionally however, it seems like you're torn (understandably so) since you've had a good relationship with him.

He's not so old that you'd attribute it to slight dementia although it's not unheard of. It's also not unusual for accomplished, powerful men to seek sexual conquests with women and to also believe that they are somehow above the law. He sees a different side to you now and identifies you less as a patient - but you are and he needs to be reminded of that. Even if you were a co worker and not a client, the text is still very wrong. The semantics would just be different - instead of a boundary violation it would be called sexual harassment.

You can give your T a reality check without being too harsh. The next time you see him, if you feel like you can, you can start the session by saying something like "I want to address that text you sent me. I'm not going to keep rehashing it but I just want to make sure we're on the same page because it really made me uncomfortable....". It's important for him to know what your boundaries are so this can be nipped in the bud immediately. Men are often told to pursue women who are politely unresponsive because they're really just being coy. Men with his status may not believe you're not into him unless you spell it out for him, like you're talking to a child.

Woman? I thought the OP was a man...lol, it's hard to to remember sometimes for me...

I forgot to add about the video part. That is crossing the line and should have not done it