Boundaries, transference/CT in an EXTREMELY unique situation

LONG detailed post!

I would like some input regarding my interpersonal interactions with a psychiatrist (but not my primary psychiatrist.) I’ve been having VERY hard to describe strong countertransference reactions. I need some input on how to proceed. I also find myself in a VERY unique situation which makes things trickier.

I am receiving an intensive treatment at Clinic. Separate from this, I have a therapist and a psychiatrist. During my treatment, a psychiatrist, Dr. X., sits in with me.

After I began treatment I was hired by Clinic. Even though I won’t be interacting with the Dr. X as part of my job, I will be working part time in the same building and we can say we are colleagues. This sets up a unique dynamic.

Dr. X (older male) and I (younger female) had great rapport right away and we have tons in common, not just some unique interests but also personality features and experiences. Self-disclosure grew organically – he was very open since the beginning but not TMI. His general approach is to be quite open and chatty with patients, but I suspect the colleague component affects the dynamic.

As I shared more stuff, he began to share quite a bit of personal stuff with me – I believe his intention was to help me feel understood. After a while, he shared about severe mental illness in his family, trauma symptoms, his own psychopathology, divorce, etc.

Last week, during the last 10 minutes of my treatment he just revealed a lot of deeply personal stuff all at once. I even processed it in therapy because I was very affected by such feeling of shared vulnerability, rawness, and intimacy given my role. I believe he was having a very strong affective reaction that ended up affecting me since I had already made myself vulnerable earlier in the session. There was no wrapping up after he told me all that stuff. My treatment was over so I walked out.

I felt confused about whether I am his patient, colleague, or somewhat of a friend.

Now, I am known for being hypervigilant during one on one interactions so it’s hard for me to know if I overread into things when I feel that I’m picking up on subtle things, but I felt there was a degree of subtle, underlying anger/hostility when he spoke to me this week. The treatment is often double booked, but when another patient comes he will usually set the other patient up and then come back to sit with me. Yesterday when the other patient arrived, he just walked out without even saying goodbye.

Given my attachment issues, it just felt surprisingly devastating and rejecting. But again, because of my “attachment issues” I sometimes overread into these things. I am extremely attracted to him so that might play into the equation. He has hinted (in an appropriate context) that he thinks I’m attractive but I have no concerns he’d do something inappropriate or that that will be an issue.

Essentially, I’d like any thoughts on this situation. What do you think is happening with him? Should I bring up what I perceived happened last week? Should I just let it go? Should I wait and see if his behavior continues? He is not my therapist so I’m really confused about what is appropriate and what is the nature of our roles.

Thank you for reading my long post!

First thought, you might want to edit identifying information on your post and maybe your city because we have learned all sorts of students, therapists and colleagues read this board.

Not a criticism, just looking out for you.

Very good idea. I appreciate it!

Hi GrimTopaz...

I have to admit, I'm a bit confused about what's going on. It's not your description, it's the situation.

So... you have a T and a Psychiatrist. Then, you start going to a clinic (outpatient?) for intensive treatments. A random psychiatrist there who is NOT treating you decides to sit in on your treatments to be supportive... ? Is that right? I think that's what's confusing me, and I wonder if I just missed something, because that sounds weird and not appropriate? ("Hi, I'm Dr. X. I'm not going to be treating you, but I'll just sit here and be supportive, even though we've never met and don't currently have any sort of ongoing professional relationship. How's that sound?")

It sounds like the level of disclosures that he's making are not appropriate. Period. You are there for treatment, and the fact that you also work there doesn't change that. He's disclosing things to you... during the process of treatment? Not when you're hanging around as an employee? Not on coffee breaks where you bump into each other, or company-wide meetings where you're making small talk?

Yeah, that's not good. I'm sure you know this, but as a patient/client - the people working with you (or supporting you, given he works for the facility) should (in a perfect, ethical world) be monitoring themselves and only disclosing things that they feel are helpful to *you*. From what you said, it sounds like he's starting to disclose in a way that's helpful for him, maybe? Like, it's helping *him* feel connected, less crazy/weird, and less burdened?

That's not OK, and you deserve better.

Can you talk to the people that ARE providing treatment? Is this something you could bring up with them, and let them deal with it? If I were in your shoes, I'd probably talk to them (assuming I trusted them) and specifically tell them that I don't want to do anything that might negatively impact my work relationship (though it sounds like you don't have to interact with him at work, I suppose that could change?) with him. They may be able to phrase it as something they've noticed, rather than something that you brought up to them.

Ugh, I'm sort of frustrated for you - because these people who are providing treatment should have noticed and stopped this already! They should be protecting you from this. I'm so sorry!

Anyway, that's my interpretation. I'm sorry that you're going through it, and that you were left affected by his disclosures. It's hard enough to deal with your own stuff, you don't need people adding their stuff to the pile! Take care, and I hope you can find a way to get this resolved!

Thank you for your reply and sorry for the confusion. The treatment is provided by a machine. Only psychiatrists can set up the machine but they don't have to stay in the room. Dr X chooses to stay in the room with patients while the machine runs.

I thought I had your situation figured out...until you mentioned being treated by a machine. What does that mean, exactly?

When the boundaries are this broken (including the dual relationship, however much you do or don't interact at work) things can only end badly for you. I think you should get out now and lean on the people you already have.

As an aside, what kind of therapy is given by a machine? Sounds like Eliza from old computer days.

I wouldn't mind therapy by machine, or robot...lol It would help with any attachment or dependency issues I sometimes feel! LOL

Machine as in ect or rtms? Did he ask you to appy for a job while you were getting treatments? Odd.

It sounds like you may be unsure about appropriate casual relationships with new coworkers given that you are a patient too?

He sounds lonely or needing someone to dump on. If you want to befriend someone like that, why not, if he's your coworker. Maybe he's a bit quirky. Too much too soon like that, and knowing many psychiatrists have a good deal of issues, i might stay away, and just be polite.

If you feel rejected by him, I'd imagine that happens at other times too.

It's called TMS. It's for treatment resistant depression and it is a machine that sends magnetic pulses to activate parts of your brain. It's used when (lots of) medication and therapy have not worked. It's starts out as daily treatment. It's relatively new technology and very expensive - so most insurances will fight against it.

It's not therapy per se. You are hooked up to a machine that sends magnetic pulses to your brain. It's called TMS.

Very interesting! Thank you!!

If I have understood correctly - the psychiatrist who is treating you as a patient, made a lot of self disclosure at the end of your last treatment session. Now you feel confused, hyper-vigilant, and worried about your next session, as well as unsure how you are supposed to relate to this psychiatrist - are you friends, or colleagues, or are you his patient. I'm summarising what I've understood, you can say of this is correct or not, apologies if not!
Anyway if I have more or less understood correctly, then I think that firstly, it is not your fault that this situation has come about. It is the responsibility of the psychiatrist. Secondly, this goes to show exactly why dual relationships (e.g. patient and colleague) are usually best avoided, and also why Ts including psychiatrists neeed to be very careful of self disclosure. I'm not saying it's always wrong for them to reveal things about themselves, my T does this. But they should be very mindful of why they are doing it. When the psychiatrist is in a session with you, he is at work, and his job is to help you. It sounds like he has lost sight of this and it has made things difficult for you. I'm sorry this is the case.
Any chance you could switch to a different clinic, or see a different person within that same clinic? It might make things a lot easier for you. I would say ideally switch to b img treated somewhere other than your workplace.