Can psychologist and patient be friends? – Online Psychologists

“And you're coming to the ceremony, right?”, “How about we meet for lunch?”, “Would you mind being our daughter's godmother?”

Requests like the above, or similar ones, are not surprising within the scope of the Therapeutic care relationship between patient and psychologistAnd in every case, no matter how good it was, the answer is always the same “no, sorry.”

Next comes the explanation to a somewhat upset patient: the relationship between you, the patient, and me, the psychologist, is called therapeutic relationship and this is a professional relationship, not a friendship relationshipIn other words, it is the relationship between a Mental Health professional and a person who, at a given moment in their life, seeks help to solve a specific problem, a family conflict or, simply, to increase their emotional well-being.

Therefore, correctly defining the role of the therapist and the patient throughout the therapeutic relationship will help to eliminate future problems and misunderstandings. Therefore, and at all times –even after the therapy has ended–, our role will always be the same: that of a professional focused on work and cooperation, never that of a friend, lover, partner or family member.

It is necessary establish a working and cooperative relationship with the patient that facilitates:

Taking responsibility on the part of the child so that he or she can increase his or her perception of control over his or her behavior.

In order to avoid confusion in roles and in the therapeutic process, it is useful to establish a contract with the user or provide the operating rules in writing, where the following points are specified, among others:

As professional psychologists we must act in such a way that we are perceived by patients as reliable, trustworthy and consistent. At the same time, we must be able to communicate clearly and unambiguously either verbally or non-verbally and using as few technical terms as possible.

Since the professional-patient relationship often produces a special intimacy, there is potential for powerful feelings of attraction to emerge in patients. These feelings may induce professionals to become more distant, leading to patient dissatisfaction, or to become emotionally over-involved, which will have psychological and clinical consequences.

Personal knowledge and understanding of emotional reactions towards patients allow professionals to appropriately set emotional boundaries that will allow them to objectively connect with patients.

If the patient has a dependent personality, he or she could change psychologists, but this does not guarantee that he or she will not relapse, over time, into a new emotional dependency, while the problems that brought him or her to the consultation are not resolved.

If the professional is good enough, he or she will set appropriate boundaries, let the patient know that there is an unhealthy relationship so that the therapy can continue, and restrict all calls before the scheduled appointments or bring the appointment forward if it is not a real emergency. This usually solves the problem.

Every care relationship in psychological therapy must promote and protect the patient's well-being. To do so, we have our code of ethics, but the following aspects are also relevant:

Well-being of the patient who attends psychological therapy. We must protect and put the patient's well-being first. This means that we are prepared to give them the best we can as professionals, and if we cannot, to be able to refer appropriately.

Confidentiality and limitations thereof. It is closely linked to well-being. It is advisable to inform the patient of our absolute confidentiality as well as the situations in which exceptions will be made, specifically when there is a serious threat or a serious crime may be committed.

Dual relationships. Despite all that has been said, there are dual relationships, which are those in which the professional simultaneously maintains a therapeutic relationship and another of any other kind (friendship, family, teaching, work, etc.). In any case, and following what has been said before, Dual relationships are always problematic since they deprive us of the objectivity necessary for the act of care and, above all, they place the patient in a position of forced consent.

Patient rights. At the beginning of therapy, it is recommended to discuss with the patient issues related to the procedures of psychotherapy and the side effects of changethe knowledge and experience of the psychotherapist and the possibility of accessing other resources and alternative aids should they request it.

Derivations. It is important to inform the patient and request written permission to discuss his or her history with another professional.

Now, back to the beginning. Would any patient ask the surgeon who operated on her meniscus to be at the ceremony X, to be Y's godmother, or to go to Z's house for dinner this Sunday? No matter how good the care relationship has been, any patient sees them as surgeons and knows that there are limits that they impose, perhaps excessively at times, and more flexible at other times. At the same time, they create a «surgical field» so that they cannot see the patient's face and, thus, if something went wrong, their affections, which they obviously have, would not be removed and they would be more effective in their solution.

In our case, As psychologists, the comparison is parallel: our “surgical field” is the care relationship itself, which presents limitations.; many therapists even have a physical limitation in the form of a table, while others have no more, but there is a certain distance between the sofas. This does not mean that one is more important than the other, but rather that our aim is to “cure when possible, relieve almost always and console…console always.”

At we have been experts in online therapy since 2012. Throughout our career we have helped more than 2,000 patients overcome various emotional problems. If you are interested in seeking the help of an online psychologist, you can request a free first session by clicking on the button below.