Patient and therapist boundaries

As previously stated, I’ve become a recluse since my diagnosis of Bipolar. Pushing people away has become easy for me. I’ve done this for many reasons, mostly unintentional but the less people I interact with that don’t have a mental illness, the less people will know that I have one. People often say to me quite, that if I can go to a doc it shouldn’t be so hard to go out into the world. Well to me the justification of why that is not accurate is simple…those people at the doc office, well they’re sick too. Just like me. That makes it easier to make it to my doc appointments. Yesterday was a different story as I sat in a full office of a new doc that would be giving me a second opinion about my new cancer diagnosis, (see Stage I – II Thyroid Papillary Carcinoma). As I looked around at each person, for once I didn’t panic and ask myself if they could see that I have Bipolar …this time I wondered if that person was even going to be alive a few months from now. There was no focus on me…no one cared that I have a mental illness, they cared about being alive to spend more time with the people they love. Now, if I could find a way to do that with every crowded social situation, I’d be good. I wish I could tell you that I sat in the waiting room for the entirety of my wait but sadly I did have to get up a few times and go pace in the hallway. Finally I heard my name and it was my time to go back to a more comfortable situation.

I learned something new, thyroid hormones can cause further exacerbation of the negative symptoms of Bipolar.

What does the title of this post have to do with anything and where am I going with this? Well, the countless situations as listed above have led my therapist attempt to help me with my lack of social interaction….outside of office hours. She told me that my current anxiety and recluse state has everything to do with me judging myself on one thing. The failure to see J on my birthday, the damaged it caused, and the days that followed (the days that I knew there was no going back, that it was over). A few weeks back my therapist gave me a sort of a homework assignment and I had two weeks to complete. There were 5 tasks on the list and I only accomplished 2 of them. One tasks was to take a ride on public transit. After many failed attempts one morning I finally was able to take a trip on the trolley system here. I took the easy way out (I didn’t plan it that way) because it wasn’t crowded at all but I remained on the trolley for the full trip around so the potential to for the situation to get crowded was certainly there. Two weeks later when I showed up in her office without success, it was a huge disappointment and she could see the further damage it had caused. I had also been diagnosed with cancer during that two weeks also and that didn’t really help the situation. I guess she had enough of my self destructive mind and offered to help me. This past Saturday (after waiting in my lobby for one-hour while I paced frantically in my apartment and corridors) she drove me over to meet her brother who also has a mental illness, his wife, and their child. The goal? She wanted me to see that with the right balance that mental illness doesn’t have to ruin lives as I always complain about.

I feel like I’ve ruined the lives of everyone around me and for that reason I fear dying alone.

When I met B he seemed like a normal down to earth dude. Similar to how I used to view myself. I honestly couldn’t even sense his mental illness at all until he would leave the room, I could see his shadow pacing in other rooms as though he were arguing with himself but really he would just be looking for whatever item his wife had summoned for him to retrieve. His wife, J (ironically enough) was very warm and inviting. She seemed intrigued by me as though she saw something in me that she had previously seen in her husband. I must admit I was a bit in shock that all of them were so inviting to a stranger…a stranger with a mental illness. It took me over an hour to finally feel the sense that I could interact. That was due to just hearing about B’s struggle with schizophrenia and how he met J. Now he is a successful graphic artist for a video game company and he works remotely from his home office 3 days per week when he isn’t traveling. Before this job he was bouncing from job to job (the same as I have been for the last few years) and one day he incidentally met J in a park, that has since been turned into a mixed development community, she offered him some food and money. She thought he was homeless due to his disheveled appearance. The both give different accounts of the story but the one thing I could pick up on from both sides is that their meeting was one of their live changing experiences. The dated for awhile and J said it was very hard because he was extremely unreliable and all of out of sorts. It was a few months after dating or not so dating that J learned that his sister was just out of psychiatry fellowship from Harvard so she arranged a meeting. Long story short, his sister (my psychiatrist) found B a therapist that he was willing to see (previously he had not been seeing a therapist). He was then put admitted into inpatient psychiatry unit and underwent intense conditioning and therapy that consisted of ECT. J noticed the changes almost 6 months after the inpatient therapy. She first noticed he became more positive, more reliable and less hallucinations. There were months of relapse but eventually 2 years later everything finally seemed to calm down in B’s head. That was 9 years ago and he hasn’t had a full relapse since. He does have bad days but he has more good than bad. He’s doing great in his life all-around by managing his disease with a successful job, marriage, and family. It was truly an inspirational meeting for me and the timing couldn’t have been better. This is the balance my psychiatrist must be talking about. Who knows what would’ve happened in J had given up on B? His life might be different now, who knows? My family is worried that my doc has crossed the line of the patient and doc relationship. I guess I can see their POV but I feel more of an experiment than being taken advantage of. I don’t see what I had to lose. The point is, my current doc has helped me more than any previous doc has and discontinued meds that I never should have been on and she truly listens. She’s given me other avenues than traditional psychiatrist in the past and she took the time to personally contact the new psychologist that I will be transitioning to next week. Have any of you experienced any sort of therapy outside of the office?

I think I finally have come to terms with knowing I haven’t found my balance yet and with that a new chapter must come (not renewing my lease). Next stop, this boy is getting a job.


I hope you all have a wonderful day and week.

5 thoughts on “Patient and therapist boundaries

  1. Hi Christopher,

    I think as long as you are two adults about the relationship of your therapy then there isn’t a conflict. If the two of you began spending time outside of therapy then I think that does cross that patient-physician boundary especially in the realm of psychiatry. Your therapist having you meet someone who has successfully managed their illness seems like something you really needed. I’ve read more of your posts and to me it seems like you haven’t really accepted your disease just yet because you’re focused on what others think of you and see it as an embarrassment. I hope you find that balance that you are searching for. I too have Bipolar and I am lucky to have the support of my husband. I don’t know where I would be if he had given up on me. I left him so many times because I didn’t want to cause him pain but he was always there to pick me back up. Keep your head up, it seems like you’ve been diagnosed fairly recently. It takes time!! Good luck!! Keep writing and keep fighting!!!

    Liked by 1 person

    1. Thanks, Samantha. We definitely don’t have any plans to “hang out.” She just offered to help me achieve something I’ve had a difficult time with lately. Perhaps you’re right about the acceptances…who knows.


  2. When I read that your therapist met you outside the office to drive you to meet her family my thought was that it was way out of line. My guess is that most therapists would frown upon it. To me it goes beyond the boundaries of a therapist/client relationship,however, If it helped her to help you then who am I to judge. Early diagnosis is tough, but for me it got much better, so hang on.

    Liked by 1 person

    1. Yea, it’s something we had been contemplating for almost a month but the scenario wasn’t to meet her brother. I never knew about her life or family. The scenario was always to help me accomplish the one thing I was having such a hard time with. It probably all started by how I always state that I just wish I had some help in stressful social interactions. For example, my sister was visiting a few weeks back and we stood outside of a restaurant for a few hours before I was able to go inside. As I was revealing this to her I could tell it made her feel some sort of way because she really dug into her pad with her pen as she was writing her notes..haha. I would love to get my hands on those notes. Thanks…I will hang on for as long as I possibly can. I hope you’re having a good week.

      Liked by 1 person

  3. so, i think your doc is brilliant. sometimes you have to think outside the box, and reach beyond what “they” say should be done. what a wonderful thing for you to be able to see.. even if it was a byproduct of trying to get you more comfortable in social situations…. it sounds like seeing B living his wonderful life with despite his mental illness was something that helped you.. something you could never really have the full understanding of just by your doc telling you it. i am glad you were able to see it and experience it for yourself. it’s good to see in real life that there are people in this world who will stand by those whom they love- through good times and hard times. You can have that life, it is possible, it does happen… you will find someone who loves you illness and all- just as i am sure you could love someone the same way in return. I have a pretty amazing sixth sense about these things…

    ..nice kitchen btw. I had a dream once and in it the kitchen looked eerily familiar to that one. weird.

    Liked by 1 person

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