A lot like friendship: How close is too close with your therapist?

When a recent essay in The New York Times (He Showed Me His Tiles, So I Showed Him Mine by Christie Tate) talked about walking the slippery tightrope of friendship and professional functionality with one’s psychotherapist, the intimate memoir of left questions lingering in its wake. Not surprising; for all the visibility campaigns around mental health, its many dimensions, unique for every individual, remain politely undiscussed.

Tate, in her article, talks about the rewards and foibles of baring all to an empathetic therapist, and the bittersweet process of being weaned off the emotional dependency built around an almost-friendship. Perplexed by an inability to beat her “non-reader” husband in scrabble, and her unwillingness to leave the counsellor’s chamber after successfully decluttering her life over nine years of group therapy, Tate asked her “father figure” (the group functioned on the basis of assigned roles) for one last favour — to teach her how to play scrabble. While this could appear irrelevant in the context of mental health, it is not unusual for clients to slip into a sense of foster-kinship, spilling beyond the realms of clinical counsel, especially if they are allowed informal access to the therapist.

Alvin M Sam, Counselling Psychologist at Fortis Hospital (Cunningham Road, Bangalore) says, “There are times when a psychologist would relate to their client more than desired. The onus is on us to distance and establish ourselves in a position of authority, steering the boat, instead of being stuck in it with the person”. Sure enough, there are situations where the client believes him/herself to be in a state of extraprofessional intimacy with the therapist, as Bodhirupa Raha, 27, would vouch. The Mumbaikar recalls how her therapist initiated the ritual of ending each session with a hug. Initially awkward, Raha came to anticipate such gestures with a sense of strong personal entitlement. “I’d began to think of her as a friend, having lost all inhibitions after crying in her presence a number of times.” Raha was left feeling betrayed when one of her sessions could not be extended, on account of another client’s. The Content Writer remembers suddenly feeling like a “token number in a chamber” — the “breach of trust” leading her to quit treatment. In retrospect, she acknowledges failing to draw “that line”, maintaining, however, that the cognitive behaviour therapy used to stir up memories of childhood trauma (so she could tackle them) did not work at all”. While Raha failed to communicate her reservations and expectations to said therapist on time, she has, after taking some time off and sending resolutionary text messages to the person, sought out a healthy, if less cuddly, relationship with her new counsellor. “I realised it was important to acknowledge what I was feeling, to seek help beyond what was on offer. She did wonders for my friends, so a lot depends on your personality and your therapist’s.” Raha’s parting words ring of calm resilience: “Keep looking till you find the right match (of therapist)”.

S Basu, an IT Consultant, never straddled the blurred line of professional and personal camaraderie with her therapist, but did feel the heat when she was asked to stop coming in after a scheduled session of eight wrapped up successfully. “I wanted to continue seeing her, but she asked me to wait for a few months, during which I was to employ different thought replacement techniques to fight my anxiety. It’s not that the exercises work every time, but once you school yourself into actually following the techniques, they begin to work,” Basu insists. And work they did, seeing that the Hyderabad resident has not sought therapy for a good eight months. “My issues have not magically disappeared, but now I work on them by myself,” she says.

Not every client can be expected to show this kind of fortitude at their particular stage in recovery, and sometimes therapists encourage dependency as a method of fostering trust/intimacy, used in turn to empower them into a state of self-reliance. There’s no set method. “The line isn’t a defined one, just like the troubles of the mind,” points out Sam, who’d rather improvise to suit a client’s individual needs. He talks about a case at the beginning of his practice where he became emotionally invested in a young client struggling with the absence of his father. “When he began to call me bhaiya and I found myself checking with his teachers for signs of behavioural improvement, I knew it was time to cut down on the proximity. Gradually, I reduced the length and number of sessions. By the end of it, he was out of school, enabled and independent,” Sam recalls.

While it worked out for Sam, Mumbai-based psychiatrist Dr Dayal Mirchandani cautions that the manner of distancing must be in sync with the client's condition, re-emphasising the need for information and distinction (about/between the different mental disorders). "Mental health is a broad spectrum, where specific conditions demand specific treatments and treatment duration, entertaining varying degrees of interaction and intimacy". The thumb rule would seem to be transparency and willingness. "The therapist and client should be able to openly discuss a situation of dependency, and if required, involve a second opinion," he winds up. 

Would it be too optimistic to conclude that there's always room for a second run, a recourse one hadn't considered till the point, when it comes to restoring our mental health? Tate is likely to say no. With almost a decade of working on herself behind her, the author came out of her therapist's office one last time, after a difficult, if reassuring game of scrabble. It involved the therapist offering to "play open" (where players help each other build words) after a few weak moves nearly left Tate believing "I stink at this". Nearly.

When we finished our game, I snapped a picture of the board with my phone.

"You crushed me," I said.

He smiled. "I believe we crushed you together."