Lately I've been dreaming about my patients. I don't even want to tell you how many years I'm in practice. Let's just say a lot. And this has never happened, not ever, not that I remember, anyway.
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Dreaming in Living Color |
Most therapists have an occasional dream about a patient, don’t they?
It’s happened twice, each time the night after a visit. My subconscious apparently picked out these unsuspecting women to join in on whatever adventure it had scheduled for the night.
My dreams are always adventure dreams, usually about getting lost and driving endlessly on a clover-leaf highway exit in an unfamiliar city. Or I’ll be on vacation with FD and we find ourselves in a house that is smelly and dilapidated with broken windows. It most likely has been hit by a bomb, and yet is huge, a city in itself. There’s no way out, no map, and no one cares about getting out—or so it feels, except for me.
Reliably in my dreams I have no idea where I'm supposed to be, which isn't atypical, others tell me they have that, too. Those are bad, but I’ll take that confusion over the terror of those recurring home-invader dreams in my youth. Those are gone. Now I just live with the fear, lock constantly.
The most recent dream with a patient in a starring role had the feel of a chick flick. There’s no remembering the plot, but one thing for sure: she isn’t a patient but a girlfriend. We are doing friend things, shopping. My mind’s eye tells me however, that although she’s a patient I should carry on, keep dreaming.
We do not usually have this choice in that other reality, wakefulness, the choice to turn relationships into whatever we please, alternative genres.
The plot of the flick, alas, is forgotten. I wake only with the sense of positive emotional engagement, the feel-good of the friendship bond. But it is laced with guilt about having breached a professional boundary. I attempt to rationalize away the guilt. As the dream fades away my brain says:
Hey who cares, woman? This is a good dream. You like this dream. Here you are, the two of you, that person who sits across the invisible divide every week, and you . . . you’re girlfriends.
Wait, I say. Isn’t everyone in my dream really me?
Well, technically, yes. Nobody else is there, after all, just the dreamer, just her, dreaming away.
Meaning both of us are me. I’ve created a friend, projected from inside Me Myself, and I. Hal’vai (Hebrew for “it should be so” rhymes with rah-l’-tie). Hali’vai we should all have friends who are the people we want them to be. Most of them are already, right? That’s why we pick ‘em. But sometimes they pick us, is the truth.
I’m not Freud, just making sense of dreams.
We’re out somewhere, girlfriend and I, at a mall then a pool. Our roles as doctor-patient are no longer relevant, deliberately abandoned. Those roles that determine the dynamics of our usual interaction—gone! There’s no implied hierarchy or expectation of therapeutic appearances, no guise of being therapeutic.
Well, that could be nice. A wish dream!
If we look at dreams as emblematic of wishes, fears, or gas, then this dream for sure lands in the wish category. Sweet and happy, it gets 5 claps and 4 stars, maybe even 5! Except that threaded throughout the cognitive/emotional content is that disturbing certainty that this is a patient not a friend, and the dream is a warning:
Be careful what you wish for, cross that boundary and you will regret it. Oh, and by the way. Haven’t you noticed? You have more friends than you even want.
The dual relationship is unethical, unbecoming of a professional. It takes advantage of the patient’s trust in us, that trust that we are there to help them for one thing, not visa- versa, which is why upon waking I feel a bit disturbed, disoriented, and guilty, despite the 5 stars.
The next movie is the usual Where am I? How did I get here? And what in the world is she doing in my dream?! Not a nightmare so much as a bad dream. It is a different patient and we share a difficult circumstance. We are upset, lost, and dependent upon each other in some way that is out of the official context of our relationship. And we both need to find our way out of messy confusion. Messy and confused. A typical dream.
That’s all I remember.
The interpretation of this dream could it be me unsure of the quality of my work, needing to tackle it at night to get a good grade. Or maybe my head is remarking on the complexity of the patient, that she isn’t progressing. Her dreamlike confusion is expected, mine is not. There should be emotional spillover to me if there's a feeling incompetence, even if it is unconscious until now, and consequences for staying in denial
It makes sense. She is complicated. And yet, we've been living together in all of her chaos for years and she’s doing so well! Still, the dream is talking to me. The other dream, too.
What is going on here? Am I working out unresolved patient/therapist dynamics—a wish in the first dream, fear residing in the next? Are they warnings to resolve my feelings during waking hours to avoid doing it at night?
Or could it be that because we only see one another on screen, that patients are externalized to the extent that they have simply become videos in the library of the therapist's subconscious. Choose one a week. The Blockbusters of therapy.
Maybe I just miss them. Maybe I simply miss being with people, any people, but these people in particular, having known both for some time. They are a part of my weekly groove. Maybe I miss the sensuousness of being together—the swish of their bodies as they pass me to enter the office; the whiff of cologne or perfume, a new hairstyle. I saw someone in the office this week and felt that. It was wonderful for both of us to be there, in real time, in real space.
We can't even be sure if anyone is grooming on Zoom. It doesn't look that way. It's so black and white, even though it isn’t, not really. Data of the senses, other than visual and hearing, is not communicated on digital media. We could say a dream is making up for that, but rarely does it feel that real.
Considering that dreams are legitimate ways to blur boundaries, if this is about wish fulfilment, then patients should always be in our dreams. If you eschews hierarchy (like me) there’s nothing keeping them out! But to its credit, hierarchy is about who knows more about mental health, if not the person in the room doubting his-- and it helps keep emotional distance. Respecting them keeps patients out of our heads on off hours. The boundaries of therapy are wise indeed.
PROBABLY. . . the problem is that I miss my friends! The ones who come over and have long Friday night dinners with us. The ones I go out with—remember going out?— to talk about our feelings, our histories, that trip we took together. This is as close as it gets, hearing about the lives of the patients, about their histories. Because after seeing people on Zoom all day to work, it isn’t something some of us care to do in the evening with friends.
In a sense therapy is the equivalent of lunch, except that we consume nothing but reality. So maybe I simply miss lunch.
Oh, but now patients are in my living room. They see me a little too closely, frankly.
Let’s sum up:
In pre- and post-corona times the relationship boundary is tight— therapists don’t socialize with patients. We refuse gifts (no thanks for the opera tickets); we don’t take a lesson from a tennis pro; and we make self-disclosure rare and relevant. In fact, if I am honest with myself, my self-disclosure with patients the past few months is off the charts. It isn’t me and it has to stop.
It can be hard. There’s temptation to talk about ourselves with patients, our past experiences, which is probably why these dreams that blur the boundaries are so compelling. They speak to unconscious wishes of both therapists and also, patients. Keeping it professional is work. If dreams are another way to master our issues, than that’s what is going on here.
There is some intimacy, too, in a dream. Therapeutic intimacy, meeting that projected need of the patient for a mother, a friend. When she cries in a digital visit I feel so powerless—not that I would hug anyone in the office. But it used to feel like all I had to do was move my chair closer and this helped.
And yet, like I said, that online human, the one on screen—no matter how large or small our home theater—now has carte blanche to come into our homes, something they may have considered or alluded to —because don’t we all, at some point in therapy, want to be a fly on the wall of one another’s homes? We want to see what’s really up with the other.
And if we’re using a tablet or a phone with the freedom to get up and walk around, we might even walk together into the kitchen for a cup of coffee, a piece of fruit. Once she has been in your living room and kitchen, what’s to stop the patient from having a visit in your dreams?
Nothing apparently. Nothing.
therapydoc
TAGS #boundariesInTherapy, #telehealththerapy, #therapistPersonalBoundaries, #wishOrfearDreams, #dualRelationships, #Nightmares, #badDreams, #patientFriendRelationship, #consultationWithOtherTherapists, #therapysupervision
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