Boundary Violations: Non-Sexual Relationships with Patients

Ms. J is a 24-year-old unmarried woman with borderline personality disorder (BPD) who lives with her parents in a large housing estate in the heartlands of Singapore. She is an only child and was first diagnosed with BPD as a teenager following a number of suicide attempts and self-mutilating episodes. While she received some treatment, which reduced her suicidal thoughts, anxiety and feelings of emptiness, her behaviour continues to be moody and impulsive, and she struggles in holding down employment and maintaining stable relationships. She began seeing a male psychiatrist, Dr. D, for psychotherapy about 18 months ago. However, her parents who are paying for her therapy have now sought help for her from another therapist as she has begun to feel depressed again and has been engaging in self-harming behaviours.

Over several sessions, the therapist learns that Ms. J had been undergoing psychodynamic psychotherapy with Dr. D on a regular basis. Ms. J reported that at first she was a little uncomfortable talking to an older man about her feelings but that she felt more comfortable with him after a couple of months. One day after her session was over, heavy downpour prevented her from leaving the clinic to catch the bus. Dr. D, having finished work for the day, offered to drive her home, which she accepted with some apprehension but figured that he was just trying to help her out. During the drive, he told her that he was having some marital problems. This revelation made her feel a little better since it seemed that even doctors can have relationship problems and that no one is perfect. She now felt that she could really trust him.

A few weeks later, Dr. D offered to drive Ms. J home again and this soon became a regular occurrence. He would talk about the difficulties he was experiencing at home and say how much he enjoyed talking to her. Soon, she began to feel like his equal and looked forward to seeing him at each session. One day, Dr. D told her that he was upset because his wife had left him. Feeling sorry for him, she gave him a hug and he thanked her for being such a good friend. She began to call his cell phone to see how he was doing and it was not long before she started to think about him as being more than just a friend.

The phone calls and car conversations continued for several months. Coming from a traditional Chinese family, she did not tell her parents about her feelings or that Dr. D had been driving her home. Soon, she began to feel frustrated that the relationship was not going anywhere and so she decided to reveal her feelings to Dr. D during one of their sessions. She wanted to know if he felt the same way and was devastated to learn that he did not. He said that he was sorry but still had feelings for his wife and was trying to reconcile with her. Shocked and humiliated, she ran out of the office.

She kept these events to herself and refused to go back to see Dr. D. She started feeling depressed and has begun cutting herself again. Her parents eventually convince her to see another therapist, a woman. Ms. J tells the therapist that she is confused and cannot understand why Dr. D would pretend to be her friend only to reject her. She refuses to allow the therapist to contact Dr. D for her treatment records and is thus unable to confirm whether he had in fact been driving Ms. J home or talking to her about his own personal matters. The therapist is nevertheless worried about her emotionally unstable patient and wonders what she should do.