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I Walk the Line

Recently I ran a very scientific Twitter poll and asked people about how they'd feel if they found out their therapist had the same/a similar chronic disease as they did, if the disease was the reason the person was seeking counseling.

Here are the results:

Most people, 42 out of 49, would be thrilled to indifferent about the news.  However, 13% (or 7) would feel some concern or even switch therapists.  Since this is a very small sample of people, we shouldn't disregard that some people don't find this appealing.

I was diagnosed with Crohn's in 2002 and at that time was living a completely different life.  I worked in a corporate job writing code for .NET applications for a commercial real estate company. Exciting stuff, I know.  I was making a good wage, had health insurance (!!), and a clear career path laid out at 26.  I was also working on a huge project for Microsoft, as a client of the company I worked for, that I knew was going to fail.  We're talking 80+ hour work weeks, repeated trips to Seattle to try to essentially polish and roll out one enormous turd of a product upper management at the time decided was a good idea.

Then one day in February or so I went to the bathroom and created a crime scene in the toilet.  The rest is history. The annual mulling-over of my plan to return to graduate school for clinical psychology I'd done the last 7 years prior became a whole lot clearer and I walked away from everything to pursue my doctorate in 2004.  Bye, corporate Felicia.

The reason I bring up that history is, while my programming training took my analytical brain up a few pegs and made comprehending statistics easier, and my corporate days taught me invaluable lessons on navigating interpersonal dynamics and politics, I had to learn a completely new way of being and working that coincided with my new narrative of someone with an incurable disease.

When you learn how to be a therapist, they drive a few things in your head.  1) Boundaries with patients are vitally important, both for you and, more importantly, your patients.  2) Disclosure of personal information should be done with extreme caution and gravitas.  3) Don't have sex with your patients.  No really, don't do that.  4) Obligatory jokes about your mother, mind reading, analyzing people at parties will become status quo. And probably a few other things I've forgotten.

As someone who straddles the patient world and the clinician world, the first 2 on that list have evolved over the last 13 years.  If you follow us on Twitter or read this blog, you can see how I've opened up about having Crohn's disease, and as of 2016, eosinophilic esophagitis.  I still withhold a lot because I know patients, or potential patients who are Googling us, read our social media.  And stalkers. I had one of those, once.

As Twitter and Facebook and Instagram et al. either weren't around or in their infancy in 2004, and those who were users most likely weren't doctors or psychologists operating in the open under their real names, maintaining boundaries became trickier as social media use exploded, including among those who work in medicine.

If you ask 10 psychologists their thoughts on personal disclosure you'll get 7 different answers.  Opinions vary widely, from you should never tell patients anything personal to stories of completely inappropriate role reversal where the therapist is using the patient's time to work through their own issues.  Early on, I fell more to the "don't disclose" end of the spectrum but as I've worked with hundreds of patients over the years, I've learned the value of making myself less robotic and more human.  Keeping it real.  Whatever you want to call it.

Do I disclose in my sessions with patients my illness status?  Sometimes.  It really depends on the person and situation.  If I feel compelled to disclose, I do rapid mental calculations in my head about whether my disclosure will somehow benefit the patient, our relationship, and ultimately their treatment.  This calculation, to me, is critical. Whether a therapist has a chronic illness or wants to discuss any part of the human condition they relate to in their patient's story.

If the patient is newly diagnosed with Crohn's, or has never met anyone else with IBD and feels incredibly isolated, will my telling them "hey I have this too" help or will they launch into a lot of personal questions about my experience in an attempt to predict their own course?

If a patient with UC is struggling to reach their life goals with work or starting a family, will my disclosure that I have IBD and, thus, I have IBD and got a doctorate and am married and have 2 kids, help or make them feel worse because they compare themselves to me?

If I tell a patient with IBS that I have Crohn's disease as a way to relate to their symptoms, will that help or will they worry that I judge their disease as not as severe as mine?

If a patient with Crohn's is considering a new biologic medication, of which I've taken many, if I disclose my experience with these medications, including my own concerns about side effects, will this help normalize the patient's experience and generate a discussion of pros/cons or will they pick up on any biases I may have no matter how careful I am with my words?

You get the idea.

I can't really say how often I disclose versus not, I'd guess it's about 30% of the time I do.  That means 70% of the time I keep my status on the down low because it's just not appropriate with that particular patient. But in the back of my mind I will wonder if they've seen our social media posts or found information on the Google, and if they know.  

Then there are my peers on social media, other health psychologists, social workers, dietitians, and physicians who know my status.  What do they think?  Do I offer a unique perspective as both patient and professional?  Or does my patient status automatically cloud my clinical judgment and perspective?

I suppose the point of this blog entry is there's a hell of a lot behind disclosure as a therapist.  It's something to reflect on often, and accept you're never going to get it perfectly correct.  But I accept my dual role and will continue to share and speak up about my illnesses on social media and other patient and professional events where I deem it to be appropriate.  I feel like it'd be wrong not to at this point.

Fade out to Johnny Cash.....


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