I’m a Retired Psychiatrist. Is It OK to Befriend a Former Patient?

I am a retired, married, male psychiatrist. A divorced, female former patient of mine contacted me recently, 45 years after her treatment ended. Would it be OK to correspond with her by email? Or is this a case of “once a patient, always a patient?” — Name Withheld

From the Ethicist:

The relevant professional associations tend to have strictures that are specifically about sexual relationships with former patients. The American Psychiatric Association has a crisp, narrow rule: “Sexual activity with a current or former patient is unethical.” The American Psychological Association forbids sexual intimacies until at least two years after the termination of therapy, and says that, even then, it’s acceptable only “in the most unusual circumstances.” In light of the potential for exploitation within the therapist-patient relationship, these rules are meant to maintain clear boundaries, protect patient welfare, uphold the integrity of the profession and eliminate any gray areas that could lead to ethical breaches.

But though you do mention her marital status, and yours, you’re just asking about emailing her — about establishing friendly relations. The question for you is whether she might be harmed by this, whether whatever knowledge or trust gained from your professional relationship would shadow a personal one. Yes, almost half a century has elapsed since your professional relationship, but you still have to be confident that a correspondence with her clears this bar. If it does, you may email with a clear conscience.

Readers Respond

The previous question was from a reader who was holding onto a devastating secret. He wrote: “When I was a child, I was sexually abused by my father. I never told anyone about it when it was happening. To this day, nobody in my family is aware that the abuse occurred. My mother is still married to him, and he has a good relationship with most of our immediate and extended family. In adulthood, I’ve chosen to continue keeping his transgressions to myself. I’ve followed this path not only to avoid familial conflict but also for the sake of containing the damage he has done. … After many years of therapy, I finally followed the advice of therapists and friends and cut ties with him. I let my family know that I couldn’t be around him anymore. … A few trusted friends have told me that I should consider telling the family about all of this. They say that if they had an abuser in the family, they would want to know. What is the ethical thing to do here? Should I continue my silence to protect the rest of my family from emotional harm? Or do I owe it to them to tell them the truth?”