Advice from the Trenches: Boundaries

Dear C;

I am working on my masters in psychology and planning on going into teaching. In the meantime, I work part time as staff at a local psychiatric hospital specializing in children, teens and young adults. Some of the patients are just a couple of years younger than I am.

There’s one girl in particular I’m really getting to know. Julie came into the hospital on an overdose. She isn’t a bad kid, she just came from a seriously dysfunctional home; her stepfather molested her from the time she was 7 until she was 16. When she tried to tell her mom, she got thrown out on the streets, and that’s where she got into drugs. She’s 18 now, and very motivated to turn her life around. We talk a lot and she’s been opening up to me. I think I’m really helping her get her head straight.

Thing is, I think that something else is beginning to develop between us. She is very attractive, and there is undeniable chemistry, but that’s not the only reason I’m interested. I’m drawn to her because of the way we talk. I’ve gotten closer to her than any girl I’ve ever gone out with. I’m starting to wonder if there could really be something there. I understand her in a way regular guys never could. I can tell she wants to be closer to me too, and not just emotionally.

I know better than to get involved with a patient here, but would it be wrong to stay in touch after she leaves?

Ward One

Dear Ward;

There are so many things wrong with that idea, I don’t know where to begin.

The relationship that you have with this girl is not social, it is fiduciary in nature. This means that you are in a position of responsibility. You’re a medical professional she has placed her trust in. The thoughts and feelings she has confided in you were as your patient. People will say a lot of things to a doctor (or a staff worker) that they won’t say to someone they have to live with or see every day. However much you understand her and are drawn to her, she is in your care. This isn’t everyday life.

As a psych student, I’m surprised you don’t see the potential problems here. When children have been sexually abused, it has usually been by someone who was in a position that should have been one of trust – a parent, a stepparent, babysitter, teacher, priest – a type of trust that can only be called fiduciary. It is remarkably similar to the position you are in with her now. If you really care about her future, and if she really is trying to turn her life around, then you should realize that the last thing she needs is to have another man in a fiduciary position approach her with sexual intent, because no matter how harmless you think your motives are, no girl who has been sexually molested by an adult will think that an older man is approaching her for reasons of mere friendship.

Girls who have been abused at an early age also don’t have a clear picture of their own behavior. Their early inappropriate experiences with sex can cause them to act out in a reflexively seductive manner. Any healthy male is going to respond, especially if the girl is pretty. Attracting men is probably nothing new for Julie. What would be different, and could really help turn her life around, would be if an adult male she put her trust in would understand her vulnerability and keep a respectful distance instead of trying to get closer.

If you intend to be a teacher, that is a somewhat fiduciary position, too. You are probably going to have many female students over the course of your career and some will develop a crush on you; it is not an unheard-of occurrence. If you respond to them the way you’re responding to Julie, you could find yourself facing uncomfortable accusations down the line.

How you choose to handle women in your personal life is up to you, but in your professional life, you have to be the one in control. This is good practice. Tell yourself that’s all it is, and you’ll be doing everyone a favor.