Your brother-in-law asks for your insights about a cousin he thinks may have an eating disorder. A friend asks you whether it's normal to be consumed by depression months after breaking up with his girlfriend. Meanwhile, your best friend wonders what you think about her husband's constant hand-washing.
Such requests are common for psychology grad students, and they can be flattering. "It feels good—especially when you're just starting a new profession—to have your expertise recognized," says APA Ethics Director Stephen Behnke, PhD, JD.
But given your stage of training, don't jump in with more input than is appropriate—a scenario akin to the "medical student syndrome," in which fledgling doctors diagnose and treat themselves and others, says Jenny Cornish, PhD, training director at the University of Denver's Graduate School of Professional Psychology.
"Often, students are eager to take on a helper role by giving people advice or telling them what to do," Cornish says. "That's not very helpful for therapy clients, and it's not very helpful for other people, either."
So, how can you respond in a way that is helpful but maintains appropriate boundaries? Experts suggest that you:
Beware of multiple relationships. When you offer professional advice to a friend, you're stepping into a situation the APA Ethics Code describes as "multiple relationships," in which a therapist brings his or her therapy role into relationships with family members, friends, dating partners or others (see box for more). While the code doesn't explicitly forbid such relationships, it does caution practitioners against them, Behnke says.
"When you mix different kinds of relationships, each of which has unique challenges and complexities, it can be a recipe for difficulties," Behnke explains. "In the end, trying to blend your therapy role and relationships with friends and family members may place both your friendships and your psychotherapeutic work at risk."
Consider the potential dangers of briefly counseling a friend who reveals a painful secret, says Karen Twigg Sagisi, who is earning her forensic psychology degree at Argosy University.
"The person may feel great about spilling the beans at the time, but six months later when she starts feeling better, she may look at you and say, 'She knows about that; what does she think of me?'" Sagisi says.
Giving off-the-cuff advice may also steer someone in the wrong direction, Cornish points out, and it's no substitute for real therapy, which helps people gradually face their own defenses and draw their own conclusions.
Be prepared. To prevent such pitfalls from occurring, have some standard responses on tap, advises Pia Khandekar, a PsyD student at the University of Denver. "I usually start out by saying, 'It sounds like a hard thing you're going through,'" she says. "Then I make the conflict explicit—that I can't give psychological advice because I'm in the role of a friend, and it's difficult to be objective."
Sagisi says she puts troubled friends at ease by explaining that psychologists don't consider anyone to be "perfect" or "normal." She then asks the friend to think about how the problem is affecting his or her life and sometimes suggests getting professional help to resolve the situation.
Refer, refer, refer. Referring people to vetted practitioners is one of the best interventions you can provide, others say.
"When people would tell me about serious, long-standing issues, I came to realize that I could either give them advice that wouldn't do much, or help them find someone they could really get into therapy with," says Neal Brugman, a student in the University of Denver's PsyD program.
He emphasizes that therapy is not meant to be threatening, but supportive and collaborative: "I stress the fact that therapy is a process and that therapists are people trained to listen, observe, and help people … resolve those issues on their own terms," he says.
Listen up. Not all of your clinical skills need lie dormant, however, says Sheila Woody, PhD, director of clinical training at the University of British Columbia. In particular, good listening skills can help people feel understood, cared about and less alone, and that they are in a place where it's safe to think more deeply about their problem, she says.
Likewise, it's appropriate to attend to the level of seriousness of the situation, Woody says. If a friend has told you about a family member she thinks may be suicidal, for instance, convey your judgment that the person may indeed be in danger. You can then suggest that your friend discuss the situation with other family members and determine a way to get the person appropriate help, she says.
A good rule of thumb in all such instances is to consider your goals vis-`a-vis the meeting, Woody adds.
"If you're trying to help the person change the problem, you may be stepping over the line," she says. "But if you're conveying warmth, caring and genuine interest without trying to fix the problem, then I think you're in appropriate bounds."
Have resources on hand. Another germane tool: psychoeducation. Sagisi regularly hands out Web sites, phone numbers and other resources for people who might need them. These include relevant online resources from the National Institutes of Health and the National Alliance for the Mentally Ill, which both have Web sites that provide information on mental illness and local mental health services; and www.militaryonesource.com, a Department of Defense Web site that provides mental health information and referral resources for military personnel and their families.
"I also warn people not to take pop quizzes on other Web sites that 'diagnose' or identify traits of a particular mental illness," Sagisi says.
Remind people about self-care. In addition to referring people to therapy, experts suggest advising people to take interim self-care measures, such as exercising, getting enough sleep or laughing to lighten their mood. (Tapping your own humor is also a great tool if people ask whether you're psychoanalyzing them—another common grad school phenomenon, says Chris Weinkauff, who is earning her developmental psychology degree at Claremont Graduate University in Claremont, Calif. When someone questions whether she has them under the microscope, "My response is, 'I'm much too busy analyzing myself to worry about you!'")
Monitor yourself. It can be tempting—though inappropriate—to play therapist with loved ones, Brugman acknowledges. To make sure he's not assuming an improper role, he regularly checks his responses in close relationships.
"If I realize I'm doing all of the listening, that's a warning sign," he says. "So, I'll make sure to talk about a problem I'm having or about how that same issue came up for me and how hard it was. I make sure I take a supportive role where I'm more of a friend than a therapist."
Get input. Finally, talk to your training director or supervisor if you're having trouble navigating any of these situations—that's what they're there for, Cornish says. The APA Ethics Code, APA Ethics Committee and state association ethics committees are good resources as well, she says.
And bear in mind that mastering these situations is just another step toward becoming a full-fledged practitioner, she says.
"Don't be discouraged by the growing pains," Cornish advises. "Dealing with these kinds of personal issues is all part of the bigger picture of your development of a professional identity."
By Tori DeAngelis
Tori DeAngelis is a writer in Syracuse, N.Y.
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