The psychiatrist’s role is to help people help themselves: to show them where their problems lie and begin resolving them one by one. Patients arrive with many expectations depending on the problems they face, and some of these expectations can be surprising. A psychiatrist must first understand that the person who comes to them needs their help and may have certain wishes. Sometimes a patient wants the psychiatrist to listen without stopping, as though the session had no limits, or arrives with numerous problems and expects them to be resolved immediately.

What is the psychiatrist’s role?

  1. A psychiatrist first considers whether the problem lies within the person or is related to their biological and physiological makeup and the cognitive and emotional processes within their nervous system. Or is the problem connected to society, the family or the power structures in society? This is an important question. We usually find a mixture involving the interaction between these internal factors, the patient’s vulnerability, and how the family and society respond to the patient’s problems.
  2. It is important for psychiatrists not to rush into treating everything as pathological. Families sometimes consult a psychiatrist because their son does not share their particular religious outlook or prefers a different approach to marriage. Some families tend to label anything that conflicts with their views or with society as an illness.
  3. It is therefore important for psychiatrists not to side with those who hold the power—the patient’s family who pays for treatment. They should listen to the patient’s perspective and determine whether the patient has internal or cognitive problems or a problem with the surrounding environment.
  4. A patient may arrive with a narcissistic expectation and want complete containment and unconditional embrace without recognizing the limits involved. To work properly, a psychiatrist needs to explain their boundaries, including time limits, fees and respect for the setting. A patient’s need for a doctor does not mean that the psychiatrist must accept everything.
  5. The psychiatrist’s role is to listen, identify whether the problem lies within the individual or their surroundings, understand how these problems interact, make a diagnosis and provide therapeutic interventions. Most interventions form part of a treatment course that follows diagnosis. This includes psychoeducation: explaining where the symptoms came from and discussing the solution while making clear that it may be difficult to provide and implement in a single meeting. Most problems are chronic and cumulative, and patients often seek help after the situation has worsened. After listening and making a diagnosis, however, the psychiatrist can outline a roadmap for working with the patient, helping them out of their distress and equipping them with tools to help themselves after clarifying the psychological obstacles in their way.

How does a psychiatrist work with patients?

A frequent question is: Why can’t my psychiatrist become my friend after I have told them about my entire life and all my problems? Why do medical rules prevent a psychiatrist from becoming a patient’s friend? The psychiatrist would lose the neutral perspective through which they view people, the boundaries between patient and psychiatrist would become permeable, and the psychiatrist would lose therapeutic effectiveness. The mental health professional must therefore maintain these boundaries by doing the following:

  1. If a psychologist has a friend or relative experiencing psychological problems, they should refer that person to another psychotherapist whom the person does not know.
  2. A psychiatrist should be friendly and respectful, but social interaction that crosses therapeutic boundaries is inadvisable. It is the therapist’s duty to preserve these boundaries because patients arrive with many expectations.
  3. The relationship between therapist and patient is defined as nonreciprocal. It is a relationship between someone with expertise in psychological sciences and someone with a need, so there is no exchange or equality. A psychiatrist may discuss external topics such as the weather, but only to break the ice. Breaking the ice must not cause it to melt away between therapist and patient, because the therapist would lose effectiveness.

A patient’s attachment to their psychiatrist

There are many forms of attachment, and attachment is very likely to occur. It does not necessarily have to be romantic. It may resemble attachment to a father, mother or daughter—a familial attachment. Many patients come from difficult circumstances and emotional deprivation and have no safe space in which to talk, confide and reveal what lies within them. The therapeutic setting with a psychiatrist may be the first place where they can open up about these aspects of themselves. This creates a sense of comfort and safety that they wish could last forever.

What is the psychiatrist’s responsibility upon noticing signs of attachment in a patient?

  1. The psychiatrist should notice these signs and give the patient an opportunity to talk about them. Their response should neither embarrass nor reject the patient, as the patient may already have experienced rejection outside therapy.
  2. It is important to help patients recognize reality and boundaries without embarrassing them. Having such thoughts is human and acceptable, but turning them into reality is not.
  3. The expectations and hopes in the patient’s imagination should be received calmly, thoughtfully and supportively.
  4. The diversity of the people we see should be respected without allowing it to cross our personal boundaries.
  5. Psychiatrists and psychotherapists must preserve their own psychological, professional, family and personal balance. Protecting their personal and professional boundaries is fundamental to maintaining this balance.

We often expect our psychiatrist to be available at all times. Social media has created more ways to reach them, and if the psychiatrist does not respond, people may see this as a failure or complain that the psychiatrist responds only through paid sessions, among other concerns. We must remember that psychiatrists are human beings with lives of their own and must preserve their balance. At times, they need to turn off their phones and stop taking calls.

Patients may wish the doctor were exclusively theirs and blame the doctor for not responding. In any case, before beginning treatment, you can choose where to seek it: a government institution, a private organization or a private doctor. Choosing a private doctor does not mean you have exclusive access to them or can contact them at any time. The boundaries of the patient–doctor relationship must be respected and preserved.

Even in emergencies, the psychiatrist determines whether the situation is an emergency. During each patient’s initial assessment, those considered at risk of harming themselves are identified, as are patients trying medication for the first time who fear possible side effects.

Patients who disturb psychiatrists by phone are often those with very mild symptoms, such as panic and anxiety. The nature of their condition makes them complain frequently. If you want a good doctor, allow them to maintain their psychological balance and personal boundaries. As a matter of courtesy, written messages are preferable, followed by patience while waiting for the psychiatrist to answer your question.


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