My patients and I will not always agree. This should not surprise us. We may have different political beliefs — that’s fine. We may have different religious beliefs — that, too, is fine. We will likely have markedly different values and preferences — no problem. Some people worry about what will happen if they disagree with their psychiatrist. I suppose that that is not an unreasonable worry for some people. We might as well get this out in the open for me and my patients.
The first thing that needs to be said is that I will try to always be looking out for what is best for my patients. That is, as far as my intentions go, I want them to do well. I may or may not always achieve this, but I am always trying to. Next, know that I make a distinct effort to let them decide what constitutes what is “best for them.” I am very reluctant to put my opinion above theirs As far as I can control it and as far as it is ethical, their desires trump mine. Only in situations of imminent, serious danger will I assert my opinion above theirs, if needed.
On the other hand, what if we disagree about some goal my patient has set? What if his opinion of some action I suggest is that it is morally wrong or if I have a similar opinion about some action he proposes? What if I don’t believe what he tells me or if he doesn’t believe something I tell him? What will happen? Well, first I hope that my patients will not notice anything different about these situations. It is not my job to set goals for them — that is their job. I’ll try to stay out of the way. It’s not my job to dictate morals to them; it is their job to make decisions about their own morals. Truthfully, I may not always believe everything they tell me. I reserve the right to suspect (at times) that they may have left part of the story out, that they are unaware of possibly important parts of the story, or that they have altered the story for emphasis. So what? It is my job to listen to them and try to understand what the truth is, how they see it, and how it affects their lives.
Although it would be great if we agreed on everything, we don’t have to agree in order to work together. All we need is an area of common understanding. If I understand their goals, values, and preferences, I can help them use their guidance in their behaviors. If I know their political and religious beliefs, I can help them see where they enrich or complicate their lives. Of course, if we share similar beliefs and values, I can understand more deeply how these affect their lives. But even if we don’t share them, my job is to set aside my preferences in the service of theirs.
Not all of my beliefs and values are ignorable, though. If my patients ask me to do something that I believe to be unethical, immoral, or harmful to others, I will refuse. This is not because I think you are bad for asking, but because I am responsible for my own behavior. And I will not simply say, “No!” and leave it there. These times when we disagree about matters that are serious for both of us are opportunities for both of us to learn how to live in relationships that are sometimes frustrating and often hard to understand. I will not make my patients follow my standards, nor will I let them dictate their standards to me. But I will gladly enter in to a discussion of our conflicting views and attempt to understand how you see the world, understand it, and interact with it.
So in the long run, what happens if you and I disagree? Not much. I will respect your views and your right to run your own life in almost all circumstances. If I happen to be all too human and fail to give you proper respect, I expect that you will tell me about it. You can even yell at me if you need to — I’m a big boy, I can handle it. When you are in my clinic, you deserve good, respectful treatment. When you come for treatment, you deserve to be helped to achieve your own goals, not be bullied into pursuing someone else’s (even mine).