Crossing The Line in Therapy: A Guest Blog by Mark Rubinstein M.D.

Crossing The Line in Therapy: A Guest Blog by Mark Rubinstein M.D.

Crossing the Line in Therapy

Sometimes Rules Are Meant to be Broken

by Mark Rubinstein, M.D.,

Author of Bedlam’s Door

As a practicing psychiatrist, I was treating Alice, a 38-year-old, unmarried artist living in a Manhattan loft. She was depressed about her career and life’s direction. Above all, she was distressed that she’d been unable to sell her oil abstract paintings, although she’d displayed them at shows and at a prestigious gallery. Things had become so dire, she thought she might have to sell her apartment so she could pay for ordinary living expenses, and continue painting.

She was seeing me once every two weeks for supportive sessions. I become somewhat alarmed, when in addition to her lack of career success, a relationship with a man—a fellow artist—fell apart and Alice became despondent.

Over the next few months, her financial status worsened. The real estate market was headed to record lows, and she was desperate for money. Alice took a part-time job as an office temp, but that barely helped pay her bills. Because of her financial plight, I progressively lowered her fee. I had to charge her something for her to maintain a sense of self-respect.

Despite her best efforts, her career did not progress, even though she was a talented artist. She came to such a low point, financially and emotionally, I began considering if there was something I could realistically do to lighten her burden.

I was fully aware of the admonition that a therapist should not enter into the “real” life of a patient. There should be no social relationship; no sexual relationship; and no business dealings with someone in treatment. The therapeutic dynamic required freedom from such real-life interactions which could place the treatment in jeopardy. It’s considered an ethical violation for a therapist to engage a patient outside the office.

But desperate times call for desperate measures.

Alice’s financial situation was by now so precarious she was barely able to pay her co-op maintenance.

I decided the most ethical and caring thing to do was to get involved.

I made arrangements with Alice to bring my wife to her loft studio where we looked over a number of paintings. We purchased three pieces. In essence, I became a “customer” of hers. I realized the potentially difficult—even treacherous—relationship I’d allowed to develop, but felt Alice would probably decompensate emotionally if her travails continued much longer. In so doing, I created a boundary violation (mixing “business” with Alice’s therapy), but felt I was working toward a far greater good.

Fortunately, the money Alice earned from our purchases was enough to tide her over for the next few months, and she soon sold a few paintings. Her fortunes improved over the next two years, as she sold more.

Eventually, Alice sold her loft at a much higher price than she would have received, if she’d disposed of it under the desperate circumstances of a few years earlier.

Fortunately, my breaking the rules helped Alice find her financial and psychic equilibrium.

As a psychiatrist and therapist, it became clear that one should not always stick by arbitrary rules. Yes, sometimes rules can and should be broken.

© Mark Rubinstein, M.D., author of Bedlam’s Door: True Tales of Madness and Hope

About the Author:

Mark Rubinstein, M.D., an award-winning novelist, a physician and psychiatrist, is the author of a non-fiction book, Bedlam’s Door: True Tales of Madness and Hope. For more information, please visit and follow the author on Facebook and Twitter.