YOU DON’T HAVE TO LOVE ME, YOU DON’T EVEN HAVE TO LIKE ME, BUT YOU WILL RESPECT ME (LYRICS FROM BOSSY, BY KELIS)

Yup, I live by those lyrics in my work as a child, adolescent, and adult psychiatrist. Let me explain.

Behavior is often driven by unconscious triggers, feelings, and biases (race, gender, etc.). When people behave without awareness of what they are doing and/or why they are doing it, their actions and choices can leave them isolated, caught up in anxiety, depression, or other mental health difficulties, and unable to form meaningful relationships. My job is to help patients become self-aware of their unconscious behaviors and biases so they can “live their best lives.”  Often these unconscious behaviors and biases are linked to their past experiences (with family, environment, etc.). 

Interestingly though, it’s not uncommon for some patients to consciously behave in negative ways towards me, but lack understanding about why they’re doing it. Here are some examples:

  • Not showing up to scheduled appointments

  • Not paying copays on time, or at all, when they possess the financial means

  • Wanting to be friends

  • Attending appointments high or drunk

  • Expecting or demanding that I fill out forms that are not medically necessary

  • Expecting or demanding that I prescribe medications that are not medically appropriate

  • Not attempting or following through on treatment recommendations but then expecting or demanding that I do what they say when they say it

  • Being flirtatious 

  • Making subtle misogynistic, racist, or belittling comments

  • Lying


It’s difficult to withstand these types of behaviors sometimes, and I’m not perfect, but I understand the psychological link between maintaining strict boundaries and patient improvement. I understand the importance of turning misbehavior towards me into therapeutic gains for patients because the goal of therapy is to not need it anymore. If patients are willing to work with me on getting through the strict boundaries I set forth, and trying to change their behavior towards me, then we can explore the unconscious reasons that motivated them to do so in the first place. And that is where the money’s at. You see, that psychotherapeutic work can lead to increased self-awareness and lifelong improvements in self-worth, decision-making, and relationships.