Writer Adam Baer on the lines and boundaries that therapists must keep. Psychosocial oncology is a field to support, honor.

1. 4/29/2015 Beyond the Boundary Principle - NYTimes.com
http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/?_r=0 1/5
C O U C H
eond the oundar Principle
 ADAM AR
April 21, 2015 7:00 am
Couch is a series about psychotherapy.
It was a murky winter morning; I could tell that much from my hospital
window. I carefully shifted my neck, trying to keep my head straight so that my
newly bald scalp wouldn’t burn as it brushed against the pillowcase. A small
sea rock rested in my right palm.
This was the day of my autologous stem-cell bone-marrow transplant. My
own baby white blood cells, extracted weeks before, would be reintroduced
into my body now that large doses of chemotherapy had obliterated my
immune system.
I was 20. Death, I’d been told, was possible.
Earlier that day, my therapist, Dr. Morgan, visited me for what could have
been the last time. A slight, middle-aged woman, she was calming, with a soft
vocal timbre.
“Remember your breathing?” she asked.
I nodded.
“Want to do muscle relaxation?”

2. 4/29/2015 Beyond the Boundary Principle - NYTimes.com
http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/?_r=0 2/5
“No, thanks,” I said.
“Take this,” she said, offering me the rock. “Hold onto it. It may sound
cliché, but grip it for strength when you need it most.”
I forced a smile.
“I will see you in a couple of days,” Dr. Morgan said. “You will get through
this.”
I appreciated, but had trouble sharing, her positivity. Then she left.
I’d been seeing Dr. Morgan, the founder of the hospital’s psychosocial
oncology program, for about six months, ever since my Stage 4 lymphoma had
relapsed. I had never seen a psychotherapist before, and I was resistant. I was
sullen. I felt that I had a right to be depressed, a right to all these unusually
helpful professionals.
But Dr. Morgan didn’t fight me. She just wanted to help. So I let her try,
and she did.
She introduced me to mindfulness meditation, or, as she put it, thinking
in the moment, feeling everything. This wasn’t indulgent psychoanalysis. We
had short-term, practical goals: Keep the anxiety down; learn how to relax by
tensing and releasing my muscles; focus on the good things, despite the
nausea, chest pain and fear.
Dr. Morgan occasionally said that, like my parents, she had a son named
Adam. This was, for her, a rare crossing of boundaries.
My transplant was successful. My stem cells took, grew. But my physical
struggles were now more intense, especially as I convalesced at home. I was
weak, riddled with infections.
I wondered about Dr. Morgan. I had not been able to see her in months. A

3. 4/29/2015 Beyond the Boundary Principle - NYTimes.com
http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/?_r=0 3/5
week passed, then another. A medical fellow told me that Dr. Morgan had a
cold.
After a month, feeling stronger, I phoned Dr. Morgan’s office for an
appointment. A woman answered. She told me that Dr. Morgan had died.
I was stunned. Dr. Morgan had been sick, it turned out, the entire time
that I’d known her. She’d had lymphoma, too. She died after an infection had
overwhelmed her chemo-compromised immune system.
“She cared about you,” the woman continued. “She’d asked me to let you
know if anything like this ever happened. She was sorry that she couldn’t tell
you. She didn’t want you to feel betrayed.”
I couldn’t believe Dr. Morgan had never told me that she was sick with a
version of my disease.
“There are boundaries,” explained the woman.
I said that that made sense. It didn’t.
Over the next month, my health improved. But I was left with a hole in my
life. I didn’t think I could talk to anyone the way that I’d spoken to Dr.
Morgan. I didn’t think anyone could listen like her.
My mother and I found a death notice for Dr. Morgan. It mentioned her
husband. It mentioned her children, her pioneering work. It mentioned her
town.
It didn’t mention me. She’d had a private life, and she’d obviously had a
right to that. It was even likely that her impact on me had been so powerful
precisely because of this shared experience that had gone unmentioned.
Still, I felt alone.
When I began to resume some kind of life, my oncologist recommended

4. 4/29/2015 Beyond the Boundary Principle - NYTimes.com
http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/?_r=0 4/5
that I see an old pal of his: a psychiatrist-oncologist in his 80s who disavowed
the rules of therapy, including the maintenance of boundaries.
It worked out. This anti-therapist told me stories from his life. He even
hugged me. “Boundaries,” he said, were “bull.” Therapy was for “suckers.” He
worked with terminal patients who adored him and his no-nonsense attitude.
His mantra: “Stop feeling sorry for yourself.” We had an entirely different kind
of relationship than the one I’d had with Dr. Morgan. We became friends.
With his help, I healed.
He died some years ago — long after I’d stopped seeing him as a patient —
although not without first telling me that he was fighting cancer. We’d kept in
touch for nearly a decade.
But his death, like Dr. Morgan’s, was followed by a posthumous
revelation.
I’d wanted to get permission from his adult children to republish a book of
his mordantly funny tales that he had once self-published. I’d donate the
proceeds to his charitable foundation.
But when I mentioned the idea to my oncologist, he told me that
approaching the children would be tough. “He had a totally dysfunctional
family,” my oncologist said. “His wife hated him for separating from her. His
daughter wanted nothing to do with him.”
I was dumbfounded. My anti-therapist had always gushed about his
children. Evidently, he’d kept a large part of his life from me.
So much for boundaries as bull.
Today, there’s some irony in my life with respect to boundaries. The
woman I married eventually became a psychologist who works with the
chronically ill, and I like to joke that she’s had the good fortune of never
having me as a patient. I know that she must make strong connections with

5. 4/29/2015 Beyond the Boundary Principle - NYTimes.com
http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/?_r=0 5/5
her patients, but she never speaks about these people with me, and she doesn’t
share her personal life with them.
It’s intriguing that I’ve ended up with someone who now works in this
field and must keep a part of her life secret from me. But I know that to be
something of value for someone, you don’t have to be an open book. I know
that somewhere in the hospital where she works, someone must consider her
an especially helpful and reliable “friend” — someone who will never learn
much about her private life and who relates to her in a way that I don’t need to
understand.
Adam Baer is a writer in Los Angeles.
© 2015 The New York Times Company