What Happens When You Run into Your Therapist on the Street?

And what is your therapist thinking about you at the time?

Posted Nov 21, 2017

There you are, out and about, doing your thing, maybe hanging out with a friend or a family member, and then you spot your therapist, meandering by like a stranger. It can happen anywhere—during a night out at the movies, at a wedding, or at the grocery store. There is the person who listens to all your secrets, just walking by in ordinary street clothes, living his or her own life. For many people, this is a weird experience. What’s it like to see your therapist like this, completely out of context? What is your therapist thinking and how is he or she likely to react? 

 CC0 Creative Commons
Source: StockSnap: CC0 Creative Commons

First, I’ll share a few stories from therapists I know who have had this experience. I’ve often heard about how odd it is to have to ride in the elevator with a patient when both people arrive at the therapist’s office at the same time. A colleague of mine said that a patient approached him at the gym, while he was using the bench press—and no matter how he hinted that he’d prefer to talk about the incident later, in therapy, the patient kept chatting him up as if they were old friends. Another colleague ran into a patient at a concert, with both of them carrying sloppy waxed-paper cups full of beer. Personally, I have seen my patients here and there on the streets of Manhattan, and once, in a bar. I also used to treat someone who lived close to my neighborhood; I saw her fairly often on the street, and even once in the school that my children attended. When I worked in a large metropolitan hospital, I treated medical students, residents and other hospital employees in psychotherapy; I often bumped into them in the cafeteria or the hallways, where most of the time we’d just offer each other small nods of acknowledgment. 

In many of these cases, the therapists I spoke to felt more than a bit awkward about their run-ins with patients, outside the office. But this awkwardness has a unique flavor. It comes from the intense, momentary process of sorting through several significant priorities: evaluating who your patient is, what your therapeutic relationship is like, and what the situation suggests about both of you—as well as who is with you, and who is accompanying the patient. Remember, your therapist’s job is to use your professional relationship to help you get better, and you’ve just surprised him or her by turning up unexpectedly, and therefore adding an awful lot of information to the mix. 

The number one factor in a therapist’s mind, when spotting a patient in a public place, is (and always should be) confidentiality. This is why most therapists will wait for you to acknowledge them first, if and when you spot them outside of an office setting. If you don’t give signals that you’re open to contact, your therapist will likely pretend not to see you. (Of course, he or she will probably still bring it up in next week’s session.) 

It will also depend upon whom you are with and when the surprise meeting occurs. You might be in the company of a family member who doesn’t know you’re in treatment, or with someone you’ve just started dating. You might even be at work with a boss who doesn’t need to know you’re going to therapy. Identifying your therapist in this situation might make you feel exposed or embarrassed. For these reasons, your therapist will most likely wait for you to signal that you’re ready for a public acknowledgment and only then may respond in kind. In this way, the confidentiality you depend on when meeting with your therapist is preserved, even if you see him or her somewhere far from private. 

Psychodynamic and psychoanalytically trained therapists will also want to “preserve the frame” of the therapeutic experience when a meeting occurs outside of the therapy room. In other words, because the usual framing details of your interaction (the formality of the office setting, the 45-minute time limit, the financial arrangements you make) are not present, this casual interaction can feel radically different. When your relationship has developed in a very clear context, it’s not easy to switch to another on the spur of the moment. Thus, your psychodynamic therapist is likely to limit your in-person interaction outside of therapy in ways that might surprise you, or could even seem rude. Even so, you and your therapist end up learning small but potentially significant new things about each other when you meet in public, and your therapist may wish to integrate these new details into your ongoing therapy. They may contradict a theory your therapist has formed about you, or help to confirm one. New details can lead to new insights or to a previously unconsidered avenue of discussion. Despite limiting your extra-therapeutic engagement, then, your therapist will very likely want to integrate what you learn about each other into your ongoing therapeutic dynamic. 

And it’s not only your privacy that can be undermined in a meeting like this. Your therapist has a life of his or her own, and to a greater or lesser degree, keeps this life private from you during therapy sessions. Although you may be very curious about your therapist and may be fascinated to see him or her out of context, the encounter may be uncomfortable for your therapist, as well: it’s not difficult to imagine ways in which a therapist could feel compromised. Even if he or she has no reason to be embarrassed, knowing certain things about the life of your therapist can have powerful or deleterious effects on the therapy. Imagine working with your therapist for years to get over your divorce, and then seeing her in the company of a very handsome gentleman who appears to be her husband. Imagine talking to your therapist about the difficulties of weight loss, and then running into him in line at Krispy Kreme. 

Overall, though, your therapist should be a professional who places a high priority on the therapeutic relationship, even in situations where he or she feels less than comfortable. Your privacy and the coherence of your treatment are the most significant factors in play when you run into your therapist in the wider world.