Don't get in your patients' boats

From the New York Times on providing therapy to the super rich:

A couple of years ago, Dr. Karasu received a call on behalf of an entertainment executive who wanted to reschedule an appointment at the last minute.

Dr. Karasu said the only time he had available that week was at 7 one night. The executive’s assistant said: “He’s having dinner then. How about 10 p.m.? He’s flying out to the Hamptons, but we’ll send a car for you and you can ride with him and do therapy on the helicopter, and then we’ll send you home in the morning.”

On and on it went. “If I would say I am busy on Saturday, the assistant would offer to pay me extra, as if that would be the answer,” Dr. Karasu said, adding that he declined the request. “For the average patient, the 45 minutes with a therapist is the most precious time. For this patient, it was just another activity superimposed on his schedule, and the therapist has to accommodate his way of being — like his trainer, his cook, his pilot, his administrative staff.”

Dr. Karasu and several of his peers voiced a concern that a rich person today was ever more inclined to view his or her psychotherapist as nothing more than a highly skilled member of his personal army.

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Dr. Karasu acknowledged that he was not immune from taking satisfaction in the success and fame of his patients. “Wealthy people bring about a degree of awe, even in their therapists sometimes,” he said. “This is the biggest problem I see in the doctors I supervise. And these are fully practicing doctors, doctors making $400, $500 an hour.”

He added: “It’s King Ludwig Syndrome. In the 19th century, Bernhard von Gudden was the psychiatrist for the Bavarian royal family and began to treat King Ludwig II, who was psychotic. In the end, the two of them drowned in a boat. So I teach my people who are treating wealthy people, ‘Don’t get in your patients’ boats.’ ”