Should I hide behind the magazine rack? Duck over to the canned goods aisle? Uh oh, she already saw me! Now what? Do I say hi? Pretend I don't see her?

Whenever we see people out of a familiar setting it can be awkward. The other day I was having dinner with my husband at a restaurant when a very familiar lady walked by and stopped to say hello. I couldn't remember for the life of me where I had seen her before. My poor brain sifted through the files until finally it reported that she worked at the library where my kids and I go once a week. Whew. Embarrassment averted.

Occasionally I run into old or current patients in public resulting in another kind of challenge. Do I say hello or not?

In my Dad's day there would be no question. Psychoanalytic thinking was very clear back then. Both patient and therapist should pretend they don't see one another, even if it's obvious to both that they have.

There are reasons many therapists still feel that way. One is that it could be seen as inappropriate, even harmful, to acknowledge the working realtionship outside of the 'therapeutic frame' meaning the clear boundaries of the time and day of the session and the four walls of the office.

Plus there are the issues of confidentiality. Saying hi to my patient in public might put them in the uncomfortable position of explaining who I am and why they know me.

While these are good reasons to take such unexpected encounters seriously, I don't believe we need to be all rigid about it.

Salman Akhtar, MD, renowned psychoanalyst and author, says that if a therapist runs into his patient outside of the office and the patient says hello, of course the therapist  says hello back! That's just common courtesy and it can be done in a therapeutic, professional manner.

Here are a few guidelines to help public encounters between patient and therapist feel as safe and comfortable as possible:

> Therapists usually take their cue from the patient. We will steer clear of saying hi unless our patient indicates in some way that it's OK. You are free to make the choice that feels right to you at the time. There is no judgment either way.

> If you do greet each other, the therapist does his/her best to put the patient at ease, keeping conversation friendly, short and sweet. Because the therapist is the professional in the relationship the onus is on him/her to give guidance at a time when the patient may feel vulnerable.

> Neither party will say anything referring to your therapeutic work or relationship like, "Doc, I'm having trouble with that homework you gave me." or "We'll talk about that in our next session."

> If other people are present, do not feel obliged to introduce your therapist. Your therapist will understand your need for privacy. He/she probably won't introduce you to whoever they are with, but if they do, you are not required to say anything beyond, "Nice to meet you."

> Debrief the encounter in your next therapy session if you have any lingering concerns. Whether or not you actually greeted each other, if you have any thoughts at all about running into your therapist in public, what you said, didn't say… air it all out together.

> An ounce of prevention… Ask your therapist what to expect if you run into him/her in public before it happens. Such a conversation could be helpful to you both.