I’ve known therapists who slept with their patients. I’ve known therapists who took “down on their luck” patients into their homes. I’ve known therapists who made friendships with their patients and socialized with them outside of the office. And, I’ve known therapists whose sense of their own value depended on their patients’ approval and improvement.
There are problems here and I hope most of them are obvious. But, just in case, I will explain.
A therapeutic relationship involves unequal power. Authority figures, be they bosses, teachers, parents, clergymen, or therapists, usually have a power advantage. Patients assume a therapist has only the patient’s best interests at heart. The patient might never previously have had someone in his or her life who seemed so interested, who listened so patiently, who seemed so caring. Under these circumstances, the patient is vulnerable if the therapist should pursue his own sexual agenda.
For a time, it might feel good to both parties, but it is a fundamental corruption of the therapist-patient relationship and, in the long run, can do extraordinary damage to the patient and add one more life-injury to the long list of hurts the patient has already suffered. This is true even if it is the client who provokes or initiates the sexual contact, as sometimes happens.
Dual roles are generally a problem. Thus, a therapist is well-advised to avoid the complication of being more than a therapist to his patient. Meaning he shouldn’t be a therapist/lover or therapist/friend. To take on more than one role almost inevitably confuses both the therapist and the patient as to which role takes priority. And, it compounds the potential feeling of rejection, if the therapist should say or do something that seems critical or indifferent.
Expectations of friends, therapists, and lovers depend on which role you believe that person occupies in your life.
Even the anticipation of a possible future friendship or sexual relationship after therapy ends can change the therapeutic relationship for the worst if either the client or counselor harbors such hopes. Imagine a therapist who desires a patient who is considering a possible divorce; if he anticipates the possibility of “dating” the newly divorced woman once treatment is over, might he be more likely to encourage her to end her marriage?
It is for reasons like this that the American Psychological Association’s ethical guidelines rule out any such contact between counselor and patient, during or after therapy, in virtually all cases.
None of this is to say doctors do not, sometimes, have feelings of attraction to clients. We treat the beautiful, the charming, and the handsome, as well as the less than beautiful and less than charming. But all counselors should be trained about and reminded of the boundaries concerning therapeutic relationships, boundaries that must never be violated.
Therapists run other risks, as well. Among them, is the need for approval from their patients. Certainly, it is human to want such approval. But the therapist needs enough confidence to be able to withstand his inevitable inability help everyone; and, that in order to help some people, it will be necessary to tell them painful truths that may cause the patient to end the therapy and reject the therapist.
If the counselor is too invested in the patient’s improvement for his own good, he can be laid-low if the patient does not get better. And, ironically, if the therapist is working too hard to help his client, harder (in fact) than the client is working, he is likely to steal the essential initiative of the client so necessary for his or her improvement.
Anyone in a helping-profession faces a problem with respect to how close he should get to his patient. If he is emotionally distant from this person, his ability to help is compromised. Most people, after all, want a doctor who cares. If you think your healer doesn’t care, or is only in it for the money, you are likely (and correctly) guided to go elsewhere for treatment.
On the other hand, however, is the problem of the health-care-professional who cares too much; who feels your pain almost as much as you do; who suffers the ups and downs of your mood as if he is a passenger on the same roller coaster, sitting right beside you. He is in danger of giving too much of himself, to the point burning out. Moreover, when you reach for him in your sadness or confusion, you are not likely to find a “rock” upon whom you can rely, but instead someone who is just as pained or disoriented as you are over the reverses in your life. From that vantage point, no therapist can be of any use.
Therapists need to be solid, emotionally and physically, to take on the complicated emotional and intellectual lives of the people sitting across from them. They need to be involved, but not to the point their own emotional well-being is compromised by the sadness or turmoil of the people who they are treating. They need to know their own limitations and set limits on the extent they provide care, lest they be sucked-dry by the process and unable to be of any use to anyone, including themselves.
It can be useful for therapists to receive their own therapy. But when the counselor’s world is rocked from the outside, or when he is unable to navigate the white-water of human emotion that he is attempting to traverse, sucked into whirlpools beyond his control, he is well-advised not only to seek supervision and treatment, but sometimes, to refer the patient or patients in question to those who do have the equanimity to be able to do good for those same people.
Nearly all therapists mean well. Nonetheless, as the saying goes, “The road to hell is paved with good intentions.” If you think your therapist is unstable, too involved, or in some way inappropriate, it is time to consider your options: there are lots of good therapists out there, but there is only one of you; one life to live and set on the best possible course you can.
You may find the following related post of interest: How Therapists Fool Themselves.
The above image is Cropped Photo of 2007 KKC Participant with Self-made Custom-fabricated Crutches by Rich Cosgrove, sourced from Wikimedia Commons.
Thank you for taking up the subject of the pitfalls of therapy. I appreciate it and your generosity pointing out these issues.
Can I raise a couple of areas of discomfort in this?
One is the territory of a therapist telling people “painful truths.” I would think constructive dialogue would be geared toward LEADING to truths rather than TELLING someone else truths. Only the client knows what these truths are, as the only witness to life beyond the consulting room. Are the “painful truths” some sort of judgment or label? I feel those are limiting and don’t help a client live a more functional life.
There’s a danger to this “for your own good” philosophy. It was my experience, anyway. My therapist delivered what he thought were “painful truths.” In the real world, anyone would call them what they were–putdowns.
I do wish too that therapy could be delivered to mitigate this “authority figure” mystique which I feel reinforces powerless and causes more damage when a therapist errs. If a client could see a therapist realistically rather than magically, it might be healthier.
Your point is well taken and it is a fine line indeed. I agree that coming from “on high” is a problem for therapists. Sometimes, however, the Socratic method does not lead the client to all of the conclusions that might be useful to him or her. Certainly therapists can err and one must make a good assessment of what information will reveal itself in time and what has been missed by methods that perhaps have been too subtle and indirect. As you say, we have no “magic” and the best of us try to let our clients know that we do not offer only truths written in stone.
I understand what you’re saying. And as we’re discussing this, we’re obviously each mentally referencing back to very different scenarios. I experienced the abusive end of some “truth-telling,” but I can also imagine critical situations which might call for more direct interventions. My bottom line, if someone were to call me on something, is first the delivery and secondly can this jarring translate into immediate and concrete steps to correct/improve the problem.
The authority issue is a difficult because of so many factors before the client even arrives at your door. I’m sure my biggest problem years ago was idealization, and I hear it in that way people talk/write about their therapists. Indeed it’s something of a paradox to address this construct.
Again, thanks for your generosity.
As you say, this is enormously complex. But what you have to say is very important and unfortunately, based on some difficult experience with therapists. I’ve put you on my blog roll and hope that others who read my blog will benefit from your perspective. Thank you for taking the time to write.
I wrote because I feel a dearth of conversation about some of these issues, among professionals, to the public, and certainly between the two groups. I will add you to my blogroll as well.
Thank you very much for this post. As a therapist and as someone who was traumatized in therapy by a dual relationship with my therapist, I appreciate this post tremendously. I also find the discussion on “telling the painful truth” interesting, as I see it from both perspectives. I think that, even if there might be some objective truths in this world, our ability to know them is limited. We can, however, have our subjective knowledge and vision that, I think, is perfectly fine to share with others including our clients, as long as we present it as our vision and not The Truth. I personally always appreciated when others told me their perspective on my situation even if it was different from mine, as long as they did not insist that their vision was The Only Right One. Honesty for me is an essential component of any relationship, otherwise, the relationship doesn’t feel genuine. I especially value genuineness in the therapist-patient relationship, because I believe that if it is not present, then no real work can take place. I was actually harmed more by my therapist’s constant agreeing with me on everything and seeing everything from my perspective only. It felt good for a while that he could empathize to the point that he would cry with me and for me, but eventually it put me in a very dark place, where I could see no way out, no solutions for my problems.
On the other hand, giving people your opinion prematurely, before they were able to establish some basic level of safely with you could feel very invalidating, and I have had this experience as well. I needed to feel heard and understood on my own terms before I was willing to be receptive to the therapist’s input. It is also important how you deliver the message and what kind of intention is behind wanting to give the client an honest feedback. I know from experience that sometimes it feels like we want to do it for the client’s “own good” but, in fact, we might feel the need to impose our own agenda on them. I think, mindfulness and self-awareness is the key in navigating through these complicated situations, and in order to stay mindful we need to be brutally honest with ourselves.
Your very thoughtful comment — indeed, a mini-essay — is much appreciated. I expect that others who read it will benefit from your wisdom and the hard-won experience you describe.
Thank you. I am working on my own blog/website on therapy process in general and harmful therapy in particular. When it is ready I will put a link to your blog there among other resources.
I will look forward to seeing it. Thanks.
Gerald, I just wanted to share the link to my interview/article on yahoo associated contend regarding abuse in therapy. Here it is
I happened to be one of the survivors of this kind of abuse. This is just the beginning of all my future attempts (articles, books, presentations etc) to raise public and mental health community awareness of this phenomena that is, sadly, not uncommon. This issue perfectly fits with the idea of your blog about therapists who need therapy. My therapist certainly needed it badly.
Many thanks for this, Marina. I’m sure that it will be useful to a great many people. While I can imagine that some of the warning signs you have listed will help people to detect possible therapist inappropriateness, I also believe that some of them may occur in patients who project many of their own feelings on to the therapist and may attach their emotional life to that of the therapist without the clinician having done anything inappropriate to encourage it. In any case, I think your point of view is an important one.
I am guessing that your are talking about patient’s transference here. From experience of being a therapy patient, who was abused by her therapist and listening to stories of other patients, who were abused in therapy and also being a therapist myself and knowing what patients could attach to you through transference, I can say that I don’t know of any single case, where therapist inappropriateness was imagined rather than real. Patients might sometimes falsely perceive you as non-compassionate, judgmental, uncaring, inattentive, but they don’t make up inappropriateness where there is none, as this is something that is impossible to make up. Transference does not cause trauma even though it could be intense and uncomfortable. Therapist’s exploitation of transference does. There is even a legal term that is used in therapy abuse cases “the abuse of transference” or “professional incest”. When my therapist/perpetrator and I saw two therapists together (after seeing each other outside of his office as “colleagues” for two years), they too implied that my trauma was self-created and had nothing to do with his behavior. When I pointed out to how he violated boundary on many occasions, they did not even respond to that. They just refused to talk about his behavior at all. I was the only one who was supposed to be under scrutiny, but he was off limits no matter what he did. It is interesting how therapists typically respond to those cases..The initial automatic reaction is to believe that the patient is making it up as opposed to believing that the therapist did something wrong..There are two websites that offer support and advocacy for those who were abused by therapists
I think, it’d be educational and helpful for all therapists to browse through these websites and read their materials.
Very well put. My point is that I am simply disinclined to judge individual cases in the abstract. I do not question the data you site. However, having dealt with in excess of 3000 individuals (many of whom I was asked to evaluate by other therapists rather than treat), including many who were psychotic or had severe personality disorders which often produced idiosyncratic ways of looking at the world, I wouldn’t want to judge based on a presumption that the therapist must be in the wrong. God knows, usually that it the case, but you never know. I would add that the presence of links to the websites (above) should not be understood as my endorsement of the material that is present on those sites.
Speaking as a consumer, I fear it’s not uncommon for therapists hide behind their transference theories to avoid examining their role in a therapeutic impasse. Patterns of human interaction don’t suddenly change at the consulting room door. Therapists can do tremendous damage maintaining their pride, then attributing a breakdown to the client’s projections.
That’s not to say a client might have heightened vulnerability in an injury. If the therapist idolizes the therapist (that some therapists even encourage), or is otherwise dependent, a boundary crossing leaves her feeling quite fearful and adrift. But assuming a client reasonably sane and functional, I assume at least some provocation.
My point is different though. I think, psychotic people could be left out of this discussion, as they simply live outside of this reality. Everyone else, including those with severe personality disorders do not simply say “My therapist told me that he loved me and held my hand in session”, if the therapist didn’t do it. They have no reason to lie intentionally and consciously. In case when the therapist really did something inappropriate, the patient’s disorder or any psychological issues that she is struggling with are irrelevant. I was fortunate to find the third therapist, who my ex-therapist and I saw together, who clearly labelled his behavior as inappropriate and abusive, and to all his attempts to discuss my issues and my history she responded that my material was irrelevant, and that when the therapist behaves unethically, the patient’s issues cannot be held against her. After all, if I had not had any issues, I would not have been seeking help in the first place, and it was his job to deal with whatever I brought to the table. If he had felt that he was not able or competent to work with me, he should have referred me out. When patients project, demand, manipulate, provoke, they simply bring their material to us, and it is our job as therapists to deal with this material professionally instead of using patients’ disorders as an excuse for for doing something inappropriate. As one of my supervisors said: “It is your patient’s job to seduce you and it is your job not get seduced”. One of the things that I found on http://www.therapyabuse.org is the statement “You could be a prostitute and begging for sex and it is still the therapist’s responsibility to hold the boundary.” I think, this statement reflects the heart of the matter.
Disequilibrium1 adds to my point. My addition to her post would be that people with sever disorders are even more easily provoked than those who are reasonably sane.
My dispute involved the therapists (a team) behavior when I wanted to leave treatment. When I complained, they accused me of transference and distortion. Now to fabricate a story, I’d have to dig deep in professional texts to learn of clinician termination issues, then imagine a full scenario. If one is inclined to cry victim to get attention, wouldn’t she choose something a little more dramatic than a dispute around termination? It’s preposterous. I only understand the scenario–because I lived it.
Thanks to both you and Marina for adding to the discussion with your personal experiences. I agree with your characterization of the preposterousness of the scenario you lived through, and Marina’s statement that the therapist, regardless of provocation, must hold to the boundary.
I am looking for help. I work a graveyard shift as a “Case Manager Assistant” (which means I am a bottom of the rung worker–one of many) in a Battered Women’s Shelter, at very low wage, as you can imagine. The graveyard workers have very little interaction with the residents and NO TRAINING in counseling. In order to bring in a little more money for those of us on the graveyard shift, out director made an agreement with the local crisis line–we now answer the crisis line over night. Several of us are feeling traumatized by some of the stories we have to listen to. But we are not offered ANY kind of debriefing or counseling. I for one was unemployed for many many months before I got this job, and I am not the only one who is afraid of losing my job if I complain about answering the crisis line calls.
Do you know if there is a professional organization that can look into this situation–and ask questions about how the WORKERS are being helped with what they are forced to listen to?
We are beside ourselves–and frankly, feeling victimized! (Most of us have endured abuse in our own pasts–and this just triggers us!)
Help us, please.
It is not clear where you live, so different governing agencies might apply to your situation depending upon that. You might consider looking into the following: find out what governing body licenses the company for which you work. If your company is not providing you with adequate training or supervision, that agency might be willing to examine the situation. You may also wish to determine whether there is a local, state, or provincial governing body that is responsible for health/human services or civil rights. From the information that you have offered, you would probably be well-advised to consider whether you would be identified personally by your workplace and considered to be a “whistle-blower,” with possible negative consequences to you. Another possible place to look for help might be the ACLU (American Civil Liberties Union), if you live in the United States. I also cannot say whether you would benefit from receiving counseling. If you do not have adequate medical insurance, then governmental agencies are likely to be able to provide some direction on getting therapy. Alternatively, some therapists are willing to see people on a pro bono or sliding scale basis. Your situation sounds genuinely difficult, but these are at least some things to consider. I hope this helps. Best of luck to you and your co-workers.
It’s been a while since I was on your blog. It looks more organized now. I just wanted to let you know that I’ve created a blog http://www.therapyconsumerguide.com that is still developing. Many topics are coming up but it’s already up and running.
Thank you, Marina. I will definitely take a look.
i too have been hurt by therapists. Not physically. No visible wounds. Just internal. It is worse than the original abuse. You look for help, you finally build up some trust, and then they hurt you more than anything you ever experienced growing up. Why did I start this?
I’m sorry you had to go through that, Nancy. No therapist I know is perfect, but the responsibility to “first, do no harm” is something every healer needs to be reminded of over and over. Thank you for your comment.
Thank you for replying. I have a question.
How do you trust another therapist? I don’t know what to do. I understand that I am not perfect and neither is anyone new that I might seek help from. I understand mistakes, but not planned out unethical behavior. I am glad that my husband sat in on the last session and saw for himself what happened. Otherwise, I would have thought it all my fault. That I must have done something wrong.
I have to put this behind me and move on. But I don’t know how to trust a new therapist. Or for that matter anyone else. It has changed my whole outlook. I don’t like the change. I struggle with thoughts of just giving up, But I am not going to quit fighting to stay alive. I am beginning to think that I might be better off without therapy.
Trust is always difficult. You might want to read this, about what to do when therapy fails: https://drgeraldstein.wordpress.com/2009/08/30/what-to-do-when-therapy-doesnt-help/ Best of luck. Also, as I mentioned in response to an earlier comment to you on another post, the Association for Behavioral and Cognitive Therapy has a website that will help you find another therapist. If you live in the Chicago area, I can also give you some names.
Hi Nancy. I know how you feel because I was harmed in therapy as well. I don’t think I’d ever see a therapist again. It’s not that I don’t trust their good intentions. The therapists that harmed me were well-meaning people and certainly didn’t want to do any harm. The damage they did came as a result of their ignorance and unconscious arrogance that unfortunately is not so uncommon among therapists and come as a result of professional training that promotes some ideas and beliefs about therapy process and therapist-patient relationship that have little to do with reality (no disrespect to the author of this blog). I am saying this not only as a former therapy patient but also as a professional because I am a therapist. If you want me to share my experience of how I have been healing from emotional damage I received in therapy, you can contact me privately at email@example.com
Dr. Stein: thank you for your blog. I also have seen many therapists, and had to leave most of them. many had more issues than I did; others would ‘lecture’ me re: what I ‘should’ do (as opposed to asking what I wanted0). Many said such vicious things to me (about me); one female therapist hated men (her husband had affairs), another would tell me HER problems,and when I told her I had to leave her she began crying, & told me the main problem was that during our sessions I told her MY problems before SHE had a chance to tell me hers. I reminded her that I was the client, & paid her money for the sessions.
Oh yes, another was anti-Semitic (I am Jewish and he knew it.). Also, trying to tell other therapists about my prior bad experiences is usually a JOKE! The first thing they ask: what degree did they have: social worker, marriage and family counselor, etc. I would always respond: IT DOES NOT MATTER WHAT DEGREE THEY HAD. What matters is how they treated me, which was: AWFUL. I then get asked what school of therapy they adhered to. Usually, they told me “eclectic’. However, I replied the same way: IT DOES NOT MATTER WHAT ‘SCHOOL’ THEY ADHERE TO. It is their personality, and how they treated me. What school and/or degree program instructs them to viciously criticize their clients? or to hate men? or to sit there silently, and not speak ONE word during an entire session?? (I had 2 who did this-and one blamed ME for her silence!!!, etc. I really appreciate you, because most therapists will NOT look at their own profession. Instead of therapy, I now read excellent, well-written ‘self-help’ books & talk to wise friends. I can’t go to therapists anymore.
I’m sorry that you’ve had this unfortunate history. In defense of the profession, I know a number of good counselors, but that is surely little comfort when the therapist in front of a person does harm.
I’ve been to your blog before and we had an interesting discussion re: the topic you explored in this post. You’ve also visited my blog http://www.therapyconsumerguide.com and we had an equally interesting discussion there. My site has changed since then and I am planning other big changes in the future. I was wondering if you’d be interested in exchanging links. I’d put your blog in my blogroll and you’d put my blog in yours. Let me know. Feel free to email me privately at firstname.lastname@example.org
There is a group called TELL> Truly well meaning peole who help those who have been hurt by thrapists.
It’s free too. Google TELL. They helped my best friend when know one else did.
Thanks for this, Lisa.
thanks for the article for covering this issuse that desperatly needs to be addressed
I’m afraid i bring dark news
i’m slowly picking back up my life after being put through a living hell, from an inadequate man completely corrupted by power…a control freak who wanted to excert as much negative influence over my life, a man who wanted to see how much he could get away with, I have to say even if you have experienced it before, this there is nothing you can do, absoutley nothing, (short of explosive violence – which if you where like that’ you wouldn’t have had the nerve to enter into therapy in the first place) there is nothing you can do, it is the therapist fault, fully, totally completely
There is no money in the cure and as my parents where willing to pay the therapy – all he had to do was make me need therapy as much as possible,
4 years i lost and i expect for the rest of my life to be in pain,
there is nothing a person can do, a therapist (with the information given through training and experience) decides to exploit your issues for his/her own gain there is nothing that you can do – when dealing with your issuses you are weaker than a child
afterwards I was so beaten down, so repressed, no self esteem no confidence, just a mess of confusion and self doubt, that when ever i tryied to tell people about what happened including medically professionals they just pushed me aside, I dont neccesary blame them for this (allow if they had of listened to me they could have saved me a couple of extra years of pain), but because of the affects of the abuse on me (the point of psycholoically/mentally torture is to fuck you up) and his social status – if i was in there position I wouldn’t believe me either and at the time I had no fight or willingness to just scream at the professionals about what happened – which is what you have to do, dont do any of that nice stuff if you wanna be heard and you havn’t got the strength or confidence to make a rational argument and stand your ground – be as unreasonable as possible, be loud, scream, threat, refuse to listen etc untill your taken serious and get the help you need
eventually allow i got myself sorted out enough to bring action against these people and in doing so I found out some rather disturbing stuff about hypnotherapy
for starters there is no regulator’s for hypnotherapy
these guys are a law unto themselves, hypnotist’s posing as therapist’s, who really only are qulaified to deal with the smallest of issues such as quitting smoking
its is ridculously easy to become a hypnotherapist you apply online and do a thirty hour course and thats it complete (i’m not saying that a person with a 4year degree, deserve’s to have your trust for this action, but in getting a degree shows the therapist in question has shown at some point in his life to have patience and discipline,)
the institutes that give out these qualifications, they do not put therapist’s through therapy they just take the money and here’s your certificate, there was news articles in the recent past of people applying and obtaining certifcate’s for there pets
An industry that has no market is designed to fail, being that hypnotherapy (nlp) is marked towards people with dubious characters (lazy and greedy)and selling them grand ideas of makes vast cash, is there any wonder to make a reasonable basic wage, hypnotherpist’s are delieralty setting out to make a certain amount of patient’s dependant on them, aka cash cows
the instiute when i rung up to complain and even thou they did believe me and knew i was telling the truth, where more concerned with using there nlp techniques to get me to sit down and be quiet, than in stopping this little tyrant
he could have like other hypno-therapist’s got himself another office, in another town and made a better living a more honest living, but way bother going to that effort when all he really is interested in is money and appearance
Reblogged this on Darque Thoughts.
the only time I felt helped by a therapist was when the therapist reached out, took my hand and one day cried along with me. It made it real and my feelings real. There is not way to make it so simple a relationship. If my therapist did anything less or became dry I would no longer go.
Thank you for commenting. As I tried to say, Jen, being a therapist requires a balancing act between caring too much and caring too little. If a therapist shed tears with you and for you on a single occasion, then he has much company in this regard. If he did it every time he saw you, I’d be worried about his stability and his ability to be helpful — himself laid-low by his profession, especially if he was doing this hour after hour, with each of his patients.
Bad therapy mimics your problems underneath and adds to them too. It forces you to take another few hundred pounds of luggage with you on your journey to heal, as if you are climbing a mountain and someone throws another backpack on top of your existing one. – From The Sandbox.life (http://www.thesandbox.life/two-packs)
Thank you for this, Sue. All the best.
I enjoyed reading this article, as well as all the comments. Different perspectives are so valuable. 🙂
Glad you appreciated it, Rayne.