Is There Something Wrong or Questionable in Your Treatment?
Estelle Disch, Ph.D.
The purpose of this list is to alert you to boundary issues that frequently occur in poor or abusive treatment and health care. If you are currently in a treatment that doesn't feel right, and/or if several of the items below describe your treatment, I suggest that you find a consultant who does not know your current practitioner in order to assess whether or not the treatment is viable. If you have been in a treatment relationship that didn't feel good to you, this list might help you identify what went wrong. The list below is not exhaustive. It is intended to offer examples of the kinds of behaviors that very often accompany poor treatment. Although most items apply to psychotherapy, some can apply to other kinds of health care, pastoral counseling, or clergy relationships. There is a section on touch-based health care (including body work) at the end of this checklist.
Certain items below might not always reflect poor treatment. For example, it might make sense to break ties with abusive people in your life, and a practitioner might support this with your best interests in mind. If, however, the practitioner is encouraging you to break ties with all your close relationships with the sole purpose of making you extremely dependent on him or her, that is very likely to be poor treatment. A practitioner who encourages you to see him or her as often as you can afford might genuinely have your best interests in mind. The issue to examine is whether he/she is encouraging extra sessions as part of his or her own need to have you become excessively dependent. A practitioner might occasionally share something about him/herself in order to help you (e.g. let you know you're not the only one who has experienced that difficulty; offer some advice about what helped him/her in a similar situation). If, however, the practitioner talks about him or herself as a way of asking for help from you, as a way of having you serve as an audience, or as a way of derailing you from the issue you raised, there's probably serious trouble in your treatment.
Good, boundaried psychotherapy, pastoral counseling, addiction counseling, bodywork, medical practice, etc. should always be oriented to your emotional and medical needs and not to the emotional needs of the practitioner. Practitioners who are lonely, need attention, have deep unresolved problems, and/or who lack good training in boundary issues, are apt to do marginal or poor treatment. There are good practitioners, and you have a right to be treated by them.
Many of the items listed below might fit into more than one category.
___Practitioner has offered to see me free or for a very low fee as a favor to me.
___Since my fee is so low, the practitioner expects me to bring food for him/her to the sessions, or to do other tasks in exchange for treatment.
___Practitioner bills insurance company for sessions that don't occur.
___Sessions frequently run over by half an hour or more.
___I am usually the last appointment of the day.
___There is usually no one else around when I have my appointments.
___The practitioner often keeps me waiting for long periods of time.
___I owe the practitioner over $1,000.
___I often don't know how long a session is going to last. Sometimes it's 20 minutes; other times it's an hour and a half.
___The practitioner frequently answers the phone during my sessions.
___If the practitioner is hungry, we go to a restaurant during my session.
Dependency, Isolation and Goal Derailment
___The practitioner has told me that I should break ties with most of my important relationships (such as those listed below) and I don't understand why:
partner or spouse
___The practitioner encourages me to see him/her as often as I can afford to do so, even if I don't feel a need to come so often.
___The practitioner encourages me to telephone him/her often even if I feel I don't need to.
___The practitioner tells me what she/he is doing in terms of personal growth and suggests that I do the same thing.
___The practitioner goes out of his or her way to accommodate to the frequent schedule changes which I request, even though it is very inconvenient for him/ her.
___The practitioner suggested that I drop out of school.
___The practitioner seemed to think that my plans to go to or complete school were a bad idea.
___The practitioner thought that my ideas to change my career for the better were not a good idea.
___The practitioner offered to see me free if I were to run out of money, even if I needed long-tern free treatment.
___The practitioner has given me his or her personal used clothing.
___The practitioner tells me what clothing to wear and/or how to wear my hair.
___The practitioner demands that I talk with noone about my treatment.
___I have said several times that I'd like to see another practitioner for a consultation about my treatment, but my practitioner is adamant that I shouldn't do it.
___The practitioner regularly offers concrete support to me such as visits to my home, accompanying me in difficult situations, frequent calling to see how I am. When I am in a crisis, he/she is even more available.
___I feel with this practitioner as though I've found the kind of help and understanding I've wanted all my life.
___The practitioner regularly reminds me that she/he is the only person in my life who really cares about me.
___The Practitioner regularly reminds me that he/she is the only person who really understands me and knows what's good for me.
___I have been to parties where the practitioner was and the practitioner didn't discuss the implications of traveling in the same social circles.
___The practitioner has invited me to parties.
___I have invited the practitioner to parties to which he/she came.
___I have invited the practitioner to parties to which he/she did not come but said it was because of a prior engagement.
___I have attended professional meetings with this practitioner, at his/her invitation.
___This practitioner and I usually attend the same AA or AlAnon (or equivalent) meeting.
___This practitioner often gives me a ride to the bus at the end of the session.
___This practitioner often gives me a ride home.
___I have stayed at this practitioner's house overnight.
___I have spent social time with members of this practitioner's family.
___I have been/am intimately involved with one or more members of this practitioner's family.
___This practitioner and I have close friends in common.
___Practitioner said or implied that we could be friends when treatment was over.
___The practitioner sometimes takes drugs or drinks alcohol with me.
___The practitioner has given me illegal drugs.
___I have seen my practitioner nude at the health spa, gym, etc.
___I have seen my practitioner at the gym or health club (dressed).
___My practitioner and I are on the same sports team.
___My practitioner and I are on competing sports teams and predictably see each other in that context.
___I have access to a lot of personal information about the practitioner from mutual friends or colleagues.
___We have never discussed how social contact outside the professional relationship might affect the professional relationship.
___Other kinds of social contact. Please describe:
___The practitioner told me that I was his/her favorite client.
___The practitioner talked about other clients in my presence.
___The practitioner took calls from other clients in my presence and let me know who they were.
___The practitioner said that she/he had never known anyone like me before.
___The practitioner gives me lots of presents and says they're a reflection of how important I am to him/her.
___The practitioner tells me about other clients in a way that makes me feel important, trusted and special.
___The practitioner told me I was special.
___Other ways the practitioner helped you feel special. Please describe:
___There are many clients who seem close to this practitioner. I have met them or heard about them.
___The practitioner likes to foster a sense of family and community among his/her clients which I have been part of.
___There are often parties or social meetings at the practitioner's home that I have attended.
___The practitioner often takes former clients on as trainees at his/her training institute.
___The practitioner plays the role of "guru" for his/her clients. He/she has a vision about how the world should be and is trying to develop a community of clients as followers/participants.
___I have been part of the planning group for the community the practitioner hopes to develop.
___The practitioner talks about other clients I know with no respect for their right to confidentiality.
___Ritualized group activities such as ceremonies were part of my relationship with the practitioner and his/her community.
___The practitioner is the "Guru" of the group in which she/he is involved.
___Ritualized sadistic activity in the presence of others.
___Other ways the practitioner established a community or family-type atmosphere. Please describe:
___The practitioner uses hypnosis as part of the treatment and I often don't know what's going on. When I ask, he/she refuses to answer.
___I feel as though I've been hypnotized or somehow in a trance-like state in the practitioner's presence, though he/she doesn't seem to obviously use hypnosis.
___I remember the practitioner making hypnotic suggestions with which I don't feel comfortable.
___After treatment was over, I began to remember some of the things the practitioner said or did while I was in a trance-like state which in retrospect feel very uncomfortable or abusive.
___The practitioner suggested that I kill myself.
___The practitioner failed to take my suicidal feelings seriously. The practitioner suggested or implied that I might be better off dead.
___The practitioner fostered a lot of dependency, and then started trying to get me to do things I didn't want to do.
___The practitioner insulted what I believed were the good parts of my life.
___A short time after I started treatment, my life began to fall apart. The practitioner didn't seem concerned about my life. Rather, he/she seemed concerned that I stay dependent on him/her. Sometimes I feel/ felt drugged after sessions.
___Other ways the practitioner affected your thinking or undermined your strength. Please describe:
___The practitioner engaged (with or without physical force) in overt sexual contact such as: kissing of mouth, breasts, genitals; sexual hugs (prolonged full body hugs, pelvic thrusts, obvious erections); partial or total disrobing for the purpose of sexual contact; fondling of breasts or genitals (with or without clothing) masturbation; oral sex; vaginal or anal intercourse; use of sex toys; sexual activity while I was drugged.
___Practitioner engaged in sexual activity with me against my will.
___Practitioner initiated sexual activity with me on the condition that I keep quiet about it by saying things like: If this gets out it will ruin me and/or my family.
___After the sexual part of my relationship with the practitioner ended, he/she told me that if I told anyone she/he'd be ruined.
___After the sexual part of my relationship with the practitioner ended, he/she threatened to expose embarrassing parts of my psychological history if I ever told anyone in authority or filed a complaint.
___Practitioner threatens that if I don't work on my repressed sexuality by being sexual with him/her, I'll never get better.
Seductive Language and Nonverbal Interaction
___practitioner says, "if only I'd known you back then, we'd have made a good couple..."
___practitioner compliments my body.
___practitioner discusses his/ her sexual attraction to me.
___practitioner says, "if only we both weren't married."
___practitioner seems to have a voyeuristic interest in my sex life.
___practitioner sends me love letters.
___practitioner gives me sex toys to use at home, tells me how to use them, and asks for details about how I'm doing with them.
___practitioner makes frequent comments on my appearance with the goal of having me appear as "sexually attractive" as possible.
___practitioner often suggested or implied that we could have an affair when treatment was over.
___practitioner looks at me in a voyeuristic way.
___After treatment ended, the practitioner called to ask me for a date.
___A short time after treatment ended, I started a sexual relationship with the practitioner.
___Practitioner tells me his/her problems so that I can offer help or advice.
___Practitioner talks a lot about him/herself, and I don't understand the relevance of what she/he is sharing for my treatment.
___Practitioner seems to free associate to what I say and spin off into his/her own thinking. I feel like my issues aren't being addressed.
___Practitioner always acts like he/she knows what's best for me without asking me.
___Practitioner is cold, distant, and rigid.
___Practitioner gets very angry, sometimes yells at me.
___Practitioner interprets everything that happens between us as transference, even when ___I'm sure he/she has had a clear effect on how I feel.
___Since starting treatment, I've felt worse rather than better, and the practitioner doesn't seem concerned that this is happening or explain why it might be happening.
___After starting treatment, my life began to fall apart. Rather than being concerned about the quality of my life or my state of mind, the practitioner seems more interested that I stay dependent upon him/her.
___Since starting treatment, I've felt suicidal for the first time in my life; the practitioner doesn't seem concerned.
___Practitioner is hostile, sadistic.
___Practitioner seems to enjoy my pain.
___Practitioner fails to take my suicidal feelings seriously.
___Practitioner suggested, either directly or indirectly, that I kill myself (e.g. that I would be better off dead; that s/he dreamt that I was dead; that suicide might be a reasonable alternative for me, etc.).
___Practitioner insults parts of me over which I have little or no control such as my physical characteristics and abilities, weight, race, gender, age, sexual orientation, hospitalization history, etc.
___Practitioner insults other aspects of my life. She/he seems more interested in tearing me down than in building me up.
___Practitioner threatens that if I don't do what he /she says, I'll never get better. Sometimes that feels right, sometimes it doesn't.
___The practitioner diminished the importance of a prior abusive treatment.
The practitioner refuses to address my current needs, always insisting that my current problems must be addressed by working with my earlier experiences.
___The practitioner repeatedly yells at me in a loud voice.
___I often say that I don't think treatment is going very well and the practitioner brushes me off.
___When I raise questions about what is happening in my treatment, the practitioner refuses to discuss the treatment process, how he/she works, what I can expect from the treatment, etc.
___The practitioner would not tell me what his/her credentials are.
___The practitioner misrepresented his/her credentials.
___The practitioner advertised services for which he/she is not qualified to deliver.
___The practitioner uses drugs or alcohol with me.
___The practitioner encouraged me to use drugs or alcohol, even though he/she knows that I have a history of troubles with drugs or alcohol.
___The practitioner seemed drugged or drunk in sessions.
___The practitioner and I used drugs or alcohol together during treatment sessions or office visits.
___The practitioner insults me for having the problems I have.
___The treatment ended without a termination process.
___The treatment ended with me feeling very upset and the practitioner didn't suggest a referral to another practitioner.
___The practitioner talked about me with other people without my permission.
___The practitioner failed to carefully explain the limits of confidentiality.
___Other aspects of the therapy process which didn't feel right. Please describe:
___The practitioner is my clinical supervisor (or vice versa).
___I work for the practitioner.
___I work for the practitioner in exchange for treatment sessions.
___The practitioner is/was my teacher, dissertation advisor, etc.
___The practitioner and I are friends apart from the treatment.
___The practitioner is a relative of mine.
___The practitioner is a close friend of my family.
___The practitioner and I are colleagues or peers in a work setting.
___The practitioner and I are engaged in a joint business venture.
___The practitioner has borrowed money from me.
___Other dual roles. Please describe:
In Bodywork, Health Care, etc. Involving Physical Contact
___This practitioner touches parts of my body that seem unrelated to the issues I've presented and I don't understand why. When I ask, I don't get an adequate explanation.
___This practitioner's touches seem more like sexual caresses than the kind of touch that feels appropriate in a medical treatment or examination.
___This practitioner's hands seem to linger too long on my body during a physical examination or treatment.
___This practitioner touches me in ways that hurt without preparing me for what will happen and without negotiating what my treatment or diagnostic alternatives might be.
___This practitioner seems to enjoy the fact that some of the physical contact he/she initiates is painful to me.
___This practitioner blames me for the health problems I have and acts as though I deserve them.
___This practitioner seems hostile towards my body.
___This practitioner makes comments of a sexualized nature about my body.
___This practitioner has not asked me whether there are parts of my body that I would prefer not to have touched.
___This practitioner does not explain what she/he is doing or what I should expect in an exam or treatment.
___This practitioner leaves parts of my body uncovered after she/he has finished examining or treating those parts, even though I have requested that my body be covered except for those parts being treated or examined.
___If I take a friend or advocate along when I see this practitioner, he/she addresses communication to that person rather than to me.
Estelle Disch, Ph.D.
Boston Associates to Stop Treatment Abuse
528 Franklin Street
Cambridge, MA 02139
Copyright © 1998 BASTA! All rights reserved. Used with permission of the author.
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