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Outside of those who work with or support victims of therapy abuse, this is an issue fraught with misperceptions. Confusion around what therapy abuse is can leave us wondering how to separate the serial offender who preys on clients from the therapist who might have made a mistake in the services they offer. To start, let us examine what is not therapy abuse. In my opinion, it is not therapy abuse if a client is unhappy with their progress or is experiencing a personal conflict. While it is malpractice when therapists work beyond their skill level, make poor clinical decisions, and then fail to correct that mistake with consultation, acknowledgement, and action, by this definition, is not therapy abuse. A therapist who falls in love with a client has not committed therapy abuse. One who acts on those feelings and has sexual contact with that client is, by definition and unequivocally, committing therapy abuse. Therapy abuse is about exploitation.It is using patients to fulfill the needs and desires of the offending therapist while pushing the best therapeutic interests of the client aside. Offenders groom their victims with the intent to exploit them financially, emotionally, psychologically, physically, and/or sexually with a direct benefit for the professional. Offenders often have more than one victim. Therapy abuse follows patterns of grooming and coercion seen in other forms of abuse, to induce the victims' compliance, secure their silence, and, if necessary, ensure a means to discredit disclosure. In the mid-80s, we learned how child molesters groom their victims with flattery, the employment of 'secrets,' labeling the relationship as speecial, insisting that no one would understand, and encouraging role reversals: victim as caregiver and protector of the offender, i.e., "If you tell I will go to jail." We know child molesters use employment to gain access to victims, including daycares, schools, camps, and churches. In intimate partner violence, we learned how batterers groom and isolate their victims using a cycle of abuse to maintain control. For battered spouses, the most dangerous time is when they leave. Since the #metoo movement emerged, we have been confronted with a shocking number of adults who have been emotionally coerced into sexual activity by those, such as employers, with authority. As with teachers, priests, daycare attendants, it offends our sensibilities to see how therapists, who are assumed to be helpful and compassionate, might use their power and authority over vulnerable clients to exploit them for their own needs or benefit. Unfortunately, this profession is not free from being used by serial offenders. Lack of resources, knowledge, and expertise, along with long-held social norms, have left survivors largely silenced. That is changing. Those who are trauma-informed will recognize the phases of therapy abuse: The Grooming Phase in therapy abuse is well defined. It may start within the first few sessions but can begin as early as the first consultation. It can go on for many years. The grooming phase mirrors that of child molesters including calling the victim special, giving gifts, creating a sense of financial indebtedness (e.g., misuse of pro bono), pushing boundaries around contact and touch, solidifying the victim's sense of responsibility for the perpetrator's well-being ("You must keep this secret."), creating a profound dependence on the therapist, setting up covert forms of communication, and isolating the victim from family and friends. The Exploitation Phase may take financial, physical, emotional, and/or sexual forms. The financial exploitation of a victim may include but is not limited to buying property together, accepting financial gifts, borrowing money, being designated as beneficiary of estates and/or insurance policies, or accepting free services such as legal or administrative work. Physical exploitation may include free labour such as renovating therapists' home or office, babysitting, running errands, and even serving as surrogates for in vitro fertilization. Therapists employ role reversal and exploit clients emotionally depending on them as sounding boards or for support. Sexual exploitation, the most obvious and easiest to define, is any sexual interaction and includes talking about the therapist's own sex life to sexual touching and intercourse. Many forms of exploitation may take place concurrently. The Termination Phase generally occurs when the offender's interests wane, when the victim is asking for change and/or confronting them on the exploitation, or when the offender feels at risk of exposure . In the same way battered spouses are most at risk when leaving, so too may therapy abuse survivors find themselves in precarious positions. In this phase, perpetrators may initiate a pre-contrived defense strategy. Where other molesters or batterers might rely on threats of physical harm, abusive therapists primarily employ emotional coercion or threats. This may start with soliciting a victim's agreement to protect them with silence and the mutual destruction of evidence of transgressions including but not limited to texts, emails, photos, gifts, therapy notes, etc. If they fear being formally reported, whether to police or licensing boards, offenders rely on having groomed their victim to take responsibility for their well-being while positioning themselves as the real victims. ("I only did this because of you." or "My working with you has cost me.") Perpetrators may plead for forgiveness and offer promises to reform.They may incessantly call, text, email, or show up at their victims' homes or work hoping that access will help them regain control. If all that is unsuccessful, they may turn to emotional violence to enforce their victims' silence. Their assaults use the clients' secrets, vulnerabilities, and confidences disclosed in sessions to inflict fear and grave emotional harm. The love and acceptance they once offered is now replaced with intentional triggering of shame, guilt, abandonment, rejection, and threats of exposing secrets. Offenders may work to break up clients' support systems. Those who offered pro bono arrangements may use it to disprove a professional counseling relationship or claim consensual affairs. And if all else fails, they may assign a new diagnosis, such as borderline personality disorder, to undermine their victims' self-confidence and discredit their disclosures. The damage done to victims of therapy abuse is likely catastrophic. During the grooming and exploitation phases, healing is actively undermined, and victims are often faced with new issues such as insomnia, depression, suicidal ideation, and anxiety. In the termination phase, victims struggle to regain a sense of self and may end up losing friends, family, and partners/spouses. Emotionally overwhelmed, victims may be unable to work and thus risk losing jobs, homes, and even child custody. Victims often experience PTSD and the impact of Stockholm Syndrome while fielding both individual and institutional victim-blaming. Potential healing relationships become triggering in ways that subsequent mental health professionals may not understand.ictims may be accused of being vindictive, dangerous, and/or lying. Add to that a popular culture which incorrectly depicts a sexual relationship between therapist and client as 'romantic,' victims are often left grappling with what is and is not real. It is no wonder that therapy abuse survivors engage in self-harm and are ten times more likely to attempt or commit suicide than the general public. Given this definition, it is easy to differentiate between the therapist who has made a mistake or has misjudged the needs of their patient and the serial offender who grooms and then exploits their victims. Because therapy abuse offenders exhibit the same patterns as child molesters, batterers, and other offenders, those who are trauma-informed will recognize these patterns Most recently, social media platforms have provided spaces for survivors to find each other, compare notes, and get support. Websites, such as TELL, accessed by as many as 40,000 unique visitors every year, offer on-line resources and opportunities for networking for those concerned about their therapy. These resources for information and support are resulting in more survivors emerging empowered with knowledge and healing opportunities. Consequently, the known number of survivors appears to be increasing exponentially across the globe. Mental health organizations, colleges, and licensing boards require their members to adhere to a Code of Conduct or Ethics and/or Bylaws. Many of these include a standard or principle that allows for a sexual relationship between therapist and client two to three years after termination. While such allowances, along with their qualifying conditions, may seem, on the surface reasonable, those of us who work with survivors know how these clauses too often open doors for opportunistic abusers. In addition, promises to a therapy abuse survivor of a future love relationship, after the waiting period, allows offenders to move on with their lives while victims are left in limbo, kept from forming healthier and appropriate relationships, and entrapped Given what we know about the enormous dangers and damage done to victims, many educated, and trauma-informed mental health professionals and organizations have recognized that the power imbalance between therapist and client is akin to that of parent and child, and that it is life-long. Any sexual activity is, therefore, unavoidably abusive. They recognize that there is no good reason for this type of permissive principle or standard to be included in the codes of conduct/ethics or bylaws and are removing and replacing them with ones that specifically preclude any sexual contact between therapist and former or current clients.Changing these standards or principles in our mental health organizations goes a long way towards making the mental health field a safer place for clients. The catastrophic damage that they suffer behooves these institutions, if they haven't already, to do this as soon as possible. There is no known way for clients to prevent therapy abuse from occurring. We can, however, arm them with information that helps.
In and of itself, understanding what therapy abuse is, recognizing how mental health organizations might enable it, and knowing the steps clients can take to protect themselves won't, overall, prevent therapy abuse. However, they will raise awareness for clients and warn an abusive therapist that they are not dealing with a client who can be naïvely coerced into taking part in transgressions or an organization that will look the other way. Together, it may go a long way to interrupt therapy abuse from beginning or help clients extricate themselves earlier. Bernadine Fox To return to the list of Essays, click here. |
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