First, Do No Harm: Abusive Psychotherapists
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When reaching out for help after an abusive relationship, some people end up being re-traumatized by a therapist. Others sustained their initial trauma from an abusive therapist. Recently, I heard from a reader who reported experiencing both of these things: She was first victimized by a psychiatrist who manipulated and abused her for five years, and when she saw another therapist years later for help overcoming her trauma, the therapist invalidated her experience (because she did not want to believe that another professional in her field could deliberately try to harm a patient).
This post is not intended to scare anyone away from trying therapy. There are good therapists who are able to make a real difference in people’s lives. The purpose is to bring the problem of abuse by psychotherapists–and the enormous toll it takes on their victims–into your awareness. Some therapists inflict harm without intent, for example by a lack of knowledge or empathy, while others are dangerous predators who purposely act in ways that inflict suffering and lasting trauma.
*If you decide to see a therapist, please make sure they are knowledgeable about character disorders ( psychopathy, narcissism) and the trauma these people inflict upon others.
“Gaslighting and further trauma await when a victim seeks help from a therapist who fails to recognize a manipulator’s ‘crazy making’ tactics.”
~ George Simon, PhD, Help That Only Hurts: More on Therapy-Induced Trauma
“Although I thought that everything would be fine now that I was out and away from him, in fact, things got worse. I had to contend with all the reminders of him that were triggering my PTSD responses, the repressed feelings that were now making themselves known, and the near-daily realizations about what had actually been going on all that time. I also had to deal with the loss of the fantasy I’d been so sure was real. The disillusionment was traumatic, and the fact that I’d believed his lies left me feeling very ashamed.”
Read More: A Survivor’s Story
Unfortunately, predators do exist in the mental health profession. They take advantage of their position and authority, and of our inherent trust in them, to do harm. What a heinous betrayal it is to victimize those who look to them for help. Afterward, their victims–who are severely traumatized–must seek help from the very profession that abused them and betrayed their trust in the first place. Imagine that. Those of you who have lived it know just how difficult that is.
There is an innate imbalance of power in the therapeutic relationship. Therapists have a significant amount of power and influence over their patients, who respect their opinions and invite their guidance. The power and influence of the therapist has the potential to do a lot of good, but when misused it can cause great harm. Abusive therapists use it to control, manipulate and exploit their patients. Not all abuse in therapy is sexual, but even non-sexual boundary violations and manipulation can be highly damaging to patients. An emotionally abusive therapist can easily undermine a patient’s progress and worsen their emotional trauma. Therapists without an intent to harm, but who do so anyway because of a lack of knowledge or sufficient empathy, or by providing poor therapy in general, can easily re-traumatize a patient with just a few careless words or an attitude of invalidation or victim-blaming.
“Traumatic experiences within the context of therapy don’t have to be the result of unethical or blatantly improper conduct on the part of the therapist… More often, therapy induced trauma occurs subtly and insidiously, with the full effects of it being realized only after damage has already been done… it’s the truly innocent parties that often end up being victimized yet again. The first axiom of all good healthcare is: ‘Do no harm.’ And that’s just one of the many reasons it’s so important for treatment providers to know how to recognize and how to deal appropriately with character disturbance.”
“Therapy-Induced Trauma: What It Is and How It Can Happen,” George Simon, PhD, author of In Sheep’s Clothing: Understanding and Dealing with Manipulative People
When therapists aren’t knowledgeable about character disturbances–psychopathy, narcissism and the like–they can’t understand what the affected patient has experienced, so they won’t be able to empathize with or validate the patient. I experienced this in my own therapy.
“I’ve unfortunately heard from thousands of folks dismayed at how little genuine understanding or assistance they got when seeking professional help for themselves… often it was because the therapy itself – especially the psychological paradigm guiding the therapy – was ill-suited to the task. When it comes to understanding human aggression and the problems it can cause in relationships, many of psychology’s most time-honored models have proven to be seriously inadequate, if not fatally flawed…
A truly adequate psychology would need to set aside our outdated, well-intended but purely speculative and unverifiable notions about who we are and why we do the things we do and build on the hard science we’ve acquired.”
“Serious Abusers And Psychology’s Failure to Understand Them,” George Simon, PhD
“The reality is that for most of us trying to overcome therapist abuse (regardless of whether it is sexual, emotional, spiritual, etc.), very few other people have any idea what we are going through (even the mental health professionals we finally get up the courage to see after the abusive ones to try and pull ourselves back together). And because of that, healing can be significantly more difficult than it should be.”
Read Michelle’s Story: “Reclaiming My Life”
It should be more widely known that there are psychotherapists who victimize patients. When it comes to crossing sexual boundaries, psychiatry even has a name for it: “Malignant Eroticized Countertransference.” The pathology of therapists who commit sexual boundary violations is divided into four categories, for the purpose of evaluation after their abuse has come to light. One of those four categories is “predatory psychopaths.” Psychiatrist Glen O. Gabbard, MD, professor in the Menninger department of psychiatry at the Baylor College of Medicine, and who served in the role of evaluator, consultant and therapist for abusive colleagues, writes the following about this category:
“Predatory Psychopathy and Paraphilias: This category of therapists who engage in sexual boundary violations is not nearly as rare as the psychotic group. While some therapists who fit this category have DSM-IV antisocial personality disorders, others have severe narcissistic personality disorders but still engage in psychopathic behavior for which they feel no remorse or guilt.
Paraphilias are included in this category, not because all clinicians with sexual perversions are predatory psychopaths, but because those who enact their perversions with patients they are treating tend to have the same underlying character pathology and superego deficits that typify the predatory psychopathy group.
Therapists in this category, usually male, have sometimes risen to positions of leadership within professional organizations and begin to think that the ethics codes of their professions no longer apply to them.
They take advantage of their position as a transference object and sadistically and exploitively abuse their power. They may have histories of corrupt or unethical behavior in other areas as well. They generally have multiple victims, and they lack the capacity to empathize with the patients they have exploited, so they typically deny that any harm was done to the patient… The therapists who fall into this category are unlikely to be amenable to rehabilitative efforts, and they often have their licenses to practice revoked because they are seen as a persisting danger to the public.”
“Patient-Therapist Boundary Issues,” Psychiatric Times, Glen O. Gabbard, MD
Dr. Gabbard writes that other therapists who cross sexual boundaries “may be neurotically organized… many have mild narcissistic disturbances, and others are in a state of personal or professional crisis…. They may profess that they are ‘in love’ with the patient and rationalize their behavior on that basis.” Often these therapists have a desperate need to be validated, idealized and loved by patients as a way of regulating their self-esteem, according to Gabbard.
“Dr. T suggested that we could hug at the beginning or end of our sessions as a way of fostering that type of emotional support for me. Perhaps it would help me go more deeply into my issues. Although therapists weren’t really supposed to have physical contact with their patients, he thought that, in my case, we could make an exception and see how it went. And if it worked out all right, then, down the road, maybe we could even spend some session time with him holding me as a form of emotional nurturing…”
Read More: A Survivor’s Story
While the vast majority of the cases of sexual misconduct occur between a male therapist and a female patient, about 20% of cases involve a female therapist who engages in sexual relations with either a female or male patient (Schoener et al., 1989).
In most sexual abuse or exploitation cases, other inappropriate behavior comes first. While it may be subtle or confusing, it usually feels uncomfortable to the patient. Even if boundary-crossing doesn’t lead to sexual abuse, it can cause plenty of damage.
How can you tell if your therapist is crossing the line, or is engaging in poor therapy that is harming you or has the potential to?
- Your therapist talks about other clients, their personal life, or their own problems. Your therapy should be oriented to your emotional needs, not to the emotional needs of the practitioner.
- Your therapist relies on you for personal and emotional support.
- You can’t tell if therapy is helping or hurting.
- You feel your therapist is degrading, humiliating, intimidating, blaming or shaming you.
- You feel your emotions or experiences are being invalidated.
- You feel your therapist is cold, lacks empathy or is unresponsive.
- Your therapist makes suggestive, sexual or erotic comments.
- Your therapist urges you to make decisions you’re not ready to make or to engage in activities that you feel uncomfortable with.
- Your therapist calls you on the phone, sends you emails or text messages, or suggests meeting with you socially.
- Your therapist suggest having sessions in your home or in places other than their office.
- Your therapist suggests late evening or after-hours appointments, or you’re always scheduled for the last appointment of the day.
- Your sessions go beyond the usual allotted time period.
- Your therapist suggests physical contact, such as hugging you or holding you, as a treatment.
- Your therapist gives attention to your looks or compliments your physical appearance.
- You feel like you “need” your therapist; you feel anxious if you miss a session.
- Your therapist makes promises to never abandon you and always be there for you, or tells you they will never let you down.
- Your therapist gives you gifts or free therapy.
- Your therapist hires you to work in their office.
For a comprehensive list to alert you to boundary issues that frequently occur in poor or abusive treatment, please see “Treatment Abuse Checklist: Is There Something Wrong or Questionable in Your Treatment?” Estelle Disch, Ph.D.
“This time last year, I was just beginning to feel my ‘old self’returning. I was finally able to leave my house for short periods of time without having panic attacks or near panic attacks… And I have to tell you, I couldn’t have been more relieved. The truth was that for a very long time before this, I wasn’t sure I would EVER recover from what I had been put through. In fact, I truly believed I was broken beyond repair. It was the most frightened I have ever been in my life.”
Read Michelle’s Story: “Reclaiming My Life”
Here is a good example of how a therapist can cause harm with nothing more than a cold and detached attitude:
“She was a traditional therapist, detached, impassive. I thought, in spite of this, I would keep an open mind. I was at the stage that I needed to do some more work on issues relating to my early childhood experiences… I had been recently coming to terms with the extent of emotional abuse that had gone on in my relationship with my mother…
We had five sessions. On session three, she asked me if it would be okay if she took notes. The next three sessions she did almost nothing else but write. It felt like she was just sitting back uninvolved, her professional mask firmly in place, saying very little. I was able to rationalise my feelings of discomfort and fear. I was able to ignore how unsafe I felt. I kept thinking, it will change, surely it can’t stay like this, she is supposed to be a “good therapist.” It’s my fault that I feel like this. I should be able to handle this.
During session five I experienced an enormous feeling of grief and aloneness. I became overwhelmed with these feelings and began to sob uncontrollably. It was as if I had fallen into the abyss and was going deeper and deeper. She just sat there writing, then she said “Time is up. If you need some time to get yourself together you can sit in my front room.” Nothing more was said.
The session was over. I sat there for a moment in disbelief, confused, disoriented. feeling out of control. Somehow I got myself out of the building and to my car. I felt abandoned, abused. I never went back.”
~“Emotional Abuse in Therapy,” Michelle Webster (this excellent article contains many more examples)
Rather than challenging the therapist, the patient is more likely to go quiet, become numb, and feel despair.
Many victims end up staying with an abusive therapist for years. How does it happen that intelligent people stay with them for so long? Manipulative therapists know how to make a patient become emotionally dependent on them:
“The abusive therapist knows how to create a high, at the very beginning of the relationship, which makes people feel good, although they have not actually made changes in their lives from which a true sense of well being would arise… The high is temporary, because it is not really based on anything except the effect produced by the therapist. Hence a low follows, and a need for more contact… there may be other perfectly healthy ‘highs’ at the start — caused by finally being heard, getting your story out, being understood and respected and accepted, feeling things shift. The difference is that these highs are quite clearly located in yourself, and not ‘the person who has done this to you.’ Although there may well be a kind of emotional intimacy, a competent therapist is eager to help you strengthen your own perceptions and not theirs, to help you freely choose and facilitate changes in your ‘real life’ which will render their presence in your life unnecessary.” The “Highs” of Just Plain Bad Therapy
U]nfortunately, when people who have been abused by a therapist seek help with their trauma from another therapist, they may be disbelieved and invalidated. Psychiatrist Wanda S. Needleman, M.D. was abused during her training by a psychiatrist who was supervising her. This is her advice to her colleagues who are treating a victim of therapist abuse:
- Please do not call this an affair or imply in any way that this abuse was about love.
- Please do not assume that you know what has happened to us until you have really listened and really taken in the soul murder that results from this abuse.
- You cannot help us until you truly and deeply understand.
- Please do not in any way hold us responsible for our abuse.
- When we explore questions of vulnerability, please be certain that we absolutely understand that it was always solely the responsibility of the professional to set and to maintain safe and therapeutic boundaries.
- Please put away all of your theories and books, and listen to us.
- Please listen very carefully to those of us who come to tell you how we have been abused.
- Please validate our experiences.
- Please help us name our feelings and bring light to what has happened to us.
- Please work hard to understand that each of us has been absolutely helpless to prevent this from occurring.
- Please know that if you listen openly to us, you will also feel our agony.
- Please be prepared to support our actions when we choose to hold our abusers accountable, including, but not limited to, writing concise and clear letters about the harm perpetrated upon us by him or her and being deposed in the course of a malpractice suit we may choose to file.
A reader named Elizabeth shared her heartbreaking story of the harm she suffered at the hands of therapists whom she sought help from after an abusive marriage. It is also a story of her strength, determination and resilience:
“Ialso was re-traumatized by therapy, being diagnosed as variously bipolar, cyclothymic, dysthymic and borderline personality disorder during different stages of my attempt to recover from a 16 yr relationship and marriage with a malignant narcissist/psychopath. Not one of the ( all male) therapists could fathom how my very talented, successful, charming and popular husband could be in any way at fault for our marriage dissolution.
Every time I tried to discuss my pain and confusion over the sudden and exceptionally cruel abandonment and devaluation I had experienced, I was advised that it was better to focus on my own problems and ‘work on myself’. Although true that we should indeed focus and work on ourselves, the refusal to even discuss my perceptions or allow me to ‘tell my story’ was invalidating in the extreme. Consequently, I was essentially forced to assume the label and identity of a ‘disordered, mentally ill, unstable’ individual, leading to a two-decade period of unremitting clinical depression and generalized anxiety disorder, covert bias and apathetic disregard by the medical/psychology system and 20 yrs of continual (unsuccessful) pharmacological manipulation with at least a dozen different psychotropic drugs in random combinations.
Whether it was all the psych drugs or the effects of untreated CPTSD or both, I was effectively in a despair-ridden and unproductive coma for those 20 years. Just over 4 years ago, I learned the TRUTH, am off all meds, in therapy with a therapist knowledgeable about character disorders and in full recovery mode. I MADE THIS HAPPEN. In the depths of my worst depression, on sick leave because I couldn’t cope or work, I buckled down, and fully researched my medication options (I am a former registered nurse). For the first time, I chose my own medication – one never before suggested to me, but that seemed to most closely fit my symptomology… and what do you know? I was right – for the first time in 20 years, I had improvement…..became engaged in life again….reading….stumbled upon narcissism while online, and in less than 3 years of educating myself on character disorders, I am a COMPLETELY different person.
There was nothing wrong with me except untreated, unacknowledged severe trauma in my marriage and in my childhood. My point is, that psychiatry has for the most part only hindered my healing, misdiagnosed, invalidated and shamed me… and wasted my time/life. The mental healthcare system is completely fu… um… broken, both externally and internally. It is an appalling mess, that if it weren’t so tragically, sometimes fatally dangerous to it’s clients, it would be almost comical. All mental health practitioners should be embarrassed by the current state of their profession and be making it a priority to restore some scientific credibility to it’s foundation, cuz right now, in my opinion (as a former health practitioner myself), it’s possibly doing more harm than good and may end up in historical hindsight, as having committed crimes against humanity.”
Healing IS possible after abuse by a therapist. I highly recommend the following Survivor Stories. They are detailed accounts of manipulation, abuse and of healing:
“Reclaiming My Life” – Michelle Mallon’s Story of Healing — Michelle Mallon has a Master’s degree in Social Work from Ohio State University. Her understanding of therapist abuse came after she was emotionally abused by a psychologist to whom she had taken her two young children for counseling. Now an advocate for victims of Narcissistic Abuse, Michelle is currently working with the Ohio chapter of the National Association of Social Workers (NASW) to create a CEU program to prepare social workers to effectively help these victims.
For More Information On Therapist Abuse:
Resources: Articles and Publications, Attorneys, Legal Issues and Resources, Patient Bill of Rights, Professional Organizations and Licensing,Trauma and Healing
♥ Thanks to Christine for inspiring this post. I dedicate it to you.
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