Striano - Can Psychotherapists Hurt You (1988)

Can
Psychotherapists
Hurt You?
Judi Striano, Ph.D.
PROFESSIONAL PRESS
P. 0. Box 50343
Santa Barbara, California 93150
CAN PSYCHOTHERAPISTS HURT YOU? Copyright ©1988 by
Judi Striano. All rights reserved. Printed in the United States
of America. No part of this book may be used or reproduced
in any manner without written permission except for brief
quotations in critical articles and reviews. For information
write to Professional Press, P.O. Box 50343, Santa Barbara,
California 93150.
FIRST EDITION
Library of Congress
Cataloging-in-Publication Data
Striano, Judi Cecere, 1941-

Can psychotherapists hurt you?
Bibliography: p.
Includes index.
1 . Psychotherapy-Evaluation.
2. Psychotherapist and patient.
3. Consumer education. I. Title
RC480.5.S725 1988 616 .89'14 88-32208
ISBN 0-943659-03-5
Contents
CHAPTER 1
How Can Psychotherapists Hurt You? 1
CHAPTER 2
Is A Physical Illness Causing Your "Psychological"
Problem? 5
CHAPTER 3
Is It Depression- Or An Underactive Thyroid? 23
CHAPTER 4
Psychotherapy Cults: The Pied Piper Phenomenon 33
CHAPTER 5
Psychotherapist Or Lover? 45
CHAPTER 6
Therapy "Addicts" 57
CHAPTER 7
Your Reality Or Mine? 67
CHAPTER 8
Give Me A Hint 75
CHAPTER 9
Researching Harmful Psychotherapists 79
References 105
Appendix 117
Research Studies On Harmful Psychotherapists
Subject and Name Index 133
Dedicated to
Ted Berkman
For his incomparable guidance
Acknowledgements
T his book would not have been possible without
the contributions of the following people:
Godfrey T. Barrett-Lennard, Ph.D.
Allen E. Bergin, Ph.D.
Laraine Tarsky-Bosco
Joanne Desmond
Chad D. Emrick, Ph.D.
Harold Greenwald, Ph.D.
Richard Hall, M.D.
Frances Halpern
Frederic M. Hudson, Ph.D.
Dean Lobovits, M.A., MFCC
Martin Francis O'Malley, ACSW
Newton Malony, Ph.D.
Janet Pickthorn, M.D.
Dona Renelli, M.A., MFCC
James T. Richardson, J.D., Ph.D.
Gary Schoener, M.A.
Hans H. Strupp, Ph.D.
E. Fuller Torrey, M.D.
Haw Can Psychotherapists Hurt You? 1
CHAPTER 1
How Can Psychotherapists

Hurt You?
P nate and improve your life enormously. Conversely,

sychotherapy, with the right therapist, can illumi
in the wrong hands inspired by the wrong motives, it

can be disastrous . For the therapy-seeker, an acquain
tance with the process and with its practitioners, and
especially with the pitfalls that await the unwary, is indis
pensable. There are many competent, effective psycho
therapists. It is not the intention of this book to discredit
my profession in any way. But bookstore shelves are
packed full of books about the benefits of psychotherapy
with a good psychotherapist, and there is no other book
like this to tell you about practitioners who can hurt you
by being who they are as persons as well as with faulty
professional skills.
What are some ways psychotherapists can hurt you?
1 . By failing to diagnose a physical illness that is caus
ing symptoms mistakenly attributed to "psychological"
2 CAN PSYCHOTHERAPISTS HURT YOU?
problems: for example, an underactive thyroid that gets

misdiagnosed as depression. This is astonishingly com
mon.
2. By engaging the client in an intensely personal re
lationship instead of a professional helping one. The
client is buying psychotherapy, not purchasing a
friendship or romance; yet in time of stress is particularly
vulnerable to sexual exploitation, for example.
3. By robbing the client of independence-control
ling the client, continually telling him or her what to
do-with the client becoming helplessly dependent on
the therapist, kept in a perpetual cycle of fruitless
unnecessary sessions. This is what creates "therapy
addicts. "
4 . By using social influence and persuasion to trap
the client in a cult-like system, based on unproven con
cepts propagated by a forceful leader and encouraging
fanatical dedication to this person and organization.
5. By always looking for sickness instead of health:
"pathology hunting." That's a sure way to be labeled
with a psychiatric diagnosis you don't deserve and even
land you needlessly in a psychiatric hospital. An exam
ple is that hospitals are now advertising for parents to
hospitalize their teenagers whose behavior is actually
normal for that stage of life.
6. By extreme passivity and robot-like responses (the
restrained "Uh huh") which consumes the client's time,
energy, and money without contributing any help- not
offering advice, suggestions, or information when
needed.
7. By continual analyzing and interpreting of every
thought, dream, interaction with other people, without
How Can Psychotherapists Hurt You? 3
regard for constructive and practical action in the real

world.
8. By cold impersonal detachment that compounds ·
the low self-esteem of an already shaky client.

9. By clinging to rigid techniques, applying and jus
tifying their own special brand of therapy, rather than
considering a variety of theories and techniques in deal
ing with the unique client's individual problems. Such a
rigid approach might prevent the client's full participa
tion in planning his therapy and evaluating his progress.
10. By use of techniques such as hypnosis that can
conceivably harm clients if the hypnotist is unskilled or
if the client's condition prohibits such a procedure.
1 1 . By use of "psychotropic drugs," that is, drugs to
treat psychological problems chemically, when they are
not needed, or by using them improperly.
12. By using other potentially dangerous treatments
that can affect the physical well-being of clients, such as
"electroshock" treatments, electricity directed through
the brain.
In my first book, How to Find a Good Psychotherapist: A
Consumer Guide, I discussed what to look for and avoid
when shopping for a therapist, and presented reports by
consumers, in their own words, about how they were
helped or harmed. In this second book you will learn
more about how psychotherapists can harm clients. My
purpose is to alert you to dangers you may never have
dreamed of encountering in your search for help with
problems-in-living. This book is a resource for consum
ers, psychotherapy researchers, malpractice attorneys,
and legislators developing governmental regulation of
those who practice psychotherapy. Books and articles
will be listed as sources of information. This is not in

tended as a textbook, but as a brief and easily readable
aid in making you aware of what can happen.
Chapter 1 gives an overview of ways a psychother

apist can hurt you, and orients you to the use of this
book. Chapter 2 will tell you about disorders of your
body that can affect your mind, and educate you about
the importance of "ruling out" the possibility that it is
your body, not your mind, that you should be treating.
Chapter 3 focuses on what may be the most frequent
physiological source of misdiagnosis-a malfunctioning
endocrine system, in particular a dysfunctional thyroid
gland. In Chapter 4 you are asked to look carefully at
your therapist: are you in a psychotherapy cult? The
warning in Chapter 5 is about the perils of letting your
therapist become your lover. Chapter 6 will acquaint you
with psychotherapists who create "therapy addicts,"
manipulating their clients into captive dependent re
lationships. In Chapter 7 you'll learn that your "reality"
may be more accurate than your therapist's. Chapter 8
covers the issue of too little intervention by the therapist,
those who won't even give you a "hint" of advice or
warm response. Chapter 9 completes the presentation
of what is known about harmful practitioners, and
explores self-protective attitudes within the psychother
apeutic profession that complicate the situation for con
sumers. A reference section in the back of the book
covers existing research on harmful psychotherapy by
authorities in the field, listing articles and books that
provide information and will lead you to the rest of the
literature.
In the next chapter we'll focus on the foremost hazard

of faulty therapy: the neglect of physical illness as the
source of "mental" symptoms.
Is A Physical Illness Causing Your "Psychological" Problem? 5
CHAPTER 2
Is A Physical Illness Causing Your

"Psychological" Problem?
I
don't belong here! I'm physically ill, not mentally ill!
Let me go!" the thin, middle-aged woman begged as
four men dragged her into the ward of the well-known,
private, $1,000 a day psychiatric hospital where celeb
rities are frequently hospitalized, and locked her in, com
mitting her. She was right. The doctors were wrong. A
biological illness was causing her symptoms.
She is not alone. Many people have similar experi
ences that would make frighteningly effective scripts for
"horror movies ."
In fact, recent studies of psychotherapy clients have
found that many had a medical illness that either caused
or worsened their psychiatric illness, with the percentages
of such cases in each study varying from higher to lower
numbers in accordance with differences in settings, med
ical opinion of the researchers, and research methods.
But regardless of these discrepancies these studies all
make the point clearly and dramatically that there are

people with undetected physical illnesses producing
their "mental" distress, and that some of these physical
diseases are treatable.
A report in the May 1981 American Journal of Psychiatry
tells us that 46% of 100 patients in a state psychiatric
hospital in a large Texas city, who were chosen for admis
sion to a research ward to participate in a study just be
cause they happened to arrive one after the other in con
secutive order, were found to have a medical illness that
either caused or worsened their psychiatric illness. The re
searchers included psychiatrist Dr. Richard C. W. Hall,
Medical Director for Psychiatric Programs of Florida Hos
pital in Orlando, and Clinical Professor of Psychiatry,
University of Florida in Gainesville, one of the major re
searchers and writers on the topic of physical illnesses
that can cause symptoms incorrectly diagnosed or "mis
diagnosed" as psychological, that is, said to be caused by
emotions. A person with a medical illness that produces
his or her symptoms cannot, in fairness, be given a psy
chiatric diagnosis.
The patients in the above study were about to be com
mitted to a state "mental hospital." In the receiving unit
of the hospital, along with tests to judge their psycho
logical functioning, careful medical and life histories
were also taken. Several physical exams were done for
each patient by a number of different physicians, and
patients were also seen by specialty consultants. Twenty
eight of the 46 patients who had been found to have a
medical illness that either caused or worsened their psychi
atric illness were dramatically and rapidly "cured" of
their symptoms after treatment for their physical disor
ders, and the other 18 were substantially improved
immediately following the medical treatment. These
people might otherwise have been declared "incompe

tent," been committed to a state hospital, possibly for
their lifetimes, have had their rights taken away. They
would probably have been given "psychotropic" drugs
(drugs that are used to treat psychological problems),
and possibly "electroshock treatments," which might
have caused irreversible side effects and even have killed
them. And their medical conditions might never have
been recognized, never been treated, and become worse.
Those who were diagnosed as having not so serious psy
chiatric illnesses-the ones said to be neurotic -might
or might not have been placed on medications or hos
pitalized, but could have spent years in psychotherapy,
and definitely would have been robbed of the best
chance possible for healthy bodies and enjoyable lives.
Dr. Hall and co-authors in the November 1978 Archives of
General Psychiatry write: "A plea is made for careful med
ical evaluation of psychiatric patients."
The average cost of such proper diagnostic medical
testing, Dr. Hall and his associates say in the May 1981
American Journal of Psychiatry, should not be more than
$400, and should take no longer than 3 days. And the
benefits in relieved human suffering are profound.
We hear lots about how emotions can cause such
illnesses as ulcers and heart attacks. The word
"psychosomatic" is known to most Americans. If you
complain to a friend that you don't feel well, the common
reaction these days is "It's all in your head," or "It's be
cause you're nervous," "It's a reaction to stress," "You're
making yourself sick," "Just relax."
It's true that emotions can cause illness of the body.
But we seldom hear about the opposite: diseases of the
body causing problems of "the mind . " Physical illnesses
may cause what, to the untrained eye, seems to be de-
pression, anxiety, aggressive outbursts, personality

changes, sexual problems, delusions (believing some
thing that is actually not true), hallucinations (seeing or
hearing what is really not there), irrational thought dis
orders as in schizophrenia, and manic states (elated,
frenzied behavior which is the opposite of depression).
If you're thinking that this failure to screen for physi
cal causes could only happen in a state hospital to those
patients who are mostly from the poor, deprived classes
and who rarely have frequent medical care, and who
have been "put away" by their families, or have had
other unfortunate experiences leading to this end of the
line for them in which the state must "warehouse"
human beings who have nowhere else to go, you're
wrong. In 1978 Dr. Hall and others studied 658 people,
examined as they voluntarily arrived for outpatient visits
to a suburban community mental health center and who
reported physical symptoms, and the researchers say in
the November 1978 Archives of General Psychiatry that
9.1 % had medical disorders that were causing problems
labeled as psychiatric.
The most frequent causes of psychiatric symptoms
were cardiovascular (heart and blood vessels) and endo
crine (thyroid and parathyroid and diabetic) disorders,
followed by infections and parasites, pulmonary (lung)
disease, gastrointestinal (stomach, intestines, and liver),
hematopoietic (disorders in the making of blood result
ing in varieties of anemia), central nervous system (brain
and spinal cord), and malignancies (cancer). Forty-six
percent of these clients had not known they had these
diseases. And their own personal physicians did not
know either!
Specific symptoms are listed below in order of frequency

as reported by patients.
Sleep disorder
Severe weakness
Extreme fatigue
Inability to concentrate
Memory loss
Change in speech
Auditory hallucinations (for example "hearing
voices")
Chest pain
Intermittent tachycardia (abnormally fast heartbeat)
Recent nocturia (urinating at night)
Recent-onset of confusion
Tremulousness (trembling)
Productive sputum (spitting up of mucous)
Frequent urination
Dyspnea on exertion (difficult or painful breathing
with exertion)
Recent personality change
Paresthesias (abnormal sensations such as tingling)
New cough
Polyuria (excessive urination)
Pleuritis pain (pain in chest a nd on breathing)
Visual hallucinations (seeing things that aren't there)
Lymphadenopathy (swelling of the lymph glands)
Severe anorexia (severely underweight)
Dyspnea (difficult or painful breathing)
Arrhythmia (irregular.heart beat reported by patient)
Paroxysmal noctural dyspnea (difficult or painful
breathing at night)
Costa} vertebral angle pain (pain in the costal verte
bral area of the back)
Chest pain
Wheezing (breathing hard with a whistling, breathy

sound)
Decreased muscle coordination (muscles don't pro-
duce complex movements well)
Skin had recently become dry
Lost all desire to eat
Hair recently became fragile
Ankle and/or pretibial edema (swelling of ankle and/
or pretibial area of leg)
Reduced sense of touch
New and different headache
Neck pain
Difficulty with mastication (chewing)
Two-pillow orthopnea (sleeping with two pillows to
be able to breathe)
Recent change in menstrual periods
Recent muscular weakness
Dysuria (difficulty or pain on urination)
In the suburban outpatient group studied by Dr.
Hall, 18 people were diagnosed as neurotically de
pressed, 12 supposedly had anxiety, with one obsessive
compulsive. Most alarmingly, 42 people were said to be
psychotic, that is, not in touch with reality, which means
seriously mentally ill - 15 of them, in fact, were
categorized as schizophrenic. One of the hallmarks of
schizophrenia is hallucination, but 28% of the patients
with a medical illness experienced visual hallucinations,
that is, they saw things that weren't really there. In fact,
they were not so emotionally disturbed that they were
hallucinating, but a biological process was producing
this phenomenon. When people have visual hallucina
tions or distortions, medical impairment should be consi
dered until proven otherwise. There were various other
inaccuracies, including one diagnosis of "hysterical per-
sonality," one "antisocial personality," and one "be

havioral disorder of childhood."
The State of California's Department of Mental
Health funded other researchers to study clients attend
ing other kinds of mental health service s to determine
the prevalence of undiagnosed a nd untreated physical,
also called "organic," conditions or diseases in California
mental health system clients. The first report was submit
ted to the Legislature in November 1985, and dealt with
clients in the county mental health programs. The
second discussed clients residing in state hospitals.
And the third report will be issued in 1988 recommend
ing the most appropriate and cost-effective methods of
identifying those clients whose mental disorder is
caused or worsened by physical illness.
The study in the county mental health system was
done between July 1983 and July 1984, examining 529
clients attending 8 mental health programs consisting of
crisis intervention, psychiatric health facilities (non
hospital), inpatient, outpatient, day treatment, skilled
nursing facility, community care (such as board and
care), and state hospital, in the 4 counties of Santa Clara,
Santa Cruz, Monterey, and San Benito. Two physician
assistants a nd a medical clerk, travelling in a motor home
converted into a mobile medical examining facility,
visited each mental health program, and each client was
medically evaluated by a physician assistant who was
supervised by physicians i n internal medicine. Thirty
two of the clients, or 6%, were found to have physical
illnesses that were causing their psychological symp
toms. Of the illnesses that had been missed by previous
physicians but were detected by the researchers, 2 were
neurological, that is affecting the central nervous system
(brain and spinal cord), and 3 were the following: anemia
12 CAN PSYCHOTHERAPISTS HURT You?
secondary to peptic ulcer, hyperparathyroidism, and

hypothyroidism. Forty-six of the clients, or 9%, had
physical illnesses worsening the psychological symptoms.
It was estimated that in a one year period from 1983 to
1984, 24,200 people being treated in 6 mental health pro
gram categories had physical illnesses that were causing
their psychological symptoms, with a n estimation that
in 20,400 of the cases, the program staff were aware of
the illness, and that the program staff were not aware in
3,800 cases. It was also estimated that another 20,300
people had physical illnesses that worsened their mental
disorders, with program staff aware of 9,200 cases and
not aware of 11,100 cases. Thirty-six percent of people
with a physical illness known to the staff of the mental
health systems were believed to be receiving inadequate
or ineffective medical care. The researchers comment in
general about mental health systems saying:
"The mental health system is not very active or is not
very effective in helping mentally disordered patients
obtain or cooperate with medical care."
The two state hospitals in the other study were Met
ropolitan State Hospital in southern California with
clients coming from urban Los Angeles and Orange
counties, and Napa State Hospital in northern California
with clients from 18 counties both rural and urban.
Clients were 153 people who had been recently admitted
as inpatients. Those at Metropolitan had been admitted
through the emergency rooms of county medical centers
a nd had had a physical exam for the purpose of ruling
out a physical illness, but Metropolitan does not know
ingly admit clients with a physical illness requiring treat
ment because they do not have an acute medical/surgical
unit. Clients admitted to Napa had come from a variety
of settings, i ncluding some who had been living at home
and were brought to the hospital by a county mental

health crisis center. They may or may not have had a
recent physical exam. Napa does have an acute medical/
surgical unit and does admit people known to have phys
ical illnesses. The evaluation of Metropolitan clients was
done within 5 days of admission by the research team
from Harbor/University of California at Los Angeles
Medical Center, and the NAPA evaluation was done
within 1 to 4 weeks of admission by NAPA staff.
At Metropolitan, 75 clients who volunteered to be
studied were evaluated between January and July 1984
by a physician, a psychiatrist, and a psychologist. Fifteen
clients, or 20% of those studied, had physical illnesses
that the researchers thought either caused or worsened the
psychiatric symptoms that led to admission, with 1 1 of
these having psychiatric symptoms that were caused by
the physical illness, and 4 having psychiatric symptoms
that were worsened by the physical illness. Ten of the 15
illnesses judged by the study team had been missed by
previous physicians.
At Napa, 78 clients were studied between May 1983
and July 1984, of whom 3 had illnesses that were judged
to have caused the psychiatric symptoms which led to
admission. One illness had been known prior to the
study, one had been suspected but not confirmed, and
one had not been detected by physicians previously. In
addition, 56 clients had illnesses that were judged to
worsen the client's psychiatric problems.
The California study demonstrates that 1 in 6 sup
posedly mentally ill people has a physical illness that is
causing or worsening their mental condition, and that
more than 15% of causal illnesses and 60% of illnesses
that worsen are currently unrecognized by the mental
health system. For full details on the reports, see the
"References" section in the back of this book, looking

under "California." For summarizations by Dr. Hall of
his work and that of his predecessors on this topic, see
his book Psychiatric Presentations of Medical Illness: Somato
psychic Disorders, published in 1982, a nd his lengthy arti
cle on "Psychiatric Manifestations of Physical Illness" in
the three-volume reference book Psychiatry, published in
1988. Your librarian can help you locate this literature.
It must be emphasized that these failures of diagnosis
are not confined to large government-run institutions.
Studies like those cited in this chapter merely provide
statistical confirmation of attitudes and oversights also
reflected in private practice. And a major irony of this
situation is that precisely those practitioners who might
be expected to provide the best safeguard against such
misreadings- namely, medically trained psychiatrists
with degrees from prestigious universities -may be
among the worst offenders, pleading that their intense
specialization in mental disorders has put them "out of
touch" with advances in physical medicine.
The following cases described in the California study
will bring this problem to life for you. All of the physical
diseases described had been discovered by the research
ers, and the mental health care system had not previ
ously detected them-had missed the causes of client
distress. If it were not for the researchers, chances are
that these people would still be suffering and still be
clients in the California mental health system.
Case #1. Mrs. A had been depressed for several years
before a calcium oxalate kidney stone was removed
in 1977. She was told that she had a n elevated blood
calcium level, but nothing was done to treat it. She
attended the county mental health clinic for out
patient psychotherapy in January 1982. No medical
screening was done and the clinic remained unaware

of her elevated blood calcium. Over the next 18
months, despite weekly psychotherapy, she was de
pressed and lost three clerical jobs because of inabil
ity to concentrate, fatigue, and impaired memory.
She was about to lose her fourth job when she was
examined by the researchers in July 1983. The team
found her elevated blood calcium levels and diag
nosed the cause as a parathyroid gland tumor. The
day after this tumor was surgically removed, her de
pression completely disappeared. When contacted a
few weeks later, she said "I have so many good feel
ings, a whole new way of life." She had remained
free of depression during a one year follow-up
period, had decreased her outpatient psychotherapy
from once a week to once a month, and intended to
discontinue therapy in the near future after she had
finished grieving over the 10 years lost unnecessarily
to depression caused by a treatable physical disease.
Case #2. Mrs. B. was being treated in an outpatient
mental health clinic for an a nxiety disorder and
"psychogenic pains" (meaning they were thought to
be caused by emotions). The researchers found that
she had pernicious anemia, a disease caused by ina
bility to absorb vitamin Bl2. When her disease was
treated, her anxiety diminished from severe to mod
erate, her mild depressive symptoms cleared, and
her physical symptoms (pains in her abdomen,
numbness a nd tingling in her hands, and light
headedness on standing up) disappeared. She felt so
much better that she terminated her outpatient
psychotherapy.
Case #3. Mrs. C. was treated in a Day Treatment pro
gram for depression. The researchers referred her to
a neurologist, who diagnosed her headaches as of

the migraine type and began treatment. The
headaches had been greatly worsening her depres
sion, in part because her family did not believe they
were "real." Mrs. C. said "The diagnosis of migraine
helped my family understand that I had a real illness
and they became much more understanding of me.
This made the headaches less depressing. " In addi
tion, Mrs. C. established an excellent relationship
with her neurologist, saying "She helped me learn
that I could ask my doctor questions - I had never
been able to do that before. She listened to me, even
about my depression." She continued in day treat
ment for 5 months, attended outpatient psychother
apy for 4 more months, and then terminated treat
ment in the county mental health system.
Case #4. Mrs. D. was being treated in a Day Treat
ment program for depression. She was also having
medical treatment for a seizure disorder and was
being treated with an anti-seizure medication called
Dilantin. The researchers found that she had low
blood levels of vitamins B12 and folate and brought
this to the attention of her physician, who began
treating this problem with vitamin replacement, but
her vitamin levels failed to respond. Meanwhile,
Mrs. D. dropped out of day treatment feeling it had
helped, but had nothing more to offer. Because Dilan
tin is associated with low vitamin B12 and folate
levels, her physician then gave her a different anti
seizure medication. Shortly after this medication
change, Mrs. D. noted that her energy level had in
creased and her memory had improved. These im
provements can reasonably be attributed to the
change in anti-seizure medications and perhaps to
the subsequent return of her blood vitamin levels
into the normal range. Her depression was reduced,

although not completely eliminated. She is currently
dealing with the stress of a divorce which she in
itiated, and she and her children are in family psycho
therapy with a private psychotherapist. She is no
longer in the county mental health system.
Case #5. Mr. E. was examined by the researchers on
his first visit to the mental health clinic. He had been
feeling depressed, anxious, and easily fatigued for
several months. A friend told him he didn't look well
physically, and that he could get both psychotherapy
and a free medical examination at the clinic. An in
dustrial designer, he had been out of work for a year
and had recently been too tired to look for a new job.
The researchers found that he had severe iron defi
ciency anemia due to gastrointestinal bleeding
caused by a peptic ulcer. His anemia and ulcer both
responded well to treatment, and four months after
the researchers had examined him he had returned
to work and was feeling well. His first visit to the
mental health clinic was also his last. He didn't need
psychotherapy because his symptoms had been
largely due to his physical disease.
E. Fuller Torrey, M. D., for four years Special Assistant
to the Director of the federal government's National Insti
tute of Mental Health, clinical psychiatrist at St.
Elizabeth's Hospital in Washington, D.C., and affiliated
part-time with the Public Citizen's Health Research
Group, does research on the causes of schizophrenia,
and summarizes what is known at present about medical
illnesses that can seem to be schizophrenia-a serious
form of psychosis-in the 1988 revised edition of his
book Surviving Schizophrenia in chapter 4, "What Schizo
phrenia is Not." He includes not only diseases of the
body, but also side effects of prescription and street

drugs, metal poisoning (e.g., lead and mercury), and
insecticide poisoning (e.g. organophosphorus com
pounds). Dr. Torrey is a wonderful source of information
both about schizophrenia and about generally distin
guishing between ailments of the body versus those of
the mind. He tells me that an article by K. Davison in the
j ournal Psychiatric Developments on "Schizophrenia-like
Psychoses Associated with Organic Cerebral Disorders:
A Review" is the classic on the topic of physical or "or
ganic" illnesses causing the mental aberrations that re
semble schizophrenia. A book by Bonnie Busick and and
M artha Gorman, Ill Not Insane, is one of the recent books
about schizophrenia written by the families of patients,
this one arguing the case that almost all cases of schizo
phrenia are disguised medical conditions. Dr. Torrey also
recommends Mind or Body: Distinguishing Psychological
from Organic Disorders by R. L. Taylor.
The issue of psychiatric specialists and their responsi
bility for detecting physical illness has been around for a
long time. In 1894 Dr. S. Weir Mitchell addressed the
group of physicians now known as the American Psychi
atric Association with:
" . . . you were the first of the specialists [to isolate
yourselves] and you have never come back into
line . . . . "
referring to the fact that they had, for the most part,
sep arated themselves from the practice of medicine after
their medical training was completed and they had their
M.D. degrees. He went on saying he was:
" . . . too often surprised at the amazing lack of com
plete physical study of the insane [and even] in a
certain asylum I could not get a stethoscope or an
ophthalmoscope."
He continued:
"I . . lament the day when the treatment of the insane
.
passed so completely out of the hands of the profes

sion at large and into those of a group of physicians
who constitute almost a sect apart from our more vit
alized existence. "
Eighty-two years later, psychiatrists Ors. John Mcin
tyre and John Romano asked psychiatrists in Rochester,
New York, how they felt about physical examinations of
their clients and if they do such examinations. The ques
tioners reported their findings in the October 1977 Ar
chives of General Psychiatry in their article " Is There a
Stethoscope in the House (and is it Used)?" Of the 73
psychiatrists who answered the questionnaire, 13% said
they frequently, 24% rarely, and 63% never examined their
inpatients (patients admitted to a hospital), and 8% fre
quently, 23% rarely, and 69% never examined their outpa
tients (patients who live at home and visit the doctor's
office). Among their reasons, 7% said they didn't think
it was necessary or useful, 71 % that the client had re
cently had a physical by the physician who referred the
client to the psychiatrist, and 89% that they referred the
client to another physician for the exam. And 32% con
fessed that they "do not feel competent in doing physical
examinations." An even higher number-43% -of those
who had completed their medical training 16 years be
fore this study admitted this sense of inadequacy.
And what did those who were teaching psychiatry tell
their students? Fifty-five percent thought physical exams
were very important and 32% that they were somewhat
important. But 47%, less than half, frequently discussed
the findings of physical examinations of clients when
supervising the work of their students.
The studies of medical illness among psychiatric

clients point out the need for psychiatrists to stop consid
ering themselves a sect apart" from the medical profes
/1
sion. As Dr. Hall writes in the January 1982 Hospital and

Community Psychiatry, psychiatrists " . . . cannot ignore
the infirmities of the body when considering the coping
styles of the mind."
Psychiatrists are specialists in disorders of behavior
and emotions, and if physical illnesses are causing these
disorders they must know how to diagnose and how to
treat them. They must continue to be physicians and not
take on the role of psychotherapist exclusively. The fact
that they are medical doctors distinguishes them from
all other psychotherapists. Why go to medical school if
they are going to leave their medical knowledge behind,
and have their prescription pads as the only trace of the
M.D. remaining? Psychologists have degrees in psychol
ogy, not degrees in medicine, and don't have the medical
training necessary to physically examine their clients.
Neither do psychiatric/clinical social workers or other
psychotherapists. This is the psychiatrist's specialty.
Problem behavior is not only the result of psychological
conflict, but also may involve genetic (inherited) factors,
and biological (physical) illnesses. The psychiatrist is the
expert in both mind and body. It is the psychiatrist's job
to understand, as Mcintyre and Romano put it, the
physical " . . . abnormalities that might be contributing
to, coexisting with, or resulting from the identified
'emotional' disorder. /1
The findings of these studies show us that a routine

physical exam by a general practitioner is unlikely to
define these illnesses in many cases. So the psychiatrist
who leaves such a physical to a family physician, for
example requesting their clients see their own doctors to
be "medically cleared" before beginning psychotherapy

with them, is in many cases going to have an innacurate
report about the client's biological health. Psychiatrists
must understand the fact that many medical illnesses
have the same symptoms as psychiatric problems, and
therefore, the medical evaluation and treatment of their
patients is part of their professional responsibility. And
it is the responsibility of psychiatric educators to teach
their students to become competent medical doctors.
Looking at this from a legal perspective, psychiatrists
should do their very best to rule out biological factors
before taking on "psychiatric treatment." They are, in
fact, the physicians whose job it is to determine the com
petence of persons, and to provide the data to judges
who certify that the person is indeed mentally incompe
tent and free from medical disease. Psychiatrists sign the
commitment papers! Missing a medical disease can be
grounds for a malpractice lawsuit. Several recent law
suits have been filed charging psychiatrists with malprac
tice for failure to medically evaluate their patients. Such
subjects as a patient's "right to treatment," the confine
ment of a nondangerous person who is capable of survi
val and freedom outside the hospital, failure to make a
bona fide effort to cure or improve the person, whether
the treatment given the patient was "adequate treatment
in the light of present knowledge," the development and
updating of treatment plans, are all issues. Is psychiatric
treatment without ruling out underlying medical disease
considered "adequate treatment in the light of present
knowledge?"
What happened, you might wonder, to the unfortu
nate person we heard from at the start of this chapter?
Well, thankfully, after a few days of physical and mental
abuse and terror the medical director of this elegant hos-
pital suspected that an error had been made. Although

he wasn't sure of the physical diagnosis, he concluded
that biological factors were responsible. The hospital
staff quickly released her, moving up the usual time
period legally necessary before such release could be
done on an emergency basis, stopped forcing tran
quilizers, stopped punishment with isolation in an
empty room with only a mattress on the floor, cancelled
the scheduled "electroshock treatments," and nervously
tried to ignore her until discharge date to protect
themselves from a malpractice lawsuit. After she was
free, she was eventually properly diagnosed and treated,
and she recovered. But her experience lives on in her
nightmares.
Is It Depression-Or An Underactive Thyroid? 23
CHAPTER 3
Is It Depression-Or An
Underactive Thyroid?
P nesses" have a seemingly infinite range. For exam

hysical disorders misconstrued as "emotional ill
ple, murderers may have brain damage, and the brain

damage may cause the criminal behavior, conclude Dr.
Dorothy Atnow Lewis of New York University School of
Medicine in New York City and co-authors in the July
1986 American Journal of Psychiatry, a report they also pre
sented at the May 1986 annual meeting of the American
Psychiatric Association. They found that all of the 15 men
and 2 women awaiting execution on Death Row whom
they examined had histories of severe head injuries and
major neurological impairment, which was not sus
pected even by defense attorneys.
Many people with systemic lupus erythematosus or
"lupus," which produces a chronic inflammation of sev
eral systems of the body affecting connective tissue,
develop what seem to be neuropsychiatric symptoms of
varying degrees during the course of this disease. There's
fascinating literature about the possibility of brain dys

function in autism and obsessive-compulsive behavior;
evidence that inheritance, transmission of genes, may
cause manic-depression and related mood disorders; re
search detailing unsuspected cancer of the pancreas mis
labeled as depression; speculation that some schizo
phrenia is a brain disease caused by a virus; and so on.
Check the titles of articles and books in the "References"
section in the back of this book for specific sources of
information.
Much of all such organically produced symptoms
may involve diseases of the endocrine glands and
metabolic disorders, and particularly of the thyroid. Ab
normal functioning of the endocrine system -glands
which secrete internally, delivering hormones directly
into the bloodstream-account for more behavioral and
other psychiatric symptoms in women than any other
physical illness, and similarly rank as the third most fre
quently known source for men, for whom cardiovascular
and pulmonary disorders hold first and second places.
Psychiatrist Richard Hall, M.D., of the Florida Hospi
tal in Orlando has done work on this subject. Especially
read his articles "Psychiatric Effects of Thyroid Hormone
Disturbance," and "Psychiatric Manifestations of
Hashimoto's Thyroiditis ." The following are case his
tories of people with problems with their thyroid
glands.
Case #1. Nick had been a "hyperactive" child. A
thin little boy, in school he could not sit still. He could
not be quiet. He disrupted the classroom, doing
everything but dancing on top of his desk. Teachers

had no power to influence his behavior. He was
punished, sent to the principal's office, sent home
with notes to give his parents, given failing grades in
"Conduct" on his report card, suspended from
classes for weeks when none of these approaches
worked. It was the same at home. He was a "bad
boy. "
No one recognized that a thyroid hormone distur
bance was the problem. Nick had no power over his
behavior. He was being pumped to overflow with
this hormone. No one-school officials, parents,
physicians- understood the problem. No one even
considered the possibility of a physiological culprit,
a chemical, a hormone.
Despite his handicap, in his early teens Nick be
came a successful entertainer, singing, playing piano
and guitar, dancing, telling jokes, writing plays and
musical scores, acting. Most of the time, onstage or
off, he was performing. But he had mood swings
from elation to depression. He had doubts and fears
and felt "nervous." He didn't know he had a thyroid
disorder.
When he was 21, he began to lose weight, becom
ing even thinner than he'd been all his life. His body
began to tremble, especially noticeable to him in his
hands when he tried to hold something or write. He
had insomnia. He couldn't concentrate. After 6
months of becoming progressively worse and nearly
dying, he was diagnosed as having "Graves' Dis
ease," a disease of the thyroid. Nick was treated and
recovered from this crisis, but didn't know that he
was going to have lifelong problems with his thyroid
functioning, and that it had affected and would con

tinue to affect his thoughts, feelings, and behavior.
This young man who had suffered all his life from
the consequences of behavior for which he was not
voluntarily responsible had felt like an outcast, un
wanted and unloved, a great deal of the time. Besides
his physical discomfort, he was lonely and lacked
self-confidence. He was the perfect target for a Freud
ian psychoanalyst he met one day who told Nick he
would be "cured" of what the analyst said were his
"neurotic" behavior patterns with 6 sessions of psy
choanalysis a week at $50 a session (a high fee at that
time in the early 1970s) for several years. Nick spent
45 minutes a day every day of the week except Sun
day, lying on a couch, talking about his dreams, free
associating every thought and feeling he had, discus
sing his supposed "psychosexual stages," the cycles
that Sigmund Freud, the founder of psychoanalysis,
thought were the foundations of personality, estab
lishing who we are and how we think and feel and
act. Nick learned to believe his analyst's version of
· how Nick got to be who he is, and now Nick can
recite this story for anyone who wants to hear it. And
also for those who don't want to hear it. In fact, a
conversation with him always involves Nick telling
you about yourself in analytic terms even if you don't
want to know. Five minutes into your dialogue with
him he's labeling you as "compulsive," "paranoid,"
"overcompensating," "immature," or stuck in an
"unresolved Oedipal Complex," or in your "Oral" or
'Anal" stages that Freudians insist everyone experi
ences.
What's happened to this vulnerable man is that
having wanted to belong all his life, he now belongs
to this group of analysts. He has even given up his

enormously creative career as an entertainer and in
vested years of schooling to become, himself, a pro
fessional psychoanalyst, narrowing his interests and
thoughts only to those taught by Freud, and exclud
ing everyone else's ideas and knowledge. He has des
perately wanted an explanation for all that has hap
pened to him, for his actions; has looked for reasons
why he has been in so much trouble all his life and
has been unable to change. They have given him an
explanation that seems to him to make sense out of
what has appeared senseless. The explanation in
volves blaming the behaviors of others, and believing
Freud's theories that people are in conflict because of
a constant battle between the "Id," or their instinc
tual strivings which want to be satisfied, and the
"Superego," or society's rules which come to be
known as the "conscience" of the person. The "Ego"
then has the task of mediator, finding ways of satisfy
ing the Id within socially acceptable ways approved
by the Superego. And so the theory goes-all specu
lation without objective proof.
But this explanation does not at all even consider
the real source of Nick's distress-his thyroid mal
function, which can be proven with blood and other
lab tests. The saddest part of this case is that Nick
continues to have the symptoms of thyroid hormone
disturbance. But he has been taught to believe that
this is not so, and he refuses even to consult an endo
crinologist for thyroid function testing. He has been
taught to believe, in the fashion of far too many psy
chotherapists today, that his symptoms are all attrib
utable to "emotional problems." Six analysis sessions
a week for 7 years have convinced him to believe.
What has happened to Nick is not uncommon. Psy

chiatrists, psychologists, clinical/psychiatric social
workers, and other psychotherapists, out of ignor
ance, financial greed, wanting power, need to be
needed, or misbeliefs, harm many like Nick.
Thankfully, he doesn't have what can be mistaken
for paranoid suspiciousness, schizophrenic irrational
thought disorder, or other psychoses that sometimes
seem to occur in hyperthyroidism. His diseased
thyroid is still functioning, but if it stops he could
become hypothyroid, have an underactive thyroid .
Then he would feel tired, would experience other
bodily discomforts, and his "mind" would appear to
be affected because his mental ability would slow
down; memory, speech, and learning ability would
decline; hearing, taste, vision, and smell would be
affected. Those who didn't know the truth would say
he had delusions and hallucinations or other psy
chotic aberrations and he would be at risk of being
certified incompetent. "Myxedema madness" would
be the proper term used to describe his condition
due to his underactive thyroid.
But Nick isn't monitoring this process. He isn't vis
iting physicians who understand this mechanism
and who can watch out for more physiological
trouble. Instead, his response to everything that is
happening to his body and his mind is to "analyze,"
and continue to pay the mortgage of his long-time
analyst, who has enjoyed quite a financial windfall in
this client.
Hyperthyroid and hypothyroid problems usually can
be treated by regulating the hormone, and suffering is
needless. And psychotherapy is neither necessary nor
effective is treating this endocrinological illness.
"Hashimoto's thyroiditis" is an auto-immune thyroid

disease that psychiatrists don't understand and seldom
test for. Even endocrinologists, whose job it is to know
about the thyroid, often miss this illness too.
Case #2. Lucy, a successful professional in her mid
thirties, suddenly began trembling, so much so that
she nearly fell off the edge of the bed. She tried to
sleep but couldn't. Insomnia would be with her for
the entire year ahead, as would her pounding heart,
nausea, intense feelings of fear, and a long list of bod
ily complaints that no physician recognized until
three years later as Hashimoto's thyroiditis. Here the
immune system erroneously identifies the thyroid
gland as an intruder to be attacked for the protection
of the body, and can damage or destroy the gland
entirely. Her immune system, normally designed to
repel foreign invaders, wasn't working the way it
should. It didn't recognize her thyroid gland as being
the normal, healthy tissue that it was, and instead
attacked it as it would attack a foreign invader
threatening to harm the body. This immune system
wasn't keeping this body healthy, it was making this
body sick. Lucy had been known as someone with a
good mind and clear thinking. Her body was in great
distress now, but her mind was as competent as it
had always been. Why wouldn't anyone believe her?
For three years she had consulted physicians, even
travelled around the country to the best teaching hos
pitals connected to the most respected universities,
looking for someone to help her. She had suspected
that the problem was with her thyroid, having some
knowledge of physiology and organic brain syn
drome, and being a sensitive and perceptive person
who knew her own body and mind well. But for three
years no one was to be correct about her illness, and

her life was to be forever changed by this experience .
The diagnoses given her by presumably qualified
physicians, included "panic attacks," depression,
manic-depression, anxiety, somatic delusions (mean
ing that the doctor said she only imagined she had
"bodily," that is, "somatic" symptoms), and lupus
(systemic lupus erythematosus). Treatments recom
mended by these doctors ranged from electroshock
to steroids to various "psychotropic" medications
(which are prescribed for psychological distur
bances). She correctly refused all of these recommen
dations as well as the diagnoses.
She was forgetful; confused; had body pain and
weakness; was fatigued; her hair was dry, brittle,
coarse, and falling out; skin was dry; menstrual cy
cles were irregular and abnormal; she was gaining
weight; she was irritable; had personality changes;
and had a long list of bodily complaints and mental
aberrations. Luckily, she didn't have the delusions
and hallucinations that often are present.
If you're thinking that many of these complaints
are related to the central nervous system (brain and
spinal cord), you're right. Her thyroid had, in the be
ginning of the illness, been overactive, which ac
counts for the symptoms early on in the illness. And
then the antibodies which had been sent by the im
mune system to destroy the thyroid had done so,
and finally the gland could not produce the hormone
that is so vital to proper management of the entire
body, and hypothyroidism-an underactive thyroid,
a deficiency of thyroid hormone -was causing im
pairment of her central nervous system.
The endocrinologist who finally diagnosed this ill

ness found that Lucy's thyroid was enlarged. This is
called a "goiter." He found that she had heart irregu
larities and previously, at the peak of her illness, had
had liver failure, all complications of Hashimoto's
thyroiditis.
Part of the reason so many doctors had missed the
diagnosis is that during the course of the illness the
thyroid fluctuates, producing either too much or too
little hormone, and test results for Hashimoto's
disease may be misleading since thyroid function
fluctuates, being overactive, underactive, and even
normal. The proper test to determine Hashimoto's
disease is the existence of what are called "autosomal
and microsomal antibody titers. " ·
After seven months of treatment of her inflamed
thyroid she returned to what was almost normal for
her. She still has some memory loss, is still confused
at times, irritable, nauseated, dizzy, and still has
some neurological trouble, but she is much improved.
Autoimmune disorders can be "polyglandular, "
that is, involving "many glands" at the same time, or
they can affect one gland at a time. So, she is at risk
for similar processes in her adrenal gland. It could
also happen in her pancreas and she would have
diabetes mellitus. She will have to watch for possible
development of pernicious anemia, rheumatoid ar
thritis, lupus (systemic lupus erythematosus), pro
gressive hepatitis, and other autoimmune disorders .
She wouldn't want to be misdiagnosed again.
CHAPTER 4
Psychotherapy Cults:
The Pied Piper Phenomenon
Y in group sessions as opposed to individual psycho

ou may think that it would be harder to be harmed
therapy, where you have the benefit of the perceptions

of others. Other participants may notice something ·you
don't. And some clients are more likely to express their
feelings, more likely' to take action -like leaving the
group, all of which may help the others become aware of
what's happening in the group. It's harder to fool all the
people all the time. If one person says there's an elephant
in the room, maybe there isn't. If two people say there's
an elephant in the room, maybe they're both wrong. But
if three people say there's an elephant in the room, there
probably is.
But the old saying that there's safety in numbers is
not always true. Group therapy is not necessarily safer
than individual psychotherapy. Groups can be powerful,
pressuring members to conform to their rules. Consider
the peer pressure exercised by teenage groups. Although
it's an extreme case, remember the People's Temple of

Guyana, and the mass suicide-murder of the members
on instruction from the leader, Jim Jones on November
18, 1978. Some people follow gurus and Pied Pipers, vul
nerable to persuasion through social influence to partici
pate in a new lifestyle, at least for a while. Organizers of
these groups, Newton Malony, psychologist with the
Graduate School of Psychology, Fuller Theological Semi
nary in Pasadena, California tells me "cultivate a cadre
of people who are dependent on their cultic-type re
lationship with each other." Joining may, in fact, be a
"normal" experience for many who are looking for a
place and someone says "Come with us," I heard during
my phone conversation with sociologist and attorney
James T. Richardson, Professor of Sociology, University
of Nevada at Reno, who researches and writes about
similar phenomenon in new religions and cults.
A summer 1982 article in Psychotherapy: Theory, Re
search, and Practice, the journal of the American Psycho
logical Association's Division of Psychotherapy by
psychologists Maurice and Jane Temerlin shows how
mental health professionals practicing psychotherapy
can be organized into cult-like psychotherapies where
both the leader and followers are mental health profes
sionals. The researchers studied five psychotherapists,
who were also teachers of psychotherapy, who ignored
the ethical rules prohibiting them from having psycho
therapy clients who are their friends, lovers, relatives,
employees, colleagues, or students. These five teachers
had people in all these categories as clients, in groups of
15 to 75 clients bonding together in admiration and sup
port of the therapist. The clients did not work on solving
their problems or understanding themselves, but rather
they were taught to accept and to believe in the
therapist's theories, to devote themselves to their
therapists' welfare, and to distrust, be fearful of and hos

tile toward other mental health professionals and the
world outside the group.
Two of the therapist-organizers were medical doctors
who were psychoanalysts (following the teachings of
Freud), and also members of the American Psychoanaly
tic Association. Two were clinical psychologists with
Ph.D.s from schools approved by the American Psycho
logical Association. The fifth had a Ph.D. and said he
was a clinical psychologist and a psychoanalyst, but this
was never verified .
Four had married their clients, and one lived with an
ex-client. Their clients also served as their assistants, col
leagues, secretaries, bookkeepers, and students. All
were submissive to their therapists. Even though these
clients were mental health professionals, they would do
work for their therapists such as housekeeping, cooking,
gardening, home and automobile repairs, and errands.
All five groups operated psychotherapy training pro
grams, two within universities .
O n the front page o f section B of June 3rd, 1988's The
New York Times we learn "Custody case lifts veil on a 'psy
chotherapy cult."' Two former male members of this al
leged psychotherapy cult in New York City, founded by
a group which had broken away from a prestigious psy
chotherapy training institute, are suing for custody of
their children, whose mothers still live with the group,
which is said to "control every aspect of the members'
lives, including their living arrangements, sexual prac
tices, choice of profession, hobbies, child-rearing prac
tices, and required thrice-weekly therapy sessions." Ac
cording to the article, members are encouraged to have
sexual relations with a different member of the opposite
sex each night, and every child is assigned a full-time

baby sitter with the parents visiting with them for only
an hour a day and one night a week.
Beware of a therapist who completely accepts the
teachings of an idealized therapist about why people
become distressed and how therapy should be done,
ignore other ways of working with clients, ignore the
fact that they can't prove that their way is better or more
effective than anyone else's way, and treat all clients with
the same therapy, as in the following case.
Novelist and journalist Dan Wakefield, in an article
titled "My Six Years on the Couch," published in The New
York Times Magazine, December 20, 1987, which is an
excerpt from his latest book Returning: A Spiritual Journey,
refers to his personal experience with "orthodox Freud
ian analysis." Today there are many varieties of psycho
analysis, all derived from the original teachings of Freud,
but all changed in some ways to fit with the personal
beliefs of the creator or creators of the new variety. Dan's
"analysts," as they are called, worked for the New York
Psychoanalytic Institute, and they believed in -or at
least practiced - the form of psychoanalysis taught by
the directors of that institute.
Dan began his five-session-a-week for five years ex
perience at age 24, with his parents paying the fees of
$25 for each 50 minute hour-$6,000 a year-a sum
which would have supported him comfortably in those
days in 1956. His parents could not afford the fees but
paid anyway, having been convinced that they were
guilty of having done something to cause their child dis
tress. According to an article on psychoanalysis in the
February 1988 Monitor, the newspaper of the American
Psychological Association, at the present time clients of
psychoanalysts pay from $75 to $150 for a SO-minute
therapy session, there are four to five sessions each

week, and therapy lasts for four to seven years or more.
Each new analysis client pays between $60,000 and
$200,000 over a period of years.
Analysts refer to their clients as "patients," a term
taken from medicine conveying the idea that the person
consulting the analyst is in some way "sick" and unable
to care for himself. Freud to them is God, says Dan, and
both analyst and patient commit themselves so seriously
to the "treatment" that it is like taking vows to a religious
order. Both dedicate many years to searching for events
early in the patient's life that they believe are causing the
current problem.
Dan's problem was impotence, which he knows now
was due to the fact that he was an inexperienced begin
ner at lovemaking.
During sessions Dan would lie on a couch, "free asso
ciating," which means he would tell the analyst about
his thoughts and feelings, while his analyst sat on a chair
behind him so he was not visible to Dan, and responded
very little, rarely saying anything but "Yes, go on."
Freudian psychoanalysis is not a conversation.
The analyst told Dan that analysis would take a
minimum of four or five years, that only he- the doc
tor-could determine when the treatment was complete,
and that Dan was not to make any major life changes.
Dan writes:
"I was not to move to another place, go into another
kind of work, or get married. In a sense, I had to
agree to put my life 'on hold' in regard to such
decisions."
A few months after taking this vow Dan discovered
that, in fact, he was not impotent. He had successfully
been sexually intimate with a wonderful woman he

loved and knew he didn't need an analyst. "I'm fine," he
announced to the doctor at the next session. But the
analyst told Dan that the impotence was simply a
"symptom" of some deeper problem, and that Dan must
continue in analysis. Weeks later when Dan still felt fine
and told his analyst he wanted to be married to his girl
friend, he was told he was breaking their agreement
the analytic pact, the promise he had made not to make
any serious decisions or changes in his life -and that he
must tell his girl friend he could not marry her. Dan did
as his analyst wanted him to, and his relationship with
this woman ended.
By the third year Dan was spending more money on
cabs to his analyst than on food. He was also abusing
alcohol most days, and he writes "I didn't know how to
control it," and the analyst "gave me no advice about it,
for . . . [giving me advice] would have meant involve
ment. He had to remain aloof, detached . . . . " Psycho
analysts are instructed not to give their patients advice.
The sessions continued, and Dan waited for "that magic
day of revelation when all my neuroses fell away and my
real life began." But when was that going to happen?
After he and his first analyst began shouting at each
other, and he knew they didn't like each other, and that
he didn't trust the analyst, he changed to another psy
choanalyst. But the second didn't help either.
One day he realized:
"I had been in analysis for five years. I had reached
30. I had begun to meet people at parties who had
been in analysis for 10, 12, even 15 years, still with no
end in sight. I tried to assess my own salvation so far.
That I had any kind of sexual satisfaction at all I attri
buted more to the almost saintly patience and kind-
ness of women than I did to Freud or to . . . [either my

first or second analyst]. I credited one childhood
memory about my father with giving me a more sym
pathetic view of him, though I could not be sure it
was not something I would have realized anyway in
the course of my life without daily sessions on the
couch. None of it seemed worth the expense in time,
money, and postponement of 'real life."'
Dan left his second analyst and found a third psycho
therapist who didn't rigidly follow anyone's teachings,
whom he "liked and trusted," and with whom he had
"open, interpersonal communication," which means
they were person-to-person instead of analyst-and
patient or psychotherapist-and-patient and talked with
each other. He had found a helpful psychotherapist.
Fortunately for consumers, the sort of cultish tradi
tional psychoanalysis practiced by his first two has de
creased in popularity, and is now one of the least prac
ticed forms of psychotherapy. The article on psycho
analysis in the Monitor noted that few of the traditional
classical psychoanalysts -the kind Wakefield described
in practice today have full time practices, and that by
most accounts, less than 3 percent of therapy clients are
in psychoanalysis.
This group had unduly influenced Dan. These
analysts intentionally induced Dan to become depen
dent on them for all major life decisions, and implanted
in him a belief that they had some special talents or
knowledge.
The Center for Feeling Therapy, founded in 1971 and
closed in 1980, was subject to the longest, costliest and
most complex psychotherapy malpractice case in Califor
nia history, which came to an end in September 1987.
According to the Los Angeles Times of September 30, 1987,

the therapists were found guilty of acts of gross negli
gence, incompetence, and client abuse, and clients re
ported that therapists "seduced them and gave them sex
assignments, publicly ridiculed and humiliated them,
beat them, and then charged high fees for such treat
ment." Does this case illustrate power corrupted? Did
they start off with good intentions?
In California magazine of August 1988 Carol Lynn
Mithers elaborates on what she calls this "cultish psycho
therapy, " which she writes was "not therapy in the trad
itional sense of the word but a community and a way of
life" in which 350 people had spent up to ten years of
their lives, living in dozens of houses adjacent to each
other in ten square blocks in Hollywood. In this world
all that mattered was having and expressing feelings.
Two years of state hearings and several civil suits re
sulted in a reported $6 million in settlements to former
clients. The two men, psychologists, who had founded
the Center held Ph.D.s from Stanford University and the
University of California. They had written three books
which were chosen as Psychology Today Book Club selec
tions, and quoted in such magazines such as Made
moiselle and House & Garden.
From 1975 to 1980 they had been regulars on the talk
show circuit, speaking of their theories and work on hun
dreds of television and radio shows, including "The To
night Show," "Merv Griffin," "The Mike Douglas
Show," and "Good Morning, America," billing them
selves as "The Butch Cassidy and Sundance Kid of
psychology. " What no reporter, talk show host, or book
publisher ever learned was the daily reality of those who
lived feeling therapy.
Phoenix Associates was the Center's public relations

firm. Management Achievement Consultants was a firm
that gave managerial advice to client-owned businesses
in return for a large percentage of their profits.
Then one of the founders resigned and took a univer
sity teaching job, later saying he had come to believe that
the Center should be a place where people came and
went, not where they spent their lives, and that clients
should have families and children -having children was
prohibited, and pregnant members were pressured to
have abortions. And on November 4, 1980 there was a
revolution. The members rebelled against the remaining
founder, finally confronted him, shouting about the
ways he had hurt them, forcing him to seek refuge in his
parents' home in Orange County for his protection.
"Within days the Center building was padlocked and
communal houses broke up as roommates expelled
roommates, couples separated, people moved away
as fast as they could. Everyone knew it was over. "
The state of California's Psychology Examining Com-
mittee revoked the licenses of the two psychologist/foun
ders of the Center. All 13 members of the Center's profes
sional staff either lost, surrendered or, as in two cases,
had severe restrictions placed upon their licenses. One
psychologist, in a signed declaration, acknowledged to
the licensing board that feeling therapy involved "physi
cal and verbal humiliation, physical and sometimes sex
ual abuse [and] threats of insanity. " The other therapists
have not publicly admitted wrongdoing. A medical doc
tor who had been one of the staff is now allowed to prac
tice in Ohio as long as he restricts his practice to radiol
ogy, another of the former staff is doing personnel work,
another has a plant business, one is writing. Of the two
founders, one is now Director of the Academic Advisory
Center of a university in California, and the other, who

was the prime mover of the group, is in private practice
in Aspen, Colorado, and New York City, advising clients
on how to manage stress and career problems- he
doesn't need licenses in these states for this work. In
1986 his newest self-help book was released. During a
break in the recent psychology licensing board hearing,
he flew to New York to do a Cable News Network (CNN)
talk show about his book, being introduced as a "promi
nent psychologist," even though in 1981 CNN had aired
its own report on the Center's demise and alleged
abuses.
The latest trend in abuse of power or influence is for
therapists and their clients to have "dual relationships"
by mixing therapy and business. In the recent news is
Brian Wilson of the Beachboys rock group and his alleged
therapyfl?usiness relationship with a licensed California
psychologist. Wilson says he is pleased with the arrange
ment, but someone else has filed a complaint, and al
though the state code does not specifically prohibit bus
iness relationships, the psychology licensing board has
charged "gross negligence" and causing Wilson "severe
emotional damage, psychological dependency, and
financial exploitation. " Central to the accusations is the
fact that the therapist received artistic credit and more
than $140,000 for acting as Wilson's business manager,
executive producer, co-songwriter, and business adviser
while also serving as his therapist.
Daniel Kagan writes on "Untidy Mix of Business,
Therapy" in Insight magazine of May 23, 1988 that a New
York City man, although not licensed in any of the psy
chotherapy professions, is operating as a "lay therapist, "
and has built an enormous group therapy practice
through his own Center. He was sued for, among other
things, fraud, deceit, negligence, and intentional induc

tion of emotional distress. According to Pittsburgh
based attorney Peter Georgiades, who specializes in
litigation against harmful psychotherapy groups, the
man claimed his Center offered therapy, but it was in
fact "a scheme designed to make people pathologically
dependent, the antithesis of therapy. " Georgiades said,
according to this article "My client bought therapy and
was sold . . . a . . . program designed to make him depen
dent on the therapist and the therapist's group." The suit
also claims that the therapist interpreted the client's ex
periences in such a way as to "exaggerate his faults and
failings," making him feel "worthless, useless, and help
less" and "therefore in need of more of defendant's
group therapy." Other ex-clients said the therapist
allowed unpaid fees to accumulate and then let clients
work for him to pay off the debt, manipulating them into
a barter arrangement. This therapist also became bi
coastal with groups both in New York City and Los
Angeles and went into business with his clients, even .
becoming half-owner of a successful Hollywood talent
management agency belonging to one of his clients, and
allegedly exerting "undue influence, domination, and
control" over his business partner/client.
There are many cultish types of psychotherapy today,
practiced both by professionals, like those Wakefield
describes and like the founders of The Center for Feeling,
and by non-professionals. New types of psychotherapy
are constantly being invented by professional psycho
therapists, and there are so many non-professional psy
chotherapies, with new ones appearing all the time, that
listing them in a catalogue would be like writing an ency
clopedia, but the listing would never be comprehensive
or complete. Read your local newspapers and the Yellow
Pages of your telephone directory and you'll find adver-
tisements placed by people who claim to be mental heal

ers, counselors, hypnotists, spiritual health advisers,
and non-professional psychotherapists of every imagina
ble stripe. The systems for "cure" are based on the beliefs
of the creators and cannot be proven scientifically or by
demonstration. Some deliberately misrepresent them
selves as possessing medical or other health-professional
qualifications and skills that they lack. They are familiar
to cowboy movie fans as the phony doctor who sells his
tonic medicine from the back of his horse-drawn wagon;
but now they extend their claims to include psychologi
cal problems. Non-professional psychotherapists oper
ate using many titles. the term "counselor" may be used
by legitimate, professionally trained psychotherapists,
but in many states nothing prevents any amateur from
designating himself as some kind of counselor and start
ing a practice, holding himself out to the public for a fee
as a psychotherapist. Most of these non-professionals
don't have respectable motives for being in such a busi
ness, but some are sincere and genuinely want to help,
even though they haven't the formal education and train
ing to do so. Although professionals too can also harm
clients in many ways, it is safer to look for a professional
psychotherapist with recognized degrees and creden
tials and professional connections than to take the extra
risks that accompany someone without legitimacy.
Licensed professionals are required to follow ethical prin
ciples by their respective licensing boards and profes
sional societies. This is explained in detail in my book
How to Find a Good Psychotherapist: A Consumer Guide.
CHAP T E R 5
Psychotherapist or Lover?
D pist! Although you and your therapist may, in fact,

on't be sexually intimate with your psychothera
be in love- some therapists have even married their

clients-if you and he or she are sexually intimate,
whether it's in the office during your therapy session
and you pay for the time, or you meet somewhere else
and you don't pay, please tell someone you trust that this
is happening, and do all you can to stop yourself from
continuing.
You and the therapist are not equals in this relation
ship. You have consulted him or her because you want
help. The therapist is the authority, and therefore has
power over you. In most of these relationships the
therapist is a man and the client is a woman, and the
therapist may be in a double power situation. First, he is
a man, and second, he is a therapist, and when Dr. Smith
approaches you romantically, he is still Dr. Smith, and
nothing he or you can do can make him Mr. Smith. The
therapist is esteemed, educated, assumed to be responsi-
ble, and a man. He is saying to the woman, "Something

is wrong with you. I'm here to help you. Do it my way. "
Maybe most women seeking psychotherapy don't know
what happens in therapy, don't know what to expect,
but they certainly don't expect sex.
You are making a mistake to mix sex and psychother
apy, and you need someone to help you correct your
misjudgments. Few clients who have been involved with
their therapists in this way have felt that they benefited
from it or have felt better about themselves.
Clients commonly develop feelings of warmth, car
ing, and even affection for their therapists. Being alone
for almost an hour once or more times a week and talking
about your most personal and secret thoughts and feel
ings can bond the two of you together, often intensely,
especially if you feel cared about. If you're having a sex
ual liaison with your therapist, stop seeing him or her
immediately, and report this situation to the ethics com
mittees of the professional associations he belongs to
and the state board that licenses him, and chances are
that they'll intervene and the violation will stop.
Often clients who have a sexual relationship with
their therapists are not emotionally healthy enough to
understand that what they are doing can be harmful to
them. Often when a client begins therapy he or she is
confused, not feeling very strong emotionally, has low
self-esteem, and has many needs that are not being
satisfied. It is unfortunate that clients who are most vul
nerable are those whose situations become worse be
cause of therapist/client sexual involvement.
Psychologist Gary Schoener of the Walk-In Counsel
ing Center in Minneapolis, a member of the Advisory
Committee on Distressed Psychologists (psychologists
who are themselves having problems) of the American

Psychological Association, and who specializes in the
issue of psychotherapist/client sexual involvement, in
forms me that since 1974 when he began working with
clients who said they had sexual relationships with their
therapists, of the 1,000 people who have consulted him,
more than 80 percent were women with male therapists,
from 10 to 15 percent women with female therapists, 5 to
7 percent men with male therapists, and approximately
3 to 4 percent males with female therapists. In an article
of January 3, 1988, in The Philadelphia Inquirer reporter
Kitty Dumas quotes Schoener as saying that a warning
sign to look for is if a therapist is doing as much as or
more talking than the client. The roles seem to get re
versed, with the client seeming to be taking care of the
therapist. "The client is flattered," Schoener says "that
the therapist would trust him or her. Here this big-gun
professional picks them from his entire client load. " But
chances are you're not the only client he has selected out
of all the clients. Most therapists who approach their
clients about sex do so with more than one client.
Schoener continues that some people find it hard to be
lieve that they could ever be taken advantage of by a
therapist. As he tells us "Don't think of yourself now.
Think of yourself at your lowest ebb, when things don't
mean much any more. You don't have anything to hang
onto. That's when the sex occurs. It doesn't happen
when you're on top of the world."
"Patients Victims of LSD, Sexual Abuse" flashed the
front page Sunday edition of the August 28, 1988, Santa
Barbara News-Press with large color photos of the two
clients referred to. One client, a woman, Jeanne, the
newspaper reports, already "suffering from an eating
disorder, struggling to cope with a broken relationship
and past sexual abuse," became even more distressed
when the therapist she saw for a few months early in

1985:
" . . . made love to her, in his office and at local motels
. . . . infected her with a sexually transmitted disease
. . . . coerced her into buying him marijuana . . . .
taught her to file bogus insurance claims . . . . sug
gested that [she] bill her insurance company for addi
tional sessions that did not occur . . . . "
And he further complicated the situation by "renting
a house to her." This therapist, after having been first
licensed as a marriage, family, and child counselor
(MFCC) in California, after further education later re
ceived a psychologist license. Dual licenses such as this
are not unique to California but probably occur more
frequently in that state than any other. California is one
of only 17 states legally recognizing the profession of
marriage and family counselors or therapists (states vary
in using the terms "counselor" or "therapist"), and the
only state that adds "child" to the term. The history of
the California experience with legally regulating MFCCs
is explored more fully in my book How to Find a Good
Psychotherapist: A Consumer Guide. Through the years,
former loose requirements for MFCC applicants has led
to a present accumulation of 22,000 MFCCs in the state,
which is approximately 1/6 of the numbers of psychia
trists, psychologists, and clinical social workers in the
entire country.
Checking out the circumstances of Jeanne's case with
California Deputy Attorney General Sande Buhai Pond,
I learned that Jeanne sued the therapist, and that in May
1988 he voluntarily surrendered both his MFCC and
psychologist licenses, although he never admitted guilt.
Is there a "type" of woman who becomes sexually
involved with her therapist? That's like asking if there is
a type of woman who is raped. Schoener and psychiatrid

clinical social worker Jeanette Hofstee Milgrom, also of
the Walk-In Counseling Center in Minneapolis, and a
member of the Minnesota State Task Force on Sexual
Exploitation by Counselors and Psychotherapists, in
their article "Evaluating the Victim" (which is available
by contacting them personally at their Center), say that
clients involved sexually with their therapists are not like
each other in any classifiable way, and after 15 years ex
perience working with these clients, they have con
cluded that characteristics of therapists are the major fac
tors in determining whether a sexual involvement will
develop. In the vast majority of situations, therapists
have had sex with a number of clients, but clients have
rarely been sexually involved with more than one
therapist. Schoener and Milgrom say:
"If one were searching for the least single predictor
as to whether a client and therapist might become
sexually involved in a given community, thus far we
have only one which would have any predictive
value: the name of the therapist."
According to a study last year by Nanette Gartrell, a
psychiatrist at Beth Israel Hospital in Boston, 6 percent
of the 1,423 psychiatrists who were asked and who re
sponded said they had had sex with their clients. Many
defended their actions by saying that the affairs helped
the clients. A third of that 6 percent acknowledged hav
ing had sex with more than one client.
Schoener and Milgrom in "Helping clients who have
been sexually abused by therapists" (available by contact
ing them personally at their Center), talk about common
reactions clients have after sexual relations with their
therapists . There is (1) massive distrust not only of
therapists of the same gender as the one who exploited
them, but distrust of all therapists, and possibly even

distrust for family, friends, and others. (2) Most clients
feel guilt and shame, blaming themselves for what has
happened. There may also be guilt for having betrayed a
spouse or lover. Therapists are sometimes what
Schoener and Milgrom call "masters of guilt-induction,"
meaning that they know how to make people feel guilty,
and clients often take almost total responsibility for the
situation. Clients may even blame themselves for ruin
ing the therapist's reputation or for threatening his or
her career. Abusing therapists often interpret a client's
pulling out of the relationship as a violation of trust or
intimacy, or as an inability to "love" or "accept love."
Clients may be angry at themselves for having been vul
nerable and trusting, and rarely even give themselves
credit for being able to leave the relationship. They may
be embarrassed by what they later feel was an "adoles
cent" infatuation with the therapist, with one client quite
angry at herself for "having been so vulnerable, trusting,
and emotionally involved with such a venomous crea
ture." Because depression and low self-esteem are two
of the common reasons people seek therapy in the first
place, it is sad when the therapist's behavior adds to
these feelings. (3) Clients are typically confused, ambiva
lent, struggling with contradictory feelings of rage along
with gratitude, helplessness, vulnerability, disdain, and
pity. They are confused about the therapist's motivation,
and wonder if the therapist felt "true love" for them.
They're not sure if they would have found the therapist
attractive if they had met in other circumstances. They
often feel "special," but as we've said, most of these
therapists have had such involvement with more than
one client. They ask themselves: "Did he (or she) really
care about me?" "Was I just a sex object?" "Why me?
What attracted him (or her) to me?" "Is he (or she)
sick . . . or evil?" "What does this say about me?" (4) Con
siderable grief may be experienced over the loss of the
relationship with the therapist-the loss of an important
helper, supportive friend, lover, or all of these. Rather
than deal with this loss, some clients stay with the
therapist. (5) Clients feel angry about the violation of
trust, having wasted time, having left therapy with addi
tional problems, having been deprived of help when it
was badly needed, having been exploited financially,
and so on. They may at times be outraged that they still
feel somewhat in the therapist's power even after the
relationship has been severed. They may be angry be
cause of the effort needed now to file a complaint, and
about having to pay for more therapy with another
therapist. (6) Many clients experience fear. They're afraid
that the therapist still has power over them, or could
somehow hurt them; that if they file a complaint, they
will not be believed, that the therapist will deny the sex
ual contact ever happened, and that he will be believed.
They are afraid their spouses, family, friends, and others
will reject them for having been involved in an illicit sex
ual relationship. Although in most circumstances
therapists do not harass clients, and the client's fear of
reprisal is due to viewing the therapist as "larger than
life," in some cases therapists who have been members
of "psychotherapy cults" may encourage other clients to
harrass the complaining client.
Articles by Schoener and Milgrom, and books like
Sexual Dilemmas for the Helping Professional by Jerry
Edelwich and Archie Brodsky, published in 1982, and
Sexual Intimacy Between Therapists and Patients by Kenneth
Pope and Jacqueline Bouhoutsos, published in 1986,
review the topic of therapist/client sexual contact in
detail, and reference the research and writing and
resources available.
Schoener tells me that in Minnesota and Wisconsin,

sexual intimacy between therapists and clients has been
introduced into the states' criminal statutes as part of the
rape and sexual assault laws. In these states, as well as
in Michigan and Florida and possibly others, it is a felony
for a therapist to have sexual contact with his or her
clients. And in Minnesota, under certain circumstances,
it is even a felony to have sex with a former client. A
client is considered to be an ex-client, for the purposes
of the laws in these two states, for two years after termi
nation of therapy. The first circumstance is (1) if the
therapist has used "therapeutic deception," that is, if he
has led the client to believe that sex between them is a
required part of the therapeutic process, or that it is con
sistent with therapy-which means that it's all right. An
example would be a therapist telling the client "You need
to learn how to love, and we need to have sex so I can
teach you." The second circumstance is (2) if the client is
so "emotionally dependent" on the therapist that even
after the therapy is terminated the client is so influenced
and controlled by the therapist, perceiving the therapist
as being so powerful, that the client is vulnerable and
unable to refuse to have sex with the therapist. Even if
the therapist tells you "It's okay for us to get sexually
involved once we terminate," it's not considered legal in
Minnesota. And it's generally not ethical anywhere.
Four therapists have been prosecuted under this law
in Minnesota. Three cases have gone to trial, and the
therapists have been found guilty, have paid fines, and
been sentenced to and served prison terms. One of the
three has been deported because he was not a United
States citizen. The fourth case has not yet gone to trial.
In Wisconsin two have been charged, but both died from
illnesses -one during the trial, and the other before he
was extradited from Nevada.
What about such relationships that are apparently

healthy and that continue for many years or even result
in successful marriage? Interesting legal and ethical
issue, isn't it? Consider this recent situation in Min
nesota, where it is mandatory for licensed health profes
sionals to report any conduct by a physician which might
result in discipline or which indicates possible medical
incompetence, which includes sexual conduct with a
client. A psychiatrist referred his wife, who had previ
ously been his client, to another psychotherapist. The
psychotherapist refused the referral, but was obligated
by law to report the psychiatrist for having sexual rela
tions with his client, even though he didn't know if the
sexual conduct had begun while the woman was still a
client or when she was a former client before or after the
two year limit.
What about therapist/client pregnancies? Some end
in abortion, some children are given up for adoption,
and some are raised by the client. While the most com
mon pattern is for therapists to deny paternity, in a re
cent case in Anchorage, Alaska, the therapist admitted
paternity and offered to support the child financially, but
had to sue for rights to visit with his child, with the
judge granting visitation rights only if the visits were
supervised by a psychotherapist, and only if the father
of the child had professional help himself, because it had
been argued that his relationship with his client had
been a form of rape. If this had occurred in Minnesota or
Wisconsin, the father might have, in fact, been treated
like a rapist wanting to see the child who had resulted
from the rape.
I have talked with John Welsh, an attorney who is
Senior Counsel for the House of Representatives of the
State of Washington. He has been involved in the pass-
ing of what he tells me is a "model law" like no other in

the country. One part of the legislation has a sexual
abuse provision relating to all health professions in the
state, making sexual abuse of clients "unprofessional
conduct." Violators may lose their licenses and be fined.
Mr. Welsh says this civil law statute threatens offenders'
"jobs and pocketbooks." The State of Washington didn't
want to go the route of the criminal laws, as the states
Schoener worked with did, because Welsh said that he
thinks that few victims file charges. And to be convicted
of a criminal law, Mr. Welsh explains, it is necessary to
prove the violation "beyond a reasonable doubt," which
he said means it must be proven 75% to 80% . To be con
victed of a civil law, however, only a "preponderance"
must be proven, and that is 51 % . So, it is easier to convict
with civil law.
However, a therapist who loses a license in one state
may continue to practice in other states, such as the
psychologist from the Center for Feeling Therapy in
Hollywood, California, which I discuss in Chapter 4,
who after losing his license and being found guilty of
acts of gross negligence, incompetence, and client abuse
now practices in Aspen, Colorado and New York City as
a "personal coach" and "counselor," titles that do not
require him to have a license. Some abusers continue to
practice in the state where the offense occurred, using a
different title, as with the Santa Barbara, California,
psychologist who lost his license after a sexual relation
ship with one of his female clients and has resumed his
practice with a different slant-advertising in the news
papers that he is a "channeler,'' who can foretell the
future and contact the dead and so help people who
want his advice about managing their lives. Or the New
York City psychiatrist whose medical license was
revoked and who was sued by one of his female
clients with whom he had sexual involvement, who is

now still practicing in New York City under the title of
11counselor. 11
There are several consumer groups organized mostly

by clients who have been harmed by sexual involvement
with their therapists. Although consumer protection and
action groups can be helpful, a word of caution. Before
you become involved with them, be sure these people
have valid complaints and are not just the kinds of
people who complain without real reason about lots of
things; that they are not using this sensational issue to
become well-known and make television appearances,
or to write sensational books and make lots of money;
and are not leading you into more trouble through their
misjudgments.
While it is, of course, good that the problem of
therapist/client sexual contact is being given public atten
tion recently, it does not mean that psychotherapists are
finally admitting to and dealing with the fact that many
clients are harmed by psychotherapists in other more
subtle ways also. No one can dispute that a psychother
apist who has sex with his or her client should not be
doing that. This is not a professional service. So no psy
chotherapist would be afraid of being in trouble with
other psychotherapists for saying that sex with a client is
wrong. And, in view of the information relating to the
research and lawsuits, no psychotherapist can deny that,
in fact, it occurs.
But what about the other ways of harming that I dis
cuss in this book? My profession still does not acknowl
edge this problem or give it enough attention.
CHAPTER 6
Therapy ��ddicts"
I
f you've been in therapy for years you might be
addicted to your therapist, supporting an expensive,
non-productive dependency!
The ultimate satisfaction in a therapist's work should
come when a client reaches a good point emotionally, is
reasonably independent and autonomous, and leaves
the therapist. In "Prisoners of Psychotherapy," the
August 31, 1987, cover story of New York Magazine, author
Terri Minsky discusses therapists who discourage their
clients from ending therapy, thereby fostering depen
dency. She cites a typical scenario. After five years,
therapy sessions for Elizabeth "passed pleasantly, " and
were:
" . . . mostly idle chitchat. It was clearly time to quit
therapy. But when Elizabeth broached the idea with
her therapist, he would bring up some niggling
trouble, usually with her mother, a subject that was
always good for 45 minutes of discussion. "
Elizabeth would leave thinking "Okay, next week we'll

finish." This went on for six months. She knew her
therapist enjoyed her company.
"She made him laugh. She was a feisty patient. She
finally confronted him. 'I'm as healthy as I'm going
to get,' she said. 'You don't want me to quit."'
Some addict-creating therapists have monetary mo
tives. They might not want to let $10,000 a year "walk
out the door." There are clients who pay their therapists'
mortgages, and the therapists can't afford to lose them.
The article continues:
"It's easy to spot therapy addicts. They're the ones
who declare their emotions matter-of-factly and with
pride: 'I'm angry and I feel good about that' or 'I'm
upset, but that's okay.' They trumpet their therapy
appointments-'Sorry, I can't do lunch tomorrow,
I'm seeing my therapist' -and often serve as surro
gate therapists for their friends. Therapy addicts
don't say, 'I know just how you feel,' They say things
like 'Could that have something to do with your
mother?'"
One of my neighbors in Santa Barbara, an actress,
after reading my first book, consulted me about her long
time friend in Beverly Hills, a woman who has been see
ing a psychiatrist once a week for twenty years, becom
ing so dependenl on him that when he is ill and cancels
appointments she doesn't manage her days well. This
woman is bright, talented, and wealthy, was quite capa
ble of getting through life before she began therapy, and
would still be if she didn't believe she needed this psychi
atrist. Adding glamour and excitement to this situation
is the fact that when she sits in his waiting room she
meets some of the most famous entertainers in the world
. . . also his clients. The psychiatrist is now in his late 70s

and in failing health. What is she going to do when he
dies? Is encouraging her dependence ethical? Is it moral
to allow people to believe that they need psychotherapy
instead of guiding them toward discovering they can
take care of themselves- empowering them? Many
people are kept unnecessarily in a position of power
lessness and helplessness by their therapists.
Some therapists will use scare tactics, predicting that
if the client terminates, something unpleasant will hap
pen. "You'll be hospitalized," "You'll become very de
pressed," "You'll lose your job," "Your marriage won't
work." Or clients may be afraid their therapists won't
allow them to leave, or feel guilty that their therapists
need and are attached to them, or may feel obligated to
them. I know a young woman who was in individual
therapy for 10 years, beginning when she was in her late
20s and her woman therapist was 66. This client had had
an unhappy situation with her parents all her life. The
therapist, to her, had become the loving, protecting, per
fect mother. When the therapist went on vacation, she
would bring a present for the client. Birthdays would be
another occasion for gifts. The client responded by fre
quently bringing flowers and gifts for the therapist. At
least half of most sessions and sometimes entire sessions
would not be therapy at all, but the therapist would talk
about something important to her that had nothing to
do at all with the client. Each time the client attempted
to break away, the therapist would be sorrowful, telling
her that the client was "my rod and my staff," using the
biblical phrase to convey that the client was comforting
to the therapist. The client worried that the therapist
would be lonely or bored without her, or wouldn't be
able to pay her rent or eat well enough without the
client's fees each week. For 10 years this young, single
woman, who had been a graduate student at the start of

this relationship and later worked and supported herself
financially entirely in New York City where living is ex
pensive, gave up a large portion of her salary for
"therapy," while depriving herself. Need for affection
from this surrogate mother, and the guilt she would have
felt at being ungrateful if she had abandoned the
therapist/mother, stopped her from leaving.
A successful businessman in New York City who is
now a professional psychotherapist himself explains
how he came upon the notion that he was a therapy
addict, paying a high price for both individual and group
therapy with a Ph.D. male psychologist.
"The reason I stopped seeing him was that after 3
years in group, I realized 'I don't schedule anything
for Tuesday nights. On Tuesday nights at 6 o'clock I
find myself in front of his building. I think that if I
were half dead I'd find myself in front of his building.'
Why be there? You could go for the rest of your life
and it might not hurt. On the other hand, it really
wasn't terribly helpful. I had seen several things that
began to fall into place. I realized that there were
some people who had been in group for 10 years. I
had begun to believe that that was really irresponsi
ble. So I came to group one night and I said 'Folks,
this is it. I really don't feel that I want to be here
anymore. ' In my private session the week before I
had said that to him, so he said 'Why don't you say
that in group?' So, I said it in group and a couple of
people said 'You know, you're right. You participate
but you really seem to be in touch with what you
want to be in touch with. And we feel very good for
you .' Finally the entire group said that. Unanimously
the group agreed. But the therapist didn't. He started
Therapy ''Addicts" 61
very slowly 'Well, I think that you have problems and

you ought to continue to work them out in the
group. ' He tried to manipulate me into staying. He
played around with my head, and if I didn't have that
one extra little thing, if I had just been on the edge, I
could have fallen into his trap. But I walked out and
I've never been in contact with him since."
If after only a few sessions your instinct is to termi
nate and look for another therapist, don't let your
therapist convince you that the reason you want to leave
is that you're "resisting" therapy or "transferring" onto
him the negative feelings you have for some other
person in your life. If you're going to resist every
therapist, you'll know that eventually. If you don't like
the therapist, you're not likely to have a successful
experience.
One of my research subjects, an attorney whom I'll
call Arnold, was for 12 years, from his mid-20s to his late
30s, a client of a prominent Manhattan psychologist. The
attorney was exceptionally gifted intellectually as well
as artistically, and was sophisticated, having grown up
and attended law school in New York City. He tells us
about it.
"Dr. G. was a great guy. He was like a buddy type
person. Very "Brooks Brothers," witty, good looking,
more of a swinging type of person. A lot of warmth
exuded from him. I guess he represented to me what
I had been looking for all my life - a very close buddy,
a confidant. I had so much pent up in me that I was
happy to have someone to talk with. For quite a while
I would lie down on the sofa and talk and he would
listen and I guess take some notes. He sat behind
me. I never saw his expression. And then after a few
months I sat up and therapy was face-to-face. By that
time I felt very much at ease with him talking about

my personal and business life. That's when he began
telling me about his personal life, and soon he be
came the center of attention in the sessions, not me.
My 'therapy' had evolved into a friendship-for
which I was paying a weekly fee.
"At the time I thought it was the greatest thing in the
world because he was disclosing some very intimate
things to me. Using my own standard, I reasoned, I
would not discuss my personal life with anyone ex
cept a very close friend, and I was flattered, thinking
he considered me a close personal friend.
"One of the reasons I wanted therapy was because I
had problems with sex and women. But he didn't
help me with this. Instead, he told me about his af
fairs with women, kept impressing me with his own
exploits, and how great he was with women, and
how women chased after him. I guess I used him as
a barometer, as a measuring stick, as an example. He
had zeroed in on the very things I had problems with,
and he was highlighting my weaknesses. He eclipsed
me. The more he said he'd accomplished, the less I
found in myself, I felt even more lacking. He told me
that every Wednesday night he would fly to another
city just to make love to a woman and fly back to New
York the next morning. I thought this was very
romantic and wondered why this wasn't happening
to me. My image of what I considered a man was tied
in with this. He was what I wanted to be. He served
as a masculine hero, and then used it against me.
"Besides our private sessions, I also joined his group,
and I noticed that the type of clientele he had was
very much like myself-middle class, professional,
not wealthy, but they could afford their sessions. I
also noticed that he had quite a number of people

both in individual and group who were husband and
wife or living together. I've come to realize that that
was tragic. He was playing one against the other. This
is like having the balance sheet for Mr. Macy and Mr.
Gimbel and advising each one of them because you
know what the other side is thinking. But I was not
aware of this at the time, and he became my mentor.
He was like my brother, my friend. He replaced my
parents, domineering people I had succumbed to all
my life.
"I was hooked on him. He took over my life. He made
me believe that I could do nothing without consult
ing with him. That his way was the best way. He
never allowed me to bring in my own ideas. He al
lowed me to depend upon him for making all my
decisions. Where will I buy my clothing, where will
I get my haircuts, where will I go to dinner, whom I
should date, where I should go on my vacations? I
kept mimicking, parroting him, wanting to be like
him. But this was impossible. Who could be him?
Each one of us is an individual. I would never make
a move without getting clearance from him. I fol
lowed his instructions. Eventually I wasn't able to
move on my own. I realized that I was the biggest
child in the world. He never said 'You've got all this
in you. Go out and do it and stop coming here and
asking me all these little things. You can do it your
self.' He didn't say 'How do you feel about that?' or
'What do you think you should do?'
"There seemed to be a role reversal. I seemed to be
his crutch. He would tell me that he was out with this
babe and it was a great place and I should take my
date there and I should buy her a certain kind of
flower and a certain kind of perfume and play a cer

tain kind of music because women go for that. I was
a clone. He was like the older brother I never had,
and I would do anything to be just like him. And he
was encouraging me to be just like him, a mirror
image of him, to test his worth, to validate himself,
because the more people he could get to be just like
him, the more he would satisfy himself that there are
people with a certain taste who are not schnooks and
if they want to be like him then certainly he must be
wonderful. He really needed help himself.
" I remember comparing notes with several of his
clients. We all went to the same barber, we all wore
the same clothes, we all did the same things. When
it was his birthday we would love to bring him some
thing. When I had my session and it was lunch hour,
I would bring a sandwich for him and me and he
would never offer to pay, as if to say I should be
thankful to feed him.
"He introduced me to a client of his who was an attor
ney also, and this person became my employer and I
got paid and I thought that this was very nice of Dr.
G . to do-to find me extra employment. But then I
realized that all he was doing was making me more
beholden to him unwittingly. And he was also pro
viding me with the money to pay for his sessions.
And it was giving him more source of information
about two of his clients because we would both talk
about each other in our sessions. He knew about me
from the other attorney and he knew about the other
attorney from me. He had quite a network like this.
He introduced clients socially and they would date
each other. He was controlling everyone. Everyone
spoke about him with such adulation.
"I began living with a woman I cared about. For 12

years he had gotten me to break with everyone who
had a hold on me-parents, friends, girl friends. He
told me that I should tell this woman that he had
advised me to have experiences with many other
women. She was absolutely thrown by that, and she
should have been, and she left me. Dr. G. had influ
enced me to end another important relationship. I
was upset. When I talked with my former girl friend's
friend, who happened to be a psychotherapist, she
said she was concerned that I was seeing someone
for so many years and that seeking a consultation
with someone else might be a good idea.
"When I told Dr. G. that I had gone to see someone
else he exploded. I had been afraid to tell him. I had
never experienced such fear about telling anyone any
thing. Wow, did he blast me for 45 minutes! He said
'How dare you question my motives? No one has
done more for you than I have. And you have the
nerve to even think of going to someone else. ' I de
cided to discontinue private therapy and stay with
the group for six months and phase out. The final
night before I left, he blasted me as the group
watched and listened with 'Go to hell. Who do you
think you are?' I left a cripple, in many ways worse
than I had been before."
Arnold was and still is furious, but has resisted the temp
tation to bring a malpractice action for fear of damaging
his own reputation as an astute lawyer.
CHAPTER 7
Your Reality or Mine?
I that of your therapist? Just trading your reality for

s psychotherapy just exchanging your personality for
his? How accurate is the therapist's sense of reality?

Our perception of reality is colored by who we are,
by our own unique experiences, by what we've learned
in our lifetimes. No two people see the world pre
cisely alike. But when psychotherapy clients differ with
their therapists about what is reality, the unequal bal
ance, with the therapist supposedly the expert, can be
disastrous.
The best way to illustrate how you and and your psy
chotherapist can struggle over the issue of "Your reality
or mine?" is to have former clients tell you in their own
words about their experiences. About how therapists
with unhealthy personalities or those who lack the tech
nical skills for competent psychotherapy can hurt you by
challenging what you believe is true. Your therapist is
just a person, and what he believes to be true may, in
fact, be false, may be rooted in his personal mispercep-
tions or inadequacies. And if he gets angry if you differ

with him, thinks he's an absolute authority and can
never be wrong, this is not the kind of person you want
to take with you on your journey into your feelings.
Although the clients quoted below initially had un
successful, harmful therapy, they subsequently did have
helpful therapists, and all have had positive life changes
and are enthusiastic about the merits of helpful
therapists.
One woman, now an executive for one of the top
advertising agencies on Madison Avenue in New York
City, tells us how when she was 21 years old her tenuous
hold on her confidence was shaken by a Ph.D. male
psychologist.
"If I disagreed with him about his interpretation of
what was happening with me, he very often would
not even deal with it, not even entertain the notion
that my interpretation might be valid. As he said 'Do
you want to listen to me? I'm the therapist. If you
don't want to listen to me then I can't help you."'
An affluent businessman in New York City had his
life disrupted and his marriage nearly ended by his
Ph.D. male psychologist's misconception of the client's
marriage and how to deal with it.
"He suggested that it would be a good thing for my
wife and I to split up, so we did. I think that's irre
sponsible and harmful. I'm willing to bet that there
are people who got divorced who might have been
able to work things out amicably. When you're shop
ping for a therapist, avoid anyone who tells you what
to do."
A 21 year old woman was, conversely, told by her
New York City Ph.D. male psychologist to stay with her
husband, and to take the blame herself for their unpleas

ant situation.
"I felt that he was siding with my husband, that it
was a male-female kind of thing. I would describe
the situation and expectations that my husband was
having that I felt were unfair and in some cases out
rageous, but his point of view was that it wasn't un
fair. He was prejudicial, I felt. I believe that I would
have left my husband a lot sooner than I did because
he kept making me believe that the reason the re
lationship didn't work was that it was my fault. He
deflated my confidence in my judgment. That's some
thing I've been particularly low on for most of my life.
I had my mother and a lot of aunts and cousins who
lived in the same building who all told me the same
thing 'What you're thinking and you're saying is in
correct. It is not right.' Not only did he not push me
in a forward direction, but as a result of my sessions
with him I was more emotionally paralyzed than I
might have otherwise been. He made me question
my own judgment even further than I already had."
She continues that she was trying to stay in the here and
now, dealing with issues critical to her daily survival,
planning constructive action in her life at the moment,
but he was interested in her childhood.
"He would always want to talk about my family, my
parents, when I was younger. But often I wanted to
talk about my career, which was going nowhere at
the time, and my marriage, which was going less
than nowhere at the time. And he would out and out
tell me that I was changing the subject because I was
being 'resistant.' I wasn't trying to resist, I just
needed help with the realities of my everyday life."
She explains:
"He told me that I felt uncomfortable with him be
cause, he said 'You're projecting me as a father
figure,' meaning that he thought that because I had
been uncomfortable relating to my father, I had
generalized the same feeling to men who seemed to
me to be father figures. It may have been true. But
the point is that I find it eminently non-useful. This
is what he would do, what he called therapy. Sure,
we all have childhood things that we carry with us,
we've all got a little kid in us. Maybe, partly, my prob
lem was resolving certain childhood conflicts, but
principally I needed a handle on how to function
after I got up in the morning. I didn't need to live in
the before and the yet-to-come. He was not giving
me what I really needed. He was trying to fit me into
his mold of 'Here's how I work as a therapist,' saying
to me 'Now you fit in here,' rather than saying 'Here's
my client. Now what does she need?"'
A man with a college degree in fine arts, who sup
ports himself luxuriously today as an artist with his own
gallery, warns of the danger of getting lost in the abstract
world of ideas and not focusing on the present, as taught
to him by his female psychiatric/clinical social worker in
Los Angeles .
"She asked m e to bring in my dreams, and insisted
that we analyze them. Her way of doing therapy was
to work a lot with material from the unconscious
dreams, symbolic interpretations of behavior. But the
amount of material was overwhelming and the con
tinual dealing with the material of the unconscious
as a way of dealing with reality instead of dealing
more directly with reality was frightening.
'l\nd for me it was during a time when I was having

a lot of problems with just concrete reality and work
ing with all this material seemed to make me feel
overwhelmed by mystical events and by events that
were far beyond my comprehension. Sometimes in
trying to interpret a dream she would ask me ques
tions that I did not have the answers to and when I
could not come up with the answers she tried a vari
ety of different techniques to try to lead me to the
answers, but she rarely accepted that I was unable to
understand the dream beyond that point at that time.
The result was that I would sit in a session sometimes
with considerable anxiety for maybe 10 or 15 minutes
and be very upset with myself for not having come
up with the answer or an answer or a better under
standing.
'l\fter I would leave the session I would continue
while driving home to think very much about the
problem posed. It was as though I could not leave the
experience of the therapy. I would carry away the
feeling that I was unable to solve these problems.
One time on my way home from therapy I got into an
auto accident. I was feeling a lot of anguish and a lot
of pain over an issue that was very confusing for me
and I wasn't able to solve. It was controlling of her to
not accept that I did not wish to pursue a symbol in
a dream in the way she wanted me to.
"When I told her I had to end therapy with her be
cause I was having a difficult time making a living
and was offered a job in another city and had to
move, instead of supporting my leaving her, which
was based on the very practical reality-rooted con
cerns of money, she dramatized the danger of leaving
her and searching out another therapist. I had ab-
dominal pain from the stress for the five months I

saw her until I found another therapist."
A psychiatric social worker currently in the private
practice of psychotherapy could have a far different life
style today if she had listened to her female Ph.D.
psychologist in Boston at age 19.
"I was having sleeping problems, and she told me
'Obviously, the pressure of school is too much for
you, and you should think about leaving college.'
Which was a crazy thing. My mother was dying.
There were so many other things that had nothing to
do with school. I was getting all A grades in school.
School wasn't the problem. Now in retrospect, I've
finished graduate school. Even though I had seen
her once a week for six months, she didn't know me
at all."
A woman client, now a prosperous writer, whose
New York City male psychiatrist kissed her romantically,
quickly found a female psychologist and told her what
had happened, thinking she would probably not be be
lieved because the client's word is seldom taken as fact
when disputed by the therapist. But the second therapist
did believe her, and the therapeutic relationship estab
lished was significant in helping this client achieve a life
now much happier than ever before.
"When he kissed me very hard on the mouth, I had
the sense that one little move and he would have
gone crazy. I told some people, but they made me
think that it was me. That I had seduced him, or they
didn't believe me and they said, 'Do you quite re
member what happened?' And then I got to see the
woman psychologist, and I told her what had hap
pened with him. I said 'I think he wanted to go to
bed with me.' And she said 'Yes. I think so, if that's
what you think. The fact that you think that was
going on -it was probably going on.' She thought it
could even be understandable. Not that he was cor
rect in doing that, but that I was an attractive woman
and he might be turned on. And that if I reported it
that way, then that was probably an accurate report.
I remember being extremely moved that she accepted
it and accepted that it happened the way I reported
it.
If
Another woman client, also a professional psycho

therapist herself, describes the ending of her year-long
therapy with a male psychiatrist who at the time was
Director of a highly esteemed psychotherapy training in
stitute in Chicago.
"During the course of my therapy I had discussed my
relationships in high school with men where on sev
eral occasions when I liked a man I would phone him
and hang up. That was something I had done as a
teenager, and at the time I was in therapy with him I
was 26, a licensed social worker, and married .
"Somebody apparently was calling him and hanging
up and he started to accuse me of doing it. It was
very clear that his misperceptions and fantasies were
getting in the way because he would not accept that
I was not doing it, and he kept insisting that I had
romantic feelings for him. For several weeks I was
paying for sessions and he was accusing me of doing
this to him. He wouldn't believe me. Whenever we
discussed it, he turned everything I said around so I
didn't even recognize it anymore, and he made his
case to try to prove me wrong. He had his own mind
that he was a right and I was a wrong person. He
didn't use good judgment. I wrote him a letter telling
him I wasn't going to see him anymore, and I never

did."
A woman client had an adversary relationship with
her Ph.D. male psychologist in New Jersey, staying with
him for 2 years, even though he was frequently wrong
about finding motivations for her behavior and would
argue with her that he was right and she was denying
or resisting the real reasons she did what she did. For
example.
"I had been going to him in the afternoon but I
changed jobs and needed a change of hours because
I now had a job that did not end until 6:00 in the
evening and could not have afternoons free. Instead
of just changing my appointment time, his conten
tion was that, supposedly, I was unwilling to con
tinue in therapy, and my unwillingness was forcing
me to force him to change my hours. I knew that his
interpretation was unrealistic."
In 1963 a prominent psychiatrist in New York City
who charged $75 an hour-more than some people were
earning in a week- told a young man:
"You'll never be able to function as we know it in
society. Unless you get help three times a week,
you'll never make it."
He was wrong. This man today is head of a happy family,
and one of our leading comics in films and television.
Give Me A Hint 75
CHA P TER 8
Give Me A Hint
"He seldom said a word to me. Mostly he just nod

ded his head. When he did speak it was usually just
'Um hm.' Sometimes he would say 'How do you feel
about that?' And he always said 'Thank you' when I
handed him my check. One day a year after I began
with him he was a few minutes late for our session.
I walked into his office, and sat down, facing his
empty chair. That's when I realized - I had gotten as
much help from talking with him as I would have
from talking to his empty chair."
Julia had been paying for a service that hadn't been ren
dered to her. This psychotherapist had been taught to
avoid guiding his clients in any way: to not offer advice,
make suggestions, actively interact with, or even talk
with his clients. Julia, a 23 year old, self-supporting
graduate student, spent money for psychotherapy that
she should have used to feed herself more substantially
in order to try to do something about the anxiety that
was interfering with her work. She was shy and not
aggressive, and although she wasn't satisfied with what

she was getting for her money, she had never told her
therapist that she had wanted him to say something to
her, to join with her in her struggle, to plan some way to
deal with her problem. She had just passively accepted
that this must be what therapy is. After all, his office was
on Central Park West in New York City where he was
part of the staff of one of the finest psychotherapy train
ing institutes in the world. It must be her problem if she
wasn't benefiting. Maybe nothing could help her.
But during the year, sitting in the waiting room, she
had listened to other clients talking about their thera
pists. Other therapists on the staff apparently talked.
They smiled and even laughed sometimes. They seemed
to be persons with their clients. Julia had felt all alone
with her therapist-she wanted some comfort too. She
began reading books about psychotherapy, trying to
understand the process. There were lots of ways to do
therapy, she learned. What did Dr. C. think he was
accomplishing by sitting back in his chair and silently
staring at her for 50 minutes a week?
She knew she didn't want someone who would domi
nate her or rigidly direct her. And she didn't want bad
advice-that would be worse than no advice. She
wanted her independence, to learn to master her world
herself, make her own decisions. But she needed some
one's response, someone's feedback, some direction,
some information so she could make the best decisions
for herself. She wanted a therapist to at least give her a
hint.
In different ways, clients complain about their
therapists' extreme passivity. As one client put it:
"He didn't talk. He had this idea that I was supposed
to solve my own problems, and I went home after
Give Me A Hint 77
each session and wondered if I had to ride all the way

out to New Jersey every week to talk to myself."
Others tell us:
"He just sat there like a lump on a log making the
'M-m-m' comment. We had no kind of reasonable
human interaction. If you can't interact and you can't
relate then, not only aren't you a therapist, but you're
not a human being. If you're going to say that you're
a therapist giving something to somebody, I think
that you have to give something. What you give is
you give of yourself, or your strength, or your ideas,
or your insights, or whatever else is appropriate. But
you have to give something. You can't just sit back in
your chair."
"He was terribly distant. I took his not relating as
being a kind of mystical, god-like quality, that some
how he was doing something that in my ignorance I
could not understand. And it was something that
was totally my own problem. Not only was I not func
tioning the way I fantasized that I should be function
ing, but I couldn't even understand my therapist
what he was doing. My reaction was that not only
did I come in not feeling well, but I was worse be
cause I went away feeling 'My God, I'm really terri
ble. I'm really sick. Because I can't even understand
! can't even function with my therapist.' The therapist
is supposed to be the person you function with. He's
supposed to understand you. It wasn't just like you
meet somebody on the street and the person doesn't
talk to you and you don't hit it off with that person.
It wasn't that kind of a chance interaction. Here was
a specific relationship which was supposed to be ter
rific and was supposed to have communication, was
supposed to help you grow. And none of that was

happening."
"I wanted interchange with a human being. Therapy
to me is kind of like nurturing a flower, nurturing a
plant. He wasn't helping me develop as a person,
wasn't allowing my human parts to come out. A good
therapist is a kind of balance between a human being
and someone who can guide you through the
difficult things that people have to go through. A
kind of almighty gardener who can really help you to
grow, to blossom. "
"He tended not to speak very often. He never pro
vided direction or 'What do we do from here?' 'What
can you do about this?' I didn't want him to be my
friend. I didn't want to go out to the movies with him
on Friday night, but I wanted a relationship that was
professional in nature. Many therapists hold their
clients at a distance, and if clients remain at that dis
tance they will be held at that distance. "
"I found her very intimidating, very cold. There was
very little interaction. I felt like I was speaking and
she very rarely gave an opinion or asked a question.
I needed more dialogue going."
"He wasn't a good model for me. He didn't give me
a real picture of what a person should be. He was this
strange non-understandable being."
CHAPTER 9
Researching Harmful
Psychotherapists
P for Studies in Values and Human Behavior, Brigham

sychologist Allen E . Bergin, Director of the Institute
Young University, is co-editor with Sol Garfield of the

Handbook of Psychotherapy and Behavior Change, a standard
reference used by researchers of psychotherapy, and a
good source of information that will lead you to research
that has been done not only about harmful psychother
apists but about all other topics in the field of psychother
apy. Bergin, a major researcher among the few who have
written on the subject of harmful psychotherapists, says
that some clients are worse after psychotherapy, refer
ring to this as the "deterioration effect."
Writing in the popular magazine Psychology Today in
November 1975 on the topic "Psychotherapy can be
dangerous," he says:
"Suppose every psychotherapist had a sign over his
door that read: 'Psychotherapy may be harmful to
your mental health.' That might not stop everyone,

but it would make many people more careful, which
wouldn't be a bad idea . . . . Evidence from empirical
studies and personal reports from former patients
indicates that some psychotherapists, like some
drugs, should be banned, and that some forms of
therapy should be dispensed only under the most
careful controls. "
He quotes Michael Scriven, a member o f the Amer
ican Psychological Association's Board of Social and Ethi
cal Responsibility, as having questioned "the moral jus
tification for dispensing psychotherapy, given the state
of outcome studies which would lead the Food and Drug
Administration to ban its sale if it were a drug." "Unfor
tunately," says Dr. Bergin:
"there is no equivalent of a Food and Drug Adminis
tration to monitor therapies and therapists for effec
tiveness. There is no psychological FDA to root out
unproved claims or dangerous practices. University
selection procedures, professional societies, and
state-licensing laws help, but they don't exert much
control over the therapist's personality and
technique. Until they do, let the buyer beware."
Hans H. Strupp, Distinguished Professor of Psychol-
ogy, Vanderbilt University, is the other major researcher
of what he calls "negative effects" in psychotherapy.
Strupp, with Suzanne Hadley and Beverly Gomes
Schwartz, reported in 1977 on a survey of 150 eminent
psychotherapists and researchers, in which 70 of these
experts responding to the questionnaire said "Yes" to
the question "Is there a problem of negative effects of
psychotherapy?"
Strupp clarifies that it is not psychotherapy, the pro
cess, that is harmful. Rather, it is the people who do
psychotherapy, the psychotherapists, who as Strupp

writes are "practitioners who somehow failed to do jus
tice to their craft. "
He says that therapists may see negative personality
factors in other therapists, but not in themselves. In Psy
chotherapy For Better or Worse: The Problem of Negative
Effects, co-authored with Hadley and Gomes-Schwartz
and funded in part of the federal government's National
Institute of Mental Health (NIMH), Strupp writes about
the therapist's personality as a factor in the worsening of
a client's condition. Among possible "noxious personal
ity traits" he cites ignorance, exploitiveness, coldness,
obsessional analyzing, excessive need to make people
change, excessive unconscious hostility, seductiveness,
lack of interest or warmth, neglect, pessimism, sadism,
absence of genuineness, greed, narcissism, lack of self
understanding. He says that harm can also be the result
of the therapist's "misapplications or deficiencies of
technique. " This includes "technical rigidity" of the
therapist who is inflexible, insecure, and essentially a
"technician" rigidly following rules of procedure. The
client's individual characteristics and needs may not be
given sufficient consideration, or the client may be en
couraged to perform certain "standard" behaviors, for
example, aggressiveness, which conform to the
therapist's definition of mental health.
It has been my observation that some therapists teach
their clients to become preoccupied with intrapsychic
phenomena to the neglect of outside reality and con
structive action in the outside world, and their clients
become lost in their heads in the world of ideas. Others
overuse interpretation so this becomes an end in itself,
and give erroneous or destructive interpretation. Some
therapists encourage dependency in their clients, enjoy-
ing being needed and being powerful. Some therapy is

overly intense, with clients being "pushed" to change by
therapists. Therapists can get too close to clients who
cannot tolerate such closeness. Therapists may have
negative feelings toward their clients which can interfere
with therapeutic effectiveness. Even the father of psy
choanalysis, Sigmund Freud, recognized and acknowl
edged that the personality of the therapist might play an
important part in therapy, and he introduced the concept
of "countertransference" to account for obstacles to
therapy contributed by the therapist's personality and
interfering feelings and attitudes toward the client. He
recommended a "training analysis" for all psycho
analysts -that all analysts should themselves have
analysis so they might understand themselves-in an
attempt to eliminate harmful influences. Some psycho
therapists harm their clients just by being who they are;
others from lack of technical skills.
An example of inadequate technical skills is given by
existential humanistic psychologist James Bugental, au
thor of Psychotherapy and Process, and one of the founders
of the Association for Humanistic Psychology. Many psy
chotherapists, he writes, concentrate on working out a
systematic account of the client's emotional reactions and
how they correlate with the theoretical beliefs of the
therapist's approach to personality. In such therapy, he
says, the client often attains extensive knowledge (mis
called "insight") about himself, but little effective "inner
vision," which is a vital sense of one's own intentions
and powers in directing one's own life. Bugental refers to
the "whodunit" strain in much psychotherapy in which
a logical and coherent "interpretation" of the client's life
is sought by the therapist and then is "carefully taught
to the client in the expectation that change or 'cure' will
result." The futility of "second-hand insight" is seen in
the many people who "can talk endlessly about their

childhood, their complexes, and their defenses
but . . . are not fundamentally changing to an enriched
life experience . . . . "
There are also practitioners who are simply unqual
ified, inept. The other story in the previously cited sensa
tional headline by reporter Woody Behrens from the
August 28, 1988 edition of the Santa Barbara News-Press
dealt with Michael, a male client in therapy with a male
therapist. Its opening sentence states:
"His mind was frazzled by LSD. His world had been
reduced to a motel-room closet. Every hour on the
hour, every night for nearly two weeks, the ringing
of alarm clocks jangled his frayed nerves and jolted
his tortured body . . . [He] trusted the man who called
it therapy. "
His therapist, writes the reporter, gave the client LSD,
which Michael voluntarily took; put him in a closet, and
the clock was set according to the therapist's instructions
for the purpose of depriving Michael of sleep. California
Deputy Attorney General Linda Vogel handled this case.
Michael, now 40, saw this therapist 16 years ago in 1972.
At the time the therapist "misrepresented to [the client]
that he was a licensed marriage, family, and child coun
selor, when in fact, he was not licensed as such until
August 1973 . " The therapist later on after more educa
tion acquired a psychologist license. A major point here
is that at the time the therapist was seeing Michael, he
was not a professional psychotherapist, was not legally
regulated as such. As a consequence of the complaint,
the therapist was ordered to surrender his MFCC
license. Michael sued him, and in 1985 settled out of
court for $17,000. Tom O'Connor, Executive Director of
California's Psychology Examining Committee, informs
me that a complaint against the therapist had also been

filed with the psychology licensing Board in the early
1980s before he was licensed as a psychologist, but the
action was taken against him when he applied to become
a licensed psychologist, and on July 16, 1987, when the
Board found him to be qualified, a license was issued to
him but he was put on probation for a year. Now a year
later he is a licensed practicing psychologist in Santa
Barbara.
I must make clear that the therapist's personality or
his technical skills are not the only possible cause of un
successful or ineffective psychotherapy. Some clients
would get worse with any therapist as well as without a
therapist. We don't know enough yet about what makes
people distressed or how to help everyone.
E. Fuller Torrey, clinical and research psychiatrist in

Washington, D.C., who for four years was Special Assis
tant to the Director of the federal government's National
Institute of Mental Health, clinical psychiatrist at St.
Elizabeth's Hospital in Washington, D.C., is affiliated
part time with the Public Citizen's Health Research
Group, has been a contributing editor to popular
magazine Psychology Today, and is author of Witchdoctors
and Psychiatrists, writes:
"Many therapists have therapeutic personality
characteristics and deliver competent and caring ser
vices. Others, however, migrate to psychotherapy be
cause of their own problems and are ill suited to
help."
I too believe that our profession attracts some students
who have emotional difficulties, and our schools do not
screen them out. Rather, most schools granting degrees
in psychology use numerical scores on the Graduate Re-
cord Exam- tests of mathematical and verbal abilities

to choose those who will become psychologists working
as psychotherapists. Schools training psychiatric/clinical
social workers, psychiatrists, and others who become
psychotherapists do not do much better in choosing their
students. They too do not screen out prospective stu
dents who have emotional difficulties likely to interfere
with their work with clients. A therapist needs a healthy
personality, the ability to get along well with other
people as well as a thorough grasp of psychotherapeutic
techniques. Really the only tool the psychotherapist has,
besides some technical know-how, is the "self;" who he
is, his personal qualities, the total blending of his percep
tions, feelings, thinking, sense of reality. The total envi
ronment created by the therapist such as qualities of
mind, temperament, values, philosophies, that is, any
thing that affects the client.
Many psychotherapists have emotional problems
that interfere with their effectiveness. I remember one of
my co-workers, a psychologist, who thought that all of
her clients were angry and needed to "get it out." Actu
ally, she was angry herself, but denied it; unaware of her
own anger, she thought others were angry instead. In
fact, she denied so much in her life that all through the
months she was dying from cancer when I visited her at
home she would tell me she'd see me back at work in a
few days, never acknowledging the fact that she was
dying. Another psychologist I know acts out an image of
what he wants to be, rather than being the person he is.
He is pompous, arrogant, and pretentious; his clients
feel misunderstood and not cared for. In fact, he is un
able to care or to have many authentic feelings.
A psychiatrist I used to work with gave the same diag
nosis to nearly all of his clients, not realizing he was
describing himself, not his clients. Another psychiatrist

walks down the street and instantly diagnoses people.
He knows someone for 30 seconds and he tells me "That
man is obviously paranoid schizophrenic. " And he
doesn't keep confidences. He talks about his clients.
Quite often therapists dodge responsibility for their
failures, blaming their clients with variations of the exp
lanation "He's not amenable to treatment," meaning that
the client is unable to benefit from therapy. When, as
frequently happens, the client also blames himself, the
client is truly the victim.
I recall a very funny comment by psychologist Harold
Greenwald, Founder and Director of the Direct Decision
Therapy Institute in San Diego, California; Clinical Pro
fessor of Psychiatry, University of California, San Diego,
School of Medicine; President of the Division of
Humanistic Psychology of the American Psychological
Association; author of several books, and co-author of
The Happy Person, in which he pointed to the arrogance
of many therapists and the common alliance that they
use to protect themselves from responsibility for unsuc
cessful therapy by blaming the client for failures. He said
"It's great being a psychologist. I never have failures
only resistant patients."
Many mental health professionals are what I call
"pathology hunters." They look for "sickness" in clients
instead of looking for health. I recall from my internship
days in clinical psychology a statement made by another
intern who, responding to the model set for her by our
instructors and supervisors, said disappointedly after a
morning of attempting to interpret results of psycholog
ical tests she had given a 13 year old boy, "I've been sit
ting here all morning looking at this test material and I
can't find anything wrong with this patient. I must be
doing something wrong. " She knew that she would not
please her supervisor if she said that she thought the
boy was basically "normal. " Her supervisor told us both
the week before "The only potential man has is for
destruction." It seems that if students talk about disease
and pathology, they're told they have good clinical ability
to diagnose; to talk about health and positiveness is
often discouraged.
This negative slanting is dangerous. A pathology
hunter might make the interpretation that someone is
"withdrawn into a fantasy world," when, in fact, he is
really "imaginative. " Instead of saying that someone is
"creative," he might be seen as "out of touch with real
ity. " What the therapist considers normal or abnormal
may have more to do with his perceptions than with
your behavior. You've surely observed how often in cour
troom battles psychiatrists for the defense are con
tradicted by psychiatrists for the prosecution on the mat
ter of the defendant's sanity. You don't necessarily need
therapy just because you phone a therapist for an ap
pointment, but probably most therapists would believe
you do, or they would say you do to get your business.
The mere fact of arriving at the admitting unit of a
psychiatric hospital will almost always get you a
pathological diagnosis you don't deserve and will proba
bly get you admitted because staff may think that just
because you're there you must be psychologically dis
turbed. D. L. Rosenhan, professor of psychology and law
at Stanford University, which has been called "the Har
vard of the West," writing in an article appropriately
titled "On Being Sane in Insane Places," published in
Science, January 19, 1973, tells about an experiment he
conducted in which eight people, including himself, one
graduate student, three psychologists, a pediatrician, a
psychiatrist, a painter, and a woman who was a home

maker voluntarily presented themselves to the admitting
staff of various psychiatric hospitals, pretending to have
only one symptom, that of "hearing voices" of a vague
nature, and otherwise behaving normally. They had not
given their actual names, and the mental health profes
sionals reported that they worked in other occupations,
but all other information given was accurate. They were,
to their surprise, admitted to the hospitals without even
being offered alternative plans to assist them. After ad
mission they stopped pretending to have this symptom.
But although many patients in these hospitals sus
pected that these researchers were "normal," and were
probably journalists or professors "checking up on the
hospital," the staff continued to believe they were men
tally ill, interpreted their behavior as if it were related to
the supposed mental illness, and when they were dis
charged the diagnosis, the "label," remained, with the
hospital records stating the mental illness was "in remis
sion," that is, the symptom was gone, but the patient
was expected to behave as a mentally ill person again in
the future, that is, to be always mentally ill. Such is the
bias of the mental health system toward illness rather
than health. Any diagnostic process that can so easily be
in error cannot be very valid.
There has been a 350 percent increase in adolescent
admission to private psychiatric hospitals, from 10,765
in 1980 to 48,375 in 1984, and a similar growth of medical
corporations and enticing advertisements. In the
February 1988 issue of the American Psychological Asso
ciation Monitor, an article titled "Is Your Teen Moody?
Misleading Ads May Lead Parents to Commit Teen
Unnecessarily," begins with:
'"Is your teenager moody and depressed?' the ad in

quires. 'Is she rebellious? Is he having trouble in
school? Is he an underachiever?' As any parent of an
adolescent knows, the answer to at least one of these
questions is likely to be a resounding 'Yes.' Such ad
vertisements, now appearing on television and
radio, in newspapers, and on subway posters, usu
ally include a phone number to call for more informa
tion, and are crafted as offers of help. Placed by pri
vate psychiatric hospitals, they are also solicitations
for business. The ads have alarmed a number of
psychologists, who see them as targeting behaviors
that are normal signs of the turbulent teen years,
rather than pathology. They fear that concerned and
desperate parents will be persuaded by profit
oriented institutions to place these children unneces
sarily in restrictive, residential treatment centers."
There's lots of money to be made by the owners of these
hospitals, with a low investment yielding a high profit.
Insurance companies are partly responsible because they
are more likely to pay for hospitalization than for out
patient care.
'"Scare' advertising, " the article continues, "is an un
fair and deceptive practice which is expressly forbidden
by the Ethical Principles of Psychologists." Advertising
which doesn't inform consumers about their choices is
also misleading. The fact is that inpatient care, that is,
care given when the client is in a hospital, has not been
proven to be more effective than outpatient care. In fact,
it may be harmful to the clients to be imprisoned, and
harmful to have a history of having been committed to a
"mental hospital. "
Hypnosis is another perilous area. It too can either be
helpful or harmful. Psychologist Frank MacHovec in
Richmond, Virginia has written a book about what can

go wrong. Some clients should not be hypnotized; they
have personality characteristics that make hypnosis
dangerous for them. Clients who have had trauma from
early life, for example from emotional, physical, or sex
ual abuse, or from adult experiences, from wars, crime,
or painful relationships with other people, may have
problems during or after hypnosis with what MacHovec
calls "mental unfinished business" which can be exacer
bated by the words or actions of the hypnotist. Some
hypnotists have personal characteristics that may harm
clients, or use the technique in ways that can cause
harm.
Don't use "auto-suggestion" tape recordings or tape
recordings advertised as influencing you below a con
scious, or what is called a "subliminal," level without a
competent hypnotist supervising you because these can
cause the same harmful effects as hypnosis. And never
let your friends hypnotize you. It is safest to consult only
hypnotists who are licensed psychologists or psychia
trists, who are members of professional hypnosis organi
zations, and who participate in continuing education
about hypnosis. The highest credential in hypnosis is a
"diplomate," which is given by national "Boards" com
posed of either medical doctors, psychologists, or den
tists after written, oral, and practice examinations are
passed. As is true with professionals in general, creden
tials do not guarantee that the hypnotist is competent,
but they provide a degree of safeguard. Your chances are
better.
What about suffering? Is it a necessary component of
effective psychotherapy? Classical psychoanalysts, fol
lowing the teachings of Freud, believe that clients must
suffer for a prolonged period of time and the analyst
must not intervene to comfort them in any way, but must

be detached, remote, unfeeling, not showing human
concern. Freud said in 1919:
"Cruel though it may sound, we must see to it that
the patient's suffering, to a degree that is in some
way or other effective, does not come to an end pre
maturely. "
Don't believe this! Changing may be painful, but there is
no evidence that the more or the longer you suffer, the
more successful your therapy will be. So much suffering
is not therapeutic or humanitarian. A significant compo
nent of therapy involves using those human qualities
that are helpful in dealing with a fellow human being's
anxiety, distress, and unhappiness. E. James Lieberman,
a physician who also has a master's degree in public
health, who is Director, Mental Health Project, American
Public Health Project, American Public Health Associa
tion, and was also a consultant for the study done by the
Nader group discussed below, and Carol Pewanick,
Administrative Assistant with the same public health
organization, in their article "Consumer's Guide to Men
tal Health Services" in Mental Health: The Public Health
Challenge published in 1975, advise the following
guidelines.
'J\lthough the work of therapy can be painful and
difficult, in general a sense of progress, improve
ment, comfort, etc., should prevail over distress and
pain. In other words, the patient who complains of
lack of progress but continues with the therapist any
way is partly responsible for the dilemma. In cases
where the therapist makes recommendations in a di
rection counter to the inclination of the patient, and
a stand-off results, a consultant should be brought
into the case."
In an article titled "Suffering and Psychotherapy," Hans

Strupp says that clients have "been silent while under
going protracted agonies."
Why would a client stay with a therapist if he's getting
worse? According to Bergin:
"Most people believe in expert, authority figures who
have lots of diplomas on the wall." But. . . [distressed
clients] "tend to question their own judgment before
questioning that of their therapist. They also tend to
become dependent upon their expert as they get
deeper into personal material. This makes it difficult
for them to break off the relationship and start all
over again with another therapist."
If you've only had one therapist, you may not know
you are being harmed. You'll recall the case of the suc
cessful attorney who was harmed for 12 years until, after
talking with others, he finally realized what was happen
ing to him. When he tried someone else who did help,
he was then able to compare the differences.
Accurate information about therapists is not easy to
come by. Consumers can find out more about the qualifi
cations of plumbers than they can about psychiatrists,
psychologists, and psychiatric/clinical social workers,
concludes a report titled "Through the Mental Health
Maze" A Consumer's Guide to Finding a Psychother
apist, Including a Sample Consumer/Therapist Con
tract," by Sallie Adams and Michael Orgel, which is avail
able from an organization founded by Ralph Nader: Pub
lic Citizen, Health Research Group, 2000 P Street NW,
Washington, D.C. 20036. Even information about cost of
services, types of clients the practitioner prefers and has
had experience with, extent and level of training, is usu
ally not available to consumers before their first appoint-
ment. In 1975 the Nader group sent questionnaires to

Washington, D.C. area psychiatrists, psychologists, and
psychiatric/clinical social workers, attempting to collect
information to be used in a consumer directory so con
sumers might be able to learn about the differences
among these health care providers, because they con
tended "the health professions are, for all practical pur
poses, unregulated as to the quality of the services they
render or the prices they charge," and there are great
differences among practitioners in the professions of psy
chiatry, psychology, and psychiatric/clinical social work,
and even among individual practitioners within the
same professions. Of the 706 questionnaires mailed to
psychiatrists with clinical practices, 172 were completed
and returned. Psychologists completed and returned 166
of 914 sent, and psychiatric/clinical social workers had
the best percentage with 110 of 331 sent, nearly a third.
The Washington Psychiatric Society members were espe
cially protective of their privacy with the President-Elect
(because the President was on vacation) responding by
sending a letter to members of this group to "recom
mend caution to our members in responding." He writes
that the Society's Council "suggests that not returning
the questionnaire would be the preferred action." The
reason for this fear of answering factual, non-intrusive
questions about their training, office hours, fees
charged, kind of therapy practiced, types of medication
used, and other aspects of the ways they work with their
clients, is "It appears to Council that there are many de
fects in this questionnaire and that the possibilities for
unfavorable slanting of the material are considerable.
Conscientious answers to it may be construed against
the responder and dishonest answers in his favor. " This
is simply not true. This questionnaire is available from
Nader's group if you want to judge it for yourself. If the
clients of these psychiatrists were equally self-protective,

refusing to answer such questions if asked by their psy
chiatrists, the diagnosis might be "guarded," "suspi
cious," and even "paranoid. "
Sidney M . Wolfe, a physician with Nader's group,
writes in the introduction to the report of the survey:
"With few exceptions, the process of collecting the
data for these directories has been met with an ex
traordinary amount of resistance from the local or
state . . . societies. It is as though these trade associa
tions feel obligated to resist any efforts to crack the
veneer of uniformity they give to the public about
their members-namely the assumption that anyone
who is licensed to practice . . . is as good for all pur
poses as anyone else. This attitude is most clearly
seen when consumers call the local society for the
names of [psychotherapists] they can go to. The con
sumer is likely to be given the name of anyone
licensed in a manner not unlike Russian Roulette."
The report goes on:
"Much more so than with either the doctor or dentist
directories [also created by this group] we received
dozens of unusual calls-especially from psychia
trists- objecting to this directory. One particularly
upset psychiatrist caller charged 'You must be out of
touch with reality to compile such a directory. ' Others
asked 'What is really behind these questions?"'
The first comment about reality contact is an attempt
by this psychiatrist to discredit those creating the direc
tory by diagnosing them as "mentally ill." The second
comment about the real intent of the questions is definite
ly suspicious and defensive . What does this caller have
to hide from the public?
What does Nader's group suggest you do about pro

tecting yourself when you begin psychotherapy? Just
what you might expect from attorney Ralph Nader: a
legal written contract between you and your therapist. A
contract cannot guarantee you helpful therapy, but it is
an attempt to define the nature of services-what your
therapist agrees to do for you. It's a way to penetrate the
privacy of the therapist's office. It's a way to negotiate as
an equal party and to hold him accountable for at least
some of his behavior. It's also a way to demystify therapy
and to avoid months or years of needless "therapy" by
defining problems and setting goals periodically and
evaluating progress toward those goals.
What can you do to prevent being harmed? The
Nader group recommends:
"If you have doubts, complaints, or dissatisfaction
concerning a therapist, the course of treatment or
anything else, discuss it with [him.] If you are angry,
tell [him.] If the differences cannot be ironed out be
tween the two of you . . . then you are faced with the
choice of getting another opinion or terminating
therapy. A therapist should not be insulted if you ask
for a consultation [opinion from another therapist],
especially if the therapy has been going on for a long
time or if the two of you differ over what the best
goals are for you. Seeking another opinion is not an
irrevocable step away from your therapist; indeed,
the therapist may benefit from the insights provided
by another [therapist] as much as you may. "
Psychotherapists, generally, are unwilling to give
their customers information. They also usually do not
publicly discuss, write about, or adequately attempt to
prevent harm to clients. Bergin says that "horror
stories . . . are often shared privately among clients and
professionals but are rarely published." They are pub

lished in this book.
E. Fuller Torrey believes that "The best defense
against incompetence in this field is an educated con
sumer." Consumers are beginning to write about their
experiences. They're beginning to educate themselves.
The Consumer Health and Nutrition Index summarizes arti
cles from popular magazines, newsletters, and books,
and categorizes them according to subject, including the
topic of psychotherapy. My favorite titles listed from the
past three years are "Pick a Therapist. Years and Years on
the Wrong Couch," and "Shrunk by Your Shrink? Should
You Keep Your Therapist?"
Why do therapists allow other therapists to harm
clients? It's not easy to report your co-worker, who sits
in the next office, when you have to work with him every
day, when you need your paycheck, and your boss
wouldn't like that kind of trouble in his clinic. Even
therapists who practice alone don't want to "make
waves," be labeled "whistleblowers," or "troublemak
ers." Making public the fact that some therapists harm
their clients cannot be a good advertisement for psycho
therapy. It's just not good for business.
In an article that covers the entire front page of the
November 1982 Monitor, the newspaper of the American
Psychological Association, titled "The spreading stain of
fraud," mainly about fraud in research, Judith Swazey
says that the "whistleblower" who exposes fraud in the
psychological profession is the "deviant professional."
She compares whistleblowing, in the eyes of one's col
leagues, to "treason, in that one undermines a country,
and the other a profession, of its claim to independence
from external control. " She says that the professional ac
cused of fraud may say that the accuser is "psychotic or
sick" to discredit him and to divert attention away from

the fraud!
But I think that cover-ups and denials of harmful
practices are truly bad for business. Psychotherapists are
just people, and people can make mistakes. Instead of
denying and losing credibility and trust, we should find
ways to acknowledge errors and prevent them. One way
is to educate consumers about what they are buying. As
E. Fuller Torrey believes:
"It is the obligation of all of us in the 'mental health'
field to educate potential clients so they can better
differentiate the helpers from the hucksters."
What do you do if you have been harmed? If your
therapist is a licensed psychiatrist, psychologist, or psy
chiatric/clinical social worker, a complaint to the licens
ing board in the state in which he is practicing will be
given to an "ethics committee," and you may feel em
powered if you tell your story and also try to prevent
others from having similar negative experiences.
If your therapist is a psychologist, psychiatrist, psy
chiatric/clinical social worker, or marriage or family coun
selor or therapist, contact the following national profes
sional organizations for information or to report your
complaint to an ethics committee. Be sure to choose the
organization representing the profession of your
therapist.
American Psychological Association
1200 Seventeenth Street, N.W.
Washington, D.C. 20036
Telephone: 202-955-7729
American Psychiatric Association
1400 K Street, N.W.
Washington, D. C. 20005
Telephone: 202-682-6000
National Association of Social Workers

7981 Eastern Avenue
Silver Spring, Maryland 20910
Telephone: 301-565-0333
American Association for Marriage and
Family Therapy
1717 K Street, N . W., Suite 407
Washington, D. C. 20006
Telephone: 202-429-1825
If your therapist does not belong to any of the above
professions, he might be a member of the following or
ganization, which represents many other people who
work as "counselors" or use other such terms.
American Association for Counseling
and Development
5999 Stevenson Avenue
Alexandria, Virginia 22304
Telephone: 703-823-9800
There are also state and local professional organiza
tions, such as the New York State Psychological Associa
tion and others organized by counties or cities that are
usually affiliated with the national groups, and which
will also investigate your complaint. If more people filed
complaints, there might not be so much abuse. I recently
heard about a client suing not only the psychologist who
had been her psychotherapist, but the others this man
had worked with in a group practice, and she sued the
state psychology licensing board that had given him his
license to practice! You can bet that this state is busily
trying to create ways to more carefully screen and con
tinue to monitor the people they license.
If you find that the therapist does not have a license,
then he is not violating rules of any licensing board or
ethical standards of a professional group. But don't think

he has nothing to lose or that you don't have a handle on
this situation. Report your experience to the local District
Attorney. Recently, I overheard a woman who was sel
ling what she claimed to be "healing crystals," which
she said had powers to heal the body and distressed
emotions, tell a customer that she uses them to "treat"
her clients in her private practice as a "psychologist."
When I asked her if, indeed, she was a psychologist, she
answered "Yes." I then asked if she was licensed in Cal
ifornia, the state in which she lives (although she sells
crystals throughout the country), and she again
answered that she was. I continued my interrogation,
asking which school she'd attended, but I'd never heard
of her alleged school. As for a doctorate or master's de
gree, she said she didn't have one. I phoned the Califor
nia psychology licensing board in Sacramento, and my
suspicion that she was not a licensed psychologist was
verified. I also discovered that she is not licensed in any
state. Soon after my complaint she received a letter from
the psychology licensing board telling her that she can
not legally call herself a psychologist in California (each
state has its own licensing laws), and the case has been
referred to the District Attorney in her locality. She is not
only pretending to be a psychologist, but she is open to
charges of fraud because it has not been proven that crys
tals are healing.
If your rights are not protected by any of these ac
tions, or even if they are, you may want to consult an
attorney about a malpractice lawsuit.
For a summary of major research studies about harm
ful psychotherapists (in addition to those in this book's
chapters on misdiagnosis of physical illnesses, cults, and
therapist-client sexual contact) and of the history of re-
search into this topic, refer to the Appendix in the back

of this book.
My own study, a consumer report on helpful and
harmful psychotherapists, was researched from 1979 to
1981, published in a professional publication in 1982 with
the title "Client perception of 'helpful' and 'not helpful'
psychotherapeutic experiences," and summarized in the
popular book How to Find a Good Psychotherapist: A Con
sumer Guide in 1987. Consumers with more than one
therapist, one of whom was helpful and another who
was unhelpful or harmful, were asked about the differ
ences between their therapists, how one helped and the
other harmed, what each did, and what they would
suggest consumers look for and avoid when shopping
for a therapist. Clients with only one therapist don't have
a basis for comparison of therapist behavior-of personal
characteristics of the therapist and of helpful technical
factors. Without these contrasting experiences a client
might believe that whatever the therapist did was right
and that he is not to be criticized.
Clients in this study were located through requests of
psychologists in New York City known to me personally
and with well-established reputations for being effective
psychotherapists, and the clients were well-known to
these professionals as accurate reporters of their experi
ences. Although it is understood that the emotional na
ture of the psychotherapy situation can affect a client's
perceptions, this researcher is confident that the state
ments of these clients are not mere gossip or incorrect
perceptions reflecting emotional distress.
The study showed that the helpful therapists were
clearly differentiated from the hurtful. In general, the
most helpful is genuine, willing to be known, has a high
regard for the client, is empathic, responsive, and active,
firm but not authoritarian, and has good technical skills

which he uses sensitively-all in a manner promoting
the well-being of the client. The least helpful therapist is
mostly the opposite: not genuine, not willing to be
known, having a low level of regard for the client, not
empathic or responsive, either inactive or too active, or
authoritarian, or having inadequate technical skills.
The Genuine therapist does not play roles. He expres
ses his emotions honestly, does not mislead the client
about his thoughts and feelings. He understands him
self, is reasonably secure, and able to tolerate criticism.
He also has a sense of humor. He is Willing to be Known
to his clients, to share himself, but he must know the
limits of such self-disclosure and intimacy.
The helpful therapist has a positive Level of Regard for
his client: that is, values and respects him, is interested,
listens, is warm and welcoming.
Empathic Understanding means really understanding
the client's feelings, not just from a detached, objective
point of view, and not being too intellectual and analyti
cal or responding mechanically.
Responding in a healthy, human way, being Active
and Responsive, seem to be asking for no more than ordi
nary human behavior. The practice of just saying "Uh
huh" or nodding his head has made for much humor
about psychotherapists. But this non-responsiveness is
not funny to someone wanting help. I quote a well
known psychiatrist as he instructs psychotherapists in a
textbook on how to interview clients, "The doctor . . .
may nod or say, 'I Understand."' Such artificially pro
grammed behavior is inauthentic. Another psychiatrist
whose book has been used as a standard psychotherapy
training manual believes that "By his facial expression,
the therapist must convey no embarrassment, fright,

hostility or excitement. " A "professional" manner is
necessary, but pretending not to be a person is silly. A
therapist who denies a human response can be com
pared to a musician who is technically proficient in his
musical skills but lacks emotional expression in his work
and is referred to by fellow musicians as a "technician,"
not a complimentary description.
Non-Authoritarian Firmness refers to encouraging
change, but in a sensitive and loving manner without
trying to "force" behavior, promoting ethical and respon
sible behavior instead of allowing complete freedom and
the acting out of impulses, but without "moralistic" or
punitive attitudes. Authoritarian therapists believe they
are never wrong, are intolerant of others' viewpoints,
and impose their own standards and their ways-of
being-in-the-world on their clients, not helping them re
solve their problems in their own ways rather than in the
therapist's ways.
Typical of self-report testimonials regarding harmful
experiences in psychotherapy were the following.
1. "He suggested that my wife and I split up, so we
did. But a few months later we started living together
again. Another harmful thing he did was when I termi
nated, he called my wife a few minutes after I left his
office to tell her that he thought that she had a hysterical
personality and that she was aborting her pregnancies
and that she ought to come back and I ought to come
back with her to see him together because her miscar
riages were obviously a reaction to things that I was
doing. What things? He answered 'Let's talk about it
when you come back.' And when I became angry with
him for this he said 'I'm glad to see you're getting in
touch with your anger. That's exactly what I've been look-
ing for all these years.' We never saw him again, and my
wife and I now have a lovely son."
2. "When I was in therapy with him I began studying
for a graduate degree in psychology. He decided that I
shouldn't be doing that and terminated my therapy
when I continued. I was in a terrible panic because I
thought there was something terribly wrong with me
and that he probably thought that I was positively un
suited for any work in this field. I later learned that his
Freudian society had a rigid rule about clients studying
psychology. "
3. "Her superior attitude really damaged me. I was
just twenty years old, and I didn't have confidence in
myself as a woman. She somehow had a way of making
me feel my own inadequacies. One time she said 'You
know, you're not a baby any more,' which was just the
thing I was struggling with. I was embarrassed and
humiliated that I couldn't handle what was going on.
And having her say that confirmed this for me and didn't
give me any hope that I could be any different. I'm still
angry at her."
4. "Twice he gave me sodium pentothal [a hypno
sedative barbiturate which is addictive and has possible
irreversible harmful side effects including death]. It was
very disorienting and I passed out. He should have seen
that I wasn't doing well with it the first time. It was very
unprofessional. And when I came to him in a crisis point
and didn't have the money to pay him, he cast me out,
literally opened the door. What kind of responsibility is
that?"
5. "He recommended electroshock treatments [elec
tricity directed through the brain]. He told me that there
was a ninety percent chance that they would cure me.
After a dozen it didn't do a thing. And he gave me no

psychotherapy after, just tranquilizers. And he told me
that therapy would never help me. He didn't know what
the problem was and wasn't willing to admit he didn't
know, so he made something up. "
6 . "Most of the times that I was there I was really
angry at him. In addition to telling me what to do and
how to do it, he also reacted very poorly when I differed
with him. If I questioned what he said, he got angry. He
had an attitude that he was some sort of profound profes
sor and I was a novice. And so most of the sessions we
would be there exchanging anger. And what angered
me even more is that I was paying for this. There was no
ultimate harm because I left him, but there could have
been harm had I just said that psychotherapy is not for
me and just walked away from all psychotherapists."
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Appendix 117
Appendix
The following briefly summarizes the professional lit

erature, the published research done by psychologists
and psychiatrists, on harmful psychotherapists, in addi
tion to the research in the chapters on misdiagnosis of
physical illnesses, psychotherapy cults, and therapist/
client sexual contact. More detailed information can be
found in the three editions of the Handbook of Psychother
apy and Behavior Change edited by Allen E. Bergin & Sol
L. Garfield in 1971 and Garfield & Bergin in 1978 and
1986; in Chapter 17 of Effective Psychotherapy: A Handbook
of Research edited by Alan S. Gurman & Andrew M. Razin
(1977); and in Appendix A of Psy_chotherapy for Jietter or
Worse: The Problem of Negative Effects by Hans H. Strupp,
Suzanne W. Hadley, & Beverly Gomes-Schwartz (1977).
Carl Rogers in the late 1950s was the first to use tape
recordings of psychotherapy in research of the therapeu
tic process. Therapists generally avoid being recorded,
and researchers don't want to risk angering their col
leagues by researching their professional behavior. Re
search on therapist behavior that portrays the therapist
as a person, and that makes public the actual processes
in therapy is unpopular, and any therapist who wants to
do what is best for his career and for his relationships
with his colleagues does not irritate his fellow profes
sionals. Rogers and a team of researchers in 1954 and
1955 did one of the earliest studies of therapist-induced
deterioration.
Researchers seldom ask for clients' perceptions of
their psychotherapeutic experiences or of their psycho
therapists. Clients' perceptions are discredited by most
researchers. The major instrument used in assessing the
client's perception of the therapeutic relationship is
Australian psychologist Godfrey T. Barrett-Lennard's Re

lationship Inventory (RI). With his doctoral dissertation
(1959) he initiated research of the client's experience of
his therapist's response, the relationship as experienced
by the client (rather than by the therapist), as the primary
locus of therapeutic influence, the most crucial factor re
lated to outcome of therapy. That is, it's the client's experi
ence that counts. And as the consumer of services, the
client must have a voice in evaluating his psychother
apist. The RI measures four factors that Rogers believed
are important in psychotherapy-Empathic Understand
ing, Congruence of the therapist (Genuineness), Level
of Regard for the client, and Unconditionality of the Re
gard -that have been found to be predictive of therapeu
tic outcome. Studies show very little agreement between
clients' and therapists' perceptions of the quality of the
therapeutic relationship. Therapists tend to rate them
selves more positively on the RI conditions than their
clients rate them, and clients' ratings of the quality of
therapist-client relationships are at least as good predic
tors of therapeutic change as nonparticipant judges. The
importance of understanding psychotherapy from the
client's phenomenological viewpoint is established, but
still the client's perception is researched very little.
Schools training psychologists who will become psycho
therapists continue to choose students on the basis of
Graduate Record Examination (GRE) scores- tests of ver
bal and mathematical abilities -rather than assessing the
person.
Charles Truax and Kevin Mitchell (1971) reviewed sev
eral studies that examined the outcome of therapy and
found repeated evidence of deterioration, with the
therapist as the possible cause. They concluded that
some therapists are helpful, others harmful, and that
Appendix 119
this is determined in large part by such interpersonal

skills as empathy, genuineness, and warmth.
Allen E . Bergin of Brigham Young University dis
cussed the "deterioration effect" (1966, 1971) following a
presentation by Charles Truax of results of the Rogers'
study called the "Wisconsin Project," which may have
marked the beginning of intensified research of harmful
effects.
Bergin thought that the "deterioration effect" was a
possible answer to the claim made by Hans Eysenck
(1952) that psychotherapy is not more effective than no
treatment. Hans S. Strupp of Vanderbilt University with
Suzanne W. Hadley and Beverly Gomes-Schwartz (1977)
later used the term "negative effects" to describe his
findings, which implicated the therapist as a factor in
harmful psychotherapy.
Among challengers to the causal link between
therapist activities and client worsening are Daniel T.
Mays and Cyril M. Franks of Rutgers University (1980,
1985) who use the term "negative outcome," which does
not implicate the therapist in blame for the failure.
Franks focuses on "patient characteristics and ex
tratherapeutic events" that may be responsible. The
client and events in his life besides his therapy situation
are blamed. In an article published in the Professional
Psychology journal (1980), Franks and Mays discuss con
cern about reimbursement for psychotherapy by insur
ance companies, and about the litigious atmosphere in a
consumer-oriented society, that is, consumer suits
against harmful psychotherapists. However my 1988 cor
respondence with Franks, indicates to me that he does,
in fact, believe that some therapists might harm their
clients.
Michael J. Lambert, Bergin, and John L. Collins (1977)

review the history of research into the role of the
therapist in the worsening of clients in psychotherapy in
Chapter 17 titled "Therapist-induced Deterioration in
Psychotherapy" in the textbook Effective Psychotherapy: A
Handbook of Research edited by Gurman & Razin. Reviews
are also included in chapters by Bergin and co-authors in
the three editions of the Handbook of Psychotherapy and
Behavior Change, edited by Bergin & Garfield in 1971 and
Garfield & Bergin in 1978 and 1986 (Look in "References"
section in this book for: Bergin, 1971; Bergin & Lambert,
1978; Lambert, Shapiro, & Bergin, 1986).
Bergin believes that one reason negative effects has
been an issue only in recent years is that most early
studies of the results of therapy merely tried to measure
the amount of change in a client's condition, assuming
that all change due to treatment would necessarily be an
improvement. The idea that psychotherapy could actu
ally cause negative changes didn't seem to occur to those
who conducted the studies. Even though some of the
earliest research into the effects of psychotherapy pro
vided a "worse" category in ratings of client change, the
researchers have seldom given much attention to or even
discussed these negative results. In order to measure
positive or negative effects accurately for any groups of
clients, it is necessary to know what changes would
occur among a group of similar clients who received no
treatment, a control group. Data from studies (consult
Bergin's writing for details) using such control groups
show that about 55 percent, or more than half, show no
change, either for the worse or for the better. About 40
percent improve, and about 5 percent deteriorate. Im
provement among clients who have not had psychother
apy is often called "spontaneous remission," but actually
some of the factors involved in this seemingly unexplain-
Appendix 121
able disappearance of distress for these clients may be

friends, relatives, and others who offer non-professional
advice or concerned attention. The deterioration of the 5
percent may be due to stressful situations or an ongoing
process of mental disorder. Assessment of the studies
about the effects of psychotherapy shows that about 65
percent improve, 25 percent more than those who do
not have psychotherapy. The fact that only 25 percent of
clients in psychotherapy show no change, while 55 per
cent of those without psychotherapy do not change, is
evidence of the effectiveness of therapy. But 10 percent
of clients in psychotherapy deteriorate, which is 5 per
cent more than the percentage of those without psycho
therapy. This means that one out of every 10 clients in
therapy ended therapy in worse condition. Some would
have worsened anyway, but some deterioration is the
result of harmful psychotherapists. The reason for these
differences may be the therapist's personality and not
the type of therapy.
Strupp, Martin S. Wallach, and Michael Wogan (1964)
mailed questionnaires with forced choice and open
ended questions to clients whose therapists were staff
members of the Department of Psychiatry of the Univer
sity of North Carolina School of Medicine, asking about
changes experienced by those clients and the kinds of
therapist activities thought to have contributed to the
change. The amount of change was positively related to
the rating of the therapist as warm, respectful, natural,
attentive, and the like. Coldness, distance, formality,
and extreme passivity were rated as absent from the
therapist's behavior. From the clients' responses a dis
tinction was made between "technical interventions" (in
terpretations, clarification, etc.) and "personality charac
teristics" of the therapist which enabled the client to
view himself and his emotional difficulties differently.
"Technical intervention" was defined by three items

focusing on the therapist's use of technical terms, em
phasis on relationships in the client's current life, and
references to psychoanalytic theory. Personality charac
teristics include the therapist's human qualities such as
interest, respect, trustworthiness, patience, acceptance,
firmness, reliability, as well as attitudes toward the client
and his problems. The researchers concluded that
through his attitudes and through his personality the
therapist educates the client and provides him with a
model for identification. Clients commented mostly on
the therapist's personality characteristics, but technical
· interventions were sometimes implied. The authors say
"Technical skill on the part of the therapist may go a long
way to capitalize on such a relationship. " The relation
ship sets the stage for the therapist to use his technical
skill and for the client to accept it. But "the most basic
ingredient of beneficial therapeutic influence" is a rela
tionship with the qualities described.
Strupp, Ronald. E. Fox, and Ken Lessler (1969) mailed
questionnaires to former clinic clients of the Department
of Psychiatry of the University of North Carolina. Most
important, the therapist's warmth, his respect and in
terest, and his perceived competence and activity
emerged as important ingredients in the amount of
change reported by the clients. A "good" therapist was
seen as attentive, willing to engage in small talk, having
a manner that clients experienced as natural, saying or
doing nothing that decreased the client's self-respect, at
times giving direct reassurance, never criticizing, and
leaving no doubt about his "real" feelings. By contrast,
the following characteristics were seen as not describing
the good therapist: causing or allowing the client to ex
perience intense anger toward the therapist, treating
him like "just another client," using abstract language
Appendix 123
which the client may not understand, failing to under

stand his "real" feelings, passivity-that is, being unre
sponsive and "doing nothing," and being "neutral" -an
indication of lack of interest and concern. Rather than
the stereotype of impersonality, the good therapist was
perceived as engaged in a "real" relationship with his
clients, occasionally gave assurance and direct advice,
was friendly, warm, and not detached, and seemed to
keep close to the client's everyday reality. He did not
encourage the expression of negative feelings or depen
dency wishes, dealt firmly with the client as an adult,
and helped him work through problems in his daily life.
The writers, however, make the following clear: a client
who made favorable statements about his therapist did
not necessarily have a successful outcome, but a client
who make unfavorable comments about his therapist
was usually a member of the low success group. And
although the attitude of the therapist is an important
component in therapy, this does not exclude the need
for technical skills.
Strupp, Suzanne W. Hadley, and Beverly Gomes
Schwartz (1977) in their book Psychotherapy for Better or
Worse-The Problem of Negative Effects surveyed 150 emi
nent psychotherapists and researchers asking the ques
tion "Is there a problem of negative effects of psychother
apy?" There was virtually a unanimous "Yes" by the 70
experts who responded to the questionnaire, evidencing
the widespread concern among professionals about
harm done during therapy. Listed are 15 therapist factors
that lead to negative effects, for example: overly intense
therapy, technical rigidity, misplaced focus, and depen
dency-fostering techniques. Among possible noxious
personality traits in the therapists they list: ignorance,
exploitiveness, coldness, obsessional analyzing, exces
sive need to make people change, excessive unconscious
hostility, seductiveness, lack of interest or warmth, neg

lect, pessimism, sadism, absence of genuineness, greed,
narcissism, lack of self-understanding. Negative effects
in psychotherapy may also be associated with "misappli
cations/deficiencies of technique." Some of these include
"technical rigidity" of the therapist who is rigid, inflexi
ble, insecure, and essentially a "technician" following
rules of procedure. The client's individual characteristics
and needs may not be given sufficient consideration or
the client may be encouraged to perform certain "stan
dard" behaviors (e.g., aggressiveness) which conform to
the therapist's definition of mental health, and the
therapist's ability to understand the client and his prob
lems is restricted. Also noted are: (1) therapists who
teach their clients to become preoccupied with intra
psychic phenomena to the neglect of outside reality and
constructive action in the outside world; (2) overuse of
interpretation, so this becomes an end in itself, and er
roneous or destructive or critical interpretation; (3)
therapists who foster dependency; (4) overly intense
therapy, e.g., "pushing" the client too much or getting
too close to him when he can not tolerate such closeness;
and (5) innaccurate assessment of the client. Errors in
technique, such as those cited above, may reflect de
ficiencies in training or skills or may be related to person
ality factors of the therapist. Among their conclusions,
Strupp and co-authors say that therapist variables are
the most common source of negative effects; this has
implications for the selection and training of therapists.
Irvin Yalom, Professor of Psychiatry at Stanford Uni
versity School of Medicine, and author of the textbook
The Theory and Practice of Group Psychotherapy (1970, 1975),
and Morton Lieberman reported in 1971 that the style of
group leaders was most predictive of negative change in
clients, and that such leaders were impatient and author-
Appendix 125
itarian, insisting on immediate self-disclosure, emo

tional expression, and attitude change.
Lieberman, Yalom, and Matthew Miles studied the
effects of encounter group therapy on 170 Stanford Uni
versity undergraduates and wrote about this in an article
in the popular magazine Psychology Today (1973). The stu
dents were divided into 18 groups, each lasting 30 hours.
The 10 group leaders selected for this study were all ex
perienced and had excellent reputations in the San Fran
cisco area. Sixteen students became worse and remained
so for more than six months, and 16 more had milder
negative change. Personality characteristics of the stu
dents were responsible for some of their negative effects,
but the group leader's style was found to be the major
cause. The most damaging style, called "aggressive
stimulator," was an intrusive, aggressive approach,
involving much challenging and confronting of group
participants. One of these leaders described his group:
"It was a stubborn group full of people too infantile
to take responsibility for themselves and to form an
adult contract . . . . I saw that most of the group didn't
want to do anything so what I did was to just go
ahead and have a good time for myself."
One of the five leaders of this type had less negative
change in his group. He said that he realized that there
were fragile people in his group, so he changed his usual
style and "pulled his p�nches."
Robert E . Kaplan repeated the Lieberman, Yalom,
and Miles study at Case Western Reserve University with
4 groups of a total of 44 participants using a T-group
model (1982). Leaders were one faculty member and 6
advanced graduate students. Nineteen participants were
"casualties," lower than the rate of injury in the Lieber
man et al. study, but corroborating the finding of that
study that "responsible, nondestructive leadership is as

sociated with a relatively low rate. " Among Kaplan's con
clusions is that "Casualties occur in encounter groups
because leaders themselves attack, reject, or coerce indi
vidual members, or because leaders allow the group to
mistreat individual members . " Leaders either use their
power destructively or fail to take power and protect
group members. Kaplan presents further explanation in
a framework for understanding how the injury occurs.
Joseph C. Bentley, Stephen S. DeJulio, Lambert, and
William Dinan of Brigham Young University in an unpub
lished manuscript (1975) also repeated the Lieberman,
Yalom, and Miles study. The group leaders were
graduate students who were less confrontive and aggres
sive than those in the original study, and the researchers
found fewer negative effects.
David Ricks (1974) followed the progress of 86 men
who were adults at the time of the study, and who as
children and adolescents had seen two therapists at the
Judge Baker Guidance Center in Boston. Although as
youths they had been equally disturbed, 55 percent later
became schizophrenic. However, 27 percent of therapist
P.:s former clients became schizophrenic later in life as
compared to 85 percent of therapist B's clients. It would
seem likely that the difference was due to the therapists.
Therapist A, with the highest success rate, was referred
to by his clients as "supershrink," and his clients wrote
to him and visited him for years after, but the other
therapist was not so loved. Therapist A gave more time
and effort to the more disturbed boys than to the less
disturbed, but therapist B did the opposite, seeming to
become depressed himself when his clients were seri
ously disturbed. Both were psychoanalytically trained,
but A worked less with inner personality dynamics if
Appendix 127
direct action was more effective. B was more fascinated

with the details of case histories, the boys' fantasies, and
deep exploration of their personalities, and when the
boys did not give him such material he felt frustrated.
Bergin comments about this study that a simple therapist
profile does not identify the good therapist or the
therapist associated with deterioration. An assertive, in
trusive therapeutic style may work with some clients and
cause harm to others. A therapist's own adjustment prob
lems may cause him to be ineffective and even destruc
tive with certain kinds of clients but not with others. In
general, however, it can be said that therapists who are
themselves psychologically healthier, and who have a
capacity to form deep, trusting relationships with others
get the best results.
The writing of psychiatrist David H. Malan of the
Tavistock Clinic, London, England (1976) reported that
clients in group psychotherapy using the theories of
Wilfred Bion and Henry Esriel said they experienced
their groups as harmful, depriving, and frustrating, and
he concluded that warmth and encouragement are im
portant qualities for a therapist.
Nicholas Cummings, Past President of the American
Psychological Association, discusses the "deleterious"
effects of long-term therapy and the "interminable"
client (1977). It was found at California's Kaiser Per
manente, which offers prepaid comprehensive health
services, that when the frequency of psychotherapy vis
its was increased to as much as three visits each week,
clients also increased their medical visits, and when psy
chotherapy visits were decreased to as few as once every
90 days, with clients choosing the frequency of visits
themselves, that they also decreased their medical visits.
More than half of the psychotherapists in this study re-
fused to decrease the visits, and the suggestion here is

that they may not have served the best interests of their
clients by allowing them to believe they were "sicker"
than they were, providing long-term endless therapy,
and somehow encouraging medical visits also.
Peter Buckley, Toksoz Karasu, and Edward Charles
(1981) conducted a study at the Department of Psychia
try of the Bronx Municipal Hospital Center, Albert Ein
stein College of Medicine, Bronx, New York. In a ques
tionnaire survey of 96 psychotherapists asking about
their own personal psychotherapy or psychoanalysis,
they found that of the 71 who completed the question
naire, 21 percent replied "Yes" to one of the 70 questions
which asked "Was your therapy/analysis harmful in any
way?" Examples of harm were: "deleterious to my mar
riage," "allowing destructive acting out," "fostering too
much withdrawal from the outside world."
Judi Striano in her doctoral dissertation in clinical
psychology for The Fielding Institute (1982), demon
strated the ease with which client self-reports can be
gathered and inferring that the harmful psychotherapy
experience is common. In a consumer report study,
examining the personal experiences of 25 selected cases,
7 of whom were themselves psychotherapists, who had
been to more than one therapist, one of whom was re
ported as being helpful and one of whom was said to be
unhelpful or harmful, she documented through the re
ports of these clients a variety of "horror stories" of the
type that are often shared privately among clients and
professionals but are rarely published. Data were
secured by administering an open-ended questionnaire
in a face-to-face interview with each client. Clients told
how one therapist helped and the other harmed, what
each one did, and suggested what consumers look for
Appendix 129
and avoid when shopping for a therapist. It was found

that clients differentiated the helpful and not helpful or
harmful therapists on 8 scales: Genuineness, Level of
Regard, Empathic Understanding, Willingness to be
Known, Responsive, Active, Non-Authoritarian Firm
ness, and Technical Skills.
Janet Sandell Sachs (1983) in her doctoral dissertation
for Vanderbilt University researched how negative effects
occur. She used the Vanderbilt Negative Indicator Scale
developed by Strupp and others, a scale rated by clients,
therapists, and independent observers, with 42 items re
lating to various factors involved in positive or negative
outcomes of psychotherapy. The results showed that the
relationship between therapist and client was important,
but technical skills were even more important. Errors in
technique which produced negative outcomes included
not structuring or focusing the session to organize the
content or process of the session, not dealing with the
client's negative attitudes toward the therapist or the
therapy, allowing behavior such as evasiveness of the
client, and interpreting behavior at the wrong time or
using destructive interventions. "Technical skills" does
not refer to "types" of technique (such as psychoanalytic
vs. client-centered vs. behavioral techniques) but rather
the "quality" of technique indicated. This emphasis on
technique does not mean that personal qualities of the
therapist do not matter. Although the therapist's per
sonal qualities may not directly affect the client, they indi
rectly do so because they affect the therapist's technique
or client-therapist interaction, which ultimately affect
outcome. Who the therapist is as a person colors every
thing he does.
Henry Grunebaum, a psychiatrist at Cambridge Hos
pital and Harvard Medical School (1986) adds to the
study of harmful effects with his report of interviews of

47 clients, all psychotherapists themselves, who
answered advertisements in professional newsletters for
people who felt they had experienced "harmful psycho
therapy. " The therapists these people felt harmed them
were characterized as either too distant and impersonal
or as overly intense involving betrayal of the client, with
the client feeling blamed or taken advantage of sexually,
or by involvement in cults. The clients reported that the
therapy had been harmful to them for the following
reasons: the therapist was rigid and distant (18 cases);
emotionally seductive (8 cases); explicitly sexual (3
cases); there were multiple involvements in cults (3
cases); there was a poor match between client and
therapist (5 cases); and there was a residual group of
unclassified cases (12 cases). In a previous study by
Grunebaum (1983) experienced therapists wanted a
warm and caring person who talked as a therapist for
themselves.
Chad D. Emrick of the Veterans Administration Hos
pital in Denver, Colorado, in "Psychological Treatment
of Alcoholism: An Analytic Review, " an unpublished
doctoral dissertation for Columbia University (1973) re
viewed the alcohol treatment outcome literature. He
found "deterioration," including intensification of pre
senting symptoms or appearance of new symptoms, and
"ineffective" treatment, in which the client fails to make
significant improvement when such improvement is a
reasonably expected outcome. Reviewing published
studies from 1952 to 1971 he determined that less than
10% of the researchers even explored the possibility of
deterioration with treatment, but the data were evident
relating to deterioration of drinking behavior in 24 of the
260 studies. Deterioration was defined as having had
more periods of abstinence before treatment than after,
Appendix 131
increased drinking, and worsening of drinking pattern

after treatment. All but 3 of the 24 studies documented
some deterioration, with an overall average rate of from
6% to 10%, with scores ranging from 0% to 30% . The
data suggest, he writes: "When researchers look for de
terioration during or following treatment, they are likely
to observe it." In a report prepared for the National Acad
emy of Sciences, Institute of Medicine, Committee on
Treatment of Alcohol Problems (1988), he lists possible
sources of treatment harm summarized by theorists and
researchers regarding professional psychotherapists as
well as researchers and commentators in the non-profes
sional alcohol treatment field. Among the most striking
in his long list that have not already been presented in
this book are the following. Misplacing the foci of treat
ment, such as focusing on the drinking problem while
ignoring internal feelings which the client finds impor
tant, focusing on drinking and excluding other psychiat
ric disorders, or placing the focus on psychiatric disor
ders and neglecting the drinking problem. Disparaging
clients who do not accept the treatment provider's
philosophy of treatment. Creating a self-fulfilling pro
phecy situation by telling clients that should they drink
at all they will inevitably lose control of their drinking
behavior. Telling clients that if they do not gain sobriety
through strict adherence to a particular treatment regi
men they will have little or no chance of "recovery. "
Blaming the client if he begins to drink again. Allowing
"feedback overload" in group treatment, that is, too
many and too intense comments from other participants
in the group. Requiring coercive rules for behavior when
participating in group treatment. Insisting that clients
label themselves "alcoholic" or adopt the disease theory
of "alcoholism," with the client potentially having a
negative perception of the therapy as doctrinaire or
humiliating. Fostering unrealistic expectations about the

client's capabilities, and when efforts to fulfill these
expectations are met with disappointment and failure,
the client may feel self-contempt and become hopeless
about the prospects of receiving help through treatment.
Being male and relatively inexperienced when treating
certain "types" of female clients, for example, those with
anxiety disorders or those who are young and single. An
important point Emrick makes is that there are optimal
and harmful treatment-therapist-client interactions, that
is, interactions among type of treatment, administered
by certain therapists, to a particular group of clients.
Subject and Name Index

Adams, Sallie: 92
Adrenal glands, and autoimmune disorders: 31
Alcoholic liver disease, misdiagnosed as "psychological": 12
Autism, and brain dysfunction: 24
Autoimmune disorders: 24-31
Autosomal antibody titer: 31
Barrett-Lennard, Godfrey T.: 118
Beachboys: 42
Behrens, \Noody: 83
Bentley, Joseph C.: 126
Bergin, Allen E.: 79, 92, 120-212, 117, 119
Bouhoutsos, Jacqueline: 51
Brain damage, as cause of criminal behavior: 23
Brodsky, Archie: 51
Buckley, Peter: 128
Bugental, James: 82-83
Busick, Bonnie: 18
Calcium, elevated blood levels, misdiagnosed as "psychological": 15
Cancer of the pancreas, misdiagnosed as "psychological": 24
Cardiovascular illnesses, misdiagnosed as "psychological": 8
Center for Feeling Therapy: 39-42, 54-55
Central nervous system illnesses, misdiagnosed as "psychological": 8
Charles, Edward: 128
"Client perception of the therapeutic relationship": 117-118
Collins, John L . : 120
Cults, psychotherapy: 33-44
and child custody: 35
Cummings, Nicholas: 127-128
Davison, K.: 18
DeJulio, Stephen S.: 126
Diabetes Mellitus, and autoimmune disorders: 31
Diagnosis, as label: 88
Dilantin, side effects, misdiagnosed as "psychological": 16-17
Dinan, \Nilliam: 126
Drugs, as treatment: 3, 7
Dumas, Kitty: 47
Edelwich, Jerry: 51
Emrick, Chad D . : 130-132
Endocrine system, and illnesses misdiagnosed as "psychological": 2,
4, 8, 24
Electroshock, as treatment: 3, 7, 22
Eysenck, Hans: 119
Food and Drug Administration, psychological: 79
Fox, Ronald C.: 122
Franks, Cyril M . : 119
Freud, Sigmund: 26, 27, 37, 82, 90, 91

Garfield, Sol L.: 79, 117
Gartrell, Nanette: 49
Gastrointestinal illnesses, misdiagnosed as "psychological:" 8
Georgiades, Peter: 43
Goiter: 31
Gomes-Schwartz, Beverly: 80, 81, 117, 119, 123
Gorman, Martha: 18
Graves' Disease: 24-29
Greenwald, Harold: 86
Grunebaum, Henry: 129-130
Gurman, Alan S.: 117, 120
Hadley, Suzanne: 80, 81, 117, 119, 123
Hall, Richard C. W.: 5-24
Hashimoto's thyroiditis, misdiagnosed as "psychological": 12, 24, 29-
31
Hematopoietic illnesses, misdiagnosed as "psychological:" 8
Hepatitis, misdiagnosed as "psychological": 12, 31
Hospital, psychiatric advertising for inpatients: 88-89
Hospital, psychiatric admission, in error: 87-89
Hospitals, psychiatric, commitment to in error: 2, 5, 21-22
Incompetence, mental: 21
Infectious illnesses, misdiagnosed as "psychological": 8
Iron deficiency anemia, misdiagnosed as "psychological": 17
Iron deficiency, misdiagnosed as "psychological": 12
Jones, Jim: 34
Kagan, Daniel: 42
Kaplan, Robert E . : 125-126
Karasu, Toksoz: 128
Lambert, Michael J . : 120, 126
Lawsuits, malpractice: 99
Lawsuits, testimony for defense and prosecution: 87
Legal issues in misdiagnosis: 21-22
Lessler, Ken: 122
Lewis, Dorothy Atnow: 23
Lieberman, E. James: 91
Lieberman, Morton: 124, 125
Lupus: 23
and autoimmune disorders: 31
MacHovec, Frank: 89-90
Malan, David H.: 127
Malony, Newton: 34
Manic-depression, inherited: 24
Marriage, family, and child counselors (MFCC): licensing laws for: 48
Mays, Daniel T.:119
Mcintyre, John: 19-20
Medical illnesses, misdiagnosed as "psychological": 1, 2, 4, 5-31
Metabolic disorders, and symptoms misdiagnosed as "psychological":

24
Microsomal antibody titer: 31
Migraine headaches, misdiagnosed as "psychological": 16
Miles, Matthew: 125
Milgrom, Jeanette Hofstee: 49
Minsky, Terri: 57
Misdiagnosis, and legal issues: 21-22
Mitchell, Kevin: 118
Mitchell, S. Weir: 18
Mithers, Carol Lynn: 40
Mood disorders, inherited: 24
Myxedema "madness": 28
Nader, Ralph: 92-95
Obsessive-compulsive behavior, and brain dysfunction: 24
O'Connor, Thomas: 83
Orgel, Michael: 92
"Panic attacks": 30
Parasitic illnesses, misdiagnosed as "psychological": 8
Parathyroid gland tumor, misdiagnosed as "psychological": 15
People's Temple of Guyana: 34
Peptic ulcer, misdiagnosed as "psychological": 17
Pernicious anemia
misdiagnosed as "psychological": 15-16
Pewanick, Carol: 91
Physical illness, misdiagnosed as "psychological": 1, 2, 4, 5-31
Physical illnesses, misdiagnosed as "psychological:" 1, 2, 4, 5-31
Polyglandular autoimmune disorders: 31
Pond, Sande Buhai: 48
Psychiatrists, as medical doctors: 18-22
Psychoanalysis: 26, 27, 29, 36-39, 82,90, 91
Psychoanalysts
training analysis for: 82
advice given client: 37
and cults: 35
Psychologists, fraud in research: 96-97
Psychosomatic: 7
Psychotherapists
practical action for client: 3
active and responsive: 100, 101-102
active in therapy: 2, 4, 75-78
advice given client: 2, 4, 75-78
analytical with client: 2
blaming clients for therapy failures: 86
and special brand of therapy: 3
and business relationship with client: 42
closeness with client: 82
cold toward client: 3, 75-78

client continung harmful experience with: 92
complaints against, where to file: 97-99
and countertransference: 82
with emotional difficulties: 84-86
dependency of client on: 2, 4, 57-65, 81, 82
fanatical dedication to: 2, 4
diagnosis, errors in: 1, 2, 4
diagnosis of health and abnormality: 87
and "dual relationship" with client: 42
education and training of: 44, 48
with emotional problems: 84-86
empathic understanding: 100, 101
feelings toward client: 82
genuine: 100, 101
and graduate school admission: 84-85
harmful: 1-4
harmful, reporting by other psychotherapists: 95-96
harmful, research studies of: 79-81, 99-104, 117-132
hypnosis used by: 3
information about: 92
interpretation with client: 2, 81
interpretation and therapist's beliefs: 82-83
as forceful leaders of cults: 2, 4
and legal regulation of sexual involvement with client: 52-55
level of regard: 100, 101
licenses, without: 98-99
licensing laws for: 41-42, 44, 48
negative feelings toward client: 82
non-authoritarian firmness: 100, 102
and client participation in therapy: 3
passive in therapy: 2, 4
as "pathology hunters": 2, 86-87
and perception of reality: 4, 67-74
personal relationship with client: 2
personality of: 67-68, 82, 84-86, 117-132
as persons: 1, 75-78
and abuse of power: 42, 82
professional organizations of: 97-99
pushing client to change: 82
and "resistant" clients": 86
rigid techniques of: 3
romantic relationship with client: 2, 4
and self-esteem of client: 3
and sexual assault against client: 52
sexual involvement with client: 2, 4, 45-55
technical skills of: 81, 82, 1 17-132
and client's unique individual problems: 3
warm toward client: 3, 4, 75-78

willing to be known: 100, 101
Psychotherapy
and client action in real life, constructive: 81
client addiction to: 2, 4, 57-65
consumer groups: 55
consumer guide to: 3, 44
therapist/client contract: 94
cults: 2, 4, 33-44
and denial of harm by profession: 4
"deterioration effect": 119
group: 33
and hypnosis: 89-90
and insight: 82-83
overly intense: 82
lawsuits, cults: 43
licenses to practice: 83-84
and LSD: 47, 83
"negative effects" of: 80
"negative outcome" of: 119
as purchase of friendship: 2
clients, as "patients": 37
and personality change: 83
and suffering of client: 90-92
types of: 43
Public Citizen Health Research Group: 92-95
Pulmonary illnesses, misdiagnosed as "psychological": 8
Razin, Andrew M . : 117, 120
Reality, perception of: 67-74
Relationship Inventory: 118
Rheumatoid arthritis, and autoimmune disorders: 31
Richardson, James T.: 34
Ricks, David: 126-127
Rogers, Carl: 117
Romano, John: 19-20
Rosenhan, D.L.: 87-88
Sachs, Janet Sandell: 129
Schizophrenia
as brain disease caused by virus: 24
physiological causes of: 18
as side effect of insecticide poisoning: 18
as side effect of metal poisoning: 18
as side effect of prescription drugs: 18
as side effect of street drugs: 18
Schoener, Gary: 46-53
Scriven, Michael: 79
Shapiro, David A . : 120
Striano, Judi: 100, 128-129
Strupp, Hans H . : 79, 92, 117, 119, 121, 122, 123

Symptoms, misdiagnosis of physiological causes of: 1, 2, 4, 5-31
Systemic lupus erythematosus: 23
Swazey, Judith: 96-97
Taylor, R.L.: 18
Temerlin, Jane: 34
Temerlin, Maurice: 34
Thyroid, underactive, misdiagnosed as depression: 2, 4, 8, 23-31
Torrey, E. Fuller: 18, 84, 96, 97
Thyroid system, symptoms, misdiagnosed as "psychological": 23-31
Truax, Charles: 118, 119
Vitamin B 12 deficiency, misdiagnosed as "psychological": 12
Vogel, Linda: 83
Wakefield, Dan: 36-39
Wallach, Martin S.: 121
Welsh, John: 53-54
Wilson, Brian: 42
Wisconsin Project: 119
Wogan, Michael: 121
Wolfe, Sidney M.: 94
Yalom, Irvin: 124, 125
Finally AHelpful . . .
Consumer Guide to Psychotherapy
How To Find A
Good
Psycho therapist:
A Consumer Guide
By Judi Striano, Ph.D.
If you're shopping for a psychotherapist for the first time

or feel your psychotherapist is not helping you, this book is
for you. It will teach you to be an educated consumer, looking
for the personal qualities and professional skills of a good
therapist. This is the FIRST consumer report of helpful and
harmful psychotherapists!
It answers these questions:
• Where do I look?
• What qualities are most important?
• Whom can I trust?
• What must I avoid?
• How do psychotherapists help?
• Are professional credentials important?
• How are a psychiatrist, psychologist, and other
psychotherapists different?
• How close do we get personally?
• How much do I pay-what's a reasonable fee?
• Where do I report complaints?
" . . . the most sensible, helpful consumer guide available,

offering inspiring quotes about how therapy can help as well
as unusually strong consumer testimonials about how it can
harm." Alex Raksin
Los Angeles Times Book Review
PROFESSIONAL PRESS
P. 0. Box 50343 Paperback
Santa Barbara, California 93150 141 pages
(805) 565-1351 phone Price $7.95
1'40 CAN PSYCHOTHERAPISTS HURT YOU?
CONSULTATION SERVICE
If you would like to discuss y our search for a psycho

therapist or your experience with a harmful psycho
therapist, licensed clinical psy chologist Dr. Judi
Striano is available to talk with y ou on the telephone
or in person, answering y our questions and provid
ing helpful information.
If y ou would like to be involved in research on help

ful and harmful psy chotherapists, y our participation
is welcome.
Telephone or write to Professional Press.
PROFESSIONAL PRESS
P. 0. Box 50343
Santa Barbara, California 93150
805-565-1351
Psychotherapists can hurt you
with harmful personal qualities or faulty professional
skills. This book will alert you to dangers you may
never have dreamed of encountering in your search for
help with your problems-in-living.
Psychotherapists may fail to diagnose a physi

cal illness causing your "psychological" symptoms, or
lure you into a psychotherapy cult, become your lover,
hook you into a therapy addiction, m isperceive reality,
lead you down the wrong path, or just waste your time
and money.
This book is intended for consumers, psychotherapy

researchers, malpractice attorneys, and legislators of
laws regulating the psychotherapy professions.
From the author of How to Find a Good Psychother

apist: A Consumer Guide, described by Alex Raksin
in the Los Angeles Times Book Review as " . . . the most
sensible, helpful consumer guide available, offering
inspiring quotes about how therapy can help as well as
unusually strong consumer testimonials about how it
can harm."
ABOUT THE AUTHOR

Psychologist Dr. Judi
Striano is a consumer advo
ISBN 0 - 9 4 36 5 9 - 0 3 -5
cate for psychotherapy
clients. She has worked as a
psychotherapist for tw�mty
years, and is currently living
in New York City and Santa
Barbara, California.
Cover Design by Robert Howard

$7.95

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Can

Judi Striano, Ph.D.

Striano, Judi Cecere, 1941-

How Can Psychotherapists

P nate and improve your life enormously. Conversely,

in the wrong hands inspired by the wrong motives, it

problems: for example, an underactive thyroid that gets

regard for constructive and practical action in the real

the low self-esteem of an already shaky client.

will be listed as sources of information. This is not in­

Chapter 1 gives an overview of ways a psychother­

In the next chapter we'll focus on the foremost hazard

Is A Physical Illness Causing Your

make the point clearly and dramatically that there are

people might otherwise have been declared "incompe­

pression, anxiety, aggressive outbursts, personality

Specific symptoms are listed below in order of frequency

Wheezing (breathing hard with a whistling, breathy

sonality," one "antisocial personality," and one "be­

secondary to peptic ulcer, hyperparathyroidism, and

and were brought to the hospital by a county mental

"References" section in the back of this book, looking

screening was done and the clinic remained unaware

a neurologist, who diagnosed her headaches as of

into the normal range. Her depression was reduced,

body, but also side effects of prescription and street

passed so completely out of the hands of the profes­

The studies of medical illness among psychiatric

sion. As Dr. Hall writes in the January 1982 Hospital and

The findings of these studies show us that a routine

be "medically cleared" before beginning psychotherapy

pital suspected that an error had been made. Although

P nesses" have a seemingly infinite range. For exam­

ple, murderers may have brain damage, and the brain

fascinating literature about the possibility of brain dys­

everything but dancing on top of his desk. Teachers

functioning, and that it had affected and would con­

to this group of analysts. He has even given up his

What has happened to Nick is not uncommon. Psy­

"Hashimoto's thyroiditis" is an auto-immune thyroid

years no one was to be correct about her illness, and

The endocrinologist who finally diagnosed this ill­

Y in group sessions as opposed to individual psycho­

therapy, where you have the benefit of the perceptions

it's an extreme case, remember the People's Temple of

therapists' welfare, and to distrust, be fearful of and hos­

sex each night, and every child is assigned a full-time

therapy session, there are four to five sessions each

been sexually intimate with a wonderful woman he

ness of women than I did to Freud or to . . . [either my

According to the Los Angeles Times of September 30, 1987,

Phoenix Associates was the Center's public relations

Center of a university in California, and the other, who

things, fraud, deceit, negligence, and intentional induc­

tisements placed by people who claim to be mental heal­

D pist! Although you and your therapist may, in fact,

be in love- some therapists have even married their

ble, and a man. He is saying to the woman, "Something

who are themselves having problems) of the American

when the therapist she saw for a few months early in

a type of woman who is raped. Schoener and psychiatrid

them, but distrust of all therapists, and possibly even

Schoener tells me that in Minnesota and Wisconsin,

What about such relationships that are apparently

will be listed as sources of information. This is not in

Chapter 1 gives an overview of ways a psychother

people might otherwise have been declared "incompe

sonality," one "antisocial personality," and one "be

passed so completely out of the hands of the profes

P nesses" have a seemingly infinite range. For exam

fascinating literature about the possibility of brain dys

functioning, and that it had affected and would con

What has happened to Nick is not uncommon. Psy

The endocrinologist who finally diagnosed this ill

Y in group sessions as opposed to individual psycho

therapists' welfare, and to distrust, be fearful of and hos

things, fraud, deceit, negligence, and intentional induc

tisements placed by people who claim to be mental heal

flower and a certain kind of perfume and play a cer

husband, and to take the blame herself for their unpleas

Another woman client, also a professional psycho

"He seldom said a word to me. Mostly he just nod

cord Exam- tests of mathematical and verbal abilities

psychiatrist, a painter, and a woman who was a home

'"Is your teenager moody and depressed?' the ad in

What does Nader's group suggest you do about pro

professionals but are rarely published." They are pub

California Department of Mental Health. Final Report Medical Evalua

Cummings, N.A. "Prolonged (ideal) versis short-term (realistic) psy

Lambert, M.J., Bergin, A . E . , & Collins, J.L. "Therapist-induced de

Schoener, G.R. Processing Complaints ofTherapist Sexual Misconduct. Pre

The following briefly summarizes the professional lit

Australian psychologist Godfrey T. Barrett-Lennard's Re

which the client may not understand, failing to under

hostility, seductiveness, lack of interest or warmth, neg

itarian, insisting on immediate self-disclosure, emo