Therapy is supposed to be a safe place. A setting wherein the client can relax his/her everyday protective stature in the hopes of exploring and resolving painful psychological issues. A place where the client "is encouraged to open herself completely to the presumably benign and therapeutic influence of the therapist's professional skill."¹ Where it is the sole responsibility of the care provider to ensure their care affords the client no harm.

Many therapists are reputable professionals. Unfortunately some therapists do abuse their clients. The Task Force on Sexual Abuse of Patients reports that "23% of the incest survivors who go for help end up being abused sexually by their "helpers"."² Within the 6 month period in which the Task Force received community input on this issue, 303 detailed reports of sexual abuse by physicians were received.³ This compared to 27 reports to the College of Physicians and Surgeons in the preceding 11 years.⁴

When the trust placed in a care provider is abused, the results are devastating for the client, his/her family, and for a society that places so much faith in the medical profession.

A client seeking help from a care giver is vulnerable by virtue of their need, and this vulnerability provides the physician with the power to exact sexual compliance. Knives, guns, physical force are not necessary.

When abuse takes place in psychotherapy the harm is particularly poignant. Not only does the client not receive appropriate and effective help for the issues which brought them in to therapy, but those issues are further exacerbated, and compounded by the further abuse. The damage can be physical, emotional, psychological, and spiritual.

In addition to all the expected symptoms of sexual abuse, clients develop a fear and mistrust of care providers, making it exceptionally difficult to receive subsequent care. Trust in the therapy process has been shattered. Often the client has also lost trust in his/herself, in his/her ability to recognize harm, to make good choices, and to protect themselves from harm. Confusion, ambivalence, shame and the need for the abuse not to be real, serve well to maintain the silence, and deter the client from seeking help elsewhere. Even where a client can muster the courage to eventually return to therapy, the nature of the harm done makes subsequent therapy problematic and overwhelming at best.

Re-engaging in therapy essentially places the client in a situation where he/she is asked to once again place his/herself in the therapeutic environment, and trust in the very process (psychotherapy) that was utilized to harm them. A good analogy is to imagine having to enter a den of spiders, in order to talk to the head spider about your intense fear of spiders. To get help for the abusive therapy, the client must enter into yet another therapeutic alliance, one fraught not only with the original issues, but where therapy itself is a concurrent issue. The problematic nature of this extra dynamic can not be overstated.

The opportunity normally afforded in psychotherapy - to postpone facing overwhelming material until such time as the client has had sufficient time to explore safety levels and 'experience' safety in relation to their vulnerability - is not present. The client is, at some level, immersed in the very dynamics he/she seeks help for from the very start. Triggered memories of how the therapy process was used to harm constantly interrupt any tentative sense of safety. Society's faith that therapists help to heal can not convince the client that it is safe, experience has shown it not to be. Further the client may not have faith in his/her own ability to recognize safety issues and protect his/herself. This powerlessness is very real. Negotiating and accepting help has been rendered fundamentally unsafe.

Depending on the particulars of the abuse, many of the 'normal' therapeutic concepts, statements and remarks traditional to the therapy environment, trigger rather than soothe. The experience of subsequent therapy sounds and psychologically 'feels' just like the process that previously brought devastating harm. The client, who has not had the luxury of working up to a level of safety that would allow for therapeutic discussion of the triggers, can find his/herself in considerable psychological distress with nowhere safe to turn. Safety and trust, the foundation of the therapeutic alliance, are precarious and fleeting at best. A fact through which all traditional assumptions regarding the therapy process must be filtered. To not do so is to invalidate the experience of the therapy abuse survivor.

Casual advice such as telling a therapy abuse survivor he/she must trust in order to heal or should report the therapist, can, despite good intentions, reinforce the negative dynamics of the abusive therapy relationship by effectively encouraging the client to disregard his/her internal protective mechanisms before he/she may be psychologically ready. A dynamic which was no doubt taken advantage of by the abusive therapist. Unfortunately, as a by product of societies faith in care providers, therapist abuse survivors feelings and experiences are regularly invalidated by well intended comments, resulting in even greater isolation

All abuse survivors, but particularly therapy abuse survivors, need to be given control over their therapy. They need the acceptance, patience, facilitation and opportunity to find safe ways to make their own decisions regarding risk and ability to tolerate subject matter. They need to learn from scratch how to listen to their inner voice, to trust their perceptions, and learn how to use them to take control over their own safety in therapy. A substantial task given the insidious manner with which these skills were undermined. The journey is a slow, difficult and an extremely psychologically painful one. Therapy is stressful rather than supportive. The courage it takes to continue to enter the therapist's office each and every week is to be applauded.

Throughout that journey they need to be truly heard in a non-judgmental, non-directive, accepting manner. They need someone to "be" where they are and to comprehend their overwhelming pain. They need help tolerating the pain of a journey only they can direct.

© 1996 Silent No Longer
Copies may be distributed freely for non-profit, educational purposes only. Silent No Longer is an electronic "Peer Support" discussion group. Participants include male and female survivors of abuse (all forms), as well as individuals with a supportive interest in the topic.

The following testimonials were all taken from the Final Report of the Task Force on Sexual Abuse of Patients. November 1991.

"A woman called to disclose incidents of sexual abuse by her male psychiatrist, 16 years ago. She said that she was depressed and confused about a lot of things, having come from a home where she was abused. She confided in him, and he started holding her when she cried. He began lying next to her, saying that he was giving her support and help. She eventually became very afraid of him, but she was desperate to keep up her therapy. She said that there was no intercourse because he was impotent, but a lot of sexual stuff was involved. He stopped the extra-billing. She wanted to get out of it but did not know how. Finally she told her husband, who confronted the doctor, and they both saw a lawyer. She didn't take the doctor to court or report to the Medical Council because she became "a basket case" over this and was hospitalized. All they wanted was their money back. She feels guilty for not stopping him from hurting other women, and feels the reason she couldn't stop was because she was so afraid of being abandoned."

"A woman reported being sexually abused by a physician, later suffering from shock and ending up in the hospital emergency room. She said that her family and friends discouraged her from taking action against this doctor by saying "you can't fight the doctor, it is his word against yours." The patient finds going to a doctor a very frightening experience. Therefore, she does not have medical checkups."

"A male called to report sexual abuse by his psychiatrist whom he consulted for help with his homosexuality. He reported a lot of hugging. He reported the case to the police an the Attorney General's office and feels that the process is much too slow. He believes that nothing will be done to perpetrators as long as they are protected within their titles and their fancy offices."

"A woman called to report sexual abuse of patients by a doctor who is her husband. She feels that this has been going on for a long time and does not know what to do with the information. She knows that there were complaints to the College about her husband, and is concerned that he is still abusing women."

"A woman called to testify. She said she went to see a psychiatrist for the treatment of phobias - phobias about being touched. She said the doctor recommended that he desensitize her by touching her. At each treatment, the doctor would fondle and touch her. She felt that this treatment was inappropriate, but she felt powerless and so allowed it to happen. The therapy lasted for 7 years. She said she never got better. The doctor often saw incest survivors."

"A woman called to report what she termed, "unprofessional behaviour" by her physician over 25 years ago. He made statements which were inappropriate and of a sexual content such as "I wonder if my penis can be big enough to satisfy you.". She asked him if he talked to his patients like that, and he answered, "Yes, if they're attractive enough.". Even though she was not physically raped, she felt abused. She is considering pressing charges. She thinks he should be reprimanded, and is very thankful for the Task Force being there. She is sick and tired of people who never believe "us patients." She also believes that the doctor is still practicing.

"A woman reported having a sexually-abusive relationship with her psychiatrist for six months. She's been suffering emotionally ever since the experience and is unable to continue her normal life. She finds herself feeling isolated from all social contact, feeling "dirty" and at times, wanting to die. She was unable to share this experience with anyone, and took the risk to speak to the Task Force on the phone. She said that she would never be able to do this eye-to-eye. She fears that the doctor is still abusing other patients out there, and wonders what can be done about it."

"A woman called to ask for time to testify privately. She said that in 1981 while she was in six months of therapy, the therapist took advantage of the fact that she was single, alone and depressed. She said she was encouraged to sit on the doctor's lap when he fondled her breast. The next time, they sat on the couch. Then he called her at home and said,"You must be very confused about what happened today, let's go for a drink." She said they did; nothing happened. She couldn't talk to him easily about it. She continued to see him for a few months. Then it ended. She said that she was very vulnerable and needy at the time, and she thought it was developing into a personal relationship. She was also helped by meeting someone (whom she married soon after) to whom she told this, and who was very supportive. She also shared this with her supervisor who, who she said, was supportive. She now has a therapist, and is working through the issue."

"A woman reported that her general practitioner sexually and psychologically abused her. She said that she had been in therapy with this physician for one year. During this period, the physician tried to hold her hand and touch her legs. He also called her "sexy," "sweet," "attractive," and gorgeous." He offered her a job at his office. The patient reveals that she feels it extremely difficult to terminate the relationship, even if she knows that it's not healthy. She shared this experience with her husband, who is having difficulty understanding her position."

"A woman called to report a 10-year sexual exploitation by her social worker when she was between the ages of 15 and 25. She was anorexic and was hospitalized for one year. She was referred to a social worker on her release. The social worker told her that he could teach her about sex. She thought he really cared about her and was really grateful to have someone treat her as "special" and care about her. She kept this to herself all these years. Presently, she feels very angry and very hurt. She wants to take action, but does not know how to go about it. She was pleased to be able to talk to the Task Force members, and felt it was a start."

Additional reading material:

The Final Report. Task Force on Sexual Abuse of Patients, November 25th, 1991. An independent Task Force Commissioned by The College of Physicians and Surgeons of Ontario.

The Preliminary Report: Task Force on Sexual Abuse of Patients, May 27th, 1991.

Sex in the Therapy Hour. A Case of Professional Incest. Carolyn M. Bates & Annette M. Brodsky. 1989, Guilford Press. ISBN 0-89862-726-5.

Patients as Victims. Sexual Abuse in Psychotherapy and Counseling, by Derek Juhu. 1994, John Wiley & Sons, ISBN 0-471-94398-3.

Sexual Intimacy Between Therapists & Patients. Kenneth Pope & Jacqueline C. Bouhoutsos. 1986 Praeger publishsers. ISBN 0-275-92253-7.

Sex in the Forbidden Zone. When Men in Power - Therapists, Doctors, Clergy, and others - Betray Women's Trust. Peter Rutter, MD. 1989 Fawcett/Balantine Books. ISBN 0-449-14727-4.

 

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