[Partless]

A time I was seriously traumatized by a therapist, this person had a solo practice. Since then I've become quite sensitive to seeing therapists who work with others in the same office. There are no guarantees either way, but my thinking is that if a therapist is being abusive or sadistic or sleeping with patients or doing whatever else that's unethical on a regular basis, it would be hard for other therapists not to notice that something is not quite right.

This is a terrible example for comparison but it just came to me, and I'm reminded me of a case of a severe and long abuse of a child I had read about long ago. The child lived in a home far away from other places and was home schooled. I had always wondered if the kid lived in a place where neighbors routinely came by, the abuse would have come to light faster. But obviously patients are not children, nor are neighbors therapists....

In an ideal world, none of this would matter. Because in this world, every therapist is ethical and every patient well aware of their rights and know very well when a therapist is abusing them and know when to end therapy. And when they don't, they're surrounded by loving family and friends who will remind them that therapy seems to be making them much worse or that it's odd that they're spending time with the therapist outside the session so often. Or whatever.

But I've seen people who go for therapy and part of their problem is that they do not have any good friends or that they're rejected by their family, and so it may be that only they and the therapist are the people who know she is going for therapy. And given her history of abuse, she may not know abuse in therapy even if it would appear clear to outsiders or other therapists, were they to find out. So I guess in a way I'm just trying to warn people to be careful and especially if they're in a real bad place in their life, take extra precautions because nothing worse than being traumatized by the person who is supposed to help you deal with past trauma and rebuild your trust in goodness of humanity.

my t has a solo practice... i'm not too worried about it though.

I much prefer to see a therapist in solo practice. I want the privacy and security that comes with the knowledge that no other people are involved.

[BlessedRhiannon]

Solo practice, and I prefer it. I saw a t in a multi therapist practice and I hated it...hated all the people coming and going. The lobby was always full of people. it was very, very stressful for me.

That's good of you to be concerned for others, Partless. I tend to think it's no different than children raised in what appears to be a good family, the ones that no one has any idea what's happening behind closed doors. So, having neighbors isn't always a guarantee. I saw an absolutely dreadful, verbally abusive one who shared a practice with two others. Fortunately, it happened within the second session so I was able to see the writing on the wall and get out before it was too late.

I do think that it's a good idea to be cautious no matter what the setting.

[NowhereUSA]

Mine works as part of a clinic so with lots of other Ts. I like it personally. They have regular consults so they can help each other out, plus he has a supervisor. Also, I like that I don't have to deal with him with regards to billing.

[msxyz]

Originally Posted by Mastodon

I much prefer to see a therapist in solo practice. I want the privacy and security that comes with the knowledge that no other people are involved.

Exactly.

[laxer12]

Mine is a part of a clinic and I like it that way. I get billed automatically after every appointment and emailed reminders about my appointment. I feel like a clinic holds them more accountable with supervision and consults. In my opinion, a T must be pretty good if someone else is willing to hire them to join their clinic. If I were to have a problem about my T that I didn't want to talk to her about, I could always contact her supervisor.

I've never seen someone with their own practice but my perception is that they could either be great or not.

Part less, this is an interesting topic. I am sorry that you have had experience with an abusive t. It's insidious and can leave us with huge scars and trust issues but also with good judgements about who to trust. I think if a t is that way inclined they will abuse clients no matter what the setting. I would like to think that working with other ts would lesson the risk but because of confidentiality most ts know nothing about the other ts work or clients.

[Lauliza]

I can see where you're coming from here and think it makes sense to be cautious. Of course all Ts in solo practice are not unethical, but for those that are, a solo practice is the ideal setting, especially if it's sexual. Like you said, it's the same with any abuser - the ideal way to take advantage of someone is be alone with them. In solo practice there are no colleagues, no supervision, no one to check in when something seems a little off. The only way unethical Ts in solo practice get caught is if clients report them, and many (if not most) clients who are abused do not file complaints. Someone who is going to hit on or sleep with patients might do it no matter where they are, but solo practice makes it much easier.

[healed84]

T works as practice of about 12 or 13 Ts.. He is the co-owner and the boss there. I like dealing with office staff as far as billing goes, and there is an office manger if I ever have to report any concerns about Ts. It nice, because when h and I were in need of a MC or my son was I need of a T, there were Ts right there at the same office to be referred to.

[feralkittymom]

Correlation is not the same as causation. It's a logical fallacy. Caution is always a good idea, but the conditions of a practice don't determine the ethics of the practitioner. As has been said, the nature of therapy is private, whether conducted in a solitary setting or a shared setting. There are factors that can be looked at as indicative of an ethical practice, but being in sole or group practice probably reflects economic reality more than ethics.

I experienced my T in both settings; while I responded differently, he remained the same.

[justdesserts]

My t works in a practice with 2 partners. They have a receptionist. My pdoc works in a clinic setting. I've seen solo practitioners before. I like the small office with partners. It's never crowded in the waiting room, but there's not the risk of T taking advantage because there are checks in place. I had a T who billed my insurance for appointments I didn't attend and I've never known if it was because he was forgetful or unethical.

Mine works privately from home.

[Partless]

Originally Posted by monalisasmile

Part less, this is an interesting topic. I am sorry that you have had experience with an abusive t. It's insidious and can leave us with huge scars and trust issues but also with good judgements about who to trust. I think if a t is that way inclined they will abuse clients no matter what the setting. I would like to think that working with other ts would lesson the risk but because of confidentiality most ts know nothing about the other ts work or clients.

Originally Posted by licketysplit

That's good of you to be concerned for others, Partless. I tend to think it's no different than children raised in what appears to be a good family, the ones that no one has any idea what's happening behind closed doors. So, having neighbors isn't always a guarantee. I saw an absolutely dreadful, verbally abusive one who shared a practice with two others. Fortunately, it happened within the second session so I was able to see the writing on the wall and get out before it was too late.

I do think that it's a good idea to be cautious no matter what the setting.

Thank you both. Also I just thought shared practice might reduce the likelihood of severe or long term abuse or certain kinds of abuse. But I agree, it's no guarantee at all, and it's useful to be cautious in any setting.

Originally Posted by Lauliza

I can see where you're coming from here and think it makes sense to be cautious. Of course all Ts in solo practice are not unethical, but for those that are, a solo practice is the ideal setting, especially if it's sexual. Like you said, it's the same with any abuser - the ideal way to take advantage of someone is be alone with them. In solo practice there are no colleagues, no supervision, no one to check in when something seems a little off. The only way unethical Ts in solo practice get caught is if clients report them, and many (if not most) clients who are abused do not file complaints. Someone who is going to hit on or sleep with patients might do it no matter where they are, but solo practice makes it much easier.

Wonderful, Lauliza you understood what I wrote perfectly. Thank you for that. Those were the kinds of scenarios I was referring to. I thought maybe going to a shared practice reduces the likelihood of such a T getting away with things so easily.

But what I said was also not in disagreement with those who say there are no guarantees. It's like everything else, all the other kinds of precautions we take with a new person. There are people who have been abused by licensed Ts, people with Ivy League education, people with many years of experience, people with great references.. Sometimes none of that is protective. Unfortunatley.

All of mine have been independent practioners, and I rather enjoy it this way. I might feel obligated to make small talk. My last therapist did most everything contrary to what people here say are boundaries, and I would check ithem with her continuously. So, much so that I she would be angry, not with me, but I was letting faceless names run my therapy at times.

Originally Posted by feralkittymom

Correlation is not the same as causation. It's a logical fallacy. Caution is always a good idea, but the conditions of a practice don't determine the ethics of the practitioner. As has been said, the nature of therapy is private, whether conducted in a solitary setting or a shared setting. There are factors that can be looked at as indicative of an ethical practice, but being in sole or group practice probably reflects economic reality more than ethics.

This. All of this.

I can think of several ways that a client would be at the mercy of an unethical T in a group practice, where they would not have suffered in the same way in a private/solitary practice. There was an example of that discussed on these boards recently, and there have been some recent articles in the papers here about the lack of respect for patients' integrity in hospitals or group practices, which has led to pretty bad violations of ethical codes. I still don't think that most Ts who are in group practices are unethical, but when they are, their patients have the exact same protection or lack thereof as do patients of licenced therapists in solo practices.

[Lauliza]

Originally Posted by Mastodon

This. All of this.

I can think of several ways that a client would be at the mercy of an unethical T in a group practice, where they would not have suffered in the same way in a private/solitary practice. There was an example of that discussed on these boards recently, and there have been some recent articles in the papers here about the lack of respect for patients' integrity in hospitals or group practices, which has led to pretty bad violations of ethical codes. I still don't think that most Ts who are in group practices are unethical, but when they are, their patients have the exact same protection or lack thereof as do patients of licenced therapists in solo practices.

There are all kinds of other ethical violations that can and probably do take place in any practice. I was really referring more to ethics as they apply to boundaries. I think it's fair to say that most Ts in solo practice don't have loose or poor boundaries and usually choose this route for convenience and economics. And your right I think in saying that colleagues will stand behind each other when professional integrity is in question- for certain things. When it relates to something sexual however, that can change. I do think sometimes there is a divide regarding what your co workers will stand behind you for. It all depends on the politics of the office and who is being accused. A director of a clinic or group practice will get away with more than a staff therapist. Still, solo practice makes it easier for the unethical T to get away with something. Especially repeat offenders- that's just more unlikely these days with the threat of lawsuits everywhere. For example, my pdoc has pretty tight boundaries, but one session we got deepn into conversation and he kept me for an extra 30 minutes. I had my T appt shortly after (They are in the same practice). When I got to her office and told her I just got out of his session she said "are you serious?!?". She and he office staff all just looked at me surprised because as I found out in her session, most people complain that he doesn't keep them long enough and he never goes over. There were no accusations and it honestly meant nothing. Still, she didn't know him well and I could tell that she made a mental note of it. When I told her about being on he same dating site as him, she was shocked again and asked if he contacted me. Neither of these things can happen in solo practice. So of course nothing is wrong with Ts or doctors in solo practice as a whole, it is just an environment that provides opportunity. And predators tend to be opportunists.

Originally Posted by Lauliza

So of course nothing is wrong with Ts or doctors in solo practice as a whole, it is just an environment that provides opportunity. And predators tend to be opportunists.

I'm really sorry that I am so bad at expressing myself. What I tried to say was that the group practice environment provides a lot of opportunity for unethical behaviour that a solo practice does not provide. I also tried to say that this is not something I am making up, I have read about such cases.

But since correlation - again - does not equal causation, the only thing we can say is that some therapists are unethical, and whether they are in solo practice or group practice, they will have the opportunity to prey on their clients.

[feralkittymom]

I don't believe anyone is denying the logistical reality that if a practitioner is unethical, solo practice may, in some instances, provide additional cover for such behavior. The problem is in the assumption that being in a shared practice affords a layer of protection: Lauliza, had you not mentioned the dating site to your T, she would not have known, despite being in the same practice. Had your T been in a solo practice, and you had the same conversation, the result would have been as it was, regardless.

It's also not often immediately clear just what the affiliation is within a shared practice. It could be a highly regulated environment with a great deal of supervision; or it could simply be a business arrangement to share space and secretarial services among independent contractors, with no structure of supervision. The consumer really has to be proactive to find such information.

I just think it doesn't benefit anyone to find false security; it's far better to look to verifiable evidence of ethical practice before choosing a T, and to remain vigilant for behavior that feels questionable--and to then check any misgivings out with a third party.

[Lauliza]

Originally Posted by Mastodon

I'm really sorry that I am so bad at expressing myself. What I tried to say was that the group practice environment provides a lot of opportunity for unethical behaviour that a solo practice does not provide. I also tried to say that this is not something I am making up, I have read about such cases.

But since correlation - again - does not equal causation, the only thing we can say is that some therapists are unethical, and whether they are in solo practice or group practice, they will have the opportunity to prey on their clients.

I think it's important to look at the research though, and the research does state that as many as 80% of offending psychologists are in private, solo practice. They also tend to be male, older and parentified (father figures to female clients):

http://66.199.228.237/boundary/bound...boundaries.pdf

[feralkittymom]

Perhaps you cited the wrong link? I only read the abstract of this dissertation, but the sample size was only 59 psychologists, and the most salient conclusions were that sexual abuse is perpetrated more often by male Ts with female clients; Ts at midlife, experiencing a recent loss, and that childhood emotional abuse was the strongest predictor.

So the lesson I would take from this is to avoid male Ts who experienced emotional abuse in childhood. I can predict an outcry of reponses denouncing such "advice." Agreed--because correlation is not causation.

[Lauliza]

Originally Posted by feralkittymom

Perhaps you cited the wrong link? I only read the abstract of this dissertation, but the sample size was only 59 psychologists, and the most salient conclusions were that sexual abuse is perpetrated more often by male Ts with female clients; Ts at midlife, experiencing a recent loss, and that childhood emotional abuse was the strongest predictor.

So the lesson I would take from this is to avoid male Ts who experienced emotional abuse in childhood. I can predict an outcry of reponses denouncing such "advice." Agreed--because correlation is not causation.

It must no give the whole paper, which is too long anyway at over 100 pages. I was citing a citation within this paper, not their actual findings of this paper. We all know that correlation does not equal causation, but such findings will raise awareness of the link. Whether it has any real relationship is yet to be seen. But but it certainly makes an awful lot of sense as it would in any situation where people are exploited or victimized. This paper is interesting for the fact alone it that psychologists who had been sanctioned for violations and lost their licenses actually agreed to participate.

It's just not a good idea to assume that therapy is safe (or safer) just because of the environment. A few years ago, it came out that a local mental health clinic counselor had been having sex with several of his female clients, one of whom moved in with him and ended up stabbing him. I think the reason he could act with such impunity without being caught or questioned is because the people receiving services are devalued, almost dehumanized. I get the same feeling when I go to the clinic for psychiatrist appt and there's a cattle call at the top of the hour. We aren't humans, but inventory. No one is watching how others behave. Colleagues look out for each other. We, as consumers, have mental problems after all. No credibility.

[feralkittymom]

Originally Posted by Lauliza

It must no give the whole paper, which is too long anyway at over 100 pages. I was citing a citation within this paper, not their actual findings of this paper. We all know that correlation does not equal causation, but such findings will raise awareness of the link. Whether it has any real relationship is yet to be seen. But but it certainly makes an awful lot of sense as it would in any situation where people are exploited or victimized. This paper is interesting for the fact alone it that psychologists who had been sanctioned for violations and lost their licenses actually agreed to participate.

The dissertation is there, I just have no interest in reading it all. I've read a lot of Gabbard's and Pope's works who also have treated offending Ts. What becomes clear is that the psychological basis for why and how some Ts offend is far more complex than any logistical conditions of their practices. What still puzzles me is the "link" you refer to. It is exactly that "link" that I find to be misleading. And that's because I think it supports a false sense of security that draws attention away from a number of other issues clients should be more aware of as consumers. There is a progression of behaviors ( behaviors being the manifestations of causative conditions) that has been cited in the research that constitutes red flags for abuse, and they happen regardless of whether a T practices alone or in a group setting.