"Red Flags" in therapy

So I've noticed in another thread that a number of people would like to share what they consider to be warning signs (or "red flags") that a therapist is moving toward crossing some kind of legal/ethical boundaries in the therapeutic relationship (i.e. wants to solicit his/her client sexually). Although I don't fear this particular issue myself (in my own therapy), I think it is important to be aware of the possibilities of abuse (something I hope is uncommon!!!). Rather than burying this information in other threads, I thought perhaps some folks might want to share their thoughts here? This could be especially useful if someone is doing a search for that type of information. So if you have specific ideas of what people should watch out for (especially regarding really subtle warning signs), please contribute!

Obviously this thread could be very triggering so I'll mark it with the icon....

Sidony

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sidony said:
I think it is important to be aware of the possibilities of abuse (something I hope is uncommon!!!).

Sidony

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Unfortunately abuse can take many forms. What to watch out for (if you can detect it): when the therapist puts his or her needs above yours. And if you express that you suspect the therapist is doing this, the therapist denies it and discounts your concerns.

I don't know if I'm skilled enought to know what is abuse or not. I know one particuliar thread felt uncomfortable, but I didn't feel I had the right to say anything because I'm just not sure, I just know it didnt feel right.

Here is a site that has a lot of good articles about this. Here is a article that talks about the precursers to sexual abuse. It is farther down the page. http://www.advocateweb.org/hope/boundaryviolations.asp

Here is another site, which has tons of information on this topic. Here is a link http://kspope.com/sexiss/research5.php

I think the related topic of "yellow flags" is also interesting. Yellow flags might or might not be ethical violations, but instead therapist actions which show he/she is not a very good therapist and that you might seriously consider terminating and seeking better help elsewhere.

Possible yellow flags (in my opinion):
--therapist does not really listen to you and forces his own agenda
--therapist is overly directive and repeatedly does not follow your lead on where to go in therapy
--therapist is inflexible and can or will not switch from a therapeutic approach that is not working for you
--therapist does not refer you to another therapist when he sees your needs are outside his scope of practice
--therapist is repeatedly insensitive and lacks empathy
--therapist seems uncomfortable talking about certain topics
--therapist is unreliable--he repeatedly cancels sessions, double books your session, is not there when you show up for session, cuts your session short, fails to return phone calls, etc.
--therapist shares your confidential information with others

Sometimes I think the red flag behavior can be seen in the clients too. When I put my former T up on a pedestal and believed he could do no wrong - I was setting myself up for trouble. If he had leanings in an unhealthy direction - I would have been a perfect target. If anyone questioned me, I'd blow them off (or getted pissed off at them...and I did!) because he was the center of my universe. When I see people in that situation, it makes me nervous for them.

As far as the T's behavior - I think the first article posted by flowergirl is very good. Some of of the behavior seems pretty innocuous, but in the context of the power differential - I think it's valid.

em

hmmmmmmmmmmmmmm....

male therapist visiting female client at her home, NOT at her request

male therapist marrying a female client

male therapist, showing tooo much emotion - ie crying, carrying on

male therapist giving too many "gifts" to female client

male therapist calling female client between sessions "just to see how you are doing"

pdoc falling asleep in session (that's just a bad one - red flag to being bad I guess)

therapist.. falling asleep (almost) several times in session

therapist spends session telling you her problems and expecting help

"cat and mouse" game between opp... sex therapist/client - bringing up the sexual tension by doing this..

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freewill said:

male therapist visiting female client at her home, NOT at her request

male therapist marrying a female client

male therapist, showing tooo much emotion - ie crying, carrying on

male therapist giving too many "gifts" to female client

male therapist calling female client between sessions "just to see how you are doing"

pdoc falling asleep in session (that's just a bad one - red flag to being bad I guess)

therapist.. falling asleep (almost) several times in session

therapist spends session telling you her problems and expecting help

"cat and mouse" game between opp... sex therapist/client - bringing up the sexual tension by doing this..

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FW, im assuming that by all the "male therapist" doing this, and "male therapist" doing that, you are also including female Ts, as female Ts can be just a destructive and unethical.

male therapist calling female client between sessions "just to see how you are doing"

i personally dont see a problem with that, i mean, i guess if it doesnt have the greatest motives...it can be sketchy, but other than that, i would have absolutely no problem with my T doing that! lol =]

just my opinions i guess.....

hope everyone is well, good night
mel

I think it is good for everyone to be aware of these things, because they do happen. Being in the profession doesn't protect you either because T's are human just like everyone else. When they are in therapy, even with all their training, they still have feelings too. They may know a lot about psychotherapy but when they are the client, they still are vunerable just like anyone else.

I know a lot of T's and they have problems just like all of us. You would think with all the school and training would keep that from happening, but sometimes it is easier to help others with their problems, and be totally be blind to their own. Some T's are better than others in reconizing that, that is why some T's are in therapy too.
But some aren't and need to be.

That is why you need to be careful with anyone, a title doesn't protect you from getting hurt. A lot of training in the field, and studying about psychology helps, but it doesn't keep you from having problems or keep you from being a target of abuse. Even T's can be exploited by their T's, because in therapy, you are in your most vunerable state.

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emily4040 said:
Sometimes I think the red flag behavior can be seen in the clients too. When I put my former T up on a pedestal and believed he could do no wrong - I was setting myself up for trouble. If he had leanings in an unhealthy direction - I would have been a perfect target. If anyone questioned me, I'd blow them off (or getted pissed off at them...and I did!) because he was the center of my universe. When I see people in that situation, it makes me nervous for them.

em

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This is true, but it is ultimately up to the T to be aware of this, and not exploit the client, even if the client is doing this. The responsibility of keeping the boundries is the T's, and that it why it is so important to have a ethical T. But sadly, not all T's are well themselves, and clients can get hurt in the process.

I think a big red flag is when a client idolizes a therapist to the point of not accepting that anything COULD be inappropriate. To lack the ability to even "see" the signs or even acknowledge the possibility.

For many, a therapist crossing boundaries feels GOOD. The client loves it... the attention, the feeling "special". The client doesn't want to see or hear it (fingers in ears chanting la la la la la) The client can convince themselves that nothing inappropriate is going on, even when sexually inappropriate behavior is actually going on.

Sadly, it's not uncommon.

Here is another good ariticle that talks about how this happens to even T's in training with their therapists. http://psychologytoday.com/articles/...01-000033.html

another good one http://www.division42.org/MembersAre...oundaries.html

IMNSHPO one of the questions everyone should ask their T is, "Do you have someone to go to when you need to talk, like a mentor or colleague?" Their answer will tell you whether they feel they don't need anyone or whether they are humble enough to know they are human.

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april15 said:

For many, a therapist crossing boundaries feels GOOD. The client loves it... the attention, the feeling "special".

Sadly, it's not uncommon.

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And I would just like to point out feeling these things is also a result of a completely healthy therapeutic relationship with no boundary crossing. If someone focuses completely on you, validates your feelings and gives you unconditional positive regard for one hour per week... chances are, you're going to love it. You're going to feel special.

It is unfortunate that in therapy, boundary crossing does happen. Therapists hold a great power, and it is so, so sad to realize that some may take advantage of that.

Lines can be blurry, I know. We need to be aware of this stuff. But I am also protective of how sacred and intimate a healthy therapeutic relationship can be.

Happyflower,

It seems that this is an important issue for you that you have done a lot of research on -- if I'm not prying, do you mind sharing why?

I just worry that people who read here for information or support might get the idea from the amount of posts on this subject that this is more of a common problem than it is and shy away from obtaining treatment that they need or worry about closeness in therapy that is perfectly appropriate and helpful.

Hi Carmen,

It is an important issue, not just for me, but many. It is only one thread, and I can't control how many view or post to it, I didnt' even start the thread. People wouldn't even read if it didn't interest them or concern them. I think an informed client is better than an uninformed client. The more informed they are, they are more likely not to fall into the traps. These articles are not just about T's , but doctors, lawyers, teachers, etc..

This is just one of the many subjects I am interested in, as I am studying to be a T. One of the main problems with this issue is that many want it to be hidden, not talked about, like many abuses. Many victims don't report it even. It is a form of abuse that has been hidden and covered up for a long time. There are warning signs and it is important to be aware of them.

These articles shouldn't scare anyone of seeking thearpy, it states in many of the articles the percentages .

There are apporpriate closseness in therapy and inapporpriate clossness. It actually accures more than we think, because much of this abuse goes unreported.

Actually it is like how we teach our children about "strangers" and inapporpiate touch. It isn't to scare our children from people. It is to teach them about appropiate boundries, what is normal and what isn't, and what to do about these situations if they occur. Knowledge leads to prevention and prevention leads to self protection. Self protection lead to less victims.

Mel.. I didn't feel well when I posted so didn't get extremely specific and precise in my post. I also probably geared the post from my personal experinece with a male therapist..

Hopefully most people could "read between the lines" and understand that it goes for both male and female therapists.

had I felt better, I could have made the post more precise.

any reponse a poster makes can be picked apart for exactness... hopefully this follow-up post lends some clarity..

so sure it goes both ways.. male/female therapists

Also if a therapist is "constantly" calling the patient between sessions then it is a problem.. for one thing it lends itself to the patient actually thinking that they cannot handle their own life - too much dependence,,, which in the long run is not a good thing..
the operative word here being "constantly" - to be more precise.

I was not picking on male therapists... just speaking from personal experience...

the visit to my home in particuliar was very upsetting to me - it was unexpected, I felt invaded and very unsure how to handle the whole situation...

so my sorry for not being specific enough...........

take care all... freewill

im sorry lol, i didnt mean to "pick apart your pose piece by piece", was just replying.....

tc
mel

no problem... it is just a subject I feel very strongly about..

take care.

What really bothers me about T's who abuse, is that with their position and the clients, the T is more likely to be believed. Even when the relationship is the T's responsibility to keep it ethical, the victim often is blamed. Which is so wrong.

Another things that bothers me is that other T's are more likely to not want to get involved either, if they know about this. It is like a secret brotherhood, like the police have. So it is so hard to do anything about it. So sad, really because a lot of these cases, the client goes over the edge. The T might lose his liscense, but the victim still suffers long after the abuse.

Sidony, thank you for posting this thread. It is an important one. As many of you already know this is a topic that is very personal to me. I think for me the first indication of a problem was not anything blatant it was just a sinking feeling that things didn't seem right. Nothing specific, nothing I could pinpoint and say ah ha this is obviously wrong. Just an uncomfortable, gut feeling. Of course, as time went on it became more specific. A hug that went too long, him talking about personal sexual experiences he had had, flirty behavior, inappropriate jokes, etc. He was testing the waters.

Happy Flower Girl, I cheered when I read your posts. You provided links to two of the best resources I've found on this topic. Kenneth Pope's book: Sexual Involvement With Therapists: Patient Assessment, Subsequent Therapy, Forensics should be required reading of every therapist and psychiatrist so that they will know how to deal with this issue should it arise. AdvocateWeb was an excellent resource, too because it connected me with other people who had been abused by mental health professionals/priests/etc. I needed that connection.

After I broke off the abusive relationship with my psychiatrist I came really, really close to ending my life. It has been devastating. I felt that if a psychiatrist would use and abuse me then who wouldn't. I didn't know where to turn or what to do. All I can say is thank god my therapist did get it. Thank god she believed me, took the duty to report seriously, and turned his butt in. Thank god she understood my attempts to protect him even when he had hurt me so badly.

So, thanks again to all for putting the resources out there. It's important that people know that if this happens to them there is hope and help and that they are not alone.