Pamphlet - In all clinics for Survivors of Unethical Therapy; what goes in it?

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Originally Posted by Xynesthesia2 I think it would be best to create a neutral email address for this and make sure people check it. Finding a name would be good, too. I personally would not invest a lot more thought and energy into organizing much more before trying something relatively simple and seeing how it works. I would be happy to edit an abstract if people put together a draft first as I have a lot of experience with those and do it all the time. A poster abstract is very easy to write... much easier than a pamphlet or a proposal for organizing a session or workshop. Then the experience/feedback gathered from the conference could be used to do more complex things. It would also have to be decided how to fund participation at a conference. Registration fee, travel, accommodation... it would likely be a few hundred US $ for sure. If people don't want to pay out of pocket, maybe create an online fundraiser of some sort.

Maybe open it up to the community, such as through a WordPress site with a contact email and a link to help fund this project??? There might be other venues, too.

Of course, someone would have to manage/create the website, manage/monitor the emails, manage/oversee the funding, and work out the logistics for the presentations, etc.

Who will be attending the conference, if accepted?

Who is willing to "out" themselves when presenting at a conference?

Who is willing to volunteer in any of the areas mentioned above?

Who is willing to oversee the funding, and should a committee be established, so as to make sure that funds are properly appropriated?

Who should also serve on the committee that establishes a unanimous vote on the final draft of the abstract, presentation, etc.?

Because this does not require IRB approval, what other precautions and limitations should be stated here? Are there any disclaimers that should be made? Are there any legal matters that should be addressed as well?

IMO that would be way too much work and complicating right now, Lilly. Even creating a website, unless someone wants to do it and does not mind the time and effort it takes. There are already websites for therapy abuse as we know, that would not be anything really new or more effective. We could potentially compose an abstract here on a thread like this, use something like Google docs, or simply just that email address we all could have access to. There wouldn't be any precautions other than submitting something that makes sense and is written well. Organizations/conferences usually state clearly in their abstract submission guidelines if they requite any specific disclosures - the max I can imagine for this would be stating we don't have any conflict of interest, which usually means financial. In the presentation, there would have to be an acknowledgement of funding sources (if any), but that is really all. As I said, it is really simple and no risk whatsoever. The only thing I would want to make sure is that the materials are presented in a reasonable, objective manner - a conference would not be a good place for gross generalizations and passion and definitely not for obviously inaccurate information - those things would likely just irritate people and would not gain interest and respect.

I would be happy to present a poster at a conference (next year) if the material is compatible with my views and agree it would be best if at least 2-3 people contributed.

I would say let HD and others who initiated this whole thing chime in and decide what they want to do. Make a plan, then just execute it step-by-step, without overworking. IMO, putting way too much into organizing committees, website, etc might be more risky in a sense that, very often, people get excited initially about an idea like this but it dies off on the go and then those who actually invested a lot of thought and work are disappointed. This is why I am saying start small and realistic, see how it goes, then decide what else is in it for the next steps.

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Originally Posted by Xynesthesia2 IMO that would be way too much work and complicating right now, Lilly. Even creating a website, unless someone wants to do it and does not mind the time and effort it takes. There are already websites for therapy abuse as we know, that would not be anything really new or more effective. We could potentially compose an abstract here on a thread like this, use something like Google docs, or simply just that email address we all could have access to. There wouldn't be any precautions other than submitting something that makes sense and is written well. Organizations/conferences usually state clearly in their abstract submission guidelines if they requite any specific disclosures - the max I can imagine for this would be stating we don't have any conflict of interest, which usually means financial. In the presentation, there would have to be an acknowledgement of funding sources (if any), but that is really all. As I said, it is really simple and no risk whatsoever. The only thing I would want to make sure is that the materials are presented in a reasonable, objective manner - a conference would not be a good place for gross generalizations and passion and definitely not for obviously inaccurate information - those things would likely just irritate people and would not gain interest and respect. I would be happy to present a poster at a conference (next year) if the material is compatible with my views and agree it would be best if at least 2-3 people contributed. I would say let HD and others who initiated this whole thing chime in and decide what they want to do. Make a plan, then just execute it step-by-step, without overworking. IMO, putting way too much into organizing committees, website, etc might be more risky in a sense that, very often, people get excited initially about an idea like this but it dies off on the go and then those who actually invested a lot of thought and work are disappointed. This is why I am saying start small and realistic, see how it goes, then decide what else is in it for the next steps.

Unfortunately, one of my personal boundaries on PC is that I will NO LONGER share my email with anyone, and I will no longer converse in private conversations with anyone via email.

If there were a website where anyone (including but not limited to PC members) could join and sign up, then the protections for identity would still be there. Without that, there might be concerns about privacy.

I agree with you about the "gross generalizations" bit.

Since this is HD's "baby," HD should be the one to spearhead such efforts; she came up with this idea. Although, everyone's unique ideas are their own and could be shared in a coauthorship with HD, if HD chooses to do so.

I don't mind "giving away" my ideas because this isn't an area that I plan to get into as a career. Anyone can steal my ideas and run with it, improve upon it, correct it, etc.

I can be the on-PC no-named helper, as I don't want or need any credit - with a pseudonym or otherwise. I just want to be of support in some way, anonymously.

This isn't my baby. This isn't about me - this is about everyone else.

Keeping the anonymity and making it simple is why I suggested to just use the public PC forum. I also wouldn't give my personal email address to anyone from a forum like this unless I have met them in person or at least have long-standing conversations with them. I am fine with PMs here, just have a tendency not to keep up with them and follow through much, I am also not consistent with checking in here. But simple practical things for a goal that is predictable are fine. Same for me on the credit thing, already collect enough of that in other areas of my life and am usually on PC more to entertain myself, engage in discussions that interest me, and learn about aspects of mental health that I would not see otherwise. I don't have any other reason or goal with it but if something useful comes of it, why not. As I said, I would not mind presenting publicly and maybe my experience would help, but the material needs to make sense and be realistic for me to participate.

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Originally Posted by HD7970GHZ This isn't my baby. This isn't about me - this is about everyone else.

Awe, shucks, HD, *blushing*, you are so sweet!

Thank you!

We haven't heard from you in a while. Are you okay? What do you think about all the ideas being shared here? Is there a way that everyone can have a voice, including those with "gross generalizations"?

I tried to share my "continuum" idea to include generalizations on the spectrum where "against therapy" rests, if that even belongs on the spectrum or as its own entity at any given point in time.

What are your thoughts?

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Originally Posted by Xynesthesia2 Keeping the anonymity and making it simple is why I suggested to just use the public PC forum. I also wouldn't give my personal email address to anyone from a forum like this unless I have met them in person or at least have long-standing conversations with them. I am fine with PMs here, just have a tendency not to keep up with them and follow through much, I am also not consistent with checking in here. But simple practical things for a goal that is predictable are fine. Same for me on the credit thing, already collect enough of that in other areas of my life and am usually on PC more to entertain myself, engage in discussions that interest me, and learn about aspects of mental health that I would not see otherwise. I don't have any other reason or goal with it but if something useful comes of it, why not. As I said, I would not mind presenting publicly and maybe my experience would help, but the material needs to make sense and be realistic for me to participate.

Go forth and carry our message! (I tried to be funny here, without being sarcastic. But seriously, thank you! If you, as a professional, could share this with the world, that would be great!)

My PTSD kicks in when it comes to sharing my identity, as does my DID. :P

Sorry.

Sorry, dude. The reality is that participating in the world requires a sense of things being about both me AND everyone else.

That's knowledge/reality won from my own personal struggle, but I think it's worth your consideration.

It's not like a real baby -- I had two of those and their survival and well-being were critically important to me. More important to me than anyone else in the world except my late husband.

This is different. I think all or most of us participating in this forum are interested in the well-being of this idea.

But you started this thing and consequently, I (and others) look to you for your input. You had enough of a sense of what was needed to push forward with some ideas. Maybe the final product won't be what you started out with, but. . .Your input on this is still wanted and needed, I believe, in order for it to go forward.

I wouldn't want to use my personal email but I can "come out" in the world with my real name. I may or may not be able to get to a conference but could possibly fund another person who can.

Coincidentally -- what I wrote above is from a sense of "me" and what I can contribute to an effort hopefully involving everyone else. It's a difficult sense to try to develop, and kind of a balancing act. Like riding a bike.

We can do this, though!! (I hope. )

I don't mean I won't be going down the rabbit hole and fighting in the trenches, I just mean I am not anyone special. I am just one person is all.

Thanks,
HD7970ghz

Still, you started this thread, and others, that have gotten a lot of responses and comments. And you're not alone in being just one person. I think that's all any of us are here, really.

What do you think about the conference idea? Or would you prefer to go back to discussing a pamphlet and what you hope to accomplish there?

I will have to look back and read everything in a day or two. Just unable to delve into it in great detail at the moment.

Thanks,
HD7970ghz

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Originally Posted by HD7970GHZ I don't mean I won't be going down the rabbit hole and fighting in the trenches, I just mean I am not anyone special. I am just one person is all. Thanks, HD7970ghz

What's wrong with the rabbit hole? Wouldn't it be fun to fight in those trenches? --JOKING. For some reason, I'm thinking of Alice in Wonderland (though I never saw the movie) and the Trix Rabbit in combat gear. I tend to have quite an imagination, especially on the weekends.

Meow meow meow

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Originally Posted by HD7970GHZ Meow meow meow

I wanted to chime in on this. I think "against therapy" is even itself a continuum. The trouble is it's too often presented as though the options are that either we stick with something that's essentially what we have, or we throw out the entire idea of mental health care altogether.

For example, I personally don't think that therapy is always bad. But I think the medical model really needs to go away entirely, or at least be severely constricted to cases where there's a clear and simple biological root. It's related to what I said earlier, where we have a fairly clear idea (in most cases) of what physical health would look like. But our ideas of what good mental health ought to be are often heavily value-laden. And I think the dominance of the medical model inevitably leads to abuses because it encourages viewing disagreement as evidence of dysfunction and fundamentally strips clients of meaningful self-determination.

That isn't, for me, to say that therapy is always bad. But it is to say that there are significant bad components that are inherent to the way therapy is practiced in the current social and legal system. And making it safe would require a significant overhaul of the fundamental assumptions we have. A given therapeutic relationship may have more or less of this aspect, depending on a number of factors, but it's never entirely absent.

Also, if we wanted a website - I don't have a lot of web skills, but I have enough to handle some basic stuff. If people want, I could put together something basic that would let people coordinate things, and do very basic screening of stories. Just to make sure we're not being trolled and to remove any identifying details that might trigger a lawsuit. It would need to be a requirement that we don't publish names or identifying information of mental health professionals involved, unless there is already publicly available information such as a completed lawsuit or formal disciplinary action regarding the events.

But I do know that I can put together a web form that would let people submit stories without having to provide an email address. Can't promise it would allow for actual formatting or anything more complicated than a paragraph break, because I'm still learning.

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Originally Posted by OnlyOnePerson I wanted to chime in on this. I think "against therapy" is even itself a continuum. The trouble is it's too often presented as though the options are that either we stick with something that's essentially what we have, or we throw out the entire idea of mental health care altogether. For example, I personally don't think that therapy is always bad. But I think the medical model really needs to go away entirely, or at least be severely constricted to cases where there's a clear and simple biological root. It's related to what I said earlier, where we have a fairly clear idea (in most cases) of what physical health would look like. But our ideas of what good mental health ought to be are often heavily value-laden. And I think the dominance of the medical model inevitably leads to abuses because it encourages viewing disagreement as evidence of dysfunction and fundamentally strips clients of meaningful self-determination. That isn't, for me, to say that therapy is always bad. But it is to say that there are significant bad components that are inherent to the way therapy is practiced in the current social and legal system. And making it safe would require a significant overhaul of the fundamental assumptions we have. A given therapeutic relationship may have more or less of this aspect, depending on a number of factors, but it's never entirely absent.

I was trying to include everyone's versions and experiences in the continuum. I think you are right though: The against therapy is a continuum of its own.

I learned a little bit about the medical model as an undergrad, and they used addictions as an example. I completely forgot what the medical model entails, but I like how you explained it here.

I also learned the differences between the medical model, the punitive model, and the trauma-informed model for adjudicated juvenile delinquents and convicted adult offenders (or convicted youth charged with adult crimes). But not everything is trauma-related. This wasn't a psych course, but rather a corrections course. Their description of the medical model differs from the psych course I had taken, since the medical model presumes rehabilitation is possible for some, but it negates the behavioral changes that need to take place in order to reduce recidivism and/or non-criminal acts/behaviors. The trauma-informed model assumes that trauma has taken place, and for juveniles, specifically, both the medical model and the punitive model are embedded within the trauma-informed framework. This could be true for other settings as well, such as those who treat certain personality disorders from a trauma-informed perspective, and one that combines the medical model with the punitive model (behavioral aspects of reinforcements - positive and negative).

If the medical model is the problem, as you say, what would be an alternative solution? And would the medical model be the problem in all of the following areas on the "REDIMME" continuum:

Ruptures

Emotional abuse

Dependency

Iatrogenic effects of treatment

Misdiagnoses and mistreatments

Malpractice

Exploitation


How would you see the medical model being problematic in each of those continuum markers?

And, for each of those continuum markers, what would the solutions or alternative methods be, apart from the medical model?

The questions I ask are problem-solving questions. We identify the problem, and then we try to find solutions for that problem.

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Originally Posted by OnlyOnePerson Also, if we wanted a website - I don't have a lot of web skills, but I have enough to handle some basic stuff. If people want, I could put together something basic that would let people coordinate things, and do very basic screening of stories. Just to make sure we're not being trolled and to remove any identifying details that might trigger a lawsuit. It would need to be a requirement that we don't publish names or identifying information of mental health professionals involved, unless there is already publicly available information such as a completed lawsuit or formal disciplinary action regarding the events. But I do know that I can put together a web form that would let people submit stories without having to provide an email address. Can't promise it would allow for actual formatting or anything more complicated than a paragraph break, because I'm still learning.

LexisNexis and FOIA requests work great to find publicly available data, including lawsuits, amicus briefs, newspaper articles (alleged, not yet convicted, unless otherwise stated), and legal cases establishing precedence.

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Originally Posted by OnlyOnePerson Also, if we wanted a website - I don't have a lot of web skills, but I have enough to handle some basic stuff. If people want, I could put together something basic that would let people coordinate things, and do very basic screening of stories. Just to make sure we're not being trolled and to remove any identifying details that might trigger a lawsuit. It would need to be a requirement that we don't publish names or identifying information of mental health professionals involved, unless there is already publicly available information such as a completed lawsuit or formal disciplinary action regarding the events. But I do know that I can put together a web form that would let people submit stories without having to provide an email address. Can't promise it would allow for actual formatting or anything more complicated than a paragraph break, because I'm still learning.

I like your idea! A website that would allow anonymity, and spread awareness about the REDIMME hypothesis (the potential risks of therapy, as perceived by lamenting clients, with definitions borrowed and synthesized from available data; each of the terms represented in the acronymn REDIMME should be defined so that those who contribute their stories with their pseudonyms can easily describe what they had experienced; examples should also be included).

The web design could include the following pages:

1. Main/home page
2. About us page
3. Story contribution page (with possible comments allowed, so as to see what the general public and/or professional guests think)
4. Resources (e.g., TELL website, PsychCentral articles, etc.)
5. Research (listed in APA style (references with DOI links)
6. Contact (with email)
7. Donate
8. Volunteer

If you can think of any additional pages, please do so. The main page will have links to each of the pages on the website.

A search/indexing feature would be great for the website, too, which can remain stagnant and at the top right hand corner, so that viewers can easily use key words and phrases to find a topic they want to read about.

The committee of volunteers could include:
1. Website maintenance committee (2 plus persons)
2. Funds appropriations committee (board members comprising all volunteers)
3. Research committee (2 plus persons)
4. Resources committee (2 plus persons)
5. Email incoming (5 plus persons monitoring)
6. Email responses (5 plus persons, with the unanimous approval of 2 plus board members - particularly gifted at written communications and legal or ethics)
7. Story contribution reviews (prior to publishing; 5 plus persons - particularly gifted at editing, written communications, and legal or ethics; all stories should be moderated and approved, with some minor editing recommendations for the author)
8. Other committees ??

From the website and its various volunteers, the committee members can work with other institutions, such as TELL administration, to see about gaining publicity for the website.

Additionally, printed materials (such as what HD originally described in terms of a pamphlet) could be handed out at various symposia. A committee might be needed for that, too, or with joint efforts of both research and resources committees and any other volunteers. If there are friendly researchers, psychologists, lawyers, or advocates that want to volunteer, that would be a plus. Poster presentations and other presentations could also be implemented.

My perspective is admittedly limited. My initial problems were largely trauma-based, and I was definitely in the misdiagnosis/mistreatment section of things. I do also have some experiences with things that I think were not at all symptoms being seen as symptoms.

I think the widest range of harm in the medical model is the disempowerment of the client perspective when the client does not accept the therapist's view of health. In any of the levels that do not involve deliberate therapist conduct, it acts to prevent the acknowledgement and repair of the problem. If the therapist is discouraged from taking the client's perspective seriously, then it will be far harder to fix mistakes.

I'll have to think about the rest. I have some interesting thoughts that come from my own catholic faith and research into that, and how some aspects of the path I took would not be considered "healthy" necessarily, but are consistent with that faith tradition. Which isn't even a particularly odd one for western society.

It's hard to deny that what I did worked, though. I went from being barely able to hold together enough to make sure I ate regularly to working a nice white-collar government job. And I did that after stopping therapy completely because I was deteriorating while in treatment.

Also, from my own research on the topic, here are some existing concepts within the psychology community that might be helpful:

- Institutional trauma. The idea here is that when institutions that people rely on harm, enable harm to, or fail to protect those relying on them, there's a particular sort of trauma that occurs in addition to the initial trauma. Much of the work has been done by Jennifer Freyd. I haven't been able to find a lot specific to mental health care, but the ideas are fairly clearly generalizable. There is some limited research on the concept within mainstream medicine.

- Cultural conceptions of mental health. This is an active area of research; there's a widening awareness that our ideas of a healthy life aren't universal. An example might be how western society is very individualistic and adult children moving out and establishing their own independence and separate support is seen as a goal. There are other societies where that might be seen as unhealthy and arrogant or ungrateful. The research I've seen has all been on cultural issues, generally as identified along lines of race or geographic origin, but it is an interesting jumping off point for questions of how universal our idea of mental health is.

- Discrimination issues. There's some research out there on how things like race, gender, and socioeconomic status can influence mental health care. One example might be that anger is viewed as more pathological in black clients. Another might be that therapists can be ineffective at dealing with poor people due to not understanding what is realistic for them. Again, interesting, mostly because it's where a lot of research on systemic bias in mental health care is coming from.

- Cognitive bias issues. Some overlap here with discrimination, but not always. A lot of these are just issues where a clinician uses heuristics that don't help. Confirmation bias is a big one here, where a clinician seeks out information that supports their initial impression and disregards or doesn't look for information that might contradict it. Not as much research that I've found, but it's at least acknowledged in the mental health field.

- Countertransference. While it's been discussed especially in the sexual realm, I think a lot of people here are also familiar with the idea in general that the therapist's emotional reactions can bias treatment. There's some specific research I've been able to find that specifically discusses therapist's reactions to being confronted by clients too. I think that is especially important because a therapist who is defensive or unwelcoming of critical feedback will be unable to fix problems within therapy. It's also worth considering for future therapists treating clients harmed by therapy, since the subject is inevitably going to be difficult and emotional for the therapist.

- Client feedback. Specifically, the development of systems that use various feedback forms (paper or computerized) to provide ongoing client feedback to the therapist. Interesting in part as a potential solution, especially if clients are also provided the data. Very interesting because it has a lot of research on how good therapists are at recognizing issues in therapy, and the picture is often not very good.

Ok, that was a mouthful. Have to think more about website stuff. If we go ahead it would probably be best to start small and go from there! For a start I would stay away from real names and any identifying information. I would also stay away from dealing with anything financial beyond the costs of website hosting until something firm was established. Anything that would require a lawyer to do it right.

Do you have an idea of what a replacement would look like? Or just do away with the medical model entirely, because of the harmful effects it can have? Where does that leave people and society in cases of severely disturbed functioning that don't have a clear biological root?

That's a powerful datum, even if anecdotal and only one person.

I'd really be interested in hearing more about about that. Even though mixing faith traditions and "mental health" is probably not going to go anywhere for awhile. I think there are some good reasons to challenge western science's wholesale rejection of what in the past was called "spirit". But I also think that is really not going to go anywhere for awhile.

Nevertheless, I would be interested if you'd like to write more, or have written more somewhere else. Do you think that there's anything in what you have done for yourself that might have a secular parallel that could help some people?

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Originally Posted by OnlyOnePerson My perspective is admittedly limited. My initial problems were largely trauma-based, and I was definitely in the misdiagnosis/mistreatment section of things. I do also have some experiences with things that I think were not at all symptoms being seen as symptoms. I think the widest range of harm in the medical model is the disempowerment of the client perspective when the client does not accept the therapist's view of health. In any of the levels that do not involve deliberate therapist conduct, it acts to prevent the acknowledgement and repair of the problem. If the therapist is discouraged from taking the client's perspective seriously, then it will be far harder to fix mistakes. I'll have to think about the rest. I have some interesting thoughts that come from my own catholic faith and research into that, and how some aspects of the path I took would not be considered "healthy" necessarily, but are consistent with that faith tradition. Which isn't even a particularly odd one for western society. It's hard to deny that what I did worked, though. I went from being barely able to hold together enough to make sure I ate regularly to working a nice white-collar government job. And I did that after stopping therapy completely because I was deteriorating while in treatment. Also, from my own research on the topic, here are some existing concepts within the psychology community that might be helpful: - Institutional trauma. The idea here is that when institutions that people rely on harm, enable harm to, or fail to protect those relying on them, there's a particular sort of trauma that occurs in addition to the initial trauma. Much of the work has been done by Jennifer Freyd. I haven't been able to find a lot specific to mental health care, but the ideas are fairly clearly generalizable. There is some limited research on the concept within mainstream medicine. - Cultural conceptions of mental health. This is an active area of research; there's a widening awareness that our ideas of a healthy life aren't universal. An example might be how western society is very individualistic and adult children moving out and establishing their own independence and separate support is seen as a goal. There are other societies where that might be seen as unhealthy and arrogant or ungrateful. The research I've seen has all been on cultural issues, generally as identified along lines of race or geographic origin, but it is an interesting jumping off point for questions of how universal our idea of mental health is. - Discrimination issues. There's some research out there on how things like race, gender, and socioeconomic status can influence mental health care. One example might be that anger is viewed as more pathological in black clients. Another might be that therapists can be ineffective at dealing with poor people due to not understanding what is realistic for them. Again, interesting, mostly because it's where a lot of research on systemic bias in mental health care is coming from. - Cognitive bias issues. Some overlap here with discrimination, but not always. A lot of these are just issues where a clinician uses heuristics that don't help. Confirmation bias is a big one here, where a clinician seeks out information that supports their initial impression and disregards or doesn't look for information that might contradict it. Not as much research that I've found, but it's at least acknowledged in the mental health field. - Countertransference. While it's been discussed especially in the sexual realm, I think a lot of people here are also familiar with the idea in general that the therapist's emotional reactions can bias treatment. There's some specific research I've been able to find that specifically discusses therapist's reactions to being confronted by clients too. I think that is especially important because a therapist who is defensive or unwelcoming of critical feedback will be unable to fix problems within therapy. It's also worth considering for future therapists treating clients harmed by therapy, since the subject is inevitably going to be difficult and emotional for the therapist. - Client feedback. Specifically, the development of systems that use various feedback forms (paper or computerized) to provide ongoing client feedback to the therapist. Interesting in part as a potential solution, especially if clients are also provided the data. Very interesting because it has a lot of research on how good therapists are at recognizing issues in therapy, and the picture is often not very good. Ok, that was a mouthful. Have to think more about website stuff. If we go ahead it would probably be best to start small and go from there! For a start I would stay away from real names and any identifying information. I would also stay away from dealing with anything financial beyond the costs of website hosting until something firm was established. Anything that would require a lawyer to do it right.

I like Freyd's betrayal trauma theory. I think you referred to another area of research though.

I love all your ideas and scholarship! Wow, that is amazing.

For countertransference, I think hostility or negative countertransference can show up when the therapist has unresolved issues, the therapist differs culturally, the therapist differs politically, the therapist identifies too much with the client's issues in some way, etc. What stems from that is potential emotional abuse (e.g., the therapist belittles the client, the therapist gaslights a client), misdiagnosis (e.g., the therapist does not like the client as part of his or her countertransference and then misdiagnoses the client with a personality disorder), mistreatment (e.g., the therapist administers attachment treatment to a client with DID, so as to form an unresolved issue of not being able to have children), or the therapist treats the client negatively by assuming that the client has a PD but was actually misdiagnosing and mistreating the client in order to avoid any emotional connection with the client, creating dependency including codependency and enmeshment, etc.

There are many chain reactions that can occur in treatment, and those reactions can escalate into harmful realms.

I like your description of biases.

Exploitation is more than sexual exploitation. It also includes bartering, demanding more treatments per week than is necessary (thus, more money), role reversal (where the therapist gets his or her emotional/therapeutic needs met in treatment), and asking the client to be a key model for his or her new book.

Social psychology might offer some additional theories and concepts related to the therapeutic dyad.

The trick will be whether the specific types of mental illness matters in terms of how the therapist treats or mistreats their clients.

Gender might also matter.

Other demographic variables, like you said concerning minorities and poor clients, might also matter.

I cannot think of anything else.

Now for the effects of the REDIMME continuum. How do any of these factors affect the client in terms of worsening conditions (increased anxiety, for instance), new conditions (newfound depression from being iatrogenically harmed, for instance), and overall quality of life (e.g., misdiagnosis of a PD now decreases the odds that a client can get a job in government or as a lawyer or as a truck driver; more money spent on unnecessary talk therapies five times per week means that the client does not have money for socializing anymore and is therefore isolating, feeling lonely, skipping meals, etc.).

Phobias about therapy or PTSD from therapy abuse could be additive diagnoses or symptoms that were not there before the therapy abuse happened, especially when experiencing exploitation, iatrogenic effects, misdiagnoses, mistreatments, and/or malpractice.

I'll have to write it up sometime.

I say that about myself also because it means I have less danger than some about speaking up. I meet most people's criteria for what a basically stable person's life should look like. And I most definitely didn't get there via therapy. In fact even aside from the religious stuff I got there by throwing a whole lot of what therapists had been pushing for me, including basically my entire diagnostic history, in the trash.

Its hard to look at results like that and say I was doing it wrong.

Institutional trauma is a type of betrayal trauma - specifically betrayal trauma that stems from the behavior of institutions as a whole rather than individual relationships. But I think it's a very important type for considering harm done in therapy. Because it's not just the harm done to us by the individual therapist, but the failure of a system that ought to be protecting vulnerable people.

It's interesting from the countertransference perspective too. The idea of therapy harming someone is naturally going to be disturbing to a therapist, especially if the harm isn't overt misconduct. The natural reaction to these things is to try to deny or downplay what happened. Within therapy there's a very real risk that the therapist's diagnosis might be influenced by this to diagnose the client as more disordered or disturbed so that the therapist doesn't have to take the harm seriously.

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Originally Posted by OnlyOnePerson I'll have to write it up sometime. I say that about myself also because it means I have less danger than some about speaking up. I meet most people's criteria for what a basically stable person's life should look like. And I most definitely didn't get there via therapy. In fact even aside from the religious stuff I got there by throwing a whole lot of what therapists had been pushing for me, including basically my entire diagnostic history, in the trash. Its hard to look at results like that and say I was doing it wrong. Institutional trauma is a type of betrayal trauma - specifically betrayal trauma that stems from the behavior of institutions as a whole rather than individual relationships. But I think it's a very important type for considering harm done in therapy. Because it's not just the harm done to us by the individual therapist, but the failure of a system that ought to be protecting vulnerable people. It's interesting from the countertransference perspective too. The idea of therapy harming someone is naturally going to be disturbing to a therapist, especially if the harm isn't overt misconduct. The natural reaction to these things is to try to deny or downplay what happened. Within therapy there's a very real risk that the therapist's diagnosis might be influenced by this to diagnose the client as more disordered or disturbed so that the therapist doesn't have to take the harm seriously.

I will say this, too: That diagnostics are also problematic, considering the historical traumas done in the name of mental illness diagnoses such as drapetomania and "homosexuality" as a pathology. This chronosystemic trauma occurred during times when biases against African American slaves and homosexuals played into the institutional roles of diagnosing such individuals with mental disorders that were not even mental disorders.

Statistics, base rates, what are considered norms for a particular society - these all factor in to diagnoses, which increases bias within the various institutions.

Before that, women were considered hysteric.

And today, personality disorders seem rather spurious diagnoses for groupings of conditions that are quite diverse and heterogeneous within each group. Some don't even consider personality disorders as mental illnesses; they think of it not on the level of the medical modal and more on the level of individual responsibility.

And when we consider the statistics of it all - the base rates, the determination of norms, etc. - maybe even the "clinical range" and measures of diagnoses are flawed and/or limited.

Those all factor in.