“While nothing is easier than to denounce the evildoer, nothing is more difficult than to understand him.” Dostoevsky
A therapist or, more appropriately, a psychotherapist, in this case, is a word we never associate with evil. The word evil is reserved for use in the religious realm as is the concept of the Devil (see Elaine Pagels’ “The Origin of Satin” or Bart Ehrman’s “God’s Problem”).
With the popularization of therapy, possibly related to its extolling by the wealthy and famous and availability of health insurance, change has come. Psychiatrists even considered whether or not if “evil” exists in anyone. Were there evil people (like Jeffrey Dahmer, John Wayne Gacy, and Dennis Rader) or were they exhibiting a form of mental illness or a personality disorder?
The question is no mean feat of theory consideration but one that has medical and legal implications. Does evil exist, or are we reverting to a less enlightened age where religion explained all for us in our wish to have answers?
Psychotherapy is dependent on introspection but if evil exists in some persons, is this concept relevant? An evil drive pushing toward acts concomitant with it wouldn’t seem open to change by careful inspection of one’s psyche.
If someone, with a predilection toward skirting the rules of ethics related to psychotherapy, were to be in a position of power, what would they do? Could they harm us in some way? If so, what would the harm be?
We need only to read some of the newspaper reports of questionable or unethical behavior of famous therapists such as Freud. What did Freud do? For one thing, he pressured patients to contribute to his own therapy association. Then, too, Freud considered his patients “riff raff” and convinced a man that he was a homosexual, urged him to divorce his wife and marry another of his patients.
Urging his patients to rid themselves of their neuroses, Freud failed to heal himself from the serious anxiety that stopped him from facing patients (he sat in a chair at the head of his famous couch), and his enuresis.
What about the equally famous Albert Ellis, the father of Rational Emotive Behavioral Therapy, who “Like Kinsey, Ellis is not the monogamous type. He has admitted to having sex with patients, though only after treatment had ended.”
Depending on state licensing laws, therapists may have a relationship with a former patient under certain circumstances. Some states this is never condoned, others say it’s fine two years after therapy ended. All licensing authorities, too, have a code of ethics by which licensees must abide.
Anyone engaged in the mental health field as psychiatrists, psychologists, social workers or counselors of any stripe need to do it be truthful to themselves and their patients. But there are those who are in the field for reasons which, if revealed, would lead to professional sanctions.
Famous or infamous?
The question of evil in a psychiatric setting would seem to have been settled by an editorial in one of the psychiatry journals.
As the editorial indicated, “Psychiatrists are medically trained in the scientific method, not in the diagnosis and treatment of evil.… (This) is the province of the philosopher and theologian and… Introducing the concept of evil into forensic psychiatry hopelessly complicates an already difficult task.”
The editorial writer indicated that evil is an exclusively human quality, and one not observed in animals. He was attempting to address one psychiatrist’s formulation of a “Depravity Scale,” which was to standardize measures of evil to provide some guidance for other psychiatrists.
In the context of this article, I am not attempting to categorize evil as anything other than a therapist’s wishes to optimize power, prestige, individual desires, or money. I do not believe they are genuinely evil, but some are not what I would see as sterling characters. Most try their utmost to deserve the trust their clients’ place in them.
However, some of the most famous names in mental health have been accused or have committed the most egregious actions. For some, it was a casual concern with their academic preparation (Erik Erickson); for others, it is ethical violations, sexual deviancy, murder case involvement, or drug use. Some engaged in unethical research. All of them are human with feet of clay.
The media is rife with the more sensational stories of therapists who have engaged in non-professional behavior. For example, they have slept with their patients, borrowed money, were involved in business relationships, controlled their patients’ lives as in the case of one famous music star, and generally allowed themselves to freewheel their lives as they wished. Of course, none of this is acceptable and violates ethical guidelines for all of the mental health professions.
Psychotherapists are supposed to help us deal with the difficulties in our lives, but that’s not always the case. Too many therapists are unqualified to practice as they do, are not licensed, got degrees from unaccredited schools, lack the training required, or are in it for the money.
Freud detailed his own love of money in his letters where he referred to it as “laughing gas.” Others may have more nefarious reasons for hanging out their shingle.
According to Dr. Jeffrey Masson, Freud denied the sexual abuse of children. ‘’The silence demanded of the child by the person who violated her (or him) is perpetuated and enforced by the very person to whom she has come for help,’’
The shingle designating a professional may also be deceptive as it indicates the person is “Doctor…” Does that mean MD, Ph.D., or what? And what type of Ph.D. did they receive? Honesty in this profession, as in others, is not a strong suit for all. How do you tell who to avoid? No one provides guidelines.
The knaves with degrees
Some therapists are so taken with their alleged ability to perform “semi-miracles” in their patients’ lives that they have stated things which are more than unacceptable. For example, one therapist who, in violation of ethics, encouraged group members to socialize and date. I know of this having heard it from others.
This licensed individual also told one of the patients that if she discontinued therapy with her, the patient would commit suicide within one year. The patient went on to work with another therapist.
In a few years, she earned her master’s degree and then went on to study for a doctorate in psychology. Thoughts of suicide never entered her mind. The therapist remained in practice and, seemingly, no charges were filed. The patient wanted to walk away and forget about it entirely.
A psychologist, who had a young man referred to her, began to engage in what she called therapeutic sex with the young man. The sessions went on for almost a year. After each sexual encounter in her office, he gave her a check for $150 and scheduled their next session. One of my professors told our class, “I have never heard of a therapeutic erection” when he heard about this.
The unethical behavior continued until he worked up the courage to discuss it with his parents. They reported the woman to her licensing board, and the board suspended her license.
One of the problems with suspension is that these individuals often return to practice in the future. During the period of supervision, they do nothing untoward, but afterward, we have to wonder. The system, in general, relies on the patient pool and the public to report.
Active violators of ethics or who engage in illegal activities are not sought out by investigators because there are so few who are hired to perform this work. Many states have only two people to look at all the licensed persons within that state.
This ongoing surveillance does not include those in the medical profession since they perform their own investigations, but, here too, it is left to someone to report. Often these persons are not reported for a variety of reasons which may include intimidation, blackmail, or threats of being cut off from treatment or being sued.
Steps to protect yourself
A short guide to assist in therapist selection is needed. Here is a list of suggested questions to ask and places to find help should you need it.
1. Do not depend on ads for therapists. Big ads mean that a person is willing to pay for these displays. They will expect to recoup the funds in therapy fees. Ads=no assurance of anything.
2. No one can guarantee you anything. It is against ethical guidelines for psychologists to provide any assurance of results or a guarantee.
3. Ask all the questions where you need answers. Don’t permit anyone to intimidate you. You are paying for a service, and you are a customer no matter whether they call you a patient or a client.
4. Some questions: What degree do they have and in what discipline? A school administration doctorate is not a doctorate in psychology. A doctorate or a Ph.D. needs explanation. Do not skip over this one. Where did they go to school, and where did they do their internship? Plaques on the wall are meaningless. Too many wall decorations can be bought.
5. What license do they have? Being “certified” is not equivalent to being licensed.
6. What is their theoretical orientation? Have them explain it to you. Take notes. Google anything you don’t understand if they tell you something unusual.
7. What is the treatment plan, and what is the timeframe for your therapy?
8. In what do they specialize? Examples: medical illness, anxiety, stress reduction, family therapy, cognitive-behavioral techniques, etc. Is a specialist someone who treats anyone who comes through the door? No, they’re not. We are not dealing with a Chinese restaurant menu here.
9. To which professional organizations do they belong? Google that one, too.
10. What is their cancellation policy? Insurance cannot be billed for missed sessions.
11. Check online with their licensing board to see if there are any actions pending currently or past violations. Also, check for lawsuits online.
If you need more assistance in deciding whether to report a therapeutic transgression or not, where do you go? The usual course would be to your state’s licensing board.
An internet search for “(state) licensing board for (psychologists, psychiatrists, social worker, counselors)” should return the result you seek. At this time, there is no national licensing board for the professions.
AI is getting in on the act
As in so many things, technology is being brought into the realm of therapy, but is it free of the problems we’ve seen in artificial intelligence (AI)? Large data sets are not devoid of major issues of bias, miscalculation, and assumptions.
The construction of an AI algorithm that would help to select a good candidate as your therapist remains problematic. Some data sets are heavily loaded in terms of bias. Hidden bias includes ageism, sexism, and racism.
For persons with specific wishes, such as someone of a similar ethnic background or religion or any other particular, the program may select only those individuals. At the same time, it will exclude individuals who might be better suited in terms of forming a therapeutic relationship.
The therapeutic relationship
The therapeutic relationship is the basis of all successful therapies. It is here that you must be most attuned to how you feel when you are in the company of that person. Of course, this assumes that you will have a screening or initial consult after you have made a selection for a therapist.
Would selecting a therapist based on shared demographic features result in a good match? The belief may be that this individual has shared life experiences which would make them more apt to understand the individual’s life experiences.
Often, a person who seeks a therapist with a similar racial or ethnic background as a preferred provider may delay therapy while waiting for a “match.” But an analysis that looked at individuals matched in terms of background and those who weren’t matched indicated the treatment outcomes were similar. Therefore, the therapist doesn’t have to share a collective life experience, ethnicity, or other background feature. But AI might skew the results in that direction.
The selection of a therapist is of utmost importance because they are dealing with your life and assisting you to make needed changes. As you would with any significant decision, check carefully, be satisfied, and never hesitate to question. It is your life.