When Diplomas on the Wall Become Dangerous

Years ago, I had enough experience to understand that some certificates on people’s walls might be worth nothing in terms of expertise, since they could easily be bought or someone could join an association and get one. No training, no education, nothing but a fee.

Originally, I thought these certificates were intended to provide evidence of the individual’s expertise, and that’s what most patients/clients believe. I was wrong. It provided nothing more than an indication that they had paid for that certificate. One of those bought certificates was on the wall of someone who supervised interns. And this was an individual who was highly regarded by people in the field in that state.

At the time, I decided I needed to do something, and I wrote an article that was published here on the internet. I believe I called it “Beware the Strike of an Evil Therapist.” Unfortunately, people practicing in all areas of healthcare can be a danger to those who come to them for care, expertise, and help in desperate circumstances.

It’s not limited to therapists. I’ve seen psychiatrists who hallucinated because of their alcoholism. They still worked at hospitals. Another psychiatrist was addicted to specific stimulants and stole scripts from his supervisor’s prescription pad, which was conveniently left on a desk. If you think this practice has been eliminated by digital prescribing, you would be wrong.

I was also a member of a licensing board, where I gained firsthand knowledge of unscrupulous practices by licensed psychologists. Recently, I read a DOJ document online regarding one of them, who, after her license was revoked, continued to practice for two more years before she was caught again. She’s only one. How many more are out there?

Why Do I Write This Today?

I decided I had to write this article because of a comment that was made by Rob Reiner, an incredibly talented film director, regarding one of his children and a problem with addiction and rehab services. Reiner and his wife were murdered over the weekend, having their throats slashed in their home. As of this writing, their son has been arrested but not charged with homicide.

In the article’s quotes, Rob Reiner still clearly remembers specific words. After years of seeing his son Nick go through seventeen rehab centers, he finally realized what had happened. “When Nick would tell us that it wasn’t working for him, we wouldn’t listen,” he told the Los Angeles Times in 2015, as reported in The Hollywood Reporter. “We were desperate and because the people had diplomas on their wall, we listened to them when we should have been listening to our son.”

His wife, Michele, shared more: “We were so influenced by these people. They would tell us he’s a liar, that he was trying to manipulate us. And we believed them.”

The Reiners’ experience isn’t unique. It highlights a broader problem in healthcare, where certificates and impressive titles can sometimes mask incompetence, ethical issues, or even fraud.

The Diploma Dilemma

We are taught to trust signs of expertise. That’s an error on our part. Diplomas, certifications, and licenses on office walls suggest skill and trust. But sometimes, these symbols can hide problems and dishonesty. Today’s impressive digital printers can provide any diploma or certificate you require, and they do it from afar for a fee. Using appropriate AI software, you can create IDs with your photo on anything you wish.

The reality is that healthcare, especially mental health and addiction services, has a problem with credentials. This puts vulnerable patients in danger.

In 2023, federal authorities uncovered a massive fraudulent nursing diploma scheme in Florida. Over 7,600 fake nursing diplomas were sold to individuals who never completed their education. These people then passed national board exams and obtained legitimate licenses, working in healthcare facilities across multiple states.

It’s clear that across the country, 7,600 people with fraudulent nursing credentials are providing care in various facilities and treating patients without the appropriate training. The Justice Department has singled this out as a serious matter, and all of us should be aware of who is providing care for our loved ones and what credentials they possess.

Background checks are not always thorough at all facilities. Do any of you know of the case of Dr. Michel Swango? He was killing patients until one physician decided to do a more intense background check on him, and called one of the prior facilities where he said he had worked. They caught Swango as he was about to board a plane to Asia, where he had another job.

Fake credentials are only part of the problem. A bigger issue is the confusion around credentials, which makes it hard for patients to know who is genuinely qualified to help them. Of course, there’s also the matter of people who, on their letterhead, seem to indicate they have a license number when, in one case, with which I have firsthand knowledge, it was a tax ID number, not a license number. He also liked people to call him “doctor” when he didn’t have a doctorate. The sign in front of his office said “DR….”

The Alphabet Soup of Mental Health Credentials

Mental health and addiction treatment have a confusing mix of credentials. A therapist’s business card might display letters such as PhD, PsyD, LCSW, LPC, LCPC, MA, MS, PA, CAC, and many others. Each stands for a different education, training, and role. A woman who regularly appeared on television as a psychological expert had a doctorate in school administration.

Some addiction counselor certifications only require a high school diploma. Others require a doctorate and years of training. But to families looking for help, all the credentials look impressive. Therein lies one of the major issues here. Remember, palm trees and swimming pools don’t create honest-to-goodness helpful rehab.

In fact, I worked in a facility where the addiction counselors were telling the patients, who had schizophrenia, that they should not be taking any form of medication because that would continue their addiction. The contradiction at that facility between the two types of therapies patients were receiving was mind-boggling. Little was done to improve the situation. And that facility was not unique because another major addiction-related hospital facility told patients they couldn’t even take an aspirin.

A cleric with questionable expertise was also brought in to attend treatment team meetings. He wore a cleric’s collar, and no one ever questioned whether, in fact, he was an ordained minister or had any experience or education in mental health issues. He came and went on the wards as he pleased.

This confusion leaves people vulnerable. When families are in crisis, whether their child is addicted, their spouse is suicidal, or their parent is getting worse, they don’t have time to look up what the credentials mean. They see the diplomas, hear the confident words, and trust. Is “trust” a dirty word now?

The Ethics Crisis in Addiction Treatment

Ethics problems in addiction treatment go beyond fake credentials. Research shows there are ongoing issues with how care is provided to patients.

A 2011 article in Focus, the journal of the American Psychiatric Association, highlighted a troubling pattern: providers develop negative reactions when treating patients who “minimize or lie about their substance use patterns.” These issues can lead clinicians to view normal addiction behaviors — denial, manipulation, inconsistent adherence — as character flaws rather than symptoms of illness. Yes, that’s an old article, but I believe it still has great value.

This is what happened to the Reiners. Providers called Nick manipulative and dishonest, leading his parents to doubt his reports that the programs weren’t helping. The diplomas on the wall made these judgments seem more trustworthy than the family’s own instincts.

Research published in the Journal of Ethics highlights another disturbing reality in that addictions are viewed as associated with a lack of personal control over the behavior, creating concerns about patients’ capacity for autonomy. This philosophical stance can lead to paternalistic treatment approaches that dismiss patient preferences and experiences. Addiction is a biological change in the brain that can make diminished control a given.

A 2024 study in the Journal of Psychoactive Drugs found that ethical issues in substance use treatment often reflect “a delicate balance between provision of person-centered treatment and adherence to program-level policies.” Too often, policies are followed instead of personalizing care, and credentials are valued more than listening.

At one hospital where patients were systematically rotated through units, each unit had a different theoretical orientation. Neither the chief of psychology nor the medical director seemed to find this a problem. How can any patient receive quality care if they are constantly being bounced from one theory to another? To say it’s ludicrous doesn’t do it justice.

The Power Imbalance

A big part of the credential problem in healthcare is the power imbalance. Clinicians have advanced degrees, special knowledge, and authority. Patients and families come in during a crisis, feeling vulnerable and desperate for help.

When clinicians tell worried parents that their child is manipulating them, that their instincts are wrong, or that the program will work if the patient just commits, parents may feel unable to disagree. After all, these professionals have diplomas on their walls. I think there should be a rule that only someone’s license should be on the wall.

This situation is especially risky in addiction treatment, where stigma already makes families think their loved ones are liars or morally weak. When providers repeat these ideas, families may stop advocating for their loved ones. I have always told patients to attend any meeting with an advocate.

Protecting Yourself in a Broken System

So what can patients and families do? How can we get through a system where credentials might be fake, confusing, or used to ignore real concerns?

First, check credentials yourself. Don’t trust what’s on the wall. Look up state licensing boards and confirm degrees with universities. For addiction counselors, check certifications with state boards or national groups. The Federal Trade Commission warns to watch for “out-of-sequence degrees” — someone with a master’s degree should also show evidence of a bachelor’s degree.

Second, trust your own experience. If treatment isn’t working, it’s not just your imagination. If your loved one says the approach is not helping, take that seriously. Credentials and authority don’t make clinicians perfect. As Rob Reiner learned, sometimes the person without the degree knows best what they need.

I heard of one family who took their son to a psychiatrist who promised he could cure the young man of his specific issue for $10,000. The family paid. The work didn’t result in a cure, and the psychiatrist admitted he had no experience in the field.

Third, get a second opinion. In other areas of healthcare, this is normal. Mental health and addiction treatment should be the same. If a provider discourages you from seeking another view or makes you feel bad about it, consider that a warning sign. I don’t believe there should be a fee for a meeting to explore whether this person would be suited for the care required. But I know that’s not always the case.

Fourth, look for care that centers on the patient. Here, the best results might be provided by someone with firsthand experience with that facility. Research shows that treatment works best when providers and patients work together, not when providers give orders. Providers should explain their choices, answer questions, and change their approach if needed.

The Path Forward

The healthcare system needs real changes. Credentialing should be stronger. Ethics training in mental health and addiction programs should focus on patient independence and working with families. Harsh, shame-based methods should be replaced with care grounded in evidence and compassion.

But until these changes are made, patients and families should be careful and ask questions. Diplomas on the wall are just a starting point for trust. They show someone has finished school and passed exams, but they don’t guarantee skill, ethics, or real help.

One psychology intern at a hospital was in the field because he had been told in medical school that he should leave because he didn’t have patient empathy. What did he choose? The worst field of all if you have no empathy — psychology.

Rob Reiner’s regret teaches us something important: “We should have been listening to our son.” In a healthcare system where credentials can mislead and authority can silence questions, listening to patients and trusting our instincts may be the most important thing we can do.