Papers: Introduction

In this section of our website, we have posted a number of full-length scholarly papers, most of which have been published previously in respected journals.

All of these papers are the express property of their authors and are used with permission.  We ask that you not reproduce or distribute them without first seeking and receiving permission to do so.  For permissions, please contact: jan@therapyabuse.org.

If you would like to submit a paper on any aspect of the topic of sexual or emotional abuse by psychotherapists or other healthcare professionals, please send it as a Microsoft Word Attachment to: jan@therapyabuse.org.  Include your name, a brief bio, and an abstract of your paper. References should appear in APA style.

Is There Something Wrong or Questionable in Your Treatment?

Estelle Disch

This paper consists of an extensive checklist, the purpose of which is to alert you to boundary issues that occur in poor or abusive treatment or healthcare.

About the author: Estelle Disch, Ph.D., is Co-Director of BASTA!, Boston Associates to Stop Treatment Abuse, and Professor of Sociology at UMass Boston. Her research focuses on the effects of sexual abuse by professionals, research ethics, and assessing student learning in university courses. She has run many workshops for professionals related to maintaining appropriate professional boundaries and has served as a consultant and trainer on various campuses related to creating more open and accepting campus climates. She has edited Reconstructing Gender: A Multicultural Anthology, 4th Edition (NY: McGraw-Hill, 2006). To view this paper, click here

Above All, Do No Harm: Abuse of Power by Health Care Professionals

Kathleen S. Lundgren, Wanda S. Needleman, Janet W. Wohlberg

Seventeen centuries after physicians were instructed by Hippocrates to “abstain from every voluntary act of Mischief and Corruption,” this early oath remains the foundation for most of the ethical codes of the health care professions.  In this paper, the ethical, legal and psycho-social reasons for health care professionals to refrain from becoming sexually or emotionally intimate with their patients are examined. The authors argue that it is the power-imbalance between professional and patient that allows health care professionals to exploit or abuse as well as to heal. Well-meaning professionals who wish to avoid harmful relationships with patients must recognize not only this power- imbalance but also the inevitability of personal limitations.  Further, professionals must be open to new ideas and remain flexible in the face of the unexpected.

About the authors: Kathleen S. Lundgren, M.Div, is an ethicist, editorial fellow and teaching fellow at Yale University. She has edited The Yale Guide to Careers in Medicine & the Health Professions.  Wanda S. Needleman, M.D. is a psychiatrist and psychoanalyst practicing in Providence, RI.  Janet W. Wohlberg, Ed.D. taught Organizational Behavior at Boston University’s School of Management.  She has edited or written seven books in the field of Organizational Behavior and authored numerous published papers and book chapters on various aspects of sexual and emotional abuse by psychotherapists. To view this paper, click here.

Why Did You Keep Going for So Long? Issues for Survivors of Long-Term, Sexually Abusive “Healing” Relationships

P. Susan Penfold

Treatment of people who have been trapped in long-term, sexually abusive relationships with health professionals or members of the clergy must include an understanding of the complex, intertwined factors involved and the survivor’s feelings of intense shame, helplessness, and lack of confidence in their own judgment.  Relatives and friends may have inadvertently intensified survivor’s shame with questions and statements reflecting disbelief that victims did not realize that they were being exploited.  Similar incredulity of courts and inquiry boards demands that the therapists, appearing on behalf of patients, are able to lay out how and why adults can be duped and used in this way.  A clear and compelling explanation defuses the ever-present specter of victim blaming.  During the author’s personal search for meaning and healing from such abuse, she sought out other survivors and read widely.  Although the professional literature yielded nothing specific, a number of concepts began to make sense of our experiences and feeling like helpless puppets, convinced that our healing depended on the “helper,” and oblivious to the damage to our own interests, needs, values, self-esteem, and emotions.  While there is no single explanation, ideas and thoughts that have explanatory value include Leonard Shengold’s description of “soul murder,” writing and research on traumatic bonding, Judith Herman’s theory of traumatic transference, attachment theory, Peter Rutter’s thoughts about “sex in the forbidden zone,” issues in female socialization, and Marilyn Peterson’s description of the 4 factors operating during boundary violations.

About the author: P. Susan Penfold, M.D., is Professor Emeritus of the Division of Child Psychiatry, Department of Psychiatry UBC and BC’s Children’s Hospital. She is author of 2 books, Women and the Psychiatric Paradox, Montreal, Eden Press, 1983 (with Gillian Walker), and Sexual Abuse by Health Professionals: a Personal Search for Meaning and Healing, Toronto, U Toronto Press, 1998, and more than 70 professional articles.  Currently Dr Penfold is working at Children’s Hospital as coordinator of the Child and Family Resource Manual Project for Children Who Have Witnessed or Experienced Abuse or Violence; as psychiatric consultant to the Oak Tree Clinic for women and children with HIV/AIDS and to the Child Protection Service Unit. She also works in the community as psychiatric consultant to the Nelson, Surrey and Delta Child and Youth Mental Health Teams.  To view this paper, click here.

Countertransference and Special Concerns of Subsequent Treating Therapists of Patients Sexually Exploited by a Previous Therapist

Linda Mabus Jorgenson

This paper explores counter-transference in the subsequent treating therapist.  The reactions of over-involvement and under-involvement of the subsequent treating therapist with the patient are examined in particular.  The conclusion addresses the special needs of this class of patient and additional concerns of the subsequent treating therapist such as reporting the abuse and seeking outside consultation.

About the author: Linda Mabus Jorgenson, MA, JD is an attorney experienced in cases involving sexual misconduct of therapists and other professionals.  She has handled more than 300 cases nationwide.  In 1989, Attorney Jorgenson, with her former partner, Stanley Spero, won the largest verdict awarded in a sexual misconduct case to that time, $1.2 million.  Attorney Jorgenson has published extensively in the area of fiduciary sexual misconduct and is a frequent lecturer on the topic before such groups as the American Psychiatric Association, the American Psychological Association, and the American Bar Association. She is co-author of the definitive legal text, Sexual Abuse by Professionals: A Legal Guide, The Michie Company, Charlottesville, VA, 2000. To view this paper, click here.

The Problem of Subsequent Therapists and Language Deficits

Brooks Mitchell

One of the most difficult aspects of being the victim of abuse by a trusted professional is knowing how to find assistance.  Many want to find a therapist to help them and, at the same time, believe it was lack of enough knowledge of what is good therapy that got them into such trouble to begin with. The latter is both true and not so true, as the author attempts to explain in this paper that describes societal limitations of understanding that affects trained therapists in the same way as on-lookers, family members, and friends.  This article includes the author’s brief accounts of poor therapy, an account of what a good “therapy” experience was for her, and an appeal to broaden the horizon of cultural limitations on behaviors and the way we regard power and leadership.

About the author: Brooks Mitchell has master’s degrees in Rehabilitation Counseling and Information and Library Sciences; has been a writer since old enough to hold a pencil; worked as a journalist and columnist; created innovative schools for children to prevent emotional distress and heighten intellect, knowledge, and common sense; rehabs old houses; has taught environmental science at a community college; and serves on the board of directors of Tampa Bay Association for Women Psychotherapists and is editor of their  quarterly newsletter. To view this paper, click here.

Sexual Abuse in the Therapeutic Setting: What Do Victims Really Want?

Janet W. Wohlberg

Current research and reflection are bringing a new understanding of the meaning and impact of patient-therapist sexual relations. To some degree, this comes from recognizing the similarities this phenomenon bears to childhood sexual abuse and rape. All are life- changing, traumatic, and damaging events that occur in significantly power-imbalanced relationships. As with childhood sexual abuse and rape, there is finally recognition that it is neither productive nor appropriate to blame the victim. However, we have not yet succeeded in establishing a culture in which victims are freed from self-blame and allowed to believe that patient-therapist sex is always the responsibility of the therapist.

This paper addresses four specific questions: What factors in the backgrounds and/or current lives of patients make them susceptible to becoming sexually involved with therapists?; What are some of the patient’s feelings or “danger signals” of patient-therapist behaviors that are discernible on the way towards sexual involvement?; What are some of the patterns of relationship that get played out in the course of a patient-therapist sexual liaison? and; What is the aftermath of such liaisons for the patient, and how does it affect subsequent therapy? Finally this paper asks: What do victims really want?

About the author: See above. To view this paper, click here.

Sexual Excitement in Therapeutic Relationships: Clinical and Supervisory Management

Nancy A. Bridges and Janet W. Wohlberg

All therapists at some point struggle with sexual and loving feelings in therapy relationships. Due to the absence of core curriculum on the resultant treatment issues, the psychotherapy supervisor or consultant may be the primary clinical teacher around these complex clinical situations. A safe, shame-free, trust-worthy supervisory relationship provides the arena for open dialogue, self-revelation, and deep clinical exploration of these issues.

About the authors: Nancy A. Bridges, LICSW, BCD is a Clinical Supervisor in the Department of Psychiatry at Cambridge Hospital in Cambridge, Massachusetts, a Lecturer on Psychiatry at Harvard Medical School, and Assistant Clinical Professor at Smith College School for Social Work.  She is author of Moving Beyond the Comfort Zone in Psychotherapy. Jason Aronson, Lanham, MD, 2005. For Janet W. Wohlberg, see above. To view this paper, click here.

Helen Bramson: Treatment After Sexual Abuse by a Mental Health Practitioner

Janet W. Wohlberg and Elizabeth Aub Reid

Patients who have had sexual contact or sexualized relationships with previous therapists present a unique set of subsequent treatment complexities. From the patient’s perspective, the breach of trust experienced in the previous therapy has likely made the formation of a new therapeutic alliance both threatening and compelling. It is likely also that whatever caused the patient to enter therapy in the first place has never been treated.

About the authors: For Janet W. Wohlberg, see above.  Elizabeth Aub Reid, M.D. is a psychiatrist and psychoanalyst at Harvard University and a member of The Boston Psychoanalytic Society and Institute. She has served on professional ethics committees, worked collaboratively with victims/survivors of sexual abuse by health care professionals, and has been a subsequent treater. To view this paper, click here.

Sexual Misconduct By Professionals: Some Historical Perspectives

Gary R. Schoener

The sexual exploitation of adult women by professionals dates back thousands of years and is mentioned as early as the 3rd century BC in medical writings. Although publicly discussed cases go back hundreds of years, for the most part women have been blamed for these events rather than seen avictims. Ethics codes, discussion, and research alone have failed tsignificantly change the situation. This paper explores the history and context of sexual exploitation by healthcare professionals.

About the author: Gary R. Schoener is a clinical psychologist who has served as the Executive Director of the Walk-In Counseling Center http://www.walkin.org in Minneapolis, Minnesota since 1973. In his private practice, Gary R. Schoener Consulting, he works with and evaluates sexual exploitation victims and offenders. He has serveas a consultant or expert witness in thousands of cases of sexual exploitation by clergy and health care professionals and has consulted to employers and licensing boards. He has provided consultation and training related to sexual exploitation in numerous states and countries as well as preventive training on professional boundaries and clinical supervision. Gary R. Schoener may be contacted at: Walk-In Counseling Center <http://www.walkin.org>, 2421 Chicago Ave. S., Mpls., Minn. 55404 (612) 870-0565, -0574 fax (612) 870-4169 grschoener@aol.com. To view this paper, click here.

The Endoscopy Patient With a History of Sexual Abuse: Strategies for Compassionate Care

Elizabeth Davy

A past history of sexual abuse may put a patient at risk of developing physical and psychological sequelae including fear of medical procedures. Invasive procedures such as endoscopy and colonoscopy may exacerbate fears and provoke stress reactions. This article reviews the need for careful assessment and intervention during endoscopy procedures for patients with a past history of abuse. Guidelines for compassionate care and follow-up are discussed.  While this paper was written for professionals, it serves as an important reminder of the right and obligation of patients both to make their needs understood to their healthcare providers and to demand and expect that their care be appropriate emotionally as well as physically. (For the complete text from which this paper was extracted, see: www.gastroenterologynursing.com/pt/re/gastronurse/ fulltext.00001610-200605000-00003.htm)

About the author: Elizabeth Davy, RN, CGRN, has been a nurse in the field of gastroenterology for 26 years, 20 of which were at Mercy Hospital in Portland, Maine.  She is currently Clinical Nurse Manager of the Portland Gastroenterology Center.  To view this paper, click here.

Sexual and Other Ethical Boundary Violations in Psychotherapy:
The Victims’ Perspective

Janet W. Wohlberg

This is the text of a talk given in New York City to the Columbia Analytic Society on April 4, 2006.

About the author: See above. To view this paper, click here.

Focus on the Facts:
My Experience Writing a Licensing Board Complaint

Nicole Todd

Written by a victim who prevailed in her civil, licensing board, and ethics committee complaints, this paper describes her experience and explains how to write a complaint letter that is clear, concise, and likely to be read and taken seriously.  This is a must-read for any victim who is considering taking action.  See also, under Topics, at this website, her essays entitled, “Taking Action:A Success Story,” and "Writing a Licensing Board Complaint," the actual complaint statement (names redacted) she filed with her state’s licensing board.

About the author: Nicole Todd lives in New Jersey and is a stay-at-home mom of four children. She graduated summa cum laude with a BA in Economics from Hunter College, and also earned an MBA from Rutgers University. She is a TELL responder. To view this paper, click here.

Emotional Abuse In Therapy

Michelle Webster

This paper, which was first published in 1991 in the A.N.Z. J.Fam. Ther. and is used here with the permission of the author, presents the experiences of clients who have been emotionally abused in therapy by either the intentional and unintentional conduct of therapists. The author explores emotional abuse in therapy, how it can be defined, the effects on clients, and the methods of healing from these traumatic experiences. Recommendations for practising therapists, professional training and development standards, and ethical committees are discussed.

About the author: Michelle Webster, PhD is the Director and principal trainer at the Institute for Emotionally Focused Therapy in Sydney, Australia. After completing her Masters degree in Counselling in 1981, Michelle became the Trainer in couples therapy with Relationships Australia (formerly the Marriage Guidance Council, NSW) and developed its first training course in couples work using systemic approaches.  She became the organisation's Director of Education for a number of years before moving into private practice and establishing the Institute for Emotionally Focused Therapy, formerly the Counselling Training Centre (NSW) in 1987. To view this paper, click here.

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