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

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.

The more I thought about it, the more I considered that the REDIMME phenomena shouldn't be on a continuum, but rather listed as an "escalation of force." Having a continuum means that there should be some level of statistical analysis for that. But having a qualitative-based "escalation of force" (like they describe in police training), might work best.

So the escalation of "inappropriate therapeutic force" includes REDIMME:

1. Ruptures (least force)
2. Emotional abuse
3. Dependency
4. Iatrogenic effects
5. Misdiagnoses and mistreatments
6. Malpractice
7. Exploitation (greatest force)

We would also need artistic volunteers to create a picture and/or logo for each of the 7 above as well as a logo/picture for the name of this venture, which brings me to the next question...

Also, what names would you like to consider for this venture? Think of creative names and we'll narrow them down to a poll vote (I think they allow up to 8 polls, maybe 10).

I think alternative approaches to achieve better/optimal mental health and balance are very important and that pamphlet would probably benefit from having such a section - for people who did not find therapy very useful - what else is there? It would also balance out all the discussion of negative and scary things. I have my own, very effective, list. There have been a few threads here on PC discussing those things as well. I often have the feeling that finding those potential useful approaches can be predicted to a certain extent because there are some strong parallels with people's personalities, thinking/emotional styles and preferences. If someone is not so aware of these or is misguided about who they really are, perhaps a function of therapy can be to identify them (instead of attempting to treat/cure the actual problems)... although I am not sure many Ts are good at guiding it. My second T likes to work with clients in this way a lot, to identify and utilize their basic values and strengths, then encourage clients to find compatible ways to improve their lives. I didn't do a lot of that with him because I was already very aware of what works for me when I met him (my issue was not doing them consistently), but I definitely believe in the approach because it was an essential part of my own self-work earlier in life and what I've figured out can be really effective if I do it, not just think and talk about it. Just remembered this from the mention of spirituality - versions of spirituality is definitely something many people turn to and find immensely helpful.

Add the infiltration of rape culture to the etiologies of some improper uses of therapeutic force. Rape culture largely includes victim-blaming, which is a form of secondary traumatic stress.

I posted about it elsewhere on PC. Do not have the links now because I am on my cell.

Also, rape culture allows sexual exploitation to be anything but a criminal sexual offense when some jurisdictions do not classify therapeutic rape as a sex offense.

Then there is the use of "complex" to describe PTSD and the misdiagnoses of other disorders that ensue because of victim disbelief, undermining, and victim-blaming.

5 types of psychiatrist negligence that can lead to a lawsuit

Can a Psychologist Be Sued for Malpractice? | AllLaw

An alternative to the therapy model altogether:

High Time for Anarchism in Mental Health - Mad In America

I think the potential success of alternative methods can depend a lot on the severity of a person's condition. There are situations when people just lose the ability to care for themselves and make realistic decisions. There is also the fact that self and communal help is useful but very often not sufficient (if these things were sufficient to resolve mental health issues, we would not be discussing these things because there wouldn't be a need for mental health treatment).

I went to a rehab facility once when I had a drinking relapse and got really scared that I would never be able to stay sober. It was a bit unconventional in a sense that most activities in the facility were voluntary. They basically created a beautiful, very pleasant, health-focused environment, with access to many different forms of (quite high-tech) professional and other kinds of help, and we could choose and combine in ways we wanted. The downside is that it was super expensive, private and not covered by insurance, exactly because too much of it and the structure does not comply with standard treatments. It is obviously a business enterprise for the owners and not for low-income clients. I found it helpful and was thinking how a more accessible and affordable version could be created, but it's hard to come up with - unfortunately management is almost always more motivated and involved when they get paid well for it. Also not sure about their long-term success. I very much liked the largely unstructured nature of it though because it fits with my personality well. I never like (or even accept) hierarchy unless it is established and maintained based on competency, not pre-determined roles. IMO, the biggest problem in society is that structure, hierarchy and leadership is often not determined based on competency but on all sorts of other sources of power. I'm not sure that will ever be eradicated or even changed much, but reasonably alternative movements are always important to balance it.

I think at the same time, we sometimes rely on mental health care in place of communal help. One of the problems in our current mental health system (and healthcare system in general) is the complete lack of options between hospitalization and outpatient care. Most people report that psych hospitals are a heavily coercive environment even for people who are there voluntarily. We just don't have anything for people who need support beyond one visit a week that doesn't involve coercion or infantilization.

We also tend to assume severity and trouble taking care of yourself necessarily correlates with trouble making realistic decisions. I know in my own history this was not really the case. I was at the point where I was having significant problems taking care of myself, but that didn't mean I necessarily was at a point where I needed forced intervention or was unable to judge what I needed. I was having a lot of problems with not sleeping and trouble eating due to nausea and loss of appetite, and I was having general difficulties taking care of myself because I just didn't have the energy for everyday life. In fact I remember one of the problems was that I would be openly telling my therapists how badly I was struggling and was treated like I was exaggerating. Rather I'd just get told things like "therapy is hard" or "it's normal to feel more anxious for a bit" and blamed for not trying hard enough.

I was fortunate that I at least had friends who were willing and able to make sure I was housed and fed while I recovered. But if I hadn't, there would have been very few options. And many of the options that are there prioritize "treatment compliance" in a way that strips away the client's ability to protect themselves if their treatment isn't in fact working. And the additional concern is a client may be falsely seen as unable to make realistic decisions simply because they don't agree with their treatment - or protest that it isn't actually helping!

The complaint I'd start with is how therapy, at least for me, seemed to proceed without any real checks or feedback. Even when I raised concerns, they weren't addressed at all. The assumption seemed to be that if I had objections, those were products of my disorder and therefore simply obstacles to treatment. This meant also that the actual ongoing abusive situation I was dealing with, as well as significant past childhood abuse, were ignored precisely because I wasn't seen as credible. Therapy was focused on treating my "anxiety" and getting me to accept that things weren't that bad, without any real work being done to verify if I was actually exaggerating,

That's going to be something that would have to be addressed as an issue. If we accept that some people might not be in a position to make realistic decisions, how do we determine that without imposing our own values and biases on people? I suspect in my case a lot of what happened was that a young adult with mental health problems making accusations against a very invested, middle class, two-parent family looked "crazy" and out of touch with reality. Someone might appear to not be making realistic decisions because they're not actually being offered realistic decisions or because we don't fully understand their situation.

Someone trying to protect themselves from an abuser will appear extremely paranoid and irrational if the abuse isn't acknowledged and taken seriously, but might in fact be making the best decisions available to them. Even within mental health issues, we have to separate, say, someone who isn't able to take care of themselves because they can't make good decisions, and someone who is suffering from exhaustion or motivation issues that could be addressed with appropriate support. There's an incredible risk any time we're allowing ourselves to decide some people can't decide for themselves that we'll end up using it incorrectly, and I don't think we're really addressing that enough, especially in settings that don't involve legal coercion.

I think if you want real options you have to stay away from mainstream healthcare. It's a dangerous parasitic monster and is not organized to make people well.

NEWSROOM | UHS Behind Closed Doors

Found this website. It has a lot of interesting links of abuse stories and failures of the medical system.

Thanks,
HD7970ghz