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

Hi Community,

I was thinking of approaching a ton of therapy clinics and asking to put a pamphlet in each. A pamphlet that sheds light on abuse in therapy and educates those seeking therapy, of the inherent power imbalances and dangers found in therapy.

Any suggestions about what will be included on this pamphlet?

Thanks,
HD7970ghz

I'd suggest you paraphrase or quote from the 2011 interview of the psychologists Michael Lambert: Interview With Michael J. Lambert About "Prevention of Treatment Failure"

Here's a quote of the first question and his response:

I'd get more current statistics about treatment failures, if there are some. I haven't kept up.

I particularly like the quote about failure within therapy itself. I definitely agree with that. It's what caused my last therapy, especially, to fail so badly.

What's not mentioned in the article is how damaging therapy failure can be to a client, above and beyond what they went into therapy with. I don't know of any studies about that, but I haven't kept up and don't have access to comprehensive databases.

Quote:

Originally Posted by HD7970GHZ Hi Community, I was thinking of approaching a ton of therapy clinics and asking to put a pamphlet in each. A pamphlet that sheds light on abuse in therapy and educates those seeking therapy, of the inherent power imbalances and dangers found in therapy. Any suggestions about what will be included on this pamphlet? Thanks, HD7970ghz

I think until the there is a formal complaint process and steps, akin to sexual harassment policies, AND those steps are actually useful and taken seriously, that whatever else the pamphlet says is like putting the responsibility of the therapists’ bad behavior on the client. I’m not shooting you down HD. You make complete sense but as you’ve experienced we are sort of ignored or not taken seriously even with whatever reporting process their currently is.

I don't understand, Sarah. Are you talking about complaints to the licensing boards?

I think HD is trying to address a different part of the problem. When we first come into therapists offices we are likely unaware of how we can get hurt and not helped by therapy. I've never been given an informed consent by a therapist that adequately listed and described the the potential bad effects of therapy and the severity and duration of those effects. It's also not a common topic in general conversation and knowledge in society, either, where the general attitude seems to be that therapy is always a positive or, at least, nothing dangerous, to be undertaken with caution.

It seems like the profession or public health systems don't have much interest in or awareness of the need for such good consumer information. Some of us with bad past experiences do, though. I'm not sure the clinics will allow the pamphlets but the process of developing it and showing it to people in the clinics and trying to bring some attention to the problem-- if HD wants to spend their time doing that, hurray in my book.

@HD7970GHZ

I'm not sure what kind of pamphlet you'd be disseminating, and to whom (clients, therapists, supervisors, educators, trainers, researchers, etc.), but I thought I could share some helpful links that might be useful:

Good Therapy's "50 warning Signs of Questionable Therapy and Counseling": 50 Warning Signs of Questionable Therapy and Counseling

Good Therapy "50 Signs of Good Therapy": 50 Signs of Good Therapy

Surviving Therapist Abuse "Treatment Abuse Checklist": Treatment Abuse Checklist – Surviving Therapist Abuse

S. O. Lilienfeld's (2007) "Psychological Treatments that Cause Harm" (Association for Psychological Science: Perspectives on Psychological Science, Vol. 2, No. 1, pp. 53-70): https://www3.nd.edu/~ghaeffel/Lilienfeld%20(2007).pdf

The Psychologist "When Therapy Causes Harm": When therapy causes harm | The Psychologist

Psychology Today "The Skeptical Psychologist": https://www.psychologytoday.com/us/b...l-psychologist

PsychCentral "Therapists Spill: Red Flags A Clinician Isn’t Right For You": https://psychcentral.com/lib/therapi...right-for-you/

PsychCentral "GoodTherapy.org and PsychCentral.com Partner to Help Therapy Seekers Find a Therapist": https://psychcentral.com/about/goodt...d-a-therapist/

PsychCentral "A Questionable New Trend: Fee-for-service Self-Help Sites": https://psychcentral.com/lib/a-quest...lf-help-sites/

PsychCentral "Should I Quit Therapy?": https://psychcentral.com/blog/should-i-quit-therapy/

PsychCentral "Your Psychotherapy Rights, Your Patient Rights": https://psychcentral.com/lib/your-psychotherapy-rights/

PsychCentral "Your Patient Rights in Therapy": https://psychcentral.com/blog/your-p...ts-in-therapy/

PsychCentral "Your Psychotherapy Rights, Your Patient Rights": https://psychcentral.com/lib/your-psychotherapy-rights/

PsychCentral "Your Right To See Your Patient Records": https://blogs.psychcentral.com/thera...tient-records/

***END***

What's not often found are the risks of seeking mental health treatment, including having a "mental health record." Certain careers and graduate school applications require the disclosure of any records of mental health problems, psychiatric hospitalizations, and mental health visits. I recently found out that driving careers, medical schools/careers, government careers, mental health schools/careers, and other fields require some level of mental health disclosure. Thus, the risk of seeking mental health care is potental career loss. Once you're in the system, your records may be requested (with your authorization, of course). It would be interesting if anyone here could find articles related to career risks affiliated with mental health records/treatment/diagnoses.

Yes Here Today,

This is exactly what I meant.

To provide information for clients about the inherent power imbalances that exist and how to protect themselves in the event that it should occur. Also supports for fellow survivors.

Basically the necessary knowledge to make informed decisions.

Thanks,
HD7970ghz

LOL Thanks for all of this!!!

HD7970ghz

I like that you are doing something proactive by doing a public service to warn about potential harm in therapy. I know you personally had a very harmful experience, so it’s good to see you empowering yourself in helping others.

Aww, thanks!

I am trying...

Thanks,
HD7970ghz

Informed consent documents are based on the risk/benefit analysis for the procedure, drug, or treatment. I am unaware of any peer reviewed clinical study specifically addressing the risk/benefit ratio for psychotherapy. Given that standardization in psychotherapy is almost nonexistent, doing such a clinical study would be damn near impossible because you can't control enough variables. The mere fact that you've got two vastly divergent human beings talking to each other for an hour with a power differential between them makes controlling for third variables nearly impossible. A formal informed consent document, while a nice idea, is scientifically unworkable in psychotherapy.

My professional opinion as a clinical researcher who has written informed consent documents.

Informed consent should still be part of the process, even if therapy itself is not a controlled process.

In fact the main thing the client should be informed about is that therapy is not a controlled process. Therapists should admit they are improvising and experimenting on you..

Also, therapists DO make claims about the scientific nature of therapy. So they lie to get you in the door, then commit lies of omission to keep you there.

Here is one example of their delusion/dishonesty:
"Therapy is a scientifically proven process that teaches you how your mind works."

They should also be informing clients about the nature and extent of the risk. But most therapists cannot, because they are not aware of the harmful effects.

Clients should be advised that therapy can be highly addictive, and that people sometimes go into regressive emotional states, become re-traumatized, have their autonomy and psychological coherence threatened, suffer acute stress and emotional disregulation, etc etc.

I would not hold my breath waiting for them to do any of this, nor do I see them allowing a pamphlet in their office covering this stuff.

I understand the sentiment for producing a pamphlet. There are laws that dictate what information is safe and scientific to give to patients. Pamphlets have to be based on scientific evidence. The data has to be verified. The types of risks have to be statistically calculated and documented and you have to show that the brochure itself won't cause more harm than it would do good. Consider this scenario where a suicidal patient is seeing a therapist for the first time and reads a brochure telling him therapy doesn't help or is risky. That patient bails on the appointment, goes home, and kills himself feeling there is no hope for him. Or consider a scenario where a good, competent therapist has new patients bail on treatment because the brochure makes them skittish. That's loss of livelihood and treatment by a good therapist. You'd be sued.

Every research institution has a scientific body called an IRB (Institutional Review Board). Their job is to make sure all information reaching patients is accurate, with the benefits scientifically spelled out and the risks accurately described. Unverified opinions of unhappy patients is not scientific data and no IRB would let it near a likely patient.

The brochure is a worthy project. However, it's got to be scientific with IRB approval. That's how patients are kept as safe as possible. Data not opinion.

I'm sorry to be so blunt. I'm the victim of both extremely unethical psychotherapy and the beneficiary of very good therapy. The brochure would not have protected me from the terrible therapist and may have chased me away from a really good one. I also am a research scientist with 30 years experience. I've seen protocols, brochures, pamphlets. websites, etc dissected for patient safety. That safety comes in many forms.

HD, I was under the impression that you are in grad school and therefore have a mentor/advisor and IRB. Are you attempting to do independent research? Are you in a PhD program? What has your supervisor said? Are you in the US or another country?

PS: The guidelines for the forums state that we are not to be using the forums to even help us with research or to get ideas for research.

Also, what are the rules in your country/state, school, or institution concerning the dissemination of such materials you propose? What are the rules of getting your project approved before dissemination?

At an APA webinar I attended a few years ago, one of the members stated that "patient preferences" is an area of needed research.

Community psychology has scientific approaches that might be useful in creating pamphlets for those who do not have access to computers or own a smart phone, or for those who are unaware of the many types of treatments that are available and how to be a good consumer when approaching mental health care (among other types of care, such as physical health or dental). One of those methods include participatory action research (PAR).

Another method that is useful comes from cultural anthropology: Ethnography. Participant observation is another option, maybe.

Focus groups could also be set up, as could surveys.

There are many ways you could approach this, but spreading awareness through pamphlets might be tricky. I liked the comments made below from @sheltiemom2007 and @BudFox

I'm no professional, but I have worked with an IRB before and published an empirical paper in a peer-reviewed journal. It wasn't the same as what you describe here, however. I like what the other professional members stated regarding IRB approval, scientific limitations, etc.

If your aim concerns prevention of therapy abuse, therapy exploitation, therapy ruptures, and/or iatrogenic effects, you have to ask yourself a few preliminary questions before diving into the solutions. Have you researched what already exists among the extant literature on therapy abuse, exploitation, ruptures, and/or iatrogenic effects? What specific variables are involved? What are the confounds? What are the limitations to your approach? What's the dependent variable, or hypothesized outcome?

Will the dissemination of pamphlets necessarily prevent therapists' unethical behaviors? Will the pamphlets serve as deterrants of therapy abuse, exploitation, malpractice, and ruptures? Will the pamphlets increase consumer awareness only, and what effects of such awareness will interact with therapy? Reduced clientele and thus reduced income for the therapists or their field as a whole? Will the therapists' attitudes and practices change if the pamphlet serves as a deterrant in conjunction with the potential loss of revenue and career-based reputation?

And what about clients who cannot read, who have learning disabilities, or who do not speak English? What about clients who have cognitive delays? What about clients who have certain disorders (both physiological and psychological) that affect their ability to pay attention to the pamphlet let alone read it, such as those with ADHD or those who are blind or those with brain injuries or those with brain abnormalities? Additionally, if patients are in crisis or are dealing with a stressful situation, the last thing they might want to do is read a pamphlet; they might skim through magazine photos in the waiting room, or they might even read the pamphlet and have an iatrogenic effect to that pamphlet if they are not thinking rationally at the moment and decide to leave treatment, feel more hopeless, and/or harm themselves or others.
Such populations would be missed unless there are alternative methods of disseminating the same exact information found on the pamphlet, and/or if there are disclaimers made to prevent iatrogenic effects of the pamphlet alone.

There are many things to consider when introducing an experimental or quasi-experimental variable into natural environments and/or controlled environments. The issues related to ethics and reducing harm come to mind. There may be ways to reduce harm and remain ethical, but skilled professional consultants and/or supervisors are good resources for a team approach. You could narrow your population to a specific group of people, such as English-speaking persons with specific disorders, and exclude other populations with other types of disorders, for instance. You could also narrow your focus to therapists within a certain region who offer one particular modality, such as CBT or DBT.

These are just a few ideas.

It depends on what your outcome variables are, what your research questions are, etc.

There are limits to convenience sampling or snowball sampling, too, which should be addressed if that's the approach you're taking.

Hope these points to ponder are helpful.

This is a problem with existing research methods. The question of the risk/benefit ratio for psychotherapy, or some ballpark estimate, is an important one believe. Somebody with curiosity and courage. . .could find a way. . .New, maybe. Unorthodox, maybe. . .Some people would be bound to object. . .So???

What about Lambert's statistics that I referenced above. Are they bogus? Or otherwise problematic from a peer-reviewed perspective?

Anyway, I thought HD was proposing doing something from a mental health consumer perspective because the professionals AREN'T. And having been hurt from therapy, I am not satisfied with the idea of just accepting that and that I was one of unknown-how-many unlucky ones. Maybe it won't exactly work but there are lots of reasons I think the effort is worthwhile and if HD wants to do it I can contribute my 2 cents. Or less, may not be worth anything, but I'll contribute it. What's the harm in trying.

Maybe there's another question that would be interesting, not just ideas for the pamphlet per se:

What, if anything, do we who have been harmed by therapy think could and should be done to warn and protect other potential therapy clients and prevent or reduce in frequency the harm that is done to clients?

We don't have to all agree, and we can work on the issue from different directions.

Quote:

Originally Posted by here today This is a problem with existing research methods. The question of the risk/benefit ratio for psychotherapy, or some ballpark estimate, is an important one believe. Somebody with curiosity and courage. . .could find a way. . .New, maybe. Unorthodox. So. . . What about Lambert's statistics that I referenced above. Are they bogus? Or otherwise problematic from a peer-reviewed perspective? Anyway, I thought HD was proposing doing something from a mental health consumer perspective because the professionals AREN'T. And having been hurt from therapy, I am not satisfied with the idea of just accepting that and that I was one of unknown-how-many unlucky ones. Maybe it won't exactly work but there are lots of reasons I think the effort is worthwhile and if HD wants to do it I can contribute my 2 cents. Or less, may not be worth anything, but I'll contribute it. What's the harm in trying. Maybe there's another question that would be interesting, not just ideas for the pamphlet per se: What, if anything, do we who have been harmed by therapy think could and should be done to warn and protect other potential therapy clients and prevent or reduce in frequency the harm that is done to clients? We don't have to all agree, and we can work on the issue from different directions.

I like your idea @here today

What is Lambert's statistics? I've never heard of that before, or I've forgotten what that was. I only hold a bachelor's degree right now, not yet a grad student. This stats stuff fascinates me.

Sorry, I meant the article by Michael Lambert that I mentioned in my first post on this thread.

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Originally Posted by here today Sorry, I meant the article by Michael Lambert that I mentioned in my first post on this thread.

@here today

I like your ideas. I'll check out the Lambert article soon. I think HD has a lot of great advice here from you and some of the other professionals. I'm not a professional, but I love to learn about this stuff - especially in terms of advocating for victims and preventative victimization. It's a step toward a safer world.

I don't think therapists would allow such pamphlets. They have a vested interest in clients remaining in the dark and uneducated as consumers.

Lambert's approach uses therapist reports, as opposed to direct patient reports, regarding the efficacy of treatment provided. It's not the same variables or methods involved in patient preferences because direct patient reports from a non-therapist or neutral party would look at things beyong the efficacy of treatment provided and more into the relationship between the therapist and the client, as well as how certain treatments are explained, evaluated, and disseminated to the client.

The variables in HD's research would likely differ, as would the methods and analytical approaches.

Research on treatment efficacy can shed light on iatrogenic effects, but in terms of therapy abuse, therapy ruptures, and therapy exploitation, the mediating or moderating effects of treatment itself may be non-significant when compared to the WAY the treatment has been disseminated, explained, or built within alternative factors such as the personality of the therapist, the personality of the client, and the dynamic between the two personalities of the therapist and client.

Patients with certain cultural backgrounds and personalities, for instance, may have different preferences for the therapeutic relationship itself. Such preferences may include a gentle yet informative approach to care by a female therapist who does not look like a past or current abuser. --That's just one example.

But the patients should be the one answering from a third party because it is so easy for patients to seek approval from the therapist if the therapist is the one who is conducting the surveys. Perhaps a double-blind approach would work best to alleviate bias. A neutral party, in such cases, would be the optimal person to conduct surveys among patients of particular therapists.

A questionnaire could include things like if the patient could identify the name of the treatment provided, the longevity of such treatment, the risks and benefits of such treatment, the reasons for such treatment (e.g., treatment for specific symptoms or a specific disorder), etc. That's different from asking about the efficacy on the treatment itself. Another question could include the ways in which the patients perceived the treatment was disseminated to them. Furthermore, it would be helpful if there were some controlled ways to test the differences between therapists by having two therapists with the same modalities offer the same treatment concurrently with one patient. Therapist 1 would alternate every week for a period of six months - Mondays one week, Fridays the next, and so on, while Therapist 2 could alternate every week for a period of the same six months in the same office/room with the same clients on Fridays one week, Mondays the next. The clients could then compare their perceptions of any differences in the treatment provided, utilizing the same approach of treatment, but maybe having other factors there. If the ratings for the treatment-based questions are the same, then there's no significant difference in the treatment itself. If the ratings for the therapists are significantly different, however, then more post-hoc analyses could be done to see what factors were perceived as positive or negative for the client.

It would be interesting to see different combos of such research.

My outline of the experimental method might be flawed, but you get the gist, I hope.

Something to consider.