Group Psychotherapy for Women Exploited by Health Care Providers

THE PROBLEMSexual misconduct by health care professionals, specifically psychotherapists, continues to be a controversial subject among care providers. One of the reasons for the controversy is the hesitancy of some clinicians to assume the role of subsequent therapist to patients who have been exploited. They fear the patient contributed to the therapy's failure, and will repeat this "entrapment" with yet another therapist. Many psychotherapists are grossly uncomfortable confronting a colleague about misconduct. The iatrogenic nature of the problem causes some therapists to feel defensive when encountering such a patient. Feelings about one's own vulnerability to making a serious therapeutic error are a factor, as well as fear of more far-reaching consequences for taking on a controversial issue.(1) Gutheil and Gabbard discuss the desire on the part of many mental health professionals for simplistic guidelines in this area, thus removing the ambiguity involved in dealing with the issues.(2)Unfortunately, mental health professionals themselves are not clear about the definitions of psychotherapy misconduct.(3) Schoener,Minneapolis psychologist, cited surveys that demonstrate a lack of familiarity among social workers with their ethical code, which may lead to decreased reporting of sexual misconduct cases. Schoener also refers to surveys of psychologists and psychiatrists that reflect disagreement among professionals about what behaviors with patients are considered inappropriate.(3) An additional area of concern is sexual contact after termination of treatment,(4) with different stances taken by various mental health disciplines regarding a formal policy. Pastoral counseling is another area where ambiguous relationships and sexual misconduct are a problem.(5)The aura of secretiveness that surrounds exploitation and sexual abuse inhibits communication and prevents diffusion of tension produced by the circumstances. Robitscher, who has studied the psychotherapy process from a legal and psychiatric point of view, refers to this secrecy as "a conspiracy of silence," that perpetuates exploitation of patients.(6) Patients in this position may be in the process of filing formal complaints with licensing boards and professional organizations as well as pursuing litigation against the former therapist. These are usually grueling and humiliating experiences. A client may be advised by lawyers or others to limit communication about the matter. Clinicians may find themselves in the position of deciding how involved they will become with the process. Will they decide to undertake a dual role as psychotherapist and advocate for the patient, assisting for example, with filing complaints Some argue that any role played by the therapist outside the therapy session dilutes the transference, hence interfering with the effectiveness of the therapy relationship. Some treating therapists feel the knowledge needed to adequately advise patients of complaint/litigation procedures is beyond the scope of their role. Considerable time and effort may be required to act effectively as an advocate. Some therapists are unwilling to expend the time without compensation, as well as reluctant to place themselves in a precarious role professionally by encouraging formal/legal action against a colleague.The role of psychotherapist for a previously exploited patient calls into play many clinical skills, not the least of which is objectivity. Luepker addresses this area. She sees clinicians as being "challenged" in a parallel manner to understand and monitor their own complex countertransference issues. She goes on to discuss the danger of attempting to compensate for the previous therapist's mistakes.(7) The difficulties encountered in working with this patient population are addressed by Kluft stating, "Often it appears that a parallel process encompasses the therapist, who may come to feel overwhelmed and perceive that the disempowered have entered treatment with the deskilled" (page 490). …