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[b:03e4f3f36b]Psychotherapy Cults: An Ethical Analysis [/b:03e4f3f36b]

Kim Boland,Lewis & Clark College, Portland, Oregon

Gordon Lindbloom, Ph.D. Lewis & Clark College Portland, Oregon


Abstract

[i:03e4f3f36b]A disparate literature on groups characterized as psychotherapy cults was analyzed. The reported practices of these groups were examined as regards confidentiality and privacy, dual relationships, informed consent, autonomy and dependency, therapist competence and limitations, financial practices, professional education, and separation and termination. The contraventions of standards of ethical conduct reported by observers typically go far beyond commonly discussed violations of ethical standards. They appear to create a new gestalt of practice and belief that directly opposes the intended protections of privacy and autonomy that form the basis of ethical codes in the mental health professions. Potential benefits of more analyses of this kind are suggested. [/i:03e4f3f36b]

Recent years have brought growing attention to issues of ethical conduct among mental health practitioners. Most of the resulting literature has focused on defining and clarifying consensus standards on salient problems in psychotherapy, such as the issues of sexual contact between therapist and client. However, little systematic attention has been given to more extreme situations where psychotherapy becomes a pretext for major intrusions in clients' lives, and violations of common ethical standards are extensive and persistent.

This investigation offers an analysis of conduct associated with groups that have been loosely characterized as psychotherapy cults. It summarizes practices that have been documented in a scattered literature, and places them within the framework of ethical standards and guidelines that are generally accepted in the mental health professions. This has been done in the hope that it will provide a basis for analyzing the practices of such groups and will stimulate more systematic inquiry. Descriptions of specific aspects of conduct in groups labeled as psychotherapy cults are collated and evaluated. This analysis does not classify any group, but does offer a first-level definition of criteria that might be used for defining the status of groups under scrutiny. The emphasis chosen for this study was a first definition of types of conduct and the extent to which they appear to contravene prevailing standards of ethical practice in counseling and psychotherapy.

What Is a Psychotherapy Cult?

The concept of a cult has been associated in the public media with tightly knit, deviant religious groups. Their practices have been analyzed in terms of Chinese thought-reform techniques (Lifton, 1961; Singer & Ofshe, 1990), the physical alteration of the central nervous system (Clark, 1979), the development of an “indoctrinee syndrome” (Barnes, 1978; Rambo, 1982; West & Singer, 1982), the effects of charisma (Newman, 1983), attachment to the leader (Deutsch, 1980), a socialization process (Long & Hadden, 1983), group dynamics and formation of group fantasies (Halperin, 1982), and mind control (Hassan, 1988). A spiritual ideology has been commonly seen as a powerful binding force for participants. Cults are described as using powerful and deceptive methods for bringing converts under their control, making them compliant servants, depriving them of independent judgment, separating them from family and friends, and exploiting them financially and otherwise. These practices challenge respect for individual autonomy which is a fundamental value in Western culture and, as such, is a touchstone of ethical codes in all professions.

The first analysis of a group termed a “psychotherapy cult” was provided by Bainbridge (1978). In Satan's Power: A Deviant Psychotherapy Cult, he chronicled the evolution of a group that began by providing low-cost mental health services and evolved over 12 years into a fringe religious movement. Temerlin and Temerlin (1982, 1986) provided the first critical analysis of the practices of several groups. Their synthesis of characteristic practices and ethos was based on their clinical work with former members of five different groups that they described as psychotherapy cults. Hochman (1984) outlined the theory, practices, and casualties of a group in California that he referred to as a “therapy cult.” Ayella (1985) wrote a doctoral dissertation analyzing the practices of the same group and comparing them to other groups that she identified as psychotherapy cults.

The essential characteristics of these groups were described variously. Appel wrote that “therapeutic cults frame the salvation they offer in psychological terms, as personal liberation or cure” (1983, p. 19). The Temerlins summarized their analyses in the following way:

'These cults were an iatrogenic perversion of therapy because the character problems their patients brought to therapy were not worked through, but were replaced in consciousness by a “true believing” acceptance of their therapists' theories, selfless devotion to their therapists' welfare, unrecognized depression, and paranoid attitudes toward nonbelieving professionals'. (Temerlin & Temerlin, 1982, p. 132)

Based on the descriptions available, the central features of the groups whose practices are under scrutiny here can be defined in at least a minimal way. They include (a) the use of psychotherapy language and concepts to offer help; (b) a predominant emphasis on working in a group; (c) the appearance and claim of competent professional leadership; (d) the elevation of a leader to charismatic status and idealization by members; (e) self-sacrifice by members on behalf of the leader and group; (f) the development of a strong group identity that separates them from other associations, groups, and professionals; and (g) the development of strong pressures for conformity and submission to the norms and practices of the group.

Method

Existing studies of groups described by their observers as psychotherapy cults vary from ethnographic analyses to journalistic accounts. Their lack of a common framework of analysis limits comparisons and generalizations. For this study, we used eight categories of conduct in mental health practice that are cited in ethical codes or derive from them (American Psychological Association, 1989; Association for Specialists in Group Work, 1983; Corey, Corey, & Callahan, 1988; Keith-Spiegel & Koocher, 1985). These categories include confidentiality, dual relationships, informed consent, professional competency, dependency and autonomy, financial practices, professional development, and separation/termination. In each of these categories accepted standards of behavior are first compared with deviations frequently cited in the literature on individual and group therapy; then, practices reported in the literature on groups described as psychotherapy cults are identified and briefly discussed.

Evidence about the conduct of these groups in each area under scrutiny was drawn from information available in both popular and professional publications on three extinct groups that have been labeled as psychotherapy cults. They are Synanon, Center for Feeling Therapy, and Compulsions Analysis. In addition, written material on another group currently operating has been analyzed. The post-hoc, second-hand analyses of five groups provided by Temerlin and Temerlin (1982, 1986) were used. Further evidence was drawn from observations and interviews conducted by the first author with members of another group (Boland, 1989). The evidence and comparisons across categories of behavior are then succinctly described. A summary of the information is presented in Table 1 at the end of the article.

Analyses by Category

Confidentiality

(Note: APA= American Psychological Association
ASGW=Association for Specialists in Group Work
NASW=National Association of Social Workers )

Maintaining confidentiality of client disclosures and safeguarding the privacy of clients are fundamental standards of conduct across helping professions (APA, 1989; ASGW, 1983; National Association of Social Workers, 1990). Both are backed by social sanctions and legal protections. In group therapies, special problems of defining and maintaining confidentiality arise (Kottler, 1982; Lakin, 1986; Roberts, 1982). Common violations include:

*disclosures of confidential information to outsiders by therapists and group members

*discussions of confidential information among group members outside the group

*unauthorized disclosures of client information to other social service workers and professionals

*“leaks” of confidential information from individual therapy sessions to group therapy sessions.

Related but distinct issues arise regarding the extent of personal disclosure encouraged or demanded in individual and group therapy. In group therapy the risks of embarrassment, rejection, and vulnerability to severe pressures are much greater though they can also exist in individual psychotherapy. An excessive emphasis on openness can increase this vulnerability. Therapists, especially those working with groups, are expected to maintain a balance between encouraging client self-disclosure and providing protection against pressures or tendencies to engage in too much revelation of personal secrets (Lakin, 1986).

The evidence available indicates that groups labeled as psychotherapy cults violate these guidelines routinely and pervasively. Observers report that leaders and group members routinely discuss personal information gathered in both group and individual therapy sessions with each other and with noninvolved persons (Boland, 1989). These disclosures are reported to often include information about the leader's personal life as well as that of members (Ofshe, 1976; Temerlin & Temerlin, 1982). This freedom has been described by Ayella (1985) as attractive, but it has also been described as a source of surveillance (Conason & McGarrahan, 1986) and the basis for threats of blackmail against an alienated member (Black, 1975).

Group dynamics are utilized to ensure that the private is made public (Ayella, 1985). The leader and other group members expect total “openness” or access into all parts of clients' lives, and sometimes those of leaders as well (Boland, 1989; Ofshe, 1976; Temerlin & Temerlin, 1986). This openness then leads to efforts to exert wide areas of control over the attitudes and behavior of members. Behavior that is not compliant is often viewed as resistance or a sign of character flaws (Ayella, 1985; Ofshe, 1976; Temerlin & Temerlin, 1982). These behaviors are then targets of “therapy,” with the goal being that the member would surrender the identified deviance and adhere to group norms (Ofshe, 1976).

Dual Relationships

Ethical codes in mental health professions urge that business, professional, social, or sexual relationships with clients be avoided (APA, 1989; ASGW, 1983). Clients are to be protected from having other aspects of their lives affected by the private knowledge gained by a therapist or therapy group. Therapists are to avoid such conditions so that they do not develop personal interests that would compromise their commitment to their clients' therapeutic welfare.

More complications arise in avoiding harmful dual relationships among group therapy clients than is characteristic among individual therapy clients. Outside contacts between group members that provide emotional and practical support can be very beneficial. They can also lead to coalitions, subgrouping, and romances that confound the privacy and central emphases of therapeutic involvement (Lakin, 1986). Therapists sometimes have clients in both individual and group therapy at the same time, raising questions of which information disclosed in each setting will be used in the other.

In the groups under study, by contrast, relationships with multiple dimensions are not only tolerated but sanctioned and pursued. The group is viewed as a new family, providing for all the clients' social and personal needs (Boland, 1989; Hart, 1972; Singer, 1979; Span, 1988; Temerlin & Temerlin, 1986). This intensified involvement is often perpetuated by ensuring that when clients finish therapy or “graduate,” they are promoted into staff or therapist positions within the group (Conason & McGarrahan, 1986; Hassan, 1988; Mithers, 1988). In some groups, therapists and staff are not excluded from the requirement that they continue to receive therapy (Ayella, 1985; Boland, 1989; Conason & McGarrahan, 1986; Hennican, 1988).

In these environments, therapists take on numerous roles in their clients' lives including employer, business partner, financial advisor, spiritual leader, and lover (Temerlin & Temerlin, 1982, 1986). In particular, sexual involvement of the therapist with clients can create an incestuous dynamic in which the client feels a need to protect the therapist from exposure or scrutiny (Pope & Bouhoutsos, 1986; Schoener, Milgrom, Gonsiorek, Luepler, & Conroe, 1990; Temerlin & Temerlin, 1986). This intensifies the role reversal where the therapist is now depending on the client to meet personal needs.

In these groups, clients are typically encouraged to take on a new identity (Ayella, 1985; Hochman, 1984; Temerlin & Temerlin, 1982). Ayella (1985) describes the emphasis in one group on open expression of feelings that became taxing and disruptive of members' outside relationships. This commonly leads to what Bainbridge (1978) described as a transition to a “culture of narcissism” and a concomitant alienation from previous relationships. This collapse of the client's social network and outside relationships is facilitated indirectly by the intensity of the new relationships and the new standards clients are encouraged to impose on themselves and on all of their relationships.

Other authors have written of the ways that clients in these groups are encouraged to end other relationships (Boland, 1989; Conason & McGarrahan, 1986; Hochman, 1984; Ofshe, 1976). Several observers reported the imposition of periods of time in which clients have been prevented from communicating with outsiders (Ayella, 1985; Hochman, 1984; Mithers, 1988; Temerlin & Temerlin, 1986). This is different from therapeutic encouragement to terminate dysfunctional relationships because the only criterion that is utilized to determine who is or is not acceptable is whether they are or are not members of the group. This enmeshed quality in relationships within the group readily leads to social isolation, which potentiates the development of internal relationships characterized as “psychological incest” (Temerlin & Temerlin, 1986) and “group think” (Janis, 1982).

Informed Consent

Therapists are now expected to provide prospective clients with accurate information about the goals, content, procedures, and risks of therapy so they can decide freely whether to become involved (APA, 1989; ASGW, 1983; NASW, 1990). Barriers that can impair the clarity and freedom of this judgment include the urgency clients normally feel to get on with doing something about their problems (Lakin, 1986) and the prevalence of psychotherapy jargon that clients do not understand (Temerlin & Temerlin, 1986). Careless or unethical group therapists can violate this standard by failing to provide adequate information and unbiased opportunities for clients to ask questions and weigh their alternatives. They can continue the violation by treating initial consent to involvement as consent to all future events and activities in the group and by pressuring members to participate in these regardless of their reservations (Corey, Corey, Callahan, & Russell, 1982).

In the groups under study here these violations are often taken to extremes. Clients are lured by false advertising offering low-cost treatment or quick cures (Ayella, 1985; Bainbridge, 1978; Boland, 1989; Mithers, 1988). Clients use social contacts to recruit new members into the group (Hochman, 1984; Ofshe, 1976). The goals of having new members commit to “the work” of long-term intensive therapy and even lifelong involvement are hidden (Ayella, 1985; Boland, 1989; Hochman, 1984; Ofshe, 1976). Risks and liabilities of participation are not discussed at all. Group pressure is used with increasing directness to overcome any reluctance to submit to the therapy process, its ideology, and the group's standards of conduct (Hochman, 1984). Threats of retaliation or physical violence to members who threaten to leave have been reported in some cases (Anson, 1978; Mithers, 1988; Ofshe, 1976; Span, 1988).

Competency

Mental health professionals are responsible under their codes of ethics to be cognizant of the limitations of their individual competence and of the therapeutic techniques they employ (APA, 1989; ASGW, 1983; NASW, 1990). Common violations of these assumptions involve accepting clients for which one is not prepared, using techniques in which one is not proficient, and not recognizing the extent to which some clients will benefit from a particular approach while others may not. In discussing the formation of groups, Yalom (1985) acknowledges the reality that the difficulty of finding enough participants often overrides considerations of appropriate fit. Safeguards intended to limit potential harm to clients in such situations include pregroup screening interviews, informed consent to the purposes and procedures of the group, therapist protection of clients from excessive group pressures, and protection of the freedom of the client to exit from the group at any time (Lakin, 1986).

Groups under study here are described as taking very different approaches to these questions. Accounts of their recruitment practices imply that they commonly take all comers. Their conduct suggests that they believe that their brand of treatment can be practiced without consideration of the individual characteristics and needs of clients. They appear to believe that the treatment itself is so powerful that any limitations are ignored (Ayella, 1985; Kottler, 1982). The therapy is standardized and applied to all clients, who are expected to fit into a very restrictive treatment framework (Ayella, 1985; Boland, 1989). Clients are encouraged to blame themselves for lack of progress. Such failure is cited as proof of the need for further therapy (Temerlin & Temerlin, 1986). This uniformity is reinforced by the reported common practice of promoting clients to positions as staff members or therapists based on their work in therapy (Boland, 1989; Ofshe, 1976), often without regard for their educational or professional qualifications (Ayella, 1985; Black, 1975; Conason & McGarrahan, 1986; Mithers, 1988).

In the context of this belief in the efficacy of the leaders and their approach to therapy, Ayella (1985) and Rubins (1974) have both noted a high degree of inconsistency and unpredictability in the interpretations cult leaders make about what is therapeutic or healthy. This unpredictability is combined with an “absolutist attitude” about what is right and wrong (Rubins, 1974). The effect of these shifting interpretations is to require clients to attend closely, to induce confusion, and to intensify the tendency to blame the unsuccessful patient (Temerlin & Temerlin, 1986).

Dependency and Autonomy

Fundamental to the protections of client welfare are the protection of freedom of choice and limitations on the extent to which clients can become vulnerable to exploitation by professionals (APA, 1989; ASGW, 1983; NASW, 1990). In group therapies, the desire to be accepted as a member and the power of group pressures to conform add risks that appear different from those associated with individual psychotherapies. Ethical group leaders are expected to take care to protect individuals from excessive pressures (Corey, Corey, Callahan, & Russell, 1982) and to promote the independence of participants (Keith-Spiegel & Koocher, 1985; Lakin, 1986) by helping clients define and adhere to their own goals (ASGW, 1983).

Unethical therapists minimize individuals' competence to make decisions and encourage dependency on the therapy and the group (Temerlin & Temerlin, 1986). It is common for clients to idealize and inflate the wisdom and skills of the therapist. Unethical therapists reinforce this inaccurate transference (Corey, Corey, Callahan, & Russell, 1982). In the theoretical framework of the groups under study, the concepts of transference and countertransference appear to be ignored (Ayella, 1985). This positive transference is labeled and accepted as “deserved and accurate” (Temerlin & Temerlin, 1986).

Whereas ethical group counselors are expected to exercise control over inordinate peer pressure and client self-esteem (Corey, Corey, Callahan, & Russell, 1982; Lakin, 1986), reports from the groups under study indicate that they often foster feelings of humiliation (Ayella, 1985; Hochman, 1984), failure (Ayella, 1985), and punishment (Ayella, 1985; Ofshe, 1976). Ayella (1985) also noted a constant striving for a “perfect” standard of mental health as defined by the group. The result of these forces is that psychotherapy cults evolve into enmeshed groups of dependent clients who are rarely referred elsewhere for help (Temerlin & Temerlin, 1986).

In these groups independence is not a goal. Instead, the measure of success is more commonly whether the individual develops a new identity (Ayella, 1985; Hochman, 1984). This is verified by “true-believing” acceptance of the therapy and the therapist (Temerlin & Temerlin, 1986). In these groups, submission to the group is “characterized as the height of personal liberation and transcendence” (Appel, 1983, p. 20). Retaining successful members as therapists perpetuates the dependency and reinforces pressures for conformity (Ayella, 1985; Bainbridge, 1978; Black, 1975; Conason & McGarrahan, 1986; Mithers, 1988).

Financial Practices

Professional standards for dealing with financial arrangements include informed consent regarding financial obligations and consideration of the clients' financial abilities to pay (APA, 1989; NASW, 1990), as well as accuracy of billing and payment practices. Common violations include manipulating a diagnosis in order to qualify for insurance payment, billing for services not delivered, bartering for client services, or entering into other business relationships with clients.

Violations in group therapy contexts follow these themes with added variations, such as charging for membership in its club (Ofshe, 1976), soliciting donations from clients to the sponsoring agency, and pressuring clients to recruit new referrals or to proselytize them from other groups or to donate volunteer time to the sponsoring agency (Ayella, 1985; Mithers, 1988). In the groups under study, financial relationships appear to become more exploitative and coercive (Bainbridge, 1978; Lewin, 1988; Span, 1988). The catalog of documented practices includes (a) requiring prepayment for services (Ayella, 1985); (b) therapists providing investment advice (Ayella, 1985); (c) borrowing money from clients (Boland, 1989; Hennican, 1988); (d) using volunteer and low-salaried labor by clients (Ayella, 1985; Mithers, 1988; Ofshe, 1976); (e) imposing fines for noncompliance (Lewin, 1988); (f) charging members fees for legal services provided to the group (Lewin, 1988); (g) asking members to donate their salaries with the exception of $50 per month (Ofshe, 1976); (h) soliciting clients to become “stockholders” in the purchase of real estate (Span, 1988); and (i) sending billings to insurance companies that appeared to be deceptive or fraudulent (Boland, 1989).

Other documented abuses took corporate form. One group attempted to become legally defined as a church in order to qualify for tax-exempt status (Ofshe, 1976), and an indictment charged that the group destroyed evidence that would have adversely affected the application (Shenon, 1985). Another group prescribed marriages for the sole purpose of gaining insurance reimbursement for counseling fees (Conason & McGarrahan, 1986; Span, 1988). Two other agencies that became the center of such practices expanded to include numerous businesses staffed by clients who were underpaid or not paid at all (Ayella, 1985; Mithers, 1988; Ofshe, 1976).

Professional Development

To remain cognizant of changing knowledge and to maintain or acquire new competencies, members of most professions are expected to engage in continuing learning (APA, 1989; NASW, 1990). In these groups, however, the open exchange of ideas and skills with the community of mental health professionals is largely cut off. Group leaders commonly claim that they have found “the way” to mental health and healing. They are likely to use hostility and condescension to minimize what other professionals have to offer, and they commonly cultivate a paranoia towards outside professionals (Temerlin & Temerlin, 1982, 1986).

Ayella (1985) found that the group she studied felt they had nothing to learn or gain from other theorists or therapies. Rubins (1974) found that members were not allowed to pursue information from other theorists. Temerlin and Temerlin (1986) observed that the leader was the appointed interpreter of other ideas and that the groups attempted to limit their members' access to outside books in the name of preventing confusion; they also observed a related pattern of minimizing the value of critical, analytical thinking. In the groups they studied, all learning was believed to take place through emotion and experiential processes.

Separation/Termination

Professional standards for psychotherapists assume that in nearly all cases clients will become independent of therapy and therapists and that competent practice includes moving clients to termination (APA, 1989; NASW, 1990). Incompetent or passively unethical practice involves the failure to encourage the development of insights, skills, and external supports that will foster clients' independence and self-confidence. Practices that discourage independence and encourage continued dependence on group or individual therapy actively contradict established standards for mental health professionals.

Unethical therapists can fail to support these goals, interpret moves toward termination as resistance, fail to assist clients in deciding when termination is appropriate, and encourage fears about being without therapy. These practices may take on particular power in reinforcing dependency on a group. They are highlighted by faith in the group that is so strong that therapists do not recognize casualties within their groups (Liberman, Yalom, & Miles, 1973).

Again, the groups under review here are described as taking a very different approach to ending therapy. The concepts of achieving a healthy level of personal functioning or of graduation from a group are commonly replaced with the concept of a permanent therapeutic community. Separation and termination are not accepted. Therapy is considered a way of life (Ayella, 1985; Conason & McGarrahan, 1986; Hochman, 1984; Mithers, 1988; Ofshe, 1976). Persons who leave are viewed not as successes but as failures (Ayella, 1985; Ofshe, 1976). Members who attempt to leave have been threatened with mental illness and an inability to survive without the group (Anson, 1978; Ayella, 1985; Black, 1975; Hochman, 1984; Temerlin & Temerlin, 1986). Other potential departees have been threatened with personal ruin (Mithers, 1988) and even with physical attacks (Span, 1988).

When members have left these groups, they have been ostracized by rules forbidding contact with other members and in one case by attempts to ostracize the therapists of former members (Conason & McGarrahan, 1986). Persecution of former members has been reported, including the use of violence (Anson, 1978; Span, 1988). Some groups have also ejected members (Black, 1975; Conason & McGarrahan, 1986; Span, 1988) in a process that has been described as a purging, which induces greater fear in the remaining members.

After the intensive and all-encompassing nature of such group participation, separation poses major adjustments for departing members. Members' identities, social support, sources of information, and personal identity all become dependent on the group (Black, 1975; Temerlin & Temerlin, 1986). Outside relationships and interests diminish. As a result, group members who leave experience major psychological and practical losses and typically experience significant adjustment problems (Singer & Ofshe, 1990).

Conclusions

The most evident generalization to be drawn from these data is that the violations of key elements of established ethical guidelines are of a different order from the violations usually discussed in texts, articles, and ethics committees. For example, in the matter of dual relationships, these groups do not simply permit these to occur more frequently; multiple relationships between therapists and clients are actively pursued and encouraged and are presented as a positive element in therapy. These and other practices that contradict consensual ethical guidelines appear to be systematic, intentional, and in opposition to the intent of most standards to protect client autonomy. They stand the content and purposes of ethical standards on their heads.

A second generalization involves the interlocking effects of these practices. Taken individually, they may develop from minor to more extensive deviations from established norms; but combined, they appear to create a new gestalt of influences and ties that contain much greater potential for harm to clients than is present in conventional individual and group therapy.

The data also suggest that there does not yet exist any concerted or systematic effort by scholars or professional groups to investigate and address the problems posed by such groups. While there are serious problems associated with conducting more thorough research, we believe that it is in the interests of the public and the profession to do so. In an era of pervasive loneliness and the deterioration of family, community, and social supports, it seems likely that such groups will continue to emerge in many places and under a variety of rubrics.

Extending the effort begun by this study would appear to be one profitable avenue of continued research. Further definition of specific practices and patterns of conduct that can be identified across groups would give at least a rough set of criteria by which interested professionals and laypersons could evaluate the characteristics of groups that come to their attention. In addition to refining the criteria used in this study, practices in recruitment, member involvement, leader behavior, content and application of therapy rationales, and relations with the community and other professionals might well be included in continued research.

While it may be notably difficult to secure such information, the results would be more and better generalizations about such groups. This would provide a much better basis for studying their impact on individuals during and after their involvement, and the processes by which they enter and eventually exit. This, we hope, might provide better guidance and supports for individuals who are at risk for being drawn into involvements that would be ultimately harmful for them. It might also raise more distant questions about how to distinguish between practices and communities in which clients benefit from substantial personal involvement, such as continuing participation in self-help groups, and those practices and communities from which the participants are clearly left less able to conduct satisfying and productive lives.


[b:03e4f3f36b]Table 1. Comparisons of Behavior across Categories of Conduct [/b:03e4f3f36b]

Note: APA= American Psychological Association
ASGW=Association for Specialists in Group Work
NASW=National Association of Social Workers )


[u:03e4f3f36b]Ethical Standards---Confidentiality [/u:03e4f3f36b]

“Primary obligation to respect the confidentiality of information obtained.” APA

“Should respect the privacy of clients and hold in confidence all information obtained in the course of professional service.” NASW

“Group leaders shall protect members by defining clearly what confidentiality means, why it is important, and the difficulties involved in enforcement.” ASGW

Confidentiality --Common Violations

Unauthorized or casual disclosures to other professionals and associates.

Therapist does not take steps to educate and ensure that all group members respect confidentiality.

Information from individual client sessions is used in the group.

Confidentiality -- Extreme Violations

Client right to privacy denied.

All issues in clients' lives seen as open for examination.

Material from counseling is freely discussed among professionals and clients.

Counseling material is used to threaten and coerce (e.g., blackmail clients into not leaving).

[u:03e4f3f36b]Dual Relationships - Ethical Standards[/u:03e4f3f36b]

“Make every effort to avoid dual relationships that could impair their professional judgment or increase risk of exploitation.” APA

“Group leaders shall abstain from inappropriate personal relationships with members throughout the duration of the group and during any subsequent professional involvement.” ASGW

Dual Relationships --Common Violations

Dual relationships (social or business) with clients.

Sexual relationships with clients.

Relationships among group clients are encouraged.

Role reversal: Client becomes emotional support for the counselor.

Dual Relationships --Extreme Violations

Multiple relationships encouraged and actually pursued.

Group pressures individuals to end relationships with outsiders.

Clients promoted to spouse, employee, business partner, and so forth.

Therapist gains additional power through multiple relationships.

[u:03e4f3f36b]Informed Consent--Ethical Standards [/u:03e4f3f36b]

“Fully inform clients as to the purpose and nature of the evaluation and treatment; freely acknowledge that clients have freedom of choice.” APA

“Group leaders shall fully inform group members, in advance and preferably in writing, of the goals in the group, qualifications of the leader, and procedures to be employed.” ASGW

“Should provide clients with accurate information regarding the extent and nature of the services available to them.” NASW

Informed Consent -Common Violations

Therapist does not openly discuss theory, practice, or professional credentials.

Group norm is not to question the leader or treatment but to accept “therapy” as directed.

Informed Consent -- Extreme Violations

Clients are recruited by false advertising that offers low cost or fast results.

Clients contact outsiders with deliberate intent to recruit.

Therapist does not encourage individual goals and choice to participate or not to participate. Hidden goal is long-term therapy.

Leader expects unqualified commitment.

[u:03e4f3f36b]Competency--Ethical Guidelines [/u:03e4f3f36b]

“Recognize boundaries of competence and limitations of their techniques.” APA

“Only provide services and only use techniques for which they are qualified by training and experience.” APA

“Group leaders shall refrain from imposing their own agendas, needs, and values on group members.” ASGW

“Should not misrepresent professional qualifications, education, experience, or affiliations.” NASW

Competency--Common Violations

Therapist practices beyond level or areas of competence.

All clients and all problems are treated as if they were the same.

Competency--Extreme Violations

Therapists (and clients) believe that “the therapy” can treat anyone without recognizing the need for specialized education and training for different populations.

Leaders see themselves as having the only true way to mental health.

Clients are encouraged to become counselors without regard for outside experience (and sometimes education).

[u:03e4f3f36b]Dependency and Autonomy -Ethical Guidelines[/u:03e4f3f36b]

“Group leaders shall protect members' rights against physical intimidation, coercion, and undue peer pressure insofar as is reasonably possible.” ASGW

“Should make every effort to foster self-determination on the part of clients.” NASW

Dependency and Autonomy--Common Violations

Group minimizes individuals' competence to make decisions without consulting the therapist or group.

Referrals outside the group discouraged.

Cultivate focus on client problems and self-doubt.

Dependency and Autonomy--Extreme Violations

Clients' positive transference viewed as justified adoration.

Demand for purity and constant striving.

Create and perpetuate shame and guilt.

Clients are promoted to staff, etc., based on “work” as clients (therapy used to test compliance).
[u:03e4f3f36b]
Financial Practices--Ethical Guidelines [/u:03e4f3f36b]

“Make advanced financial arrangements that are clearly understood by their clients.” APA

“Should ensure that they [fees] are fair, reasonable, considerate, and commensurate with the service performed and with due regard for the client's ability to pay.” NASW

Financial Practices --Common Violations

Use questionable billing practices (e.g., increasing diagnosis for insurance payment, waiving deductible).

Allow clients to barter their services for counseling services.

Do not maintain fee-for-service relationships.

Financial Practices--Extreme Violations

Pressure put on individual clients to recruit and refer other clients.

Clients are encouraged to feel responsible for the financial well-being of the agency.

Marriages arranged to take advantage of insurance possibilities.

Client-staffed businesses developed for the benefit of the group.

[u:03e4f3f36b]Professional Development--Ethical Guidelines [/u:03e4f3f36b]

“Should take responsibility for identifying, developing, and fully utilizing knowledge for professional practice.” NASW

“Recognize the need for continuing education.” APA

“Maintain knowledge of current scientific and professional information related to services they render.” APA

Professional Development--Common Violations

Neglect training and current literature in the field.

Use new techniques without adequate knowledge or supervision.

Minimize what other professionals have to offer.

Professional Development--Extreme Violations

Hostile and condescending toward other therapy and techniques.

Manipulate continuing education requirements in such a way that continuing education is only received from other insiders.

Accurate or complete knowledge of other theories forbidden.

Depreciate cognitive transfer of knowledge.

Separation/Termination--Ethical Guidelines

“The Social Worker should terminate services to clients, and professional relationships with them, when such service and relationships are no longer required or no longer serve the clients' needs or interests.” NASW

"The goal of treatment is independence from the therapist". ASGW

"Group leaders shall inform members that participation is voluntary and that they may exit from the group at any time". ASGW

"Group leaders shall help promote independence of members from the group in the most efficient period

Separation/Termination--Common Violations

Do not discuss termination or assist clients in preparing for termination.

No open discussion about how to judge when it is appropriate to leave group therapy.

Clients are encouraged to be fearful about life without the group.

Clients are blamed for any impasses in treatment.

Separation/Termination - Extreme Violations

Emotional threats and physical abuse if clients openly discuss leaving.

Ostracism and persecution of ex-members.

Clients unpredictably cast out of the group, causing fear in the remaining group members.

Therapy becomes a way of life.

Staff pressured to keep all clients.

Clients experience problems after terminating therapy related to the therapy received or the manner of the termination.

References

American Psychological Association. (1989). Ethical principles of psychologists. Adopted January 24, 1981. Washington, DC: Author.

Anson, R. (1978, November 27). The Synanon horrors. New Times, pp. 28–50.

Appel, W. (1983). Cults in America: Programmed for paradise. New York: Henry Holt.

Association for Specialists in Group Work. (1983, September). Ethics Code. In A. L. Roberts, Ethical guidelines for group leaders, pp. 174–179. Journal for Specialists in Group Work.

Ayella, M. (1985). Insane therapy: Case study of the social organization of a psychotherapy cult (Doctoral dissertation, University of California, Berkeley, 1985). Dissertation Abstracts International (1986), 46(9A), 283.

Bainbridge, W. S. (1978). Satan's power: A deviant psychotherapy cult. London, England: The Regents of the University of California.

Barnes, D. B. (1978). Charisma and religious leadership: A historical analysis. Journal for the Scientific Study of Religions, 17(1), 1–18.

Black, D. (1975, December 15). Totalitarian therapy on the Upper West Side. New York, pp. 54–67.

Boland, K. (1989). Psychotherapy cult observations of a group. Unpublished manuscript.

Conason, J., & McGarrahan, E. (1986, April 22). Escape from Utopia. The Village Voice, pp. 19–26.

Clark, J. (1979, July 20). Cults. Journal of the American Medical Association, 242(3), 279–281.

Corey, G., Corey, M. S., Callahan, P., & Russell, J. M. (1982). Ethical considerations in using group techniques. Journal for Specialists in Group Work, 7(3), 140–148.

Corey, G., Corey, M. S., & Callahan, P. (1988). Issues and ethics in the helping professions (3rd ed.). Pacific Grove, CA: Brooks/Cole.

Deutsch, A. (1980, December). Capacity of attachment to cult leader: A psychiatric perspective. American Journal of Psychiatry, 137(12), 1569–1573.

Halperin, D. (1982). Group process in cult affiliation and recruitment. Group, 6(2), 13–24.


Hart, L. (1972). Milieu management for drug addicts: Extended drug subculture or rehabilitation? British Journal of Addiction, 67(4), 297–301.

Hassan, S. (1988). Combatting cult mind control. Rochester, VT: Park Street Press.

Hennican, E. (1988, May 31). Dads' battle “cult” for children: Lawsuit penetrating a shroud of secrecy at Sullivan Institute. New York Newsday, 1, 23.

Hochman, J. (1984). Iatrogenic symptoms associated with a therapy cult: Examination of an extinct “new psychotherapy” with respect to psychiatric deterioration and brainwashing. Psychiatry, 47, 377.

Janis, I. L. (1982). Group think. Boston: Houghton Mifflin.

Keith-Spiegel, P., & Koocher, G. P. (1985). Ethics in psychology: Professional standards and cases. New York: Random House.

Kottler, J. (1982). Unethical behaviors we all do and pretend we do not. Journal for Specialists in Group Work, 7(3), 182–187.

Lakin, M. (1986). Ethical challenges of group and dyadic psychotherapies: A comparative approach. Professional Psychology: Research and Practice, 17(5), 454–460.

Lewin, T. (1988, June 3). Custody case lifts veil on a psychotherapy cult. New York Times.

Liberman, M., Yalom, I., & Miles, M. (1973). Encounter groups: First facts. New York: Basic Books.

Lifton, R. (1961). Ideological totalism. In Thought reform and the psychology of totalism: A study of “brainwashing” in China, pp. 419–437. New York: W. W. Norton.

Long, T., & Hadden, J. (1983). Religious conversion and the concept of socialization: Integrating the brainwashing and drift models. Journal for the Scientific Study of Religion, 22(1), 1–14.

Mithers, C. (1988, August). When therapists drive their patients crazy. California, pp. 76–136.

National Association of Social Workers. (1990). Code of ethics. Silver Spring, MD: Author.

Newman, R. (1983). Thoughts on superstars of charisma: Pipers our midst. American Journal of Orthopsychiatry, 53(2), 201–208.

Ofshe, R. (1976). Synanon: The people business. In C. Glock & R. Bellah (Eds.), The new religious consciousness. Berkeley: University of California Press.


Pope, K., & Bouhoutsos, J. (1986). Sexual intimacy between therapists and patients. New York: Praeger.

Rambo, L. R. (1982). Charisma and conversion. Pastoral Psychology, 31(2), 96–108.

Roberts, L. A. (1982). Ethical guidelines for group leaders. Journal for Specialists in Group Work (1985, September), 7(3), 174–180.

Rubins, J. L. (1974). The personality cult in psychoanalysis. American Journal of Psychoanalysis, 34(2), 129–133.

Schoener, G., Milgrom, J., Gonsiorek, J., Luepler, E., & Conroe, R. (1990). Psychotherapists' sexual involvement with clients. Minneapolis, MN: Walk-In Counseling Center.

Shenon, P. (1985, October 2). Nine linked to Synanon indicted by U.S. New York Times.

Singer, M. (1979, January). Coming out of the cults. Psychology Today, pp. 72–81.

Singer, M., & Ofshe, R. (1990). Thought reform programs and the production of psychiatric casualties. Psychiatric Annals, 20(4), 188–193.

Span, P. (1988, July 27). Cult or therapy: The custody crisis. Washington Post.

Temerlin, M. K., & Temerlin, J. W. (1982). Psychotherapy cults: An iatrogenic perversion. Psychotherapy: Theory, Research, and Practice, 19(2), 131–141.

Temerlin, J. W., & Temerlin, M. K. (1986). Some hazards of the therapeutic relationship. Cultic Studies Journal, 3(2), 234–242.

West, L., & Singer, M. (1982). Cults, quacks, and nonprofessional psychotherapies. In H. Kaplan, A. Freedman, & B. J. Sadock (Eds.), Comprehensive Textbook of Psychiatry/III, pp. 3245–3258. Baltimore: Williams & Wilkins.

Yalom, I. (1985). The theory and practice of group psychotherapy. New York: Basic Books.




Acknowledgment


The authors wish to thank Jane Temerlin for her comments on an earlier draft of this paper. They also wish to thank the American Family Foundation for assistance in locating references and the Positive Action Center for assistance in securing information and contacts with professionals.



******************************


Kim Boland is a Washington Certified Mental Health counselor. She will receive her MA in Counseling Psychology in June 1993. She lives and works in Vancouver, Washington, where she also teaches ethics classes for counselors.


Gordon Lindbloom, Ph.D., is Associate Professor of Counseling Psychology, Graduate School of Professional Studies, Lewis and Clark College, Portland, Oregon. His professional interests include stress and anxiety disorders, interpersonal relations and collaboration, and professional ethics.

[www.ex-iwp.org]

[i:45ca7d7ff4]This article is an electronic version of an article originally published in Cultic Studies Journal, 1986, Volume 3, Number 2, pages 234-242 . Please keep in mind that the pagination of this electronic reprint differs from that of the bound volume. This fact could affect how you enter bibliographic information in papers that you may write.[/i:45ca7d7ff4]

[b:45ca7d7ff4]Some Hazards of the Therapeutic Relationship[/b:45ca7d7ff4]*

Jane W. Temerlin, M. S. W. Maurice K. Temerlin, Ph. D.

Abstract

A hazard of long-term psychotherapy is the possible erosion of the boundaries of the therapist-client relationship. Previous work has shown how charismatic psychotherapists can so manipulate the therapeutic relationship that they produce groups which function much like destructive religious cults. This paper describes the intrapsychic and interpersonal processes which lead to a destructive erosion of therapeutic boundaries as observed in psychotherapy cults. Techniques used by cult therapists are grouped in four categories: those which a) increase dependence, b) increase isolation, c) reduce critical thinking capacity, and d) discourage termination of therapy.

One hazard of long-term psychotherapy is the possible erosion of the boundaries of the therapist-client relationship, with the result that the parties become enmeshed in multiple relationships which, at best impede therapeutic progress and, at worst, are extremely destructive. In a previous paper (Temerlin and Temerlin, 1982), we described how five charismatic teachers of psychotherapy manipulated the therapeutic relationship to produce cults, which then functioned much like the destructive religious cults described by Appel (1983), Rudin & Rudin (1980), Singer (1979), West and Singer (1980). The cult-creating therapists in our study established multiple relationships with their clients. For example, they brought their clients into their lives as students, supervisers, employees, spouses, lovers, colleagues, debtors, or servants, while simultaneously treating them as patients. The therapy then became destructive to those patients (although many did not know it at the time), who gradually became more dependent, submissive, confused, depressed, and less autonomous in the conduct of their lives.

These observations were based in part on intensive clinical study of twenty-six former clients of the five cult-producing therapists. The clients themselves were therapists, some of whom had been in therapy for more than ten years. While the cases they illustrate are extreme, and our research has all of the classic limitations of clinical methods, we nonetheless think that it illustrates the dangers of psychotherapy when limits and boundaries are not maintained. In the study, we concentrated on how the five therapists created cults, the ways in which the groups recruited new members and maintained old ones, and the effects on the personalities of the clients. Now, we will discuss intrapsychic and interpersonal processes in both therapist and client which, when their relationship is not confined strictly to therapy, permit the erosion of the boundaries of therapy, and make psychotherapy hazardous.

We will present material from our study of five therapy cults. While the cases are certainly not typical of the field as a whole, we think that a study of therapeutic relationships which seemed to increase the clients' submissiveness and reduce their autonomy, critical thinking, and capacity to make decisions independent of the therapist, while failing to decrease depression and paranoia, may teach us something about how the therapeutic process can be corrupted.

In the following outline we have grouped the hazards under three headings: idealization, dependency, and failure to maintain professional boundaries. All of our subjects seem to have suffered damage as a consequence of idealization of the therapis4 increased dependency, or extra-therapeutic contact with their therapists. Finally, we discuss techniques used by these therapists.

Idealization of the Therapist

All of the people whom we interviewed idealized their therapists. While admiration, and sometimes even idealization, of a therapist may facilitate positive change by creating an expectation of positive outcomes, idealization can also make clients vulnerable to exploitation by their therapists. Ethical therapists remain alert to this possibility and attempt to understand the client's idealization of the therapist as a projection or transference.

Cultic therapists, however, did not question the idealization, did not interpret it as a transference, but responded as though it was a deserved and accurate perception of themselves. Some therapists' statements in this regard include:

You are right; I am a genius, but it's no problem for me. I have accepted that characteristic in myself.

I'm the best therapist in the world ... Mine is the best training program in the world.

I am my own consultant. I know of no other therapist who could adequately consult with me about my therapy.

The therapy I've developed has none of the defects of other therapies. [This was usually accompanied by emphatic denigration of other therapies and therapists.]

I know what you need better than you do. Your wish to terminate therapy is just blind resistance.

These therapists thus encouraged distorted perceptions of themselves. As a result clients developed unrealistic expectations of magical solutions, which in turn created the potential for despair, hopelessness, and depression. For example, once the therapist was idealized, clients blamed themselves for a lack of progress and change. The therapist encouraged this self-blame and often cited it as proof of the need for further therapy. Idealization seen as an accurate perception of the therapist also may prevent the client from accurately evaluating a therapist who is incompetent psychopathic, hostile, or exploiting.

Idealization that is not examined and understood also has hazards for the therapist. For example, the therapist may come to feel omnipotent or become megalomaniacal. He may use the client to repair his own self-esteem. Idealization may also hamper the therapist's ability to work through his own narcissistic problems, or reduce his capacity for testing reality. Indeed, idealization by the client may lead to despair and depression as the therapist senses the discrepancy between his own evaluation of himself and that of his clients. Idealization may thus lead to the therapist's dependence on the client's adoration for the maintenance of the therapist's public image or private self esteem.

Dependence on the Therapist

Many of the people we interviewed had stayed with their therapists for ten years or more; sometimes much longer. Such individuals obviously had problems with separation-individuation, and they reported being afraid to terminate, to be alone, to separate. Their self-confidence had been eroded by the "therapeutic relationship" which had isolated them from those outside the cult. They reported paranoid attitudes about the "outside world" and found it difficult to trust anyone who was not a member of their therapeutic group. Long-term involvement with an authoritarian therapist seems also to have increased clients' dependency in that they were less able to make personal decisions or new friends unless the therapist approved. As time passed they became increasingly submissive, anxious, and fearful. In some cases, the fear was realistic; they were aware that some clients who had terminated were sued or physically attacked. It is important to note that dependency was not always reflected in the clients' external lives; they were often quite successful in business or the professions. The dependency lay in their personal lives and intimate relationships.

Hazards of the Failure to Maintain Personal Boundaries

In all the therapy cults we studied, the therapist involved the client in his personal life; clients became their therapists' friends, students, lovers, colleagues, employees, drinking companions, research assistants, etc. This created great hazards for both. The clients became confused as the professional relationship eroded into a social one. They were unable to distinguish a transference from a realistic response to the therapist. They became more infantile and dependent. If sexual contact took place, severe depression and feelings of abandonment followed. Submissiveness to the therapist increased as acquiescence in the therapist's wishes became common. Consequently, patients exercised less and less control over their lives.

Therapists in such relationships often become grandiose, surrounded as they are by adoring patients. They may lose the capacity for realistic self-appraisal, and they may have marital problems because spouses resent involvement with patients in domestic situations. Such therapists may also face legal problems, censure from other professionals, and eventually experience fear and paranoia over other professionals' disapproval.

Techniques Used by Cult-Creating Therapists

This sampling of techniques is not inclusive, nor does inclusion -mean that we think the techniques are always destructive. But each was described to us by one or more subjects as having been destructive to them in the context of the cult. We have grouped the techniques according to the function we think they served in the cult.

Encouraging confession, in individual or group therapy, and then relieving the anxiety and guilt surrounding the confession through reassurance, forgiveness, criticism, or punishment rather than by supporting the clients' attempts to reformulate their own self-evaluation in a more benevolent fashion.

Increasing dependency by relieving the client's anxiety or guilt with reassurance, advice, a "gimmick" or a technique which depended upon the placebo effect or suggestion, rather than exploring the anxiety or guilt and supporting the clients own attempts to reassure or forgive themselves.

Sexual involvement with the client, which created guilt, confusion, increased self-blame, and the feeling in the client that he Or she must protect the therapist from public or professional exposure, thus echoing the dynamic of incest and child abuse. (In cases where the client had actually experienced incest and child abuse, sexual contact with the therapist intensified the effects of the early abuse and increased the client's helplessness by encouraging dissociation and, in two cases, psychosis.)

Vacillating unpredictably between the expression of loving, gentle, and accepting attitudes toward the client to hostile, critical, and threatening ones. (Several clients reported being frozen by this technique, unable to move closer to the therapist because they feared him, and unable to leave because they felt he loved them.)

Encouraging the client, as part of the therapy, to refrain from making any personal decisions without first discussing them with the therapist. This technique included criticizing any independent decision-making by clients, and praising them for complying with the therapist's recommendations.

Taking advantage of non-therapeutic sources of influence over the patient, e.g., by treating employees, students, colleagues, or friends, and by becoming involved in financial transactions other than fee-for-service arrangements, such as lending money to clients.

II. Techniques which increase isolation (and thus dependence, Indirectly)

Treating clients in therapy communes, at extended retreats, on long trips, and the like, away from their usual network of relationships.

Prescribing long periods of solitary meditation.

Interpreting the client's problems as caused by family, friends, spouses, and/or children, and recommending that these people be avoided or rejected in the name of therapy.

Employing fear-inducing fantasies: for example, by asking the client to imagine how others would feet about him or her if they knew the client as well as the therapist did. Would others feel hostile, contemptuous, or have other negative attitudes toward the client?

Recommending that the client associate only with the therapist's other clients ("for mutual support during the difficult times of therapy," as one therapist put it), and selecting friends, dates, and spouses for clients.

Conducting group therapy among clients who also live and/or work together, so that "group think" obscures individual critical thinking and group processes can be used to create a "we" versus "them" attitude, as well as mutual admiration and support for the therapist.

Denigrating all other forms of therapy and therapists, thereby essentially communicating the message: "you're better off with me," or, "If I can't help you, nobody else can."

III. Techniques which reduce critical thinking capacity

Denigrating intellectual activity as a method for solving personal problems by encouraging the client to "stop being intellectual" or by defining critical thinking as "being negative." The therapist using this technique fails to distinguish between the clients use of the intellect to clarify and understand internal processes and using the intellect to stop the experience of these processes.

Encouraging the client to use therapy jargon.

Encouraging faith in the therapy and the therapist rather than supporting the client's critical thinking and personal hypothesis-testing through experience.

Using vague, undefined terms and non-testable concepts in framing interpretations of phenomena.

Talking to the client in complicated sentences with internal contradictions, and then interpreting the client's attempts at clarification through questioning as resistance, or as a character defect. One therapist, for example, typically responded to a client's questions with: "If I have to explain it, you couldn't understand it; you are just not ready to understand anything you have to ask me about."

Responding to the client's questions about him or herself by recommending chanting, meditation, exercises, or relaxation techniques while simultaneously ignoring the content of the question.

Recommending that the client avoid confusion by avoiding the seminars, and workshops of other therapists.

Redefining the client's problem in terms that cannot be verified personally through observation and experience. For example, one therapist refused see a couple together concerning marital problems because his diagnosis showed that each was "really" suffering from a trauma which occurred during the first year of life. What they considered to be marital problems were simply superficial symptoms. He then saw them separately for years of fruitless free association to uncover the pre-verbal trauma, without ever resolving the marital problems. They stayed with the therapist for a long time because each thought that his opinion was more valuable than their own.

IV. Techniques which seem to discourage termination of therapy

Gradually reversing roles by telling the client more and more about the therapist's own personal life and problems. (While clients were at first flattered and sometimes moved by such confidences, they began to modify their expectations of therapy and gradually started to protect and defend the therapist, putting his needs above their own.)

Interpreting a wish to terminate therapy either as disloyalty to the therapist, or resistance to therapy itself.

Telling a client who wishes to terminate that he or she has made man positive changes but is not conscious of them at this time in therapy, and that they will appear with more therapy, later.

Telling a dissatisfied client who tries to terminate that the gains he or she has made are spurious, and that they will disappear if the client actually leaves.

Defining the goals of therapy or reframing the client's original goals, it vague, mystical, or non-referential terms, and then mentioning specific goals that have not yet been achieved when the client proposes termination.

Telling the client who starts to terminate with feelings of dissatisfaction that, as one therapist put it "I'm as good a therapist as there is; if you can't succeed with me, you'd be a disaster with anyone else."

Conclusions

To some extent, idealization of, and dependence upon, a psychotherapist may be inherent in seeking help. However, it is the erosion of the boundaries and limits of the relationship between therapist and client which makes exploitation of the idealization and dependency possible and harmful. When therapists limit their relationship with the client strictly to psychotherapy, much harm is avoided, and the idealization and dependency can then be worked through and resolved rather than lived out in the relationship. While most therapists are ethical, and many studies show that psychotherapy generally is helpful (Bergin & Lambert, 1978; Luborsky, et al., 1975, Meltzoff & Kornreich, 1970; Parloff et al., 1978; Smith & Glass, 1977), the combination of the techniques we described and the blurring of therapeutic boundaries by charismatic therapists can result in harm to vulnerable clients and to the therapists themselves.

*****

This article was first presented as a paper to the Annual Conference and Training Institute, American Academy of Psychotherapists, Chicago, IL, October 17-21, 1984.

References

Appel, W. (1983). Cults in America: Programmed for paradise. New York: Holt, Rinehart & Winston.

Bergin, A. E. & Lambert, M. J. (1978). The evaluation of therapeutic outcomes. In S. L. Garfield and A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (2nd ed.). New York: Wiley.

Luborsky, L. Singer, B. & Luborsky, L. (1975). Comparative studies of psychotherapies. Archives of General Psychiatry, 32, 995-1008.

Meltzoff, J. & Kornreich, M. (1970). Research in psychotherapy. New York: Atherton Press.

Partoff, M. B., Wolfe, B. E., Hadley, S. W. & Waskow, 1. E. (1978). Assessment of psychosocial treatment of mental disorders: Current Status and Prospects. Report to the Institute of Medicine, National Academy of Sciences (NTIS no. PB-287 640/7WS).

Rudin, A. J. & Rudin, M. R. (1980). Prison or paradise? The new religious cults. Philadelphia: Fortress.

Singer, M. T. (1979). Coming out of the cults. Psychology Today, January, 72- 82.

Smith, M. L. & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32.

Temerlin, M. K. & Temerlin, J. W. Psychotherapy cults: An iatrogenic perversion. Psychotherapy: Theory, Research, and Practice, 19, 1982.

West, L. J. & Singer, M. T. (1980). Cults, quacks, and nonprofessional psychotherapies. In H. I Kaplan, A.M. Freeman, and B. Sadock (Eds.), Comprehensive textbook of psychiatry III. Baltimore: Williams and Wilkins.

Jane W. Temerlin, M.S.W., and Maurice K. Temerlin, Ph.D., are therapists in private practice in Oklahoma City. Cultic Studies Journal, Vol. 3, No. 2, 1986.

Groups of this type can be be quite durable. Some have lasted for
decades.

In some cases, ambitious disciples of cultic therapists may start their own franchises, borrowing techniques from their mentors. Founders of derivative groups may go indepedent after the mentor has died, retired, or unable to continue supervising groups. It is possible that other disciples may feel they have learned what they want to know, feel they have paid their dues after being bossed around, can offer an improved version, and have identified other group members eager to continue 'the work' but who no longer agree with the work teacher's style.

Some psychotherapy groups may not have start as cults, but over time, drift in that direction, much to people's later dismay. This can happen if a talented but uncredentialed leader has learned techniques and concepts from psychotherapy, something that may happen if a leader has adoring disciples who are therapists---and who can be persuaded to teach to 'trade secrets' to someone who has not been trained in their proper and ethical use.

In other cases the leader of a dysfunctional group may refer troubled members to a favored disciple or relative who is a therapist, whether licensed or unlicensed. Ethical problems arise if that therapist's primary loyalty is to the group leader, rather than the boundary ethics of psychotherapy.

This conflict of interests at the expense of client welfare is termed 'dual relationship' and wise therapists do all that they can to prevent themselves from becoming entangled in such situations.

In [i:3867737bd9]The Buddha From Brooklyn[/i:3867737bd9], Martha Sherrill describes how the leader of a very troubled Buddhist community singled out one of the young nuns as scapegoat--then sent her to a local psychotherapist who prescribed anti depressant medication. From this account, the therapist did not ask the scapegoated member about her day to day life in the community--which had included being assaulted by the leader during a vicious group confrontation. The nun's mother was a disciple of the leader, knew her daughter had been assaulted, yet adored the leader and paid for the abused daughter's therapy sessions. ([i:3867737bd9]The Buddha From Brooklyn[/i:3867737bd9], by Martha Sherrill) And the victim, who still honored the guru who had assaulted her, kept silent--not uncommon among abuse victims.


[i:3867737bd9]If a therapist counsels many persons who are members of the same spiritual community needs to constantly ask, 'Whose best interests am I serving? And am I prepared to challenge this group, if it appears any client of mine is being harmed in the group? Even if it means I lose many of my clients and much of my income by adopting such an advocacy position?'[/i:3867737bd9]

These groups can be quite durable. This durability can be arranged if the leader is prudent, avoids nasty publicity and does selective recruitment among persons who are respectable, affluent and discreet, and who admire the leader value what they are being taught in the group, and who gradually become unable to apply professional boundary ethics to the relationships.

If the members fall into the habit of socializing mostly among themselves, they risk becoming isolated and losing touch with the values that govern professionalism and boundary ethics.

Many therapists were involved in various encounter
groups during their student years, and came to admire their group leaders, many of whom tried to revolutionize psychotherapy by trying to combine the rule of guru/'shaman with that of psychotherapist.

In the Sixties and 1970s, the hazards of such groups and of equating
guru function with psychotherapy were not yet appreciated. Many
of these young participants formed misleading ideas of professionalism by using charismatic but unprofessional mentors as role models, and, taking these very beguiling mentors as role models, many decided to become therapists themselves.

THere is nothing wrong with forming an idealizing transferance to one's therapist, [i:3867737bd9]so long as the therapist can also accept negative transferance, and does not take adoration personally, or depend on adoration for narcissistic affirmation[/i:3867737bd9].

Alert therapists help clients recognize their idealizing transferances,and assist them to bring the emotions to full conscious awareness, so that the client becomes more adult, progressively more aware and autonomous in relation to the therapist. Because an alert therapist gets his or her intimacy needs met outside of the therapeutic relationship, the therapist will not need adoration from clients or from students and will not feel abandoned or betrayed when the client or student matures, becomes autonomous and withdraws the idealizing transferance.

By contrast, exploitative cultic therapy keeps clients trapped in the idealizing transferance, because (as the Temerlins have demonstrated) the cultic therapist craves narcissistic affirmation and relies on clients to provide it.

But what happens if a person is inspired to become a therapist after having been a young participant in one of the early psychotherapy cults of the 1960s-70s--before these problems were understood?

It is possible that with the best of intentions, some who were inspired as youngsters by the encounter group/Human Potential scene may have taken unexamined regression/idealizing transferances to charismatic mentors into their own training as therapists. Some may have become faculty members or clinical supervisors and may, without realizing it, pass their own unexamined blind spots to the next generation of student therapists.

Some alumni of the Human Potential years may have equated psychotherapy with magic, with functioning as gurus or shamans. As youngsters they were inspired by charismatic guru-therapists and wanted to become the kinds of therapists their mentors were--not realizing that their remarkable mentors were, in some cases risk takers who had professional credentials, highly talented, but who lacked the maturity and stability needed to function as professionals in the full sense.

Professionalism is more than having the right credentials. Its an attitude that welcomes accountability, in which you function as part of a community of practitioners and are accountable to objective ethical guidelines, instead of being a lone ranger.

[i:3867737bd9]The professional seeks to maximize benefits for clients while minimizing risk[/i:3867737bd9].

It is one thing to be adventurous with oneself, but it is not professional to take vulnerable clients on adventures. The prime directive in professionalism is 'above all, do no harm.'

In some cases, student therapists' adoration of their charismatic mentors may not been adequately explored in clinical supervison, because the supervisors would not have known, and some students might have been unable to examine their loyalties in a conscious manner, would not hve been able to disclose any of this to a supervisor, or they may have kept their loyalties secret.

A student therapist may be unaware that he or she has done this--perhaps even unaware that he or she is keeping the charismatic mentor a secret. Unless a clinical supervisor has superb intuition, is aware of the kinds of social influences that can affect students, and dares to ask the right questions, a clinical supervisor or training analyst may never learn the extent to which a student therapist is trapped in an unexamined idealizing transferance to a charismatic but unprofessional mentor.

Some human potential alumni might have emerged from clinical training with their idealizing transferances intact and unexamined. Emulating theri charismatic mentors they may have tried to function as guru-therapists, and with the very best intentions, and without realizing it, risk of taking thier own psychotherapy practices in cultic directions, becoming gurus themselves, or serving as recruiters for their charismatic mentor.

In certain parts of the country where there is a high degree of acceptance for New Age material, there are social networks so extensive that one can experience all this as normal, and even desirable.

But normal is not acceptable

First and foremost, psychotherapists are not supposed to socialize with patients outside of office hours and are forbidden by their professional ethics to indoctrinate patients into their belief systems or encourage them to join their spiritual communities.

The problem is, some therapists who emerged from the kind of social formation described above may have remained trapped in idealizing transferance to their own guru/therapy mentors. This means they appear adult, but covertly remained adoring children in relation to their guru/mentors.

A therapist who is an 'adult child' unconsciously regressed in relation to his or her guru-mentor cannot apply adult conscious awareness to boundary ethics and like a child in relation to parents, be unable to imagine that their beloved leader or spiritual group could ever harm patients.

In some extreme cases, a leader of a psychotherapy cult may perhaps encourage hand-picked disciples to seek training as psychotherapists. They may emerge from training with their transferance to the leader intact and unexamined, functioning as therapists while still the 'psychological property' of their adored master. They may be unable to apply boundary ethics to their relationship to the guru, and thus unable to protect thier own clients if the guru pressures them to recruit clients. Therapists in such a group may write letters of recommendation, serve as clinical supervisiors for members within the group, further perpetuating the dynamic.

An adroit leader who operates in this strategic manner may, over many years accumulate an extensive retinue of licensed psychotherapists (some of whom may be clinical supervisors or function as influential faculty members in clinical programs) meditation teachers, retreat leaders, and body workers who form a devoted and disciplined constuency.These disicples are likely to hush up any evidence of trouble if a member troubled by the group is sent to them for counseling.

Despite their loving feelings and good intentions, disciple therapists trapped in this mindset are in a cognitive fog of regression in which they cannot apply critical thinking. They will be unable to apply what they learned in ethics classes to their relationship with the charismatic mentor.

Therapists in this predicament risk of involving their clients in boundary violations.

A psychotherapist is like a designated driver--he or she is supposed to stay alert and sober. If a therapist is adoringly regressed in relation to a New Age community, its belief system and its leaders, that person is like a designated driver who is drunk at the wheel.

Another common problem in New Age therapy is to equate the process of psychotherapy with indoctrination into the therapist's belief system. Genuine psychotherapy has specific goals and modestly offers rehabilitation. By contrast, New Age therapies offer transformation--much more open-ended--and grandiose. (See the chapter on 'New Age Therapsies' in 'Science and Pseudoscience by Lilienfeld, Lynn and Lohr for an overview)

One very big problem is that persons interested in New Age issues (which include both mental health professionals and their clients) may not be trained in critical thinking or research design, so they do not know how to evaluate claims when an entrepreneur shows up promoting an excitinhg new test or treatment modality. They frequently insist that the ordinary guidelines for psychotherapy are stifling and repressive.

The article listed below are from a former New Age teacher who became troubled by the whole scene and eventually decided to change careers.

[board.culteducation.com]

It is tempting for charismatic psychotherapists to slide into a quasi-guru role. Its much more enjoyable to be surrounded by disciples who agree with you then to cope with crusty colleagues, battle with insurance companies, read journals, and attend manadory Continuing Education courses in which you're constantly reminded to stay mindful of boundaries and countertransferance issues.

There are notable exceptions, but some New Age psychotherapists do not have solid training in critical thinking or research methodology. (and as Karla McLaren notes, quite a few get their degrees at New Age oriented schools. )This is discussed in great detail in a book by Lilienfeld, Lynn and Lohr entitled [i:3867737bd9]Science and Pseudoscience in Clinical Psychology[/i:3867737bd9] The book has a superb chapter on New Age therapies and the problems that have come up.

A big tip-off is when a therapy is developed by someone who is charismatic and instead of offering it for peer review by other professionals, instead propagates that material in charisma-driven groups and workshops. A professional would offer such material for review and research by colleagues and publish the results in peer-reviewed journals. A common characteristic of New Age therapies is evasion of the customary peer-review process. When New Age therapies are tested, all too often the 'research' is done by true believers who dont know how to conduct genuine, double blind research.

Their summary of Chapter One is available here

[board.culteducation.com]

As the authors put it, the merits of many of New Age 'therapies' are often eventually assessed in court.

What you are describing could fall under the catagory of 'psychotherapy cult'. Margaret Singer has discussed this in her book [i:3867737bd9]'Crazy Therapies'[/i:3867737bd9]

In such cases, there's a charismatic leader who often keeps a low profile, and is surrounded by a discreet coterie. If that person has acquired an adoring retinue of mental health professionals, this is a nearly ideal situation, because the therapists keep quiet, so as not to lose their licenses, they refer carefully selected clients to the cult for additional 'therapy' or 'spiritual counseling' and even if the patients begin to have misgivings, they feel afraid to challenge their therapists.

But a few professionals do get excellent training, know the rules they're supposed to play by, but decide or drift in a cultic direction later in life. This issue is discussed here

[www.quackwatch.org]

This list is by no means exhaustive. For further information go to a medical library and discuss your search topics with the librarian.

Cultic therapists get used to safe social settings in which they are not
challenged, and can speak from a position of unchallenged dominance.

Their world shrinks.

A person who was formerly a credentialled professional and who is drifting in a cultic direction will, very likely, get more and more comfy in his or her cultic rut, preferring the closed, adoring society of his or her group. This person will gradually drift away from the democratic, rough-and-tumble of life as a professional. The person will find it more and more unpleasant to deal on a peer basis with fellow professionals and will stop socializing with them and perhaps stop reading journals on a monthly basis. It will be more and more tempting for the cultic therapist to stick with a tried and true reading list of famliar books, and perhaps spice it up with a few new items recommended by therapist-disciples who continue to attend meetings and read the literature.

***Research tip: If you find a journal article that really 'speaks to your condition' ask the librarian to show you how to use something called
[i:f78087ae69]Citations Abstracts[/i:f78087ae69]. This wonderful resource is updated regularly. You use it to look up other journal articles in which your favorite article
has been quoted. That way, you can assemble a collection of journal articles on your topic of interest.

***Another research tip: when evaluating a person who might or might not be running a psychotherapy cult, examine the bibliographies of his or her books.

There are different kinds of information one finds in bibliographies.
Like fruit and vegetables, information varies in freshness.

1) Books--these are imporant and must be read as part of one's continuing
education, but because there's considerable lag time in publication,
information is not 100% up to date.

2) Journal articles. Information here is much 'fresher' and is part of
the ongoing active 'conversation' that clincians and researchers have
with each other. A therapist cannot stay up to date unless he or she
is reading journals. And important updates on legal issues and
licensing/continuing education issues are published in journals.

3) Papers delivered at conferances--this is the freshest information.
New findings and topics of concern are often presented (and debated) at
conferances before it is published in journal articles.

When you look at someone's book, check the bibliography in back. Compare the date when the person's book was published with the most recent item listed in the bibliography. At most there should be a 2 year, maybe 3 year gap between the most recent item on the bibliography and the date of publication. You want to see whether the person is really staying on top of the professional literature or not.

Cultic therapists may get lazy and fail to keep up with the literature. They may not be sufficiently diligent in reading the journal literature, and may get in the habit of using a similar bibliography each time they issue a new book. Or--they may start referring more and more their own publications, and make fewer and fewer references to other sources.IMO that is a sign of trouble.

When you examine the bibliography, what kinds of books and articles does the author itemize? And, if this person is using material from psychotherapy, has he or she listed journal articles or just cites books? You cannot keep up to date on developments in psychotherapy unless you know how to read journals, not just books.

If the person lists material from an important author like Winnicott or Kohut, does he or she list a fair sampling of that author's work? Often a scholar modifies his or her theories over the years, which means you have to know about thier recent publications, not just their earlier ones.

If a therapist/leader the person has listed just early work by a major author and ignores the existence of more recent work that same author has published, thats a sign that the person is falling behind in his or her continuing education.

Look at the bibliographies in the person's books and see if they remain somewhat static or whether the person has added new material, including journal articles.

**It is an especially good sign when the person cites material from
papers that have been delivered at conferances--it indicates that he or she is getting out of the house, taking the trouble to travel, to attend conferances, and is socializing with with colleagues--not just adoring disciples.


[i:f78087ae69]Keeping Boundaries: Maintaining Safety and Integrity in the Psychotherapeutic Process [/i:f78087ae69]by Richard S. Epstein, MD American Psychiatric Press, 1994


[i:f78087ae69]Gaslighting, The Double Whammy, Interrogation, and Other Methods of Covert Control in Psychotherapy and Analysis [/i:f78087ae69]by Theo. J Dorpat MD
Jason Aronson Inc 1996

[i:f78087ae69]At Personal Risk: Boundary Violations in Professional-Client Relationships [/i:f78087ae69]by Marilyn R. Peterson, WW Norton, 1992

[i:f78087ae69]People Farm [/i:f78087ae69]by Steve Susoyev, Moving Finger Press, 2003

(Available on both Amazon.com and the author's website www.peoplefarm.com)

Fascinating memoir by a man who was in a Human Potential sex cult for ten years, led by a psychotherapist who started with excellent academic credentials but succumbed to the temptations of the guru role. The cult imploded in 1978-79, and Susoyev gives detailed descriptions of the Human Potential movement, its celebrity psychotherapists and guru-figures, the politicking and networking--and also the lack of concern for boundaries and the high toleration for sexual acting out--especially when indulged by charismatic and powerful persons. Caution: some portions are hair-raising.


General Social Commentary

[[i:f78087ae69]i]Turn Off [/i:f78087ae69]Your Mind: The Mystic Sixities and the Dark Side of the Age of Aquarius [/i]by Gary Lachman The Disinformation Company Ltd. 2001

(Gives valuable information about the whole social climate in which many groups, leaders and innovative therapists found opportunties and openings that they would not have had in more cautious, prudent times)

This thread lists URLs and text for an assortment of articles on Esalen, Carlos Castaneda and various New Age social biases. If you read the material on Esalen you will be amazed how much Esalen material is being re-hashed in various disguises today.

[board.culteducation.com]

Thanks so much, Corboy, for the material about therapists and boundaries. It helps me understand the more subtle, distressing dynamics that were in play during the 18 year relationship I had with a clinical psychologist who had transformed herself into a New Age therapist by the time I started working with her, and gradually redefined herself as a healer, then minister and prophet. She intentionally let her license lapse and declared that she was no longer a therapist, yet she continued to incorporate psychological language into her private "spiritual counseling" sessions as well as the group sessions, which were redefined as gatherings of a "spiritual community" for the purpose of meditation and discussion, and often included potluck meals.
I started out as a client in 1985 when I was 32 and investigating alternative healing resources for my recently diagnosed Multiple Sclerosis. In less than a year, she agreed to a barter arrangement that put me in relationship with her teenage children. Within two years, I was designing flyers and brochures, recording her lectures, and assisting in a variety of ways. We had something like a friendship, but she was clearly in charge. In 1990, I moved into private quarters in her house, which we began to call a spiritual healing center, and I functioned as house manager and officer on the Board of Directors of the newly created, 501(c)(3) corporation. Most significantly, I was her personal assistant and confidante.
Since I walked away one and a half years ago with profound feelings of heartbreak and disillusionment, I've been focusing a lot on what I brought to the relationship. I idealized her and supported what I now recognize as her delusions, because she brought meaning and love to my life; my depression abated and the MS, for the most part, stayed in remission. We may have discontinued formal sessions but we never terminated therapy. The transference and countertransference were solidly in place. It was my joy to devote my life to her; she didn't need to manipulate or coerce me. She contended that she was in a period of training for her emergence onto the world stage and would eventually usher in the New Jerusalem, so it seemed reasonable that she could use a guardian, a gatekeeper! Our needs fitted together perfectly.
She frequently refused to talk with others about her professional past or her credentials (although many people knew), and explained that she was offering a spiritual process, not a psychological one. She wanted people to have their own "experience" of her. She talked about the Bible, and especially about Jesus in a way that implied first hand knowledge. The people around her were generally anxious and uncertain about how to relate to her. The only "safe" way was to adore her, or to confess one's own unworthiness, and this seemed to generate many false spiritual experiences. I had several such visions which felt authentic in the moment and won her approval, but when I returned to the quiet of my room I'd feel like I'd just had a very odd type of anxiety attack.
This material about boundary issues further validates my feeling that this group operated--and continues to operate-- as a cult even though the leader is more delusional than consciously manipulative.

The article by Temerlin and Temerlin on psychotherapy cults as iatrogenic (that is, healer induced) perversion mentions that these relationships are often quite long lived.

The Temerlins note that often the counselee/disciples are pulled in to rescuing and parenting their guru-therapist --the therapist comes across as simultaneously powerful, yet vulnerable. Many of us as children found ourselves trying to rescue our wounded parents, so we often try
to re-enact this dynamic in adulthood. When our adored therapist-savior-guru seems in need of rescue--oh God, how we leap at the opportunity to give back what he or she has given to us. We will thrill to such an opportunity.

I was in a cultic relationship with someone who took the opposite trajectory to your therapist. My person was a minister who was not trained to function as a psychotherapist, but had considerable intuitive talent as a counselor. Under the guise of spiritual direction, he became, in effect, my psychotherapist, but had no training in managing boundaries, transferance and countertransferance.

Significantly, X insisted on offering his counseling services for free, even though the board of directors of his ministry persistently urged him to consider requesting donations. Only later did I understand that X didnt want the legal accountability that would have come from charging fees for his services--he pretended to welcome accountability, but in practice did
all he could to avoid it.

It appears your therapist achieved something similar. If a person has acquired counseling skills, but does not charge a fee and instead calls it 'spiritual guidance' or 'pastoral counseling' they have all the pleasure of power as therapists, but evade the legal guidelines and sanctions
that apply to fee-for-service therapists. They also dont have to pay
insurance premiums.

That was another thing the Temerlins noted in thier study of psychotherapy cults--none of the cultic therapists had a clean fee for service arrangement with clients. Boundaries became fuzzy.

RIchard Epstein notes that many boundary violating therapists drift into something called 'trance logic'. Its basically a regression to childish thought and emotion, but this is rationalized and concealed using adult verbal skills. What you have is a child in an adults body. A person
like this is like a designated driver who is drunk at the wheel. They're kind of sleep walking their way through life with thier eyes open and thats how they commit boundary violations.

An awake, adult therapist is aware of these hazards and is part of a consultancy group that meets regularly. And here is a personal hunch--my layman's hunch:

We may get some solid benefits from even a cultic therapist as well as being harmed--but those benefits do NOT in any way justify or excuse their boundary violations or other acts of negligence.

One benefit that even a cultic therapist sometimes gives is by providing inspiration. I have found that very immature people can be capable of being highly inspirational--even cold blooded sociopaths can be
inspirational.

Inspiration taps our latent vitality. Its not the same as real healing, but for those of us who are scared, depressed or in a rut, inspiration can give temporary morale boost and relief from distress. But, in the long
run inspiration is not enough to achieve deep healing.

Real mentoring, real therapy can only be offered by someone who is an adult, who has integrity, who doesnt use patients to serve his or her intimacy needs. Such a person has also been trained to maintain the special bounded relationship that distinguishes therapy from
other kinds of relationships.

A person may be capable of inspiring us, but may not be mature enough to serve as a true mentor or therapist.

Finally, an immature person who is (say) stuck at the level of age 14 may be able to help us reach that same level if we are stuck at an earlier stage (eg age 5). But a cultic therapist who is (say) immature and stuck at age 14 cannot bring us past that point.

If that immature therapist were ethical he or she would recognize this and refer us to another, more mature therapist, to serve our best interests.

Problem is, most immature therapists dont know when they must refer us. And because our adoration meets their personal needs, they do not want to let us go, even when that means referring us to someone more qualified than they are.

(Many of the cultic therapists studied by Temerlin insisted that only they were capable of providing the right therapy. If a client confessed to feeling that therapy was going no where the cultic therapists would either talk them out of it, or behave as though such misgivings were acts of rejection, even betrayal--totally unprofessional--and childish)

A cultic therapist cannot say, 'You've progressed as far as I can take you. You are capable of going further. Its time for you to think of working with a therapist who has more to offer than I can, and I will support your search for that person.'

(By contrast, in his book Call For the Master, Karlfried Durckheim, who was both a professional therapist and a spiritual teacher, wrote that one of the sadnesses for a spiritual teacher is when beloved students
have out grown the relationship and must leave to make their own way; the true teacher must let them depart. Just like being good parents when your kids have become adults and leave home.)

Celebrate what progress you've made--its yours. But you have every right to investigate where your therapist/guru failed to maintain the boundaries and used you to serve her intimacy needs--she should have left you alone and joined a consultancy group instead.

The distinguishing feature of errant gurus and therapists who are immature is that they dont feel secure enough to seek intimacy from persons who are adult peers--persons independant of them, persons who stand up to them.

One therapist I know is in a consultancy group. If a member skips
one too many meetings, he or she gets a phone call and is told, 'Where are you hiding? Get your butt in here and tell us what is going on in your life.' If someone in the group is overdue for a vacation, the others get on his or her case about it.

(Very likely, cultic therapists are such control freaks that they rarely take vacations. If they do, they probably are unable to train people to handle things successfully while they are gone, crises erupt--all of which makes
everyone feel all the more dependant on the cultic therapist. Then when he or she returns, it gives opportunities to identify a new set of heroes, scapegoats and identify who is a diehard loyalist--and who else needs to be punished or even kicked out for insufficient loyalty!

Immature gurus and therapists want risk-free intimacy (which is a contradiction in terms). They will get this by involving persons who are dependant on them--clients, patients, disciples, rather than persons who are independant of them and capable of saying 'No' or, 'You're kidding yourself. Look what you're doing.'

A psychotherapist is NEVER supposed to work on his or her problems while with clients.

It is worrisome how many non-therapists are unaware of the guidelines that therapists are supposed to follow. A few weeks ago on Craigslist.org in the psychology forum, a person was in great distress. Her therapist had socialized with her, borrowed her car (!!), then suddenly terminated her from therapy--with no explanation--didnt even take care to refer her to another therapist. This client had a history of past trauma and suicidal ideation.

I was amazed that some of the correspondants on that forum accused the person of whining and said 'But the therapist went out of her way to help you.'

Fortunately other correspondants knew a thing or two about boundary ethics and spoke up. One of them had access to a textbook written by a psychiatrist and was able to provide some well chosen quotes about both the ethical and legal obligations that the person's therapist had violated.

But that bit of dialogue demonstrated how many people are not aware of the rules that therapists are supposed to abide by. By contrast, most of us understand the rules that govern football or baseball--and will raise hell if a game is being played dishonestly.

A big problem is that many of us are in crisis when we look for a therapist, so we will have trouble applying adult critical thinking--its the first thing to vaporize when someone is under stress.

Worst of all, a lot of New Age therapies devalue objective ethics and argue against the whole notion of boundaries. THey contend that therapists are supposed to consort with patients on an egalitarian basis,a and that it is stifling and oppressive to see the therapist as the powerholder in the situation. All too often this seemingly liberal argument is twisted around to justify a therapist who remains powerful while disowning responsibility for the proper use of his or her power.

*When therapists use this pseudo-egalitarian argument, they're kidding themselves. They remain powerful in relation to their clients, yet disown conscious responsibility for their use of power. They're sleep walking.
When a therapist refuses to take conscious responsiblity for being
the actual poweholder in the relationship, the client is stuck feeling responsible for any lapses that occur.

My therapist said, 'Who was responsible for the boundaries? You or X?'

I replied, saying 'X told me he was responsible, but over the years, I was the one who ended up doing all the worrying when he eroded the boundaries,and I ended up feeling guilty all the time.'

My therapist said, 'Thats the mark of an incestuous relationship'--the parent/therapist refuses to take responsiblity for protecting the child/client, so the one who doesnt have the power (that is, the child or client) ends up feeling responsible for the abuse of power, when in fact the child or client never had any authority in the first place.

**[i:497dc82a2a]A feeling of responsibility without actual authority is crazy-making--and
that is how we feel when parent figures or therapists fail to act AS parents or therapists and get pseudo-equal with us.**[/i:497dc82a2a]
New Age rejection of boundaries also makes therapy ineffective for many clients. Many of us grew up in chaotic families where boundaries were poorly maintained, and emotion remained choatic and undstructured because parents were unable to function for us as adult caregivers. If you come out of this kind of neglect, what you'll need for effective therapy is someone who stays adult and provides boundaries--not someone who argues against boundaries and leaves you to flounder in choas of emotion--that will just be a re-run of the neglect you endured when growing up.

(Topaz wrote)

'It's this very mix--humanistic (as opposed to traditional) psychology, consciousness-altering body work, occultism, therapist/patient "incest," financial exploitation-- that makes such groups so hard to accurately define.'

What you are describing is an atmosphere of emotional/intellectual promiscuity. Its also possible that despite your skepticism, you responded to the confusion and social pressure by temporarily experiencing some regression to a child's state of mind. You quickly emerged from that regression, which is why you escaped harm and didnt remain trapped as an inmate of that group and the social setting that supports all this.

**A term like 'psychotherapy/New Age cult' is generated from a calm, adult, state of mind, so it would not seem to match the emotional charge of what you directly experienced.

Its like describing the horrors of war while sitting in an armchair. There's a reason veterans will tell you, 'Words only go so far. They help, but there's no way to put in words what happens to you when you're in battle.'

But you can still accomplish a lot with words, even if in your heart you know that language will never 100% match what you're trying to describe.

TS Eliot said that to wrote poetry is to conduct raids on the inarticulate, with equipment that is constantly wearing out. He knew this, but kept trying and wrote great poetry.

You've just now helped to educate the general public.

There is probably no way you can 'get a fix' on what you witnessed-because that situation, with its messy stew of material, is designed to confuse and disorient particpants, not empower them.

Thats how you keep people coming back for more. Promise to eventually fulfill them, but keep them confused--with just enough peak experiences here and there to keep their hopes up.

In real therapy, things gradually become clear--they dont stay confused.

If you go to a dictionary and look 'promiscuous', it is based on some Latin words which mean--'to mix up, to mix together and confuse.'

The essence of promiscuity is not sexual indulgence, it is confusion. First you get emotional confusion, then intellectual confusion because boundaries are blurred and devalued.

In social settings which foster emotional/intellectual promiscuity, you get a very high risk of boundary violation--emotional, physical, spiritual, financial.

And thats the problem with so much of the New Age--it is a social milieu that fosters promiscuity/confusion and makes people vulnerable to exploitation. Everything is kept nice and fuzzy. The very things that protect from exploitation--boundaries, respect for critical thinking, factual evidence--are jeered at and devalued.

My hunch is some people love this social setting and cling to it, because this confusion is a comfort zone--no need to face painful things about oneself.

The essence of professionalism is that the shrink's personal issues are never, ever supposed to become the client's problems.

So many of us are hurt because we grew up in confusing family environments where boundaries were unclear. Our trauma would only be compounded by a therapist or group that does not respect boundaries and operates in a state of constant confusion (often rationalized as being innovative or eclectic)

If a therapist has personal issues, he or she is supposed to get nurture from his or her peers--that is, his or her spouse/partner, clinical supervisor, consultancy group--NOT from patients.

One reason why we pay mental health professionals such good fees is because staying adult and maintaining boundaries to create a genuine therapeutic setting requires advanced training and skill. Its also stressful. So we pay therapists well enough to ensure that they have sufficient resources to take of their own issues on their own time, without involving clients!

Oh, yes. If a cult leader can get collusion and selectively recruit a coterie of psychotherapists and also include some good lawyers and accoutants, that person's group can last a good long time.

On Star Trek such respectability is called a cloaking device.

Thanks once again for your observations and clarity, Corboy. One issue, however appears to be missing from your most recent analysis which I would like to briefly address. In the case of the Pathwork (which my friend Tom belonged to) he not only was the patient of a Pathwork therapist, he attended Pathwork seminars and intensives and "lecture study" groups and "lecture study" classes and "Pathwork process" classes and "Community process" classes that were clearly advertised as Pathwork related. And all with a fee.
But he ALSO attended various other pricey worskhops and ongoing classes hosted BY various Pathwork therapists (including his own) but never openly promoted AS Pathwork related. I mean there were "men's group" workshops and "women's group" workshops, "couples" workshops, "energy awareness" workshops, "theatre/dance" workshops, "healing" workshops "prosperity" classes, "spiritual practices" classes, "core energetics" classes and a bunch of others I can't even remember his mentioning. I would often see some of these same classes and workshops advertised in various New Agey publications, on flyers, etc. with no mention that they were conducted by Pathwork therapists. Tom was always running off to one of these classes or workshops-again, at the recommendation of his therapist, and was always-no big surprise-short of money, although I am sure he pleased his therapist. These classes and workshops would be held all over the place- at his therapist's-or the hosting therapist's- office or home, at a neighboring Unity-or Unitarian I can't remember which- church, at "retreat places," and so on. On occasion, there would also be advertised in the local Pathwork newsletter a workshop of some personage with Path connections/sympathies (who some Pathwork therapists were currently enamored of) but with his/ her own primary agenda- i.e. "Come spend a fascinating week-end with mystic astrologer Laurie Looney!" etc.
Your earlier remark about the "promiscuity" of such psychotherapy cults (what I called incest) reminded me of all of this and made me realize that what these therapists were doing was three-fold (separate and aside from the astounding financial gain):
First, the Pathwork-specific workshops increased the Pathwork philosophy brainwashing effect -a "given" and no big surprise; however, and second, the "open to anybody" non-Pathwork classes/ workshops (but run by Pathwork therapists who undoubtedly used Pathwork principles in conducting them) increased the brainwashing effect ALL THE MORE in those attendees who already had Pathwork involvement; and third, the "open to anybody" non-Pathwork classes/workshops also gave the Pathwork therapists the opportunity to "make their Pathwork pitch" whether subtlely or not-so-subtlely to attendees who had no prior Pathwork exposure and most of whom had probably been lured there by patients of these therapists, at the therapists behest.
So, I guess what I'm trying to say is that part of the ethics issue re psychotherapy cults such as this is not only their inappropriate behavior regarding their conduct on their own turf, but their involvement with innocent sounding workshops -with no acknowledged Pathwork connection-as a devious tool of recruitment. An octopus with tentacles, if you will...


[/b][/u][/i]

Yes. You've identified something important.

A closed atmosphere of social/intellectual inbreeding can develop in which (my term) 'pseudo-professional' therapists hang out with each other, refer patients to each other, socialize nearly exclusively with each other.

A very lucrative 'in-house' referral network can develop in which therapists bounce each other's clients back and forth, generating revenue for each other's programs and workshops. In an atmosphere like this, pseudo-professional therapists can propagate untested material directly to a gullible, intellectually inbred audience, and avoid ever getting their material tested and peer reviewed by audiences of real mental health professionals.

The beauty of it (am being ironic here) is that many people seek out exactly this kind of psychotherapy---they distrust professionalism and ordinary boundaries, thinking these are stifling and stodgy. A lot of people gravitate to exactly this social environment--one in which many therapists have become pseudo-professional and use techniques that do not meet accepted standards of care and dont monitor boundaries to protect their clients from confusion and exploitation.

Here is an example of how a professional therapist deals responsibly when a new treatment modality is propagated: I met a therapist who specialized in working with traumatized persons. Much to my surprise, he did not use EMDR (eye movement desensitization reprocessing)--a very popular treatment for persons suffering from post-traumatic-stress disorder.

I asked how he'd decided not to use EMDR

My informant replied, 'I reviewed the literature. According to reports on various studies the results indicated that EMDR at most gave people temporary relief from their symptoms, but that later on, their symptoms returned, sometimes more severely than before.

'There just was not enough evidence of benefit in relation to the risks. That is why I do not use EMDR in my practice.'

This therapist is an LCSW who graduated from a good clinical program in which he was taught to function as a therapist on the scientist-practitioner model. He'd learned research methodology, how to tell well designed research research from poorly done research, had taken classes in statistics, and knew how to do literature reviews--and the difference between peer reviewed journals vs other publications.

X told me that it was hell taking those statistics and research methodology courses, but they were absolutely necessary. Without that knowledge base, he'd be unable to read journal articles, and tell which new treatment modality is likely to meet acceptable standards of care--or carry an unacceptable ratio of risk in relation to benefit. Without such awareness and self discipline, this guy could not protect his clients.

But not nearly enough therapists are 1) trained to function this way or 2) remain willing to function this way after being trained. Unless you have the kind of mind that adores hard science, you'll find it hard work, even painful to gut your way through statistics classes, research design classes and get passing grades.

It is [b:f771beecc2]painful [/b:f771beecc2]to deprive oneself of the easy luxury of jumping to conclusions. It requires enormous self-restraint to refrain from leaping on the bandwagon of the newest, most talked-about fad therapy, especially when your clients are suffering and you're warm hearted and want to help them.

A true professional practices intellectual asceticism--disciplined self denial in the service of a higher cause--professional integrity and the long term welfare of their clients. In correspondance with someone who is a clinical supervisor, the person wrote (my paraphrase)

'A lot of students therapists I meet think that once they are out of school they can just do therapy. Ive heard some of them say that they looked forward to 'not having to do any more reading' after they graduate. They're shocked when I tell them they have to say up to date and that I must read 20 journals a month to stay on top of things.' This person said she worried that many student therapists seemed to want to do magic on their clients.

Professionalism vs Pseudoprofessionalism

To me, a 'pseudo-professional' is someone who has credentials from an accredited clinical program, has completed their clinical supervision, has passed their board exams, etc, but they do not [i:f771beecc2]behave [/i:f771beecc2]as professionals and do not socialize on peer basis with other professionals in thier field. One tip off that a charismatic therapist is turning into a guru is when he or she socializes exclusively with adoring disciples or allies.

A professional seeks to maximize benefit and minimize risk. But many pseudoprofessionals are adventurers at heart and seek risk. Its one thing to seek risk for oneself. But a professional therapist is NOT supposed to expose patients to more risk than strictly necessary, and only if there is a high probability that the potential benefits benefits will outweigh the risks.

At best, the true professional turns clients loose to select their own adventures on their own time--with no prompting from the therapist.

Professionalism is not only a matter of knowledge, but its also a matter of attitude and socialization patterns.

First, a professional knows he or she is obligated to put a client's welfare first--ahead of the claims of any guru, human potential group or government.

Second, the true professional is adult and conscious in relation to the claims of his or her guru or growth group--that person always subordinates the claims of guru and group to the Prime Directive to protect clients. A true professional will REFUSE to refer clients to a guru or group and does everything possible to avoid conflicts of loyalty.

Third, a professional remains accountable to his or her profession and knows that learning never stops. He or she socializes with colleagues, will (ideally) be member of a consultancy group and always know to refer patients. A true professional never monopolizes therapy and always knows other excellent therapists are available for consultation and referral.

Fourth-a true professional stays up to date on continuing education and if this person comes up with a new technique he or she discusses it first with colleagues and has it tested and peer reviewed by colleagues.

By contrast, pseudoprofessionals test their material on clients in charisma-driven settings.

[b:952aa7ccb1]Our Vulnerability in Relation to Pseudoprofessionals and Cults[/b:952aa7ccb1]

1) We are already under stress when we are looking for help. Often we will not have the know-how or energy to apply critical thinking. One person on this thread reports suffering ill health from a serious illness at the time she met her pseudoprofessional. When I crossed paths with my guy, I was in the grip of a study block and was scared shitless that I would flunk out of school and return home to my family in disgrace.

Our well being can intially improve when we meet and begin working with a pseudoprofessional who doesnt monitor boundaries, especially if that person is charismatic. This temporary but dramatic sense of relief has been termed 'transferance cure.' It often kicks in after just a few weeks. Our gratitude to the therapist is tremendous. The disorientation we eventually experience from the boundary violations is much more subtle and takes a longer time to manifest--like radiation poisoning. And the pseudoprofessional will have had plenty of time to confuse us, and use our initial early gratitude against us.

Inspiration is not the same as genuine empowerment, just the way getting a high from cocaine not the same as genuine empowerment.

2) As lay-persons we often do not know the rules that therapists are supposed to play by. Even if we do know the rules, we are often under stress and forget.

So, even when we get gut feelings that something is wrong, we lack the intellectual knowledge needed to bring that gut insight to full, conscious awareness. 3) By the time we sense something is wrong, we've usually become very dependant on the therapist--usually because that therapist has undermined what capacity for autonomy we started out with. We dont want to pay the price in pain needed to recognize that a) a trusted person like a therapist could be unworthy of our trust and b) the loneliness of having to leave a close relationship--one that may well have superseded other relationships we once had and then dropped.

4) Errant therapists may recruit persons who are particularly vulnerable--the way child molesters target children who are socially marginalized, from unhappy homes. I am convinced that many of these therapists are children disguised as adults. They lack the confidence to socialize and be intimate with persons who are fully adult (that means psychologically as well as in calendar years), so they try to get intimacy needs met from persons who are their clients, not their peers.

5) Very often we are referred to a pseudoprofessional therapist by someone we love and trust--a friend, a spouse, or another therapist who is unaware that the person is going off the rails.

To have doubts about the pseudoprofessional means the risk of coming into conflict with both the pseudoprofessional and perhaps the person person who referred us. And, if the friend or loved one, or therapist who referred us happens, whether knowingly or unknowlingly to be a member of the cult centered on the pseudoprofessional, we may risk being rejected or shunned if we dare to question the pseudoprofessional and leave. If by this time, our whole social life revolves around the pseudoprofessional, we are in for a hell of a lot of trauma.

We may also have seen other people systematically shunned and ejected from the group (which totally violates professional ethics regarding termination--but this is pseudoprofessionalism in action)--so if we have witnessed this, we will be especially afraid to speak up.

We are learning as a society to feel concerned about child molesters who go after little kids. Molesters are emotionally fixated in childhood, yet in calendar years are adults.

But we have not yet as a culture come to understand that there is another kind of molester--a person who is adult in calendar years, but psychologically a child, and instead of targeting children, selects victims who are 'children disguised as adults.' A lot of errant therapists may fall into this catagory.

You can have an IQ that tests off the scale, be socially sophisticated, and be able to get all A's in medical school, graduate school, etc, yet emotionally still be stuck in childhood. That means you'll not be able to apply what you've been taught in boundary ethics classes to your work as a therapist. The child in you may even resent the discipline of ethics, may fear and resent critical thinking or any suggestion that one do a background check. And all this can be quite unconscious.

If you want a sense of how these people develop charisma and compensate for their childish fixations, Len Oakes has written a brilliant study entitled Prophetic Charisma. He interviewed 20 charismatic leaders of various groups and found they were all narcisssistic, were incapable of intimacy in the full adult sense, and compensated for this lack by becoming avid students of social manipulation, and felt driven to become gurus and prophets.

Oakes was once enthralled by such a person but recovered. He is warmly sympathetic to how desperate these people are, but makes it clear that they compensate by becoming very manipulative and are unable to enjoy life in the moment. They're always in the rat race, following an agenda, even when apparently serene.