The Sexual Abuser Who Wasn't
Colleagues have asked me why I am so adamant about not discussing any specific case on a therapist listserv. Well, I was not as adamant in the past. I shared a case once and came to regret it. Fortunately I had the patient’s permission and I did share the result with my patient. It was a learning experience but it could have turned out very badly. I would never do it again. And here is why.
There are probably few crimes considered worse than the sexual abuse of children. About the only thing as bad is to label someone a sexual abuser when in fact they are not. Therapists frequently are involved with treating people who are sexually abused and sometimes we find ourselves evaluating or treating clients who may have sexually abused others. We should not take such a responsibility lightly. If we err in concluding that someone is a sexual abuser we have done a serious disservice to not just the person we label as such, but to many others who rely on our expertise.
Some time ago in a professional discussion with some colleagues, I presented a case of a patient who was sexually abused. Now discussion among colleagues about cases can get vigorous, even heated. This is all the more true when a topic is as charged as sexual abuse. It gets compounded when there are honest disagreements about what is the best way to treat someone.
I was flabbergasted when during the discussion a colleague said (actually wrote as this was a internet discussion group or listserv), "If you can make your patient stop abusing his younger cousin by telling him to, I'm very impressed. Obviously other tried and failed." If I can make my patient stop abusing his cousin? Where did this question come from? My patient abused no one. He was the abused. Others did not try to get him to stop since he never started.
What I did say in the course of the discussion, almost as background, information (to my continued regret since it was distorted and misinterpreted), was that in addition to being abused he was “ACCUSED” of also abusing his cousin, but this accusation was not only never substantiated it was ruled out as a possibility by the police and DA. Yet, try as I might to correct the facts, my esteemed colleagues heard what they wanted to hear or read what they wanted to read. This therapist was listening, but not to me, the only person in the discussion who had the facts. Would it have been any different if it were the actual patient? [1]
Now therapists are human. We make mistakes. At one time or another, we have misunderstood a patient or colleague. We may have filtered this through our own biases, which some therapists call counter-transference. It should not occur, but it does. The question is what methods do therapists have in place to correct such mistakes when they occur. Can they ever admit they made a mistake? For another example of therapist’s failure to admit a mistake, see http://www.ric.edu/jriolo/slip.htm
Oftentimes it’s not their theoretical framework that will help them correct the mistake. As often as not and especially if they are too wedded to their favored theories they may be blinded to actual facts and in some case dismiss any facts that do not fit their opinion once formed. Imagine if an actual patient went to such a therapist and said, ‘I was accused of sexually abusing my cousin’. What if that therapist did not hear “accused” or was under the belief that to be accused is the same as actually being guilty? What if there are no allowances for reasonable doubt or due process in their theory? What if that therapist labeled that person a sexual abuser in the mental health record? That patient could suffer lasting damage in any number of ways. Therapist may try to treat them for a condition that they do not have. In addition, that record with false information would follow that patient for life. It has been my experience that therapists who claim they are the best listeners often have the most difficulty actually listening to their patients. Too often, they are too busy listening to their own claims about their abilities or the validity of their theories.
If you see, a therapist and they claim they listen, test them. If they are putting words in your mouth or changing what you say so as to mean something else and will not allow you to correct their misunderstandings; if what you say must fit their favored theories or it is discounted, I suggest you pay close attention to these red flags.
Now in fairness it also possible that the person who insisted that my sexually abused patient was an abuser, and claimed to be an experienced therapist may have been an imposter. Frankly I hope that was the case. The fact is on the Internet you can never be totally sure.
My advice would be to tell your therapist that if they plan to discuss you on the Internet they should run by what they intend to say first and that all comments from others should be shared with you. If it is about you it should not be confidential from you.
