It's always good to see survivors working together, and with regards to this article I would like to thank up front CC from the Therapy Abuse list for suggesting to me that this would make a great article. Her contribution along with those from Aly, Sue and Arthur all from the Therapy Abuse list who also kindly took the time to compile and edit this article - which provide surviors worldwide with some of the best insights into the nature of therapy abuse anywhere. Many thanks also to Marion publisher and co-moderator of the Therapy-Abuse website and list.Who gave her permission for the messages from the Therapy-Abuse list to be published in this way.

http://www.therapy-abuse.net

Ray Hurford - VEX

There are many ways in which therapists and counsellors can abuse their clients. The list below, which does not claim to be exhaustive, is based on the experiences of some of those who have been abused in therapy. Categorising the suggestions has not always been easy: some behaviours fit into more than one category, and there is some overlap between the categories themselves. NB. The words "therapy" and "therapists" here should be taken to refer also to "counselling" and "counsellors" - or indeed to any kind of talking treatment and those who practise it.

"You Don't Matter" - Lack of respect, shaming & not listening

• Treating the client as a "diagnosis" rather than as a person
• Undermining the client's self-confidence and self-esteem and making them feel humiliated; emphasising their "deficiency" and never acknowledging their good qualities
• Not listening properly to clients - and only "hearing" what fits in with the therapist's own preconceived ideas
• Rubbishing the client's own insight, understanding, ideals, goals etc. and making them doubt their own reality (gaslighting)
• Not allowing client to critically question the therapy they are being subjected to, demanding unlimited compliance and agreement and "faith" in the therapeutic process.
• Failing to act on/disbelieving/dismissing/writing off client's complaints or distress re their emotional or psychological problems, engaging in the old "same time next week" attitude
• Treating the client as though he/she is malingering/feigning symptoms so as to get sympathy, time off work etc, and thereby discounting client's complaints about symptoms
• Dismissing a client's problem (for which they are seeking help) with "you just need to deal with it/exercise/pray/do volunteer work/be more grateful" etc.
• Refusal/inability to acknowledge the realities of the client's circumstances (e.g. insisting a client of workplace bullying return to work without proper support or changes to the situation)
• Construing client's belief system as deviant/bad for their mental health/downright delusional simply because it differs from what the therapist considers "normal" (This can also occur when e.g. male therapists encounter feminists or their supporters.)
• Asking the client to pursue "homework" that is never used in the process of the therapy (e.g. telling client to "think about it!" then forgetting all about it, dismissing it as unimportant or accusing client of "wanting to stay stuck on an issue")
• Breaking promises made to a client
  

"You Don't Need To Know" - Withholding information

• Lying, withholding or distorting information
• Inflicting any kind of treatment modality on the client without discussing the treatment and particulars with client first and gaining their consent
• Not telling the client that the therapist is making some kind of assessment or diagnosis of them, and/or not informing the client of any diagnosis which has been made
• Not allowing client to critically question the therapy they are being subjected to, demanding unlimited compliance and agreement and "faith" in the therapeutic process
• Refusing to allow a client access to their client record
• Deliberately confusing a client in order to keep the client off-balance
• Refusal to explain terminology the therapist is using, such as any psychology or DSM terms
• Refusal to answer direct requests for clarification of the therapist's words or non-verbal communications
  

"I'm in Charge" - Controlling, threatening and manipulative behaviour

• Shifting the balance of power further in favour of the therapist
• Refusal to address the issues which the client wishes to address in therapy
• Setting the client's goals for them without reference to what the client sees as important, in relation to either therapy or life in general
• Making a client work on an issue on the therapist's agenda or to his timing
• Threatening to have the client forcibly admitted to a mental hospital
• Guilt-tripping the client with phrases such as "You don't want to get better", "You have a problem with trust" etc.
• Using threats of termination to control a client's actions, reactions, or behaviour
• Deliberately confusing a client so as to throw them off-balance
• Emotional blackmail and verbal assault
• Manipulation through the use of withdrawal and silence (e.g. encouraging client to overstate their distress so as to get a reaction)
• Unconditional positive regard (conveying the impression that the therapist cares and understands)
• Arbitrary, capricious or variable attitude to client (cf. "Good Cop, Bad Cop" routine)
• Making the client make "contracts" as a method of control (e.g. making a client be a "Pollyanna" by having a contract where the client must report "good things that have happened" regardless of the reality of the client's life and recent happenings)
• Therapist passive-aggressively re-enacts a traumatic or abusive incident that client experienced, without client's consent or knowledge of this "therapeutic technique", just to see how client will respond
  

"I Know Best" - Misinterpretation of client's symptoms/situation & imposing own beliefs/ preconceptions

• Not listening properly to clients - and only "hearing" what fits in with the therapist's own preconceived ideas
• Defining clients in terms of the therapist's own outlook, beliefs, ideals etc
• Using circular self-confirming hypotheses, i.e. basing assessments on the therapists's conjecture rather than actual evidence, and then making further assumptions about the client based on those assessments
• Labelling understandable distress/anger etc at external events in terms of mental illness
• Insisting the client accepts the therapist's interpretation of their distress and submits to a therapy protocol which is not designed for nor is effective for client's specific problem (e.g. treating a depressed person for narcissistic or antisocial personality disorder)
• Developing endless attributions for client's behaviour (e.g. depression/anxiety/OCD etc.) to justify solving it for a long time, and when behaviour is still present after therapy, develop a new attribution for the behaviour
• Making the client make "contracts" as a way to control the client or to minimise the client's emotional situation, not as a useful therapy tool (e.g. where the client must report only "good things that have happened" regardless of the reality of the client's life and recent happening)
• Using ANY type of spiritual/religious or otherwise-not-mainstream "therapy" without first explaining such and getting consent
• Insisting client adopt therapist's belief system
  

"You Need Me" - Encouraging dependence & setting self up as only hope

• Persuading the client that the therapist is their only hope of happiness, and that they should accept and do everything the therapist says
• Encouraging an unhealthy dependence on therapy and/or the therapist
• Making extreme and seeming serious suggestions like cutting off contact with family members or verbally abusing family members, and justifying this behaviour by claiming it will "facilitate the therapeutic process"
  

Use of jargon, clichés, pretence and other inappropriate modes of address

• Using complex jargon to confuse and disadvantage the client
• Making jokes at the client's expense
• Passing off abusive comments as "just a joke"
• Passing off superficial clichés as "insight" and "wisdom"
• Using manipulative phrases which contain a critical subtext, e.g.:
  • "This is life, you must learn to deal with it" (subtext: "You are deficient")
  • "Choose to like where you are at, what you've got and to be with whoever you are with" (subtext: "Stop complaining")
  • "I never promised you a rose garden" (subtext: "You are unreasonable" - when the only expectation may have been for decent and respectful behaviour!)
  • "Be grateful for what you have" (subtext: "You are ungrateful" )
  • "Do volunteer work" (subtext: "You are ungiving")
  • "Now you're sadder but wiser" (subtext: "Don't be ungrateful - I've done something for you" - even though you sought help in dealing with the sadness)
  • "To have a friend you must be a friend" (subtext: "You are the problem - and if you say anything against other people, you're paranoid")
  • "There's no such word as 'can't'" (subtext: "You are pathetic", or "I don't believe you")
  • "Don't you know that?" (subtext: "You ought to know that")
  • "Don't you want to get better?" (subtext: "You don't want to get better", or " You will only get better if you do what I say")
• Attempting to lead client to therapist's predetermined conclusions by any of the following:
  • Lying, omitting or distorting information
  • Loaded questions
  • Feigning ignorance about a topic
  • Passing attributional suggestions off as compliments (e.g. "you are a tidy person")
  • Making coercive/fear inducing statements (e.g. "that sounds pretty paranoid to me...")
  • Feigning an anger response to client to regain control or compliance
  • Feigning identification with client's feelings
  • Playing on client's weaknesses/fears/needs/vulnerabilities
  • Setting client up by encouraging him/her to do something that will fail or appear silly
  • Playing games with client (e.g. therapist brings own problems into sessions and has an "iddn't it terrible" competition - "you think you got problems, well, I'll give you a reason to be depressed....")
    

Causing disruption to client's life, including breach of confidentiality

• Encouraging or causing disruption to client's long term friendships and marital relationships
• Failing to respect client's lifestyle choices as a "given"
• Discussing the client with others outside the therapy setting, unless the client has given explicit and informed consent to such discussions (which may include both giving and receiving information)
• Character assassination
  

Financial/material exploitation

• Using ANYTHING from a client for the therapist's personal gain, without their knowledge (including the client's story as an anecdotal case study for publication in a book)
• Keeping any item belonging to the client, even if the item was "created" during therapy or a session of therapy (poetry, artwork, journals etc), and refusing to return these items when asked to do so
• Using billing or financial arrangements to control or manipulate the client (e.g. requiring them to pay for a fixed number of sessions when client has decided to terminate early, or threatening to withdraw counselling which is being provided free or at reduced cost)
  

"It's Your Fault" - Blaming the client & denial of any responsibility for distress in therapy

• "Pollyannaism" - emphasizing only good qualities, people are all nice, well-adjusted, polite, and kind, so if a problem occurs it's the client's fault, while ignoring/overlooking/minimizing bad things people do, or the possibility that people can deliberately do bad things to others; if client questions trustworthiness of others, he/she is labelled "paranoid"
• Demanding client "confess" to doing bad things as part of the therapeutic process and refusing to believe denials (e.g. using illegal narcotics, hurting other people, "being an asshole", theft, lying)
• "Cure must fit the symptom" (i.e. if client has excessive guilt feelings, therapist insists client must have done something bad to make client feel guilty and must "come clean about what you did")
• Treating the client as though he/she is malingering/feigning symptoms
• Saying a client is deliberately "dragging their feet" in getting well when the client is confused or does not understand what is going on in the therapy
• Labelling the client as manipulative or disturbed for questioning the therapist's approach (e.g. diagnosing a personality disorder in order to discredit a client who makes a legitimate complaint)
• Labelling the client as resistant or in denial if they don't accept the therapist's understanding
• Refusing to accept that therapists ever make mistakes and blaming the client for any distress the therapist has caused them
• Character assassination
• Assuming all therapy "works", even the latest fad, and if client doesn't improve then they are "doing something wrong" (which entails many more hours of therapy) because the "theory" certainly cannot be at fault
• Playing the victim when the client makes a complaint
  

THE EFFECTS OF EMOTIONAL ABUSE FROM THERAPEUTIC SETTINGS

• Complete devastation and despair (feeling like Munch's The Scream - see http://www.ivcc.edu/rambo/eng1001/munch.htm )
• Self blame and feelings of failure, guilt and confusion
• Loss of self-confidence and self-esteem, with excessive over-compensatory behaviour for new insecurities and fear about how others will respond to you
• Withdrawal and inability to talk about the abuse; and feeling also that no one understands
• Doubting your own perceptions and reality
• Post-traumatic stress, and ongoing high levels of stress
• Emotional detachment or "shutting down" (leading among other things to loss of empathy and lack of emotional response within oneself)
• Intrusive negative rumination/intrusive negative thoughts/flashbacks
• Extreme (but completely rational) fear of therapists and therapy
• Retraumatization in circumstances reminiscent of the abusive behaviour (this may lead to becoming unexpectedly or unduly upset with others, and even to adopting therapist's abusive style in dealing with them)
• Breakdown of or disruption to client's long-term friendships and marital relationships

HOW THERAPISTS ABUSE THEIR CLIENTS

There are many ways in which therapists and counsellors can abuse their clients. The list below, which does not claim to be exhaustive, is based on the experiences of some of those who have been abused in therapy. Categorising the suggestions has not always been easy: some behaviours fit into more than one category, and there is some overlap between the categories themselves. NB. The words "therapy" and "therapists" here should be taken to refer also to "counselling" and "counsellors" - or indeed to any kind of talking treatment and those who practise it.

"You Don't Matter" - Lack of respect, shaming & not listening

• Treating the client as a "diagnosis" rather than as a person
• Undermining the client's self-confidence and self-esteem and making them feel humiliated; emphasising their "deficiency" and never acknowledging their good qualities
• Not listening properly to clients - and only "hearing" what fits in with the therapist's own preconceived ideas
• Rubbishing the client's own insight, understanding, ideals, goals etc. and making them doubt their own reality (gaslighting)
• Not allowing client to critically question the therapy they are being subjected to, demanding unlimited compliance and agreement and "faith" in the therapeutic process.
• Failing to act on/disbelieving/dismissing/writing off client's complaints or distress re their emotional or psychological problems, engaging in the old "same time next week" attitude
• Treating the client as though he/she is malingering/feigning symptoms so as to get sympathy, time off work etc, and thereby discounting client's complaints about symptoms
• Dismissing a client's problem (for which they are seeking help) with "you just need to deal with it/exercise/pray/do volunteer work/be more grateful" etc.
• Refusal/inability to acknowledge the realities of the client's circumstances (e.g. insisting a client of workplace bullying return to work without proper support or changes to the situation)
• Construing client's belief system as deviant/bad for their mental health/downright delusional simply because it differs from what the therapist considers "normal" (This can also occur when e.g. male therapists encounter feminists or their supporters.)
• Asking the client to pursue "homework" that is never used in the process of the therapy (e.g. telling client to "think about it!" then forgetting all about it, dismissing it as unimportant or accusing client of "wanting to stay stuck on an issue")
• Breaking promises made to a client
  

"You Don't Need To Know" - Withholding information

• Lying, withholding or distorting information
• Inflicting any kind of treatment modality on the client without discussing the treatment and particulars with client first and gaining their consent
• Not telling the client that the therapist is making some kind of assessment or diagnosis of them, and/or not informing the client of any diagnosis which has been made
• Not allowing client to critically question the therapy they are being subjected to, demanding unlimited compliance and agreement and "faith" in the therapeutic process
• Refusing to allow a client access to their client record
• Deliberately confusing a client in order to keep the client off-balance
• Refusal to explain terminology the therapist is using, such as any psychology or DSM terms
• Refusal to answer direct requests for clarification of the therapist's words or non-verbal communications
  

"I'm in Charge" - Controlling, threatening and manipulative behaviour

• Shifting the balance of power further in favour of the therapist
• Refusal to address the issues which the client wishes to address in therapy
• Setting the client's goals for them without reference to what the client sees as important, in relation to either therapy or life in general
• Making a client work on an issue on the therapist's agenda or to his timing
• Threatening to have the client forcibly admitted to a mental hospital
• Guilt-tripping the client with phrases such as "You don't want to get better", "You have a problem with trust" etc.
• Using threats of termination to control a client's actions, reactions, or behaviour
• Deliberately confusing a client so as to throw them off-balance
• Emotional blackmail and verbal assault
• Manipulation through the use of withdrawal and silence (e.g. encouraging client to overstate their distress so as to get a reaction)
• Unconditional positive regard (conveying the impression that the therapist cares and understands)
• Arbitrary, capricious or variable attitude to client (cf. "Good Cop, Bad Cop" routine)
• Making the client make "contracts" as a method of control (e.g. making a client be a "Pollyanna" by having a contract where the client must report "good things that have happened" regardless of the reality of the client's life and recent happenings)
• Therapist passive-aggressively re-enacts a traumatic or abusive incident that client experienced, without client's consent or knowledge of this "therapeutic technique", just to see how client will respond
  

"I Know Best" - Misinterpretation of client's symptoms/situation & imposing own beliefs/ preconceptions

• Not listening properly to clients - and only "hearing" what fits in with the therapist's own preconceived ideas
• Defining clients in terms of the therapist's own outlook, beliefs, ideals etc
• Using circular self-confirming hypotheses, i.e. basing assessments on the therapists's conjecture rather than actual evidence, and then making further assumptions about the client based on those assessments
• Labelling understandable distress/anger etc at external events in terms of mental illness
• Insisting the client accepts the therapist's interpretation of their distress and submits to a therapy protocol which is not designed for nor is effective for client's specific problem (e.g. treating a depressed person for narcissistic or antisocial personality disorder)
• Developing endless attributions for client's behaviour (e.g. depression/anxiety/OCD etc.) to justify solving it for a long time, and when behaviour is still present after therapy, develop a new attribution for the behaviour
• Making the client make "contracts" as a way to control the client or to minimise the client's emotional situation, not as a useful therapy tool (e.g. where the client must report only "good things that have happened" regardless of the reality of the client's life and recent happening)
• Using ANY type of spiritual/religious or otherwise-not-mainstream "therapy" without first explaining such and getting consent
• Insisting client adopt therapist's belief system
  

"You Need Me" - Encouraging dependence & setting self up as only hope

• Persuading the client that the therapist is their only hope of happiness, and that they should accept and do everything the therapist says
• Encouraging an unhealthy dependence on therapy and/or the therapist
• Making extreme and seeming serious suggestions like cutting off contact with family members or verbally abusing family members, and justifying this behaviour by claiming it will "facilitate the therapeutic process"
  

Use of jargon, clichés, pretence and other inappropriate modes of address

• Using complex jargon to confuse and disadvantage the client
• Making jokes at the client's expense
• Passing off abusive comments as "just a joke"
• Passing off superficial clichés as "insight" and "wisdom"
• Using manipulative phrases which contain a critical subtext, e.g.:
  • "This is life, you must learn to deal with it" (subtext: "You are deficient")
  • "Choose to like where you are at, what you've got and to be with whoever you are with" (subtext: "Stop complaining")
  • "I never promised you a rose garden" (subtext: "You are unreasonable" - when the only expectation may have been for decent and respectful behaviour!)
  • "Be grateful for what you have" (subtext: "You are ungrateful" )
  • "Do volunteer work" (subtext: "You are ungiving")
  • "Now you're sadder but wiser" (subtext: "Don't be ungrateful - I've done something for you" - even though you sought help in dealing with the sadness)
  • "To have a friend you must be a friend" (subtext: "You are the problem - and if you say anything against other people, you're paranoid")
  • "There's no such word as 'can't'" (subtext: "You are pathetic", or "I don't believe you")
  • "Don't you know that?" (subtext: "You ought to know that")
  • "Don't you want to get better?" (subtext: "You don't want to get better", or " You will only get better if you do what I say")
• Attempting to lead client to therapist's predetermined conclusions by any of the following:
  • Lying, omitting or distorting information
  • Loaded questions
  • Feigning ignorance about a topic
  • Passing attributional suggestions off as compliments (e.g. "you are a tidy person")
  • Making coercive/fear inducing statements (e.g. "that sounds pretty paranoid to me...")
  • Feigning an anger response to client to regain control or compliance
  • Feigning identification with client's feelings
  • Playing on client's weaknesses/fears/needs/vulnerabilities
  • Setting client up by encouraging him/her to do something that will fail or appear silly
  • Playing games with client (e.g. therapist brings own problems into sessions and has an "iddn't it terrible" competition - "you think you got problems, well, I'll give you a reason to be depressed....")
    

Causing disruption to client's life, including breach of confidentiality

• Encouraging or causing disruption to client's long term friendships and marital relationships
• Failing to respect client's lifestyle choices as a "given"
• Discussing the client with others outside the therapy setting, unless the client has given explicit and informed consent to such discussions (which may include both giving and receiving information)
• Character assassination
  

Financial/material exploitation

• Using ANYTHING from a client for the therapist's personal gain, without their knowledge (including the client's story as an anecdotal case study for publication in a book)
• Keeping any item belonging to the client, even if the item was "created" during therapy or a session of therapy (poetry, artwork, journals etc), and refusing to return these items when asked to do so
• Using billing or financial arrangements to control or manipulate the client (e.g. requiring them to pay for a fixed number of sessions when client has decided to terminate early, or threatening to withdraw counselling which is being provided free or at reduced cost)
  

"It's Your Fault" - Blaming the client & denial of any responsibility for distress in therapy

• "Pollyannaism" - emphasizing only good qualities, people are all nice, well-adjusted, polite, and kind, so if a problem occurs it's the client's fault, while ignoring/overlooking/minimizing bad things people do, or the possibility that people can deliberately do bad things to others; if client questions trustworthiness of others, he/she is labelled "paranoid"
• Demanding client "confess" to doing bad things as part of the therapeutic process and refusing to believe denials (e.g. using illegal narcotics, hurting other people, "being an asshole", theft, lying)
• "Cure must fit the symptom" (i.e. if client has excessive guilt feelings, therapist insists client must have done something bad to make client feel guilty and must "come clean about what you did")
• Treating the client as though he/she is malingering/feigning symptoms
• Saying a client is deliberately "dragging their feet" in getting well when the client is confused or does not understand what is going on in the therapy
• Labelling the client as manipulative or disturbed for questioning the therapist's approach (e.g. diagnosing a personality disorder in order to discredit a client who makes a legitimate complaint)
• Labelling the client as resistant or in denial if they don't accept the therapist's understanding
• Refusing to accept that therapists ever make mistakes and blaming the client for any distress the therapist has caused them
• Character assassination
• Assuming all therapy "works", even the latest fad, and if client doesn't improve then they are "doing something wrong" (which entails many more hours of therapy) because the "theory" certainly cannot be at fault
• Playing the victim when the client makes a complaint
  

THE EFFECTS OF EMOTIONAL ABUSE FROM THERAPEUTIC SETTINGS

• Complete devastation and despair (feeling like Munch's The Scream - see http://www.ivcc.edu/rambo/eng1001/munch.htm )
• Self blame and feelings of failure, guilt and confusion
• Loss of self-confidence and self-esteem, with excessive over-compensatory behaviour for new insecurities and fear about how others will respond to you
• Withdrawal and inability to talk about the abuse; and feeling also that no one understands
• Doubting your own perceptions and reality
• Post-traumatic stress, and ongoing high levels of stress
• Emotional detachment or "shutting down" (leading among other things to loss of empathy and lack of emotional response within oneself)
• Intrusive negative rumination/intrusive negative thoughts/flashbacks
• Extreme (but completely rational) fear of therapists and therapy
• Retraumatization in circumstances reminiscent of the abusive behaviour (this may lead to becoming unexpectedly or unduly upset with others, and even to adopting therapist's abusive style in dealing with them)
• Breakdown of or disruption to client's long-term friendships and marital relationships