Last week, Kim Ariel Arad’s tear-streaked face filled the Israeli television screens. Not only was she pressing charges against the Jerusalem psychologist who she said sexually abused her, she had completed the incredible task of recording, at least in part, messages containing an admission of guilt. She recognized that what had occurred in the therapy room was so incredibly damaging to her that she took it upon herself to report and expose the psychologist, Yuval Carmi, in attempt to stop the cycle of abuse. I watched the interview, sick to my stomach. I watched the interview as a psychologist, as a patient, as a mentor, and as a mentee.
Kim detailed how she had turned to a psychologist for help with the fallout from previous sexual abuse and trauma. And she detailed how that person, that person who was supposed to heal her, instead repeated her trauma; how he used her weaknesses, weaknesses that she had vulnerably exposed to him in the supposed safety of the therapy room, against her; and how he had done that in order to exploit her for his own gratification. After she exposed Carmi’s actions, the floodgates opened. Kim was not the only victim, others came forward, one detailing the year of therapy where she felt increasingly uneasy with goings on in the therapy room until she finally left. But it took a year of increasingly inappropriate behavior by Carmi for her to pick up and leave.
What makes it so difficult for patients to identify and report therapists who overstep boundaries is that these boundaries are often not so clear, especially not to those seeking help. And by the time those boundaries have been clearly overstepped, the damage has been done and the relationship between the therapist and patient or client becomes one of an abuser and a victim, infused with its own reinforcing pathology. The pathology of an abuser and a victim is often characterized by imbalances of power, by an abuser exploiting the vulnerabilities of the victim, and by making the victim feel like they are doing something wrong. In some cases, like with Yuval Carmi, the abusers create a feeling of guilt in the victim by apologizing, exploiting the affection that the victim feels towards them, knowing that there is a tendency to forgive those we love to preserve a relationship.
As a psychologist, I am privileged to be invited by so many strong, pained and struggling individuals to get to know their innermost workings. To sit together and try to understand what creates the mechanisms that drive their dysfunctional behaviors and painful thoughts. We try and understand how their views of themselves and the world around them sometimes pull them into a vortex of suffering, and we try to find those patterns of behavior or thinking that work, that heal, that empower. And to this end, we work for change, for a better life and for a more meaningful experience. But with this understanding comes great responsibility, something that Yuval Carmi appears to have exploited.
He should have understood that Kim’s mechanism of dealing with trauma was to detach herself from what was going on — to “switch off” in layman’s terms or “dissociate” in professional lingo — to disconnect from what’s happening around her. Yuval Carmi should also have understood the white coat phenomenon, that with his position came increased trust, that his patients were more likely to believe him and do what he asked, simply because he came with the title of “therapist” or “psychologist.” And finally Yuval Carmi should have understood that the feelings of love, attraction, or desire in the therapy room are just that, feelings, they should never be acted upon. But Yuval Carmi didn’t. He exploited his psychological training and he failed his patients, all of them.
I take the responsibility that comes with my “therapist” title seriously. The fact that I am privileged to form a deep understanding of my patients together with the trust and belief they place in my understandings means that I can both encourage healing but can also hurt, to a greater extent than the layman. In addition to the professional accountability and standards that I hold myself to and the supervision and continuing education that help protect me from overstepping guidelines and boundaries, it is important that patients or clients of therapists know how to spot warning signs of abusive therapy:
- Boundaries. It may feel nice when a therapist starts sharing their personal life with you or feel more like a friend than a therapist but this is a slippery slope and not conducive to a good therapeutic relationship. Your therapist should care for you and you should feel cared for, but therapeutic caring should always be boundaried. Therapists may share their personal feelings that occur during and between sessions but this should always relate to the therapy and not to their personal relationship with you. For example, when a therapist shares his feelings of anger at a patient’s abuser or frustration when stuck in a ‘therapy rut’, this may be a helpful and poignant moment in therapy. But if a therapist shares that he views the patient as his daughter (like in the case of Carmi) or can’t stop thinking about them between sessions, this is inappropriate and a blurring of professional boundaries. Boundaries extend to the therapeutic framework. If sessions become longer, more frequent or contact extended between sessions without being explicitly addressed, this is a sign of blurred boundaries. Some therapy approaches encourage extra sessions or telephone contact but this is always agreed upon in advance and in most cases, the purpose should be discussed and clear to both the therapist and the patient.
- Dependence. Therapy should be empowering; you are the vehicle of your change. A therapist who dismisses positive change or who seems to be making life decisions for you is removing you as the agent of change. Furthermore, a therapist who encourages you to keep the therapy secret or not share what is happening is very dangerous. This could be an explicit request or implied subtly by things they say and do. Signs of controlling behaviors such as these are warning signs for abusive relationships in general in addition to warning signs for abusive therapy.
- Touch. There are therapists who include touch as part of therapy but this should always be discussed with the patient. It is not inherently wrong for a therapist to offer a patient a hug or offer to hold a patient’s hand, and there is even a strong theoretical basis for this, but if touch is coupled with any of the above warning signs I would suggest immediately seeking advice from someone other than the therapist. This is where seeing a therapist who is professionally obligated to uphold ethical standards is so important. If you have any questions about a clinical psychologist or a clinical social worker’s conduct you can contact their professional ethical boards for advice. Other non-licensed therapy professions have no professional accountability and little recourse for unprofessional behavior.
- Ignorance. “Ignorance is bliss” goes the saying but understanding the risks inherent in forming an intimate therapeutic relationship could protect you from harm. Research has shown that over 20% of therapists have had at least one patient report exposure to sexual abuse in a previous therapy relationship. Repeatedly, research demonstrates that most of the victims of such abuse are women and most of the perpetrators are men. This is not to say that women should not go to male therapists, in fact a therapeutic relationship with a male therapist may be incredibly helpful and healing, but these relationships should be conducted with extra caution.
- Sexual Undertones. Finally, any touch, behavior or speech that has sexual undertones is completely forbidden in therapy. This is the red line which should never ever be crossed in therapy.