Book Review - What to Do When Psychotherapy Goes Wrong

This article is an electronic version of an article originally published in Cultic Studies Journal, 1993, Volume 10, Number 1, pages 91-93. 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.

Book Review - What to Do When Psychotherapy Goes Wrong. 

Shirley J. Siegel. Stop Abuse by Counselors Publishing Co., Tukwila, WA, 1991, 173 pages.

This book's basic thesis is that there are psychotherapists who grossly abuse their responsibilities in service of their own needs, particularly regarding sexual abuse. As a therapist I am appalled that such violations occur. The author provides an important service in calling attention to the problem and suggesting ways to deal with it. Siegel defines the problem, providing validation and support for victims; explains what a person can do if she is exposed to abuse; and presents a guide on what to expect in psychotherapy and how to evaluate a therapist. There are a number of specific statements that warrant comment.

Periodically throughout the book there are statements acknowledging that most therapists are ethical, caring human beings. The impact of these comments is very likely to get lost among the many case examples citing horror stories of abuse. Such imbalance implicitly feeds a distortion about what happens in therapy. A more balanced view would have included a chapter with case illustrations of positive experiences in therapy.

On page 32, the author states: "It is important to note here that while clients would probably be better off with short-term therapy that empowers them to take control of their own lives" this represents, for therapists, an undeniable conflict of interest." I strongly agree that the objective of any therapy is to empower clients to function on their own. Nevertheless, the implication here is that clients would be better off with short-term therapy, which either is an oversimplification or reflects insufficient understanding of the therapeutic process. Not addressed is the fact that different problems require different kinds of therapy that may vary from short-term to long-term therapy. It is quite reasonable to suggest that therapy should be as short as possible. However, to provide short-term therapy when there is a need for more extensive therapy would be less than useful.

To state that recommending short-term therapy categorically represents an "undeniable" conflict of interest is an unwarranted generalized attack. The therapist's situation is no different from that of any other service provider. A doctor, a dentist, a lawyer, a plumber, and a mechanic are all in the same position in providing their services. The only protection is to get multiple opinions, and even that is not foolproof. Ultimately, after careful evaluation along the lines suggested in chapter 13, clients must trust their own judgment. Prudent clients will base their judgment on holding the therapist accountable to his or her rationale for the recommended service. If clients are not satisfied with what they hear, they should not participate.

On page 51, Siegel presents five pointers for clients to remember regarding the abuse of power. This is good advice for clients to follow. On page 57, she states, "Sexual relations between an adult therapist and adult client do not constitute sex between consenting adults." This is a very important point that reflects the abuse of power and violation of trust that is basic to the therapy relationship.

On page 65, the reader is reminded that "credentials do not prevent abuse." Clients should rely on more than credentials as a basis for making their decision. Evaluation of training, experience, and reputation are helpful safeguards.

In chapter 13 the author presents good advice on how to interview and choose a therapist. Chapter 14 emphasizes the importance of clients' trusting their judgment. Siegel recommends a clients' bill of rights, published in 1988 by the Task Force on Sexual Exploitation by Counselors and Therapists in St. Paul, Minnesota. This is a very useful guideline. Siegel's point of view implies that clients are sufficiently functional to make the kind of judgments recommended, which is likely to be true in most cases. Attention should be addressed to when this is not the case. In such situations, guidelines for therapist/client interaction may be somewhat different, depending on individual needs--until the ability to make such judgments is achieved.

The advice on page 108 would only exacerbate a bad experience: "If you had a bad experience with a therapist, the last thing you may want to do is . . . consult another therapist." Quite the contrary, to correct any damage, a bad experience should be quickly followed with another opinion by a therapist who has a good reputation. Doing this interrupts the possibility of the client's carrying distorted self-images and unnecessary pain.

The title does not adequately reflect the contents of the book. The first 50 pages define the nature of abuse in therapy. The next 50 pages discuss the various contexts in which abuse occurs. This is followed by a short discussion regarding what an abused client can do about being mistreated. The last 40 pages discuss whether to see a therapist and how to select an appropriate one.

In summary, this book carries a valuable message and would be helpful for any client to have. I think the book would have more constructive impact if it contained a better balance between where the therapy relationship was abused and where it worked well, as well as more positive focus on what can be accomplished in therapy.

Marvin Snider, Ph.D.

Newton, Massachusetts

Cultic Studies Journal, Vol. 10, No. 1, 1993