Dear Therapist:

We recently went through a terrible experience with a licensed therapist that a family member used. It was not a subjective mismatch; the clinician lacked professionalism and training, and other professionals and rabbanim involved in the situation were distraught to hear about the techniques he used and the ensuing damage it created. We have switched clinicians and are now going through the process of undoing and re-learning, but we are left feeling angry and hurt. In any other field, he would be facing a malpractice lawsuit, but in the mental health field, it seems that therapists can simply get away with it! How do we, as a community, weed out the "bad apples" and ensure that our most vulnerable do not get further hurt? 

Response:

The field of psychotherapy is still, to a large degree, a “soft” science. As the field progresses, there is a greater push toward treatments that have been shown through numerous studies to be effective for the identified issue. Psychotherapy is steadily—albeit slowly—moving from a therapist-directed field to one based on empirically validated treatment protocols.

These are some of the reasons that empirically-supported therapeutic techniques are important. Just as you might ask a physician for a clear explanation of their treatment, therapists should be able to clearly describe their approach and the reasoning behind it. Clients should not “give themselves over” to their therapist, simply assuming that they are in good hands. Great therapists with proven track records are not immune to this. In fact, the best therapists are usually the ones who work together with their clients in a transparent fashion from the very beginning. A therapist who cannot explain their approach is one who should be avoided.

Although empirically-proven techniques are important, this does not necessarily mean that the entire therapy process should consist of rigid adherence to one or the other of these. Often the greatest therapists are those who are experienced in many techniques, and are able to pivot when deemed appropriate. However, this should be done, as well, in a clear and open fashion. Therapists are not gods. They should be subject to the same rules that govern all professions. Consumers of therapy services should understand the process, and should never be too intimidated to ask questions or to challenge decisions and approaches.

There will always be therapists, however, who “do their own thing.” This can be due to several factors. They might simply be lacking in the knowledge of empirically-supported data. They may believe in a particular form of therapy, regardless of the presenting issue and background (because of training or because it has worked for them in the past). Or they may enjoy pushing the envelope, utilizing a therapeutic approach of their own. These approaches may not be cohesive, comprehensive, or appropriate.

With regard to the particular therapist with whom your family had a negative experience, I don’t know what techniques were used. I don’t know whether there was a logical or professional rationale for these. I don’t know whether this therapist was asked to defend his actions. Regardless, as consumers of a service, we should always feel comfortable with both the service provider and the service itself. If a plumber tells me, “Your problem is the pipes somewhere in your house, and therefore I will do stuff to make it pipe better,” I will likely throw him out of my house. Similarly, if a therapist were to tell me that I have problems that he will address in some undecided, unfocused, or inexplicable way, I would look for a new therapist.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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