What is Therapy Abuse? 

It’s Time to Make Some Changes 

About the Author:
Bernadine Fox is an award-winning mental health advocate with over 30 years of experience and has become a voice for those who are unable to speak about the traumas they have suffered in their therapeutic relationships. The article below identifies the patterns and challenges that clients can face when dealing with an abusive therapist. It also highlights ways for professional counselling associations to make changes within their organizations and to make a difference in their communities.  

Fox is the author of Coming to Voice: Surviving an Abusive Therapist and volunteers for TELL: The Therapist Exploitation Link Line, an organization that supports victims of therapy abuse worldwide. Fox is also the producer/host of ReThreading Madness, one of Canada’s only on-air radio programs about mental health which boasts of a global audience.

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Outside of those who work directly in this field, therapy abuse is often misunderstood. Confusion around what is therapy abuse can leave us wondering how to separate the serial offender who preys on clients from the therapist who might have made a mistake in their counselling practice.

To start with, let us examine what is not therapy abuse. It is not therapy abuse if:

• A client is unhappy with their progress or is experiencing a personal conflict with the therapist.
• The therapist who works beyond their skill level and has made a poor decision and is at risk of committing malpractice.
• A therapist who falls in love with a client has not committed therapy abuse. But the therapist who acts on those feelings and has sexual contact with that client would qualify as therapy abuse.

Therapy Abuse is about exploitation. Offenders groom their victims with the intent to exploit (financially, emotionally, physically, and/or sexually) with a direct benefit for them. They often have more than one victim. Therapy Abuse follows a long-recognized pattern of grooming and coercion (seen in other types of offenders) to induce the victim’s compliance, secure their silence, and, if necessary, ensure an avenue of to discredit disclosures.

In the late 80s, we learned how child molesters would groom their victims with flattery, employ ‘secrets’, label their relationship ‘special’ and insist no one would understand, and make the child into the caretaker, “If you tell I will go to jail”. In intimate partner violence, we learned that batterers groomed and isolated their victims using a cycle of abuse to maintain control. The most dangerous moment for a battered spouse is when they leave. We know molesters use employment to gain access to victims: daycares, schools, camps, and churches: people we thought would protect children. We know that even police officers can be batterers: people we look to for protection. Most recently, the #metoo movement revealed a shocking number of adults who had been emotionally coerced into sexual activity by those with authority.

It offends our sensibilities to know a therapist (usually helpful and compassionate) might use their power and authority over a vulnerable client to exploit them for their own needs or benefit. Unfortunately, this profession is not immune from being used by serial offenders. Lack of resources, knowledge, and expertise have left survivors largely silenced. That is changing.

Those who have worked with trauma over the last several decades will recognize the phases of therapy abuse (Grooming, Exploitation, and Termination) as described below.

The Grooming Phase in therapy abuse is well defined. It often starts within the first couple sessions but can begin with the first initial consult. It can go on for many years. The grooming phase mirrors that of child molesters: calling the victim special, giving gifts to create a sense of financial indebtedness (misuse of pro bono), pushing boundaries around contact and touch, solidifying victim’s sense of responsibility for the perpetrator’s well-being (must keep this secret or I lose my career), setting up covert forms of communication, and isolating the victim from family and friends to name a few.

The Exploitation Phase can include financial, physical, emotional, and/or sexual forms. Financially exploiting a victim includes such things as buying property together, accepting large financial gifts and/or borrowing money from them, being designated as beneficiary of estates and/or insurance policies, or accepting free services like legal or administrative work. Physical exploitation may include free labour: renos on homes or offices, babysitting, and errands. A therapist exploits a client emotionally when they reverse roles and depend on them as sounding board or support person. Of course, sexual exploitation is the most obvious and easiest to define. It is any sexual interaction and includes talking about their own sex life to sexual touching and intercourse.  

The Termination Phase occurs when the offender’s interest wanes, or the victim begins to pull away. In the same way battered spouses are most at risk when leaving, the therapy abuse survivor who is moving away from their offenders will be in a precarious position. In the Termination Phase, perpetrators initiate what often is a pre-contrived defense strategy. Where other the molester or batterer will rely on threats of physical harm, the abusive therapist primarily employs emotional coercion. It often starts with soliciting the victim’s agreement to protect them with silence and the mutual destruction of evidence around transgressions: texts, emails, photos, gifts, therapy notes, etc.  If they fear being formally reported (whether to police or licensing boards), these offenders will use the grooming around caretaking and appeal to the client’s compassion by positioning themselves as the real victim.  They will plead for forgiveness and offer promises to reform. If all that is unsuccessful, they turn to emotional violence to enforce their victim’s silence. Their assaults use the client’s secrets, vulnerabilities, and confidences disclosed in sessions to inflict grave emotional harm. The love and acceptance, they once offered, is replaced with intentional triggering of shame, guilt, abandonment, rejection, and fear that their secrets will be exposed. Offenders may work to break up any of the client’s support systems. Those who offered pro bono arrangements now use it to disprove a counselling relationship. And if all else fails, they are known to provide a new diagnosis that will discredits their victim’s disclosures (i.e., borderline personality).  

The damage done to victims of therapy abuse is catastrophic. During the grooming and exploitation phases, their healing is actively undermined, and they are often faced with new issues: lack of sleep, depression, anxiety, etc. In the termination phase, they struggle to regain a sense of self and may end up losing friends, family, or their spouse. Emotionally overwhelmed, they may be unable to work and risk losing their jobs and homes. They often experience PTSD and the impact of Stockholm Syndrome while fielding both individual and institutional victim-blaming. Healing relationships become triggering and subsequent mental health professionals may not understand their suffering. They are accused of being vindicative, dangerous, and/or lying. Add to it a popular culture which incorrectly depicts a sexual relationship between therapist and client as ‘romantic’ victims are left grappling what is and is not real.  It is no wonder that therapy abuse survivors are ten times (10x) more likely to attempt or commit suicide.  

The difference between the therapist who has made a mistake and the serial offender who grooms victims is stark and easily identified. Because they follow the same patterns as child molesters, batterers, and other offenders, we are already familiar with who they are and what they do.  

Most recently, social media platforms have provided spaces for survivors to find and support each other. Websites like TELL is accessed by 40,000+ unique visitors per year who spend a significant amount of time accessing resources. More survivors are emerging empowered with knowledge, healing, and assistance. Consequently, the known numbers of survivors are increasing exponentially across the globe.  

Doing what we can to prevent therapy abuse is paramount. Associations and societies require that their members commit to a Code of Conduct and Bylaws. (It may surprise you but) Many of these associations still include a clause that allows for a sexual relationship between therapist and client two to three years after termination (along with other criteria). While it seems reasonable, those of us who work with survivors know how these clauses open a door for the perpetrator of therapy abuse that other learned organizations like the College of Physicians and Surgeons, College of Psychologists, and now the BCACC closed. Those institutions recognized that the power imbalance between therapist and client is akin to that of parent and child, that it is life-long, and any sexual activity by default would be abusive. Our Canadian Criminal Code and experts in this field throughout North America concur. There is no good reason for this type of clause to be included in the Code of Conduct and Bylaws for mental health practitioners. 

Changing this clause in our mental health associations and societies will go a long way towards making the mental health field a safer place for clients. The catastrophic damage that they suffer behooves us to do this as soon as is possible.

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