Nov 11

Sexual Abuse of Boys and Men: Recovery

1in6, an organization whose mission is “to help men who have had unwanted or abusive sexual experiences live healthier, happier lives,” lists on their site eight facts that counter common myths about the sexual abuse of boys and men:

  • Boys and men can be sexually used or abused, and it has nothing to do with how masculine they are.
  • If a boy liked the attention he was getting, or got sexually aroused during abuse, or even sometimes wanted the attention or sexual contact, this does not mean he wanted or liked being manipulated or abused, or that any part of what happened, in any way, was his responsibility or fault.
  • Sexual abuse harms boys and girls in ways that are similar and different, but equally harmful.
  • Boys can be sexually abused by both straight men and gay men. It’s about taking advantage of a child’s vulnerability, not the sexual orientation of the abusive person.
  • Whether he is gay, straight or bisexual, a boy’s sexual orientation is neither the cause or the result of sexual abuse.
  • Girls and women can sexually abuse boys.
  • Most boys who are sexually abused will not go on to sexually abuse others.
  • Not understanding these facts is understandable, but harmful, and needs to be overcome.

The following pertinent quotes are from therapists/writers who are experts on the effects of the sexual abuse of boys and men.

Jim Hopper, PhD:

Many men fear their masculinity has been robbed or destroyed, that they’ll be exposed as a ‘fake’ – even if no one has a clue about what happened or thinks twice about their masculinity.

...(L)earning to experience and express vulnerable emotions (at times and places of your own choosing), means becoming more masculine in many positive ways. 

         Richard Gartner, PhD, Psychology Today (author of Beyond Betrayal: Taking Charge of Your Life           After Boyhood Sexual Abuse):

Boys who grow up without coming to terms with their childhood abuse often struggle as men with addictions, anxiety, depression, and thoughts of suicide as well as the inability to develop or maintain relationships.

Confusing affection with abuse, desire with tenderness, sexually abused boys often become men who have difficulty distinguishing among sex, love, nurturance, affection, and abuse. They may experience friendly interpersonal approaches as seductive and manipulative. On the other hand, they may not notice when exploitative demands are made on them – they’ve learned to see these as normal and acceptable.

        Mike Lew, M.Ed., Victims No Longer: Men Recovering from Incest and Other Sexual Child Abuse:

Another question I am frequently asked is, “What do you mean by recovery?” It has taken me a while to answer that one. I had been depending on other people’s definitions of recovery until I developed one that worked for me (just as you must come to one that makes sense for you.) Mine is simple. For me, it is about freedom.
Recovery is the freedom to make choices in your life that aren’t determined by the abuse.
The specific choices will be different for each of you; the freedom to choose is your birthright.  

Lists of various resources are available to male survivors at 1in6 as well as on the websites of Jim Hopper and Next Step Counseling (co-directed by therapists Mike Lew and Thom Harrigan), and Dr. Kelli Palfy (author of Men Too: Unspoken Truths About Male Sexual Abuse), among others.

Nov 09

“The Patient” Spoilers: Therapist Lessons?

Sam, the killer, is the one seeking treatment, but by the time this drama is over, nearly everyone in this drama reflects upon past actions and decisions or dies trying. David Bianculli, NPR, regarding The Patient (Hulu series)

Don’t get any ideas, I jokingly told my client (patient) who had just raved about The Patient and was recommending it. If you’ve already seen the series, and I hope you have because this whole post is a load of spoilers, you’re aware that the premise involves a client (patient), Sam (Domhnall Gleeson), who kidnaps and imprisons his therapist, Alan (Steve Carell), hoping to be cured of serial killing.

Therapist Lessons Learned (Tongue in Cheek? You Decide)

  1. Never publish a book showing you’re an authority on therapy. Your supposed expertise could be your downfall when the next client comes a-knocking (you out).
  2. Never fire your clients for not doing the work. You might not be fired back—and your work just got a whole lot harder.
  3. Therapy provided under extreme duress does not work. Well, at least not for you.
  4. Sometimes involving a client’s loved one (or acquaintance) into his therapy backfires enormously. I mean, maybe you can handle certain people—your client’s cheating spouse, for instance—but his most recent blindfolded, hands-bound, kidnapping victim who’s now going to die because of you?
  5. Sometimes involving a client’s parent in therapy backfires enormously. Can you say Dysfunctional Enabler Who Doesn’t Want to Change?
  6. Helping your client gain insight isn’t all it’s cracked up to be. I mean, when he then strangles his abuser to the point of near-death is it really such a great breakthrough?
  7. A therapy bond, once made, can be hard to break. Or kill.
  8. The ethic of confidentiality can actually be breached. You do NOT have to keep your victimization by a client confidential. That is, if you can actually find someone to tell.
  9. Dead (or otherwise gone) therapists can still be helpful. Imaginary sessions can often lead to deep insights—if not particularly long-lasting.
  10. Never lie to your client about his prognosis. If you pronounce that your uncured, still-murdering client has in fact made great progress so it’s time to end, you just might be forced to stay around forever.
  11. Never offer your honest appraisal of your client’s need to be locked up. He is not going to want that.
  12. Accept that you’re unlikely to ever know the positive therapeutic effects you’ve created for your patient’s post-treatment life. Huh, he’s actually listened to you. And now you’re dead.

On a more serious note: “Can Serial Killers Be Rehabilitated?”

Lori Kinsella, J.D., Psy.D., answers this question in a recent Psychology Today article (not connected to The Patient). Check it out. Her main points as expressed upfront:

Serial killers prioritize rewards in decision making. Consequences are of little or no value to serial killers.

Research suggests that brains and neuronal activity of people with psychopathy are different from those of typical people.

In the future, drugs may help rehabilitate psychopaths by controlling neurons in specific brain regions.

Nov 17

“The Shrink Next Door”: Wrong Therapist

When it comes to finding the wrong therapist, there’s “wrong” as in not the best match, and then there’s “wrong” as in unethical and/or criminal behavior on the part of the shrink. It’s the latter that is the theme of the new fact-based Apple TV+ mini-series The Shrink Next Door starring Paul Rudd as Dr. Isaac (Ike) Herschkopf and Will Ferrell as Marty Markowitz, the client who had the misfortune in real life of choosing this psychiatrist. Despite the comedic talents of these stars, this is not really a comedy but a tragicomedy.

Another key character is Marty’s sister Phyllis (Kathryn Hahn), who’s apparently responsible for encouraging Marty to seek therapy but who then becomes estranged from Marty because of Dr. Ike’s control.

The Truth Behind The Shrink Next Door

Herschkopf, per Dave Itzkoff, New York Times, was ultimately “ordered in April to surrender his license to practice in New York after a committee convened by the State Health Department found him guilty of multiple professional violations” against not only Markowitz but others too.

How bad was it from Markowitz’s point of view? Kai Green, Parade, reports that he told the New York Post a couple years ago that he’d felt like he was in a cult. “He took over my life very quickly…It was one ethical violation after another.”

Markowitz had no reason to suspect Dr. Ike would be like this; he was well-known on the Upper West Side of Manhattan, counting Gwyneth Paltrow and Courtney Love as two of his clients. Paltrow even attended a party at Markowitz’s home, reportedly. The story came to light when Bloomberg columnist Joe Nocera moved to the Hamptons and was invited to a barbecue at the house next door by someone who he thought was the gardener. Meeting the host, ‘Dr. Ike,’ Nocera was invited back for another get-together, where the good doctor insisted on having a picture of Nocera to add to his pictures of celebrities like Brooke Shields and OJ Simpson. However, Nocera ultimately discovered that the man he thought was the gardener, Martin Markowitz, was the actual homeowner—even though Dr. Ike acted like he owned the place. And that’s just the beginning of the shocking truths Nocera ultimately came to learn about the ‘shrink next door.’

Nocera went on to do a podcast about this true story. Additional information about Markowitz’s case has been reported by Debra Nussbaum Cohen, Forward.com:

New York State’s Department of Health, in its decision, found 16 specifications of professional misconduct – from fraudulence to gross negligence and gross incompetence as well as exercising undue influence and moral unfitness. The decision was based on records and testimony from three of Herschkopf’s patients. Markowitz is ‘Patient A…’

Markowitz says that he is ‘much happier now’ than when he was under Herschkopf’s care. ‘It’s my 40-year ordeal. It was 29 years under his power and 11 years seeking justice. I finally got it.’ What matters most is that ‘I got justice. That’s what I wanted.’

The TV Series

Kristen Baldwin, ew.com, describes the essence of Dr. Ike’s destructive actions:

Using manipulation, mind games, and precision-guided guilt, Dr. Ike inveigles his way into his patient’s business affairs, and even his grand summer home in the Hamptons…At first, therapy seems to do Marty some good, as Dr. Ike encourages him to ‘grab the reins’ to his life and stop living in fear of conflict. But it’s all in service of a larger plan: Herschkopf operates like a one-man cult, slowly alienating Marty from Phyllis, his loyal employees, and anyone else who suggests that the shrink’s methods are suspect.

Dave Nemetz, tvline.com: “It’s almost like What About Bob? in reverse, with the therapist becoming attached to his patient like a parasite.” (See my previous posts about What About Bob? here and here.)

Watch the trailer below:

A second trailer reveals more about Marty and his sister’s rift:

Nov 10

“Ted Lasso” Therapist: Fee-Based Caring?

Among the various possible challenges therapists regularly hear from prospective or new clients (or even long-term clients) is that it’s weird to have to pay someone to listen to them. I was reminded of this recently while watching the Ted Lasso therapist scenes.

Ted Lasso‘s second season actively deals with both mental health and sports psychology/therapy. To elaborate further (you probably should stop reading here if you haven’t seen the newest season), Coach Ted Lasso (Jason Sudeikis), who’s been experiencing panic attacks on a regular basis, supports his players getting therapy from Dr. Sharon Fieldstone (Sarah Niles) but is loath to accept it for himself.

Eventually desperate to feel better, however, he does make attempts to see “Dr. Sharon.” In his second of two very brief sessions (because he keeps bolting) Lasso accuses her of not actually caring for the people she treats because she charges a fee. (He blasts the profession in other ways too.)

Dr. Sharon’s response when Lasso returns again? Linda Holmes, NPR: “Finally, on his third try, she tells him that she doesn’t appreciate his attitude, particularly given that he is also paid to do a job in which he still legitimately cares about people. This brings Ted around a bit, and he finally sits down across from her to talk.”

The thing is, therapy is neither free nor a friendship—it’s a professional service generally offered by individuals who’ve chosen this as a career because they genuinely care about helping others.

In essence, if a therapist is actually serving solely as a “friend” he or she is doing professional boundaries wrong. Good therapist boundaries, which are established with the welfare of the client in mind, enable clients to develop trust and a feeling of emotional safety. Confiding in a therapist—who follows an actual ethic of keeping things confidential and is trained to be relatively objective and to understand human issues on a deep level—should feel differently helpful than confiding in a friend.

The therapist is not expecting the same in return from a client just as your roofer, to name just one instance, doesn’t expect you to now come over and do his or her roof.

In a friendship, on the other hand, each person might share thoughts and feelings in a back and forth kind of way. If it’s a healthy enough kind of friendship, this helps forge a mutual relationship involving neither payment nor obligation—but also sometimes lacking objectivity, insight, patience, consistency, effective listening skills, and other good stuff worth sometimes paying for.

Sep 08

Therapist Self-Disclosure: Appropriate, Powerful Uses

Therapist self-disclosure has been a theme expressed and dissected by various modern-day therapists.

One prominent psychologist in this camp is David Treadway, whose late-stage cancer became the subject of a memoir, Home Before Dark: A Family Portrait of Cancer and Healing (2009). It includes contributions from his wife Kate and his two young adult sons, Michael and Sam.

Treadway’s previous Dead Reckoning: A Therapist Confronts His Own Grief (1996) was similarly self-disclosing about the effects of his mother’s suicide. It included (Publishers Weekly) “parallels between what Treadway’s patients are experiencing and his own problems; revelations of his own therapy; excerpts from his family’s painful recollections; and incidents from his own ongoing life.”

Whether as a therapist or in his writing, Treadway views such openness as a carefully chosen act that can be helpful to others if used appropriately. In Andrea Bloomgarden and Rosemary B. Menutti‘s 2009 Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy, you can find his chapter on what he calls “clinically constructive self-disclosure.”

Another psychologist, Ofer Zur, has said that “(T)he decision to self-disclose is based first and foremost on the welfare of the client.” He acknowledges four types of therapist self-disclosure (“Self-Disclosure and Transparency in Psychotherapy and Counseling“):

  1. Deliberate–such as having a family photo on display in the office or responding  with personal reactions to clients’ statements
  2. Unavoidable–when things about the therapist are observable, e.g., approximate age, ethnicity, gender
  3. Accidental–for example, a client and therapist run into each other at a community event
  4. Clients’ Deliberate Actions–when questions are asked or when info is tracked down, e.g., on the internet (very common these days)

The thoughtful therapist is aware of different ways in which personal info might be revealed and works on ways not to have self-disclosure interfere with a client’s work. Above all else, it should not be about the shrink trying to get his/her own needs met.

Possibly the only shrinks today who don’t sometimes use self-disclosure or at least deal with it to any significant degree are the traditional analysts, those who may still subscribe to the “Don’t just say something, sit there” strategy and who believe in a strict interpretation of the “blank screen” approach, i.e., “only if I am inscrutable to you can you do the important work of projecting your childhood stuff onto me.”

Psychoanalyst Linda B. Sherby addressed this in the process of writing Love and Loss in Life and in Treatment (2013), which is about the grief process related to the death of her husband George. Although she anticipated condemnation from other analysts regarding her self-disclosure she felt “it was important…to demonstrate how a therapist’s present life circumstances affects the therapeutic relationship because I do believe that particular aspect of the patient/therapist interaction has been largely ignored.”

States Janine Roberts, Ed.D., an author and scholar who’s studied therapist self-disclosure (Psychotherapy Networker):

Hundreds of therapists in workshops I’ve led in the United States, Europe, and Latin America have said they share personal information to strengthen the therapeutic alliance, demystify therapy, and reduce the power differential between themselves and their clients. Given that research has found that the quality and nature of the therapeutic relationship–not the specific model or method–account for up to 30 percent of the variability in therapy outcomes, they’d appear to be on to something.

Furthermore, Roberts cites research indicating “that clients working with therapists who don’t self-disclose often describe the experience as problematic.”

Increasingly, I think that clients expect or want from their shrinks more personhood and less unknowability. Very often they’re working themselves to be more open and better understood—so isn’t it useful for therapists to model this in appropriate ways?