In 1988 Boston dailies were subjecting the sexual transgressions of psychiatrists and psychoanalysts to the harsh glare of publicity. One of the first figures to gain such unwelcome notoriety was an analyst member of the Boston Psychoanalytic Society and Institute (BPSI). Charged some ten years earlier by a former patient with having abused her trust and having a sexual relationship with her at a time when she was exceptionally vulnerable, he had been brought before an ethics panel that issued a recommendation that he obtain supervision for his clinical work and resume treatment himself. No effort was made at that time to notify a school where he was a consultant. The recommendations proved ineffective in preventing further misconduct, as he had told neither his supervisor nor his therapist the details of his behavior. When the case later became the subject of a malpractice suit, the resulting publicity made BPSI seriously examine its policies and attitudes.
In the years since the original complaint, important shifts in social attitudes had occurred. A greater awareness of sexual abuse and a greater openness about sexual matters in general had set in, and there was also some erosion of the prestige, and hence the power, of the doctor.
In the past, a self-protective stance had led analysts to minimize the harm done in such relationships. The unethical behavior of the analyst was often overlooked and there was a belief in the power of psychoanalysis and psychotherapy to effect a change in the offending physician. Responsibility for sexual relationships was often ascribed, at least tacitly, to the patient's provocations or psychopathology.
Since then a number of corrective measures have been tried. One of these has been a unique collaboration between BPSI members and members of a self-help group with the acronym TELL (Therapist Exploitation Link Line). In February 1989 a BPSI scientific meeting addressed the problem of sexual relations between analyst or therapist and patient. A BPSI workshop on ethics, initiated by Elizabeth Reid, immediate past President of BPSI, and chaired by Malkah Notman, followed to explore these issues. Jan Wohlberg, a founding member of TELL and a faculty member at a local university had brought up the possibility of a joint meeting between members of TELL and BPSI. The initial group arose from the ethics workshop. It has met monthly for the past two years, includes six members of BPSI (two men and four women) and six members of TELL.
At the beginning, the aim was to develop a dialogue and to see what could be learned about the dynamics and effects of sexual abuse by therapists and analysts. The first phase was a difficult one. TELL members felt they were wary and angry, mistrustful and cautious, while those from BPSI were edgy and given to defensiveness. A crucial experience occurred early on, when TELL members, who had been self-revealing and now wanted to equalize the situation, asked the BPSI members to talk more about themselves. BPSI members responded by revealing experiences of vulnerability, victimization, confusion, and self-doubt. They also spoke of their experiences and feelings about patients they had seen with a history of therapist abuse. With this, a crucial affective shift occurred. Tension eased, and TELL members began to speak in greater depth about their experiences. A real interchange developed with both groups exploring questions and also focusing on problems of subsequent therapy. The discussions were vivid and moving.
Out of this emerged a sense of collaboration
and several common projects. To date, two presentations have been made at national meetings; two TELL members and a BPSI member presented a workshop, at a state-wide conference on training and prevention, on subsequent therapy with patients abused by a previous therapist. Other programs are in the planning stages.
From this collaboration BPSI analysts have gained a vastly different perception of the serious impact of this experience and of its long-lasting harm, creating problems in functioning, depression, and damage to self-esteem, and of the therapeutic pitfalls encountered in dealing with this. TELL members have gained an understanding of the dilemmas faced by analysts, who must deal with issues of confidentiality while recognizing the need to sanction offending colleagues, and of the conflicts of loyalty and anger felt toward those colleagues.
At this time the group is deciding whether to focus in greater detail on the process of subsequent therapy. Several TELL members who are themselves therapists have contributed substantially to this issue. Overall, the group experience has been moving and productive for everyone. It is extremely important that these issues be dealt with more directly and openly than we have in the past. There is a great deal of anger at what has appeared to be collusion to protect colleagues at the expense of patients; left uncorrected, in the long run the appearance of tolerating abuse and the very real damage that occurs can only be harmful, both to the field of psychoanalysis and to patients who might use these admittedly serious failings as a reason to reject the considerable benefits psychoanalysis can bestow.