Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?



Showing posts with label Freud. Show all posts
Showing posts with label Freud. Show all posts

Saturday, June 27, 2009

Busted!

A psychiatrist who practices at Peachford has been indicted for sexual exploitation of a patient. Psychologists' ethics specifically forbid sexual relationships with patients, as does Georgia law, and as do most professionals' ethical codes--for good reason. The doctor-patient relationship, whether the doctor is a doctor of medicine or a doctor of psychology, is not an equal relationship and gives the doctor the power to engage the patient in activities that are not in the latter's best interests.

Adult patients who are exploited are usually female, and there has been some argument that such an ethical/legal prohibition is therefore sexist. It has even been said that, male or female, such prohibitions might deny adults their constitutional right to freedom of association. But studies of this issue have consistently found that it is not usually a case of two consenting adults falling in love (or lust) but rather one in which the therapist has serial affairs with patients, acting out her or his own issues in the treatment, much to the detriment of the patients. So I'm gonna go out on a limb here and predict that now that his mug has been on the 6:00 news, there will be more patients coming forward to report that they, too, have been taken advantage of in this fashion.

Often, it is not until someone else files a complaint that a patient realizes that s/he has an unethical therapist. In the first place, some such patients have been abused before (e.g., incest survivors) and have very poor boundaries to begin with. Their idea of what is abnormal is way, way out there, based on their growing-up experiences, and a little kiss or a date with a therapist doesn't even come close to tripping their radar. To them, this is business as usual. Therapists who are sexual predators in this way are no different from child sexual abusers in that they have a well-honed instinct for who is exploitable. Is this client emotionally needy? Does this client lack a good support system? This re-traumatization is an especially awful betrayal of what to my mind is a sacred trust placed in us.

Seduction by a therapist then proceeds in much the same way as an adult/child exploitation: Early inappropriate behaviors are highly deniable and serve as a test of what the therapist can get away with. Test behaviors also serve to 'groom' the victim, as the therapist (like any sexual predator) gradually increases hir demands. The victim is sucked in one small step at a time, and by the point that s/he feels things are badly out of whack here, s/he (a) is too far from the exits to be able to extricate hirself, and (b) has come to feel complicit in what is going on so is too embarrassed and ashamed to tell anyone. Plus, these therapists, like all sexual predators, instill the importance of secrecy in the victim's mind long before reportable, criminal behaviors occur.

In some cases, the therapists told the patient that this was part of their treatment. For example, the therapist may tell the patient that s/he needs the experience of feeling attractive, lovable. Or that sexual inhibitions can be worked out in therapy by having sex. An unsophisticated patient really has no way of knowing any better: S/he trusts the doctor and complies. This is so not a love relationship, people. It is an abuse of power, pure and simple.

This particular psychiatrist has also been charged with inappropriate prescription practices. Reading between the lines, I'm guessing that the drug was part of the exploitation. This can happen in one of two ways: First, the drug impairs the patient's judgment. Second, the patient may become dependent upon the drug, and by extension, the psychiatrist. This is especially an effective trap if no reputable psychiatrist would prescribe the particular drug, or so high a dose of it--the client has become addicted to it and can only get it from her perpetrator. If she reports him she loses her source. See what I mean about power?

Psychologists' ethics do allow for relationships between therapists and former patients under certain conditions and after a certain period of time has elapsed. This, too, is controversial. These rarely (if ever) turn out well because the power imbalance from the original relationship persists. The roots of these relationships are in transference-countertransference manifestations that were never properly worked through in the therapy, but which, instead, are now being enacted outside the therapy. By definition, then, the therapist wasn't doing hir job in the therapy, and the patient by definition got short-changed.

These are the same interpersonal relationship dynamics that probably brought the patient to therapy in the first place: If they caused the patient problems then in hir relationships, they will cause problems in this one. Similarly, the therapist's lack of self-understanding, poor boundaries, and behavioral disinhibitions exhibited during treatment spell disaster for any outside relationships as well, including especially one with a former patient. Two such relationships of which I am aware became physically abusive; in one, the patient wound up killing hir former therapist in self-defense--and went to prison for it. In a third case, the pair got married, the therapist made the former patient hir office manager, and then proceeded to be unfaithful--with patients!

There are cases in which the patient initiates sexual contact. This is no defense of the therapist: Freud long ago recognized that when the patient falls in "love" with the therapist that it is not the therapist the patient loves--and that the therapist would be a fool (not to mention an under-analyzed narcissist) to think so. The patient/victim in some of these types of cases has been previously victimized, and presents with all sorts of sequelae of previous abuse that makes hir more likely to sexualize the therapy relationship than a patient without an abuse history. When such a patient introduces sex into the mix, it is clearly a therapeutic issue and should be analyzed, not acted out. And it is the therapist's responsibility to make sure that this happens. As one of my clients is fond of pointing out, "That is what you are getting paid the big bucks for."

The ethical and legal prohibition against sexual relationships with patients is a sound one. No good can ever come of it, no matter the participants' rationalizations to the contrary. If your therapist has said or done anything even slightly sexual before, during, or after one of your sessions, run like hell in the opposite direction. And please consider filing a report with hir licensing board and/or the Ethics Committee of hir state and national professional associations. The affirmation that your therapist was in the wrong will do you a world of good.

Sunday, February 22, 2009

Excuse me?!

This month’s issue of Teaching of Psychology, the official journal of the Society for the Teaching of Psychology--ToPs for short--(Division Two of the American Psychological Association) arrived Saturday. And Dear Readers, I am not a happy camper, because it contains an article touting what is to my mind a juvenile, offensive role play exercise for teaching psychodynamic personality theory in a manner “engaging” to undergrads.

In brief, students role-play the part of the professor’s psyche (including his leering id, run amok at the local mall). Roles are "randomly assigned" to id, ego, and superego groups from among student volunteers, which presumably means that some women land in the id group, the instructions for which are as follows:

Welcome to my psyche! Your group is going to be my ID! Imagine that I am at a shopping mall and have just seen an attractive woman walk by. Remember that the ID is driven by the pleasure principle and seeks to have physical needs met immediately--with no regard for consequences. Your group's task is to come up with ideas of what the ID might "say" in this situation (Segrist, 2009; p. 52).

Excuse me?! I got this far before I threw the article on the floor for the first time.

Examples of id comments: "Wow, look at THAT! She's HOT!" "THAT", mind you--not "HER". She's instantly reduced to a THING. And Segrist doesn't seem to see anything wrong with this. Defense mechanisms employed by the ego included denial, as in "she's not really that attractive" (Segrist, 2009, p. 52). What undergrad exactly does this 'engage'? Well, in case you were wondering, as I was, the author reports feedback from his students on the exercise.

Most of the students polled were majors in their junior or senior year.On a scale of one to five (the most positive rating), students rated the activity on average a 4.6 for enjoyment. Segrist did not report the range or quote any negative comments. Since 81.4% of Segrist's students are women, I have a feeling that when I post this blog entry, I will be told that these numbers prove that nobody was offended and that I should get over myself. (How much do you want to bet? I'm thinking of starting a pool.) I contend, however, that the numbers only show how oblivious young women have become to their own objectification.* Either that or how well-schooled, if you'll pardon the expression, they have become at not confronting sexism when they see it. Plus, without knowing the low end of the range, we don't know that nobody was offended. Somebody might have rated the exercise a 1--or worse.

But I digress. Back to the article. Segrist cautions his volunteers not to be "hostile" or "clearly objectionable" in their role-playing. Excuse me?! Is it not "hostile" by definition to objectify, rate, and thereby degrade female passers-by? Apparently not, since he quotes these in an article purporting to show how great his exercise is. Which leaves one therefore to wonder how he defines "objectionable" or what it takes for a comment to be "clearly" objectionable. And would it be ok to be vaguely objectionable? Or only mildly objectionable? Besides which, should not the very fact that you have to caution them be a red flag that what you are doing is not a good thing?

Segrist concedes that "comments generated by the id group in particular have the potential to be offensive to some students and disconcerting to any student who has been sexually victimized" (2009; p. 53). Does he mean the comments that are not "hostile" or "clearly objectionable"? Or is he, without realizing it, conceding that they all are likely to be just that, given the setup for the role-play?

And what does he mean by "potential"? You ask me, offense to any thinking female is guaranteed, not "potential". And "disconcerting" does not begin to cover the impact this exercise could have on a rape survivor (which I presume is what he means by the euphemism "sexually victimized". Future post: euphemisms for "rape"-- submit your favorites for inclusion therein.).

I can’t imagine being a student in his classes–oh, wait, yes I can. I’d feel objectified, threatened, insulted, discounted and disrespected. Intellectually and professionally, I’d feel like I’d just been completely erased. (Remember, this whole exercise is framed as "inside your professor's head," not "inside some dudely jerk at the mall's head".) I would, in short, feel instantly reduced to merely the means of some dude to "have physical needs met immediately--with no regard for consequences" to the "HOT", anonymized, objectified "THAT". As a woman, I would feel that way whether or not I were objectively "HOT". (I'm not--see RateMyProfessors.) Personal hotness is not the issue here: Objectifying and rating women is. I’d be mad as hell and might even walk out of class and go file a complaint.

Nor can I imagine what the editors and publishers were thinking–oh, wait, yes I can. I bet it never even occurred to them that this is not only offensive but also oppressive. Part of the way the game is played, of course, is that the oppressor gets to be in total denial of his oppressive behavior (nota bene, no ego- or super-ego-playing student seems to have pointed out to the id what a sexist pig it was being).

But wait. Maybe it did occur to someone at ToPs that publishing this article would not be a good thing. Of the 21 Consulting Editors, only six are women, but we are otherwise well-represented among the editorial board and predominate among officers of the Society. Maybe one of them did complain about this article, and was told to get over herself. Maybe she's why all those caveats appear in the Discussion section.

Not enough: The whole thing should have been shit-canned.

Dr. Segrist and esteemed members of the ToPs Editorial Board, my lecture on Freud is coming up in a few days. I wonder what the reaction of my students, and of my department Chair, would be if I used that exercise with young men as the target. Would they not see that as totally, unquestionably inappropriate? Not to mention, downright gross? Dudes, can you not see how much more inappropriate it is to target women in such an exercise? I wonder how many of my male students would be embarrassed or offended. How many of them do you think would feel free to say so, even anonymously? I would ask you to consider how much more so that is true for the members of an oppressed class. And then yank the article already.

*In the course of his article, by the way, Segrist notes, "I have a wife" (2009, p. 53)--not, "I am married." Woman as possession (as in, "I have a car, a house, and a dog, too"): I'm not even going to go there today. That is a topic for a whole 'nother post, and I have papers to grade. Maybe after I do the one on euphemisms for rape--don't forget to send your favorites to me at wood_virginia@bellsouth.net

Reference

Segrist, D. J. (2009). What's going on in your professor's head? Demonstrating the id, ego, and superego. Teaching of Psychology, 36, 51-54.


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