By: Cub Lea
- children of neglect often receive same treatment in recovery -
- therapeutic neglect takes back seat to abuse issues -
- victims of therapeutic neglect suffer a double injury -
"Say Doc, can do help me with my deafness?"
"Not if you won't listen to my advice."
Therapy has become a new cure-all. John Bradshaw, Rosanne Arnold, Robert Bly and others have spurred a massive public consciousness-raising over the last five years in regard to adult symptoms of childhood trauma.
The result? In many areas where psychiatric treatment is covered by publicly-funded health care, it has become nearly impossible to get a first appointment with a psychiatrist knowledgeable in this area without a six-month wait. In some cases the wait is two years or longer.
The media has only begun to discover how ripe this forest is for poachers. Growing numbers of people are learning, the hard way, that the field is as young and immature as its clients were when they suffered their original injuries, and perhaps even more frightening, just as vulnerable to the irresponsibilities of youth.
One of the best-kept secrets of the adult child movement is that recovery from emotional injuries can pose grave risks to one's mental, physical and emotional stability. The little joke at the start may be no more than sick humor to most people, but it's no laughing matter to anyone left high and dry by a trusted professional. And as long as it's a seller's market, the risks will remain high.
There is an emerging professional consensus that unresolved childhood trauma can do as much damage as drug addiction and has many of the same characteristics. This observation is as frightening as it is encouraging, particularly when you consider that untreated withdrawal from some addictions can be more lethal than the addiction itself.
According to Stanislav Grof, a California researcher whose techniques and ideas have been adopted by many childhood trauma therapists, poor handling of these issues can be just as lethal. A handful of local counsellors have already begun to deal with the risk by participating in the Spiritual Emergence Network, a loosely-knit organization established by Grof and others to help those in a "healing crisis". But as long as so few know of the SEN's existence, it's like having a rape crisis line with an unlisted number.
The average consumer seems largely unaware of any danger, perhaps because these risks are seldom discussed when adult child issues are raised. Most of those I've known involved in therapy and treatment programs don't view recovery as dangerous to anyone but the perpetrators, with the obvious exception of the odd abusive therapist.
Few, if any, of the best-known authorities and spokespeople in this field have made more than passing mention of the risks of bad therapy. Even fewer discuss the consequences, and fewer still speak for the victims. What little literature there is available focuses almost exclusively on abuse. There is next to nothing which addresses neglect, which may ultimately prove to be much more common than anyone dared imagine.
Part of the reason for this "neglect of the neglect" is built right into the system. A common slogan used in professional and lay self-help circles says "Sometimes it has to get worse before it can get better." It can be a handy shield for deflecting criticism in a group or individual setting. I've heard it used repeatedly in both contexts to justify the neglect of an individual's suffering.
But it only makes sense that when you open a badly-healed wound to treat it, you don't tell the patient to come back next week for a bandage. Reopening of old wounds is the first goal of all trauma therapy, but if the client hasn't been "closed" when the hour is up, the common practice seems to be to prescribe a little ointment and send the client on their way. The client may spend the next week wearing a neon sign that says Kiss Me, Kick Me, or even Kill Me, and never know it until someone answers the invitation.
Another reason why neglect doesn't get headlines is cultural. Historically, the tendency has been to hold abuse victims at least partly responsible for their own injuries. Only in the past thirty years or so have public attitudes begun to change in this regard, and even today a substantial number of people still believe that children attract incestuous behavior in adults, and that victims of violence should have chosen safer surroundings.
It's not an attitude which will change quickly. Abuse has the element of drama. Neglect at the hands of caring professionals hardly qualifies as movie-of-the-week material. It doesn't usually leave visible scars, and if it does, they're rarely traceable. It doesn't lend itself to action sequences or lurid photo opportunities. Abuse victims often make the same noisy outcries as their aggressors; the only weapon available to most neglect victims is silence.
There also seems to be a widespread belief that neglect is less harmful than abuse, and that abuse issues must take first priority. It's a belief often encouraged by self-help groups where the first order of business is removal of an abusive or harmful behavior. The premise seems to be that there is plenty of time to replace it with something healthier.
This belief ignores proven facts. Infants die just as surely from lack of attention as they do from the wrong kind of attention, and adults deprived of nourishment, stimulation or companionship heal much more slowly than children.
It's unrealistic to expect neglect issues to be taken as seriously as overt abuse, at least for the foreseeable future. It's still too easy to claim that neglect victims should have known better, that the first people they accuse of neglect should be themselves. Western democracy expects adults to have the skills necessary to take care of themselves. The penalties can be harsh for those who never learned those skills.
The difference between neglect in romance and neglect in treatment is the trust factor. When you seek out help, there is an implied agreement that your caregiver will not add to the damage you bring to them for repair. When a mechanic damages your car, you can sue. But if he fails to fix your brakes, you may have a tough time proving you asked for the work if you wind up in an accident.
It's fine to say let the buyer beware. But is the consumer at fault when there is no reasonable method of testing the quality of the goods? It's a tragic truth that psychotherapy is one marketplace where there are no guarantees of service and no refunds for faulty merchandise. All you can claim is the damage you can prove.
Imagine someone raised by parents or authority figures who used neglect as a weapon instead of a fist, a stick or a penis, and that the neglect was denied every time it was challenged. According to the current therapeutic model, that person will grow up not knowing the difference between love and neglect and will come to accept neglect as the norm.
Such a person will seek out the same neglectful treatment in partners, groups, workplaces, and eventually in therapists and caregivers. And whether they want it or not, they'll usually find it, just as incest survivors seem to home in on sexual predators as if they had radar. Even if you're aware that you have this potential, you have no protection if you don't know what to watch out for in the other person. And there is precious little information available to protect the consumer.
Re-injury, crippling or death as a result of therapeutic neglect can be routinely dismissed by a professional as a delayed consequence of childhood neglect. This sort of denial borders on the criminal. When a psychiatrist takes sexual liberties with a patient, we don't blame the patient for not enjoying herself. If the woman attempts suicide over the incident we don't hold her responsible for never having learned the difference between love and abuse.
Yet in the past three years I have heard no fewer than fifty different people testify that their caregivers have used similar excuses to justify their lack of response to treatment. The overwhelming majority of them believe the therapist. It can be less painful to believe that you're too sick to respond to treatment than to acknowledge that a trusted caregiver has been stringing you along.
Physicians are required to adhere to an oath which states in part: "above all, do no harm". Damage to the body is measurable, and physicians can be called to account for neglect with evidence provided by their own tools. Damage to the psyche is more difficult to pin down and virtually impossible to prove. And as long as psychotherapy is seen as a mysterious process, standards for ethical treatment in regard to neglect can't be established.
To my knowledge, no such oath is required of a licensed counsellor, and adherence to an oath of non-neglect could never be enforced under the laws as they currently exist.
There are a few, too few, support groups for those who have been abused in therapy. Women Against Violence Against Women (WAVAW) maintains a resource directory for survivors of a wide range of abuses, and reports of individuals' therapeutic experiences are made available to interested consumers.
But there is virtually no support available for male survivors of therapeutic abuse, and to my knowledge, no organized support of any kind for victims of neglect.
The BC government is expected to begin soon to examine licensing requirements for counsellors and possible restrictions on who can call themselves a counsellor. This should make abusive therapy less of a risk, or at least provide more protection for the consumer. But it can't address neglect issues until the problem is acknowledged and exposed. And there seems to be great reluctance to do so.
In the meantime, it appears to be the responsibility of the consumer to monitor their own care. No mean feat for someone seeking treatment for neglect issues.
Three years ago my life was going nowhere. No big deal, or so I was told...half the world wades through the day on a booster of coffee, junk food and television, lulls itself to sleep with drugs, sex and suicide fantasies, can't find real satisfaction in anything and can't figure out why. It's all part of turning thirty. In a few weeks, maybe a few months, it would pass.
But these thirty-something problems had already been around for years. Decades in fact. I can remember questioning God's purpose for me as early as age four. I always believed there were answers, and I always believed that once I knew the reasons for these problems, the solutions would be obvious. I still believe it. If I didn't, I don't know how long I could keep from killing myself.
Today, after three years of intense, full-time effort at pulling my life into shape, I can't honestly say that I'm significantly more competent or content than I was then. I'm still on welfare, still alone, still aimless, and if anything, more numb to those conditions than I've ever been. At times I feel like all I've managed to accomplish is to exchange one set of neuroses for another.
In a whirlwind 30-day retreat three years ago I re-discovered the 12 Steps, gained a whole new perspective on spirituality, and a encountered a brand-new concept that shone like a beacon of hope for me: inner child therapy. It was the first framework I had ever seen which seemed to provide reasonable explanations for my situation.
I dove in with a vengeance, with a passion I have never devoted to anything in my life, and it appeared to virtually everyone that I was making enormous progress in a very short period of time. Too much progress, perhaps. Within three months of the retreat, only two of the many fast friends I thought I'd made there wanted anything to do with me.
I'm a good study and an expert shopper, even if I'm not always careful. According to the literature I had read, classically-trained psychiatrists are generally not qualified for inner-child therapy, so I chose an experienced lay therapist with a solid reputation and excellent credentials. Looking back, I see that therapy stopped being productive in a matter of weeks, but the relationship lasted nine months.
I began seeing a pattern in my behavior which had all the earmarks of self-treatment of schizophrenia. I've never suffered gross hallucination but I am a trained journalist and I had too many symptoms to ignore. I voiced my suspicions to her; if true, I had options for treatment which hadn't been open to me before. Her response was a grotesque parody of a Monty Python skit. We spent an entire hour arguing about the nature of schizophrenia and her certainty that I couldn't possibly have it.
Two months later I had a vivid flashback of an incident of sexual abuse which took place at age four. Again I voiced my concerns. Sexual abuse was her specialty, and with this revelation I suddenly became part of the "family". But the following week she wasn't so sure.
"Sometimes," she said, "we can want to belong so badly that we'll go where the energy is whether we belong there or not."
At that time False Memory Syndrome was not accepted as a valid condition by many counselling professionals, particularly as it concerned sexual abuse. It was generally accepted, and still is, that you should never disbelieve a client presenting therapeutic evidence of sexual abuse or discourage them from identifying with known survivors, although it is permissible to discourage taking action against the perpetrator. Apparently I fell under a whole new category.
I still don't know of anyone who has had this experience. Neglect victims don't seem to know how to make themselves visible to one another.
I couldn't trust her after that incident, and I couldn't put my finger on why. False memory syndrome is always a possibility, and I felt I had to give her the benefit of the doubt. I went back week after week, attempting to re-establish that trust without success.
Finally I confronted her about my distrust and ended the relationship. At that time she told me she had been having symptoms of obsession around me. The fact that she withheld this problem from me is a ready reminder of how unhealthy the relationship was. It took eighteen months for me to realize the depth to which I had been neglected: my therapist was actually romantically involved with me and hadn't told me.
I swore I would not to make that mistake again. I had already been abandoned or rejected by two treatment centers, made to feel less than welcome in churches, new age groups and 12-step programs, and now this: left twisting in the wind by a respected professional.
I immediately started seeing a therapist whose only credentials were his own years of therapy and the visible testimony of several friends of mine who seemed to make rapid progress while under his care. I didn't know it then, but I had walked straight into a therapeutic cult. Nothing in the literature alerted me to the dangers of so many people in the same circle all seeing the same therapist. Neglect victims don't attract people who care enough to warn them of danger.
It was a disaster from the start, but I tried to view the negative effects on my life as part of the therapeutic process, as the reopening of old wounds prior to healing. But the wounds didn't heal. They just stayed open. And in a misguided attempt to stop the bleeding I kept opening more wounds, hoping we'd eventually reach the core and begin to work back out again. He stood and watched. And collected his fee...plus overtime.
After five sessions with him I had re-established two toxic relationships which had ended months prior. In another month I cut ties with my support group, which wasn't very healthy itself but better than no support at all.
In another three months I was in full-blown anorexia for the first time in my life, had cut ties with friends, family, everyone except three other clients of his, developed strange paranoid symptoms which persist to this day, and was carrying out a bizarre plot to get money from my father which I can only describe now as blackmail.
Yet there is not a single charge I can level against this person which would stand up to the scrutiny of any lawyer with half a wit. Although he offered many a suggestion that these might be part of the healing process, he didn't actively encourage any of these behaviors. He didn't have to. He stood by, saying and doing nothing while my life fell apart piece by piece, and nothing appeared in its place except a greater and greater dependence upon him. And every time I needed him he wasn't there for me. It was an old, familiar hell, and I just kept sinking into it with faith that it would eventually end.
Neglect is highly addictive, and when I ended that relationship I went into a prolonged and severe withdrawal. The next year was almost a total loss. Far from coming to terms with my childhood, I spent most of my waking hours trying to unravel what had happened to me in therapy.
I re-established contact with friends, family and support group, but they were of little help. I studied cults, therapeutic technique and theory, whatever I could find that would shed light on my situation.
I couldn't set things right, but I did learn how to identify what was wrong. My experiences had left me highly sensitized to the subtleties of therapeutic neglect. In a vain attempt to find someone to help me sort this out I tried a procession of lay therapists, qualified counsellors, doctors and trained psychologists, all of whom gave me the same two messages. Some were not qualified to help me and told me so. The others all nudged me into crisis and left me there, but I learned to catch on to this pattern by the fifth therapist.
I've been had. Royally. I unwittingly sought - and inevitably got - neglectful treatment practically everywhere I turned. It was only through my efforts at pulling free of these relationships that I began to identify the depth of that neglect.
That awareness brought with it an equally horrifying realization: almost everyone I knew who was seeking the same kind of help was experiencing, or had experienced, the same kind of neglect. It takes one to know one. The only difference seemed to be that they were accepting the neglect as part of the therapeutic process, naturally with the full cooperation of their caregivers.
I watched at least two and possibly three other already-lean friends suffer significant weight loss under the same person's care. Two more experienced major weight gains. At least three actually lost touch with their childhood memories rather than regained them, and two engaged in the same systematic flushing of relationships I had undertaken. Only two of the seventeen people I know who have been clients of his are still under his care, but to my knowledge most of his ex-clients still believe these were "necessary experiences".
My case is extreme, but I can't believe it's truly unusual. I've read a lot of the literature; none of it describes anything quite like what I've been through. But it was precisely that extremity which opened my eyes to the pervasiveness of therapeutic neglect, and neglect is rarely if ever discussed as a hazard of the therapeutic process.
I have lost faith in the safety of any support group, professionally guided or not. I still have yet to meet a trustworthy therapist who would accept my case.
Perhaps most telling of all is that prior to therapy I could turn out 10,000 to 15,000 words a day and take the night off. That's a 200-page book in two weeks. This piece took nearly thirty hours to complete, and I've been planning it for months.
I was also known at one time for the humor in my writing. It may never return, because a side effect of the neglect and my response to it was the horrifying realization that virtually all human laughter stems from fear, and I can no longer afford to bandage my fear with humor.
I don't know what long-term effects this may have had yet; what I do know is that my breath occasionally tastes of feces and urine and that I haven't been able to walk any distance without pain since the weight loss occurred. I do know that as the law stands, I have no valid complaint against anyone.
I think that's a crime.
Cub Lea formerly wrote under the pen name of Steve Winter, and until early 1994 was known by the name Rob Shrier. He is a 35-year-old computer consultant and private tutor in the Vancouver, BC area. Since first writing, Lea has decided to attach his name to this work.
Copyright (c)1995 Cub Lea for Dynamic Living Media. Last modified June 9/95
Last reviewed: By John M. Grohol, Psy.D. on 15 Sep 2002
Published on PsychCentral.com. All rights reserved.