New York Times
Monday, January 27, 2003
By LAUREN SLATER
A few weeks ago, a patient reported to the police that his psychiatrist confessed in the privacy of the consulting room that he planned to murder six people. And if that isn't bad enough, the Nassau County police also say that the doctor tried to enlist his patient's help, asking him to find chum (chopped bait) and a gun with a silencer, thereby making the paying customer an unwilling accomplice to something as grisly as the innermost portions of the id. The plot included killing a female patient who had become the psychiatrist's lover, according to the woman's lawyer. The doctor was arrested in a Home Depot parking lot; snap, he was handcuffed; snap snap, he was marched away and later charged with three counts of weapons possession by the Nassau County D.A.'s office, charges he denies. If the analysand has not yet found another therapist, he should, to help him deal with the trauma of his treatment.
That therapy not only deals with trauma but also causes it is no new news, and yet the media are trotting out their predictable headlines -- ''LAWYER: L.I. SHRINK SAID SEX WAS RX''; ''LOVE-SCORNED SHRINK IN MASSACRE BID'' -- as though this is remarkable. It's not. Psychiatrists have been violating ''boundaries'' for as long as the profession has existed. Of course, not every case is as bizarre or extreme as the shrink with the wish to kill. Jung carried on a long affair with a patient; Bettelheim batted his children around; and on a more recent note, there are practitioners like Margaret Bean-Bayog, who shared her sexual fantasies with a patient, who later killed himself.
And yet, despite the steamy stories and the statistics to go along with them (in one survey, 7 percent of male psychiatrists and 3 percent of female psychiatrists admitted to some sort of sexual violation with a patient; nearly 10 percent admitted disclosing their own difficulties to their patients), the public churns and writhes in surprise. It would almost be sweet, our innocence about the purity of our shrinks, if it didn't have the feel of willed gloss, along with a certain Peter Pannish ''I won't grow up'' mentality. As long as we don't grow up, we can continue to hold fast to the fairy-tale idea that certain relationships -- doctor/patient, priest/parishioner, Daddy Warbucks/Orphan Annie, really are inviolable. But in fact, the opposite is true: these kinds of relationships always carry dangers. You can be left with a situation as toxic as Chernobyl, invisible and irradiating.
When a shrink confesses to a patient, is he abusing his power or trying to nullify it? Lately, within the field, it has become fashionable to think therapists should disclose some things, that such candor will even out the power imbalances; the mandate: show your real self, shed a tear or two and let the customer know you're not a statue made of stone. The impulse here is good. No one wants to talk to a statue made of stone, but the reality is far more complex.
Therapist self-disclosure of the tawdry, intimate sort rarely levels the playing field; it loosens the studs holding up the hierarchy so the structure shakes. I've seen many patients confused and even hurt when they get too much information about their therapist. I once had a patient -- a writer of some renown -- who came to me upset because her former therapist had asked her to read her autobiography. Understandably, the patient stopped trusting the therapist, but not before she had read all 500 pages detailing a Bronx Jewish childhood -- and discovered, among other things, that her therapist was a really bad writer. It was hard to go to sessions after that.
But it's not true that a therapist should be a blank slate either, in my view. The current thinking has a point: some disclosures may help patients. There are A.A. members, for instance, who would tell you they can only do good therapeutic work with another recovering substance abuser. So what is the solution? I have it. I'll reveal it by way of anecdote. I once worked in a clinic with a population so violent that, as a matter of policy, we did not close the consulting room doors all the way. Therapy occurred with a door wedge between the inner sanctum of the office and the bright lights of the crowded hall. This was supposedly for the safety of the clinician but it occurs to me now that the patients were just as protected, if not more so. If all therapy were conducted with a literal or metaphorical open door, then there would be far fewer disasters. In what other profession are people allowed to practice with virtually no supervision, without the judgment of their peers? Now that priests' lives are under the microscope, I can't think of one. There is client-attorney privilege, but legal matters are resolved in court, the esquire's performance evaluated by judge and jury.
What if we had a unified mental-health profession in which all practitioners, no matter what level of experience, had to show their peers their work: tape recordings, videotapes, random chart readings? Why not? If we removed the secrecy from the relationship while preserving the privacy (not as hard as it seems), we would see less misconduct. Practitioners could uphold patient privacy by offering a case thoughtfully to colleagues who could give their help. And if a doctor were unwilling to show his work, that itself would cause suspicion.
In the meantime, we will all read the headlines and watch how secrecy produces the strangest of role reversals. Priests confessing to the public. Therapists to their patients. I remember a patient once asking me, ''Who do you talk about me with?'' He wasn't asking out of fear, but hope. What suffering person doesn't want many minds thinking about how to help? As for the 50-minute hour, it will finally heal itself when it unseals its seconds, and offers its findings in a collegial space of honest debate.
Lauren Slater is a psychologist. She is the author, most recently, of the memoir ''Love Works Like This.''