“While nothing is easier than to denounce the evildoer, nothing is more difficult than to understand him.” Dostoevsky
Evil is a word most often reserved for use in the religious realm as is the concept of the Devil (see Elaine Pagels’ “The Origin of Satin” or Bart Ehrman’s “God’s Problem”), but in the past decade, change has come. Psychiatrists are considering if “evil” exists in anyone or are they merely exhibiting a form of mental illness or a personality disorder.
The question is no mean feat of theory consideration but one that has medical and legal implications. Does evil exist, or are we reverting to a less enlightened age where religion explained all for us in our wish to have answers?
Introspection is a critical aspect of psychotherapy. Those who are engaged in the mental health field as psychiatrists, psychologists, social workers or counselors of any stripe need to do it, also. Sufficient evidence exists to support this reasoning as newspaper articles and journal editorials emphasize.
Famous or infamous?
The question of evil in a psychiatric setting would seem to have been settled by an editorial in one of the psychiatry journals.
As the editorial indicated, “Psychiatrists are medically trained in the scientific method, not in the diagnosis and treatment of evil.… (This) is the province of the philosopher and theologian and… Introducing the concept of evil into forensic psychiatry hopelessly complicates an already difficult task.”
The editorial writer indicated that evil is an exclusively human quality, and one not observed in animals. He was attempting to address one psychiatrist’s formulation of a “Depravity Scale,” which was to standardize measures of evil to provide some guidance for other psychiatrists. The psychiatrist is in the process of collecting data.
In the context of this article, I am not attempting to categorize evil as anything other than a therapist’s wishes to optimize power, prestige, individual desires, or money. I do not believe they are genuinely evil, but some are not what I would see as sterling characters. Most try their utmost to deserve the trust of their clients’ place in them.
However, some of the most famous names in mental health have been accused or have committed the most egregious actions. For some, it was a casual concern with their academic preparation (Erik Erickson); for others, it is ethical violations, sexual deviancy, murder case involvement, or drug use. Some engage in unethical research. All of them are human with feet of clay.
The media is rife with the more sensational stories of therapists who have engaged in non-professional behavior. For example, they have slept with their patients, borrowed money, involved in business relationships, controlled their lives as in the case of one famous music star, and generally allowed themselves to freewheel their lives as they wished. Of course, none of this is acceptable and violates ethical guidelines for all of the mental health professions.
Psychotherapists are supposed to help us deal with the difficulties in our lives, but that’s not always the case. Too many therapists are unqualified to practice as they do, are not licensed, got degrees from unaccredited schools, lack the training required, or are in it for the money. Others may have more nefarious reasons for hanging out that shingle.
The single may also be deceptive as it indicates the person is “Doctor…” Does that mean MD, Ph.D., or what? And what type of Ph.D. did they receive? Honesty in this profession, as in others, is not a strong suit for all. How do you tell who to avoid? No one provides guidelines.
The knaves with degrees
Some therapists are so taken with their alleged ability to perform “semi-miracles” in their patients’ lives that they have stated things which are more than unacceptable. For example, one therapist who, in violation of ethics, encouraged group members to socialize and date.
This licensed individual also told one of the patients that if she discontinued therapy with her, the patient would commit suicide within one year. The patient went on to work with another therapist. In a few years, she earned her master’s degree and then went on to study for a doctorate in psychology. Thoughts of suicide never entered her mind. The therapist remained in practice and, seemingly, no charges were filed. The patient wanted to walk away and forget about it entirely.
A psychologist, who had a young man referred to her, began to engage in what she called therapeutic sex with the young man. The sessions went on for almost a year. After each sexual encounter in her office, he gave her a check for $150 and scheduled their next session.
The unethical behavior continued until he worked up the courage to discuss it with his parents. They reported the woman to her licensing board, and they suspended her license.
One of the problems with suspension is that these individuals often return to practice in the future. During the period of supervision that is generally required, they do nothing untoward, but afterward, we have to wonder. The system, in general, relies on the patient pool and the public to report.
Active violators of ethics or who engage in illegal activities are not sought out by investigators because there are so few who are hired to perform this work. Many states have only two people to look at all the licensed persons within that state. This ongoing surveillance does not include those in the medical profession since they perform their investigations, but, here too, it is left to someone to report. Often the persons are not reported for a variety of reasons which may include intimidation, blackmail or threats of being cut off from treatment or being sued.
Ten steps to protect yourself
You are not going to fall into the clutches of the unscrupulous if you have a guide to assist you in therapist selection. Here is a list of suggested questions to ask and the places you can find help should you need it.
1. Do not depend on ads for therapists. Big ads mean that a person is willing to pay and will expect to regain the funds in therapy fees. Ads=no assurance of anything.
2. No one can guarantee you anything. It is against ethical guidelines for psychologists to provide any assurance of results or a guarantee.
3. Ask all the questions where you need answers. Don’t permit anyone to intimidate you. You are buying a service, and you are a customer no matter whether they call you a patient or a client.
4. Some questions: What degree do they have and in what discipline? A school administration doctorate is not a doctorate in psychology. A doctorate or a Ph.D. needs explanation. Do not skip over this one. Where did they go to school, and where did they do their internship? Plaques on the wall are meaningless. Too many wall decorations can be bought.
5. What license do they have? Being “certified” is not equivalent to being licensed.
6. What is their theoretical orientation? Have them explain it to you. Take notes. Google anything you don’t understand if they tell you something unusual.
7. What will the treatment plan look like, and what is the timeframe for your therapy?
8. In what do they specialize? Examples: medical illness, anxiety, stress reduction, family therapy, cognitive-behavioral techniques, etc. Is a specialist someone who treats anyone who comes through the door? No, they’re not. We are not dealing with a Chinese restaurant menu here.
9. To which professional organizations do they belong? Google that one, too.
10. What is their cancellation policy? Insurance cannot be billed for missed sessions.
If you need more assistance in deciding whether to report a therapeutic transgression or not, where do you go? The usual course would be to your state’s licensing board. An internet search for “(state) licensing board for (psychologists, psychiatrists, social worker, counselors)” should return the result you seek. At this time, there is no national licensing board for the professions.
AI is getting in on the act
As in so many things, technology is being brought into the realm of therapy, but is it free of the problems we’ve seen in artificial intelligence (AI)? Large data sets are not devoid of major issues of bias, miscalculation, and assumptions.
The construction of an AI algorithm that would help to select a good candidate as your therapist remains problematic. Some data sets are heavily loaded in terms of bias. Hidden bias includes ageism, sexism, and racism.
For persons with specific wishes, such as someone of a similar ethnic background or religion or any other particular, the program may select only those individuals. At the same time, it will exclude individuals who might be better suited in terms of forming a therapeutic relationship.
The therapeutic relationship is the basis of all successful therapies. It is here that you must be most attuned to how you feel when you are in the company of that person. Of course, this assumes that you will have a screening or initial consult after you have made a selection for a therapist.
Would selecting a therapist based on shared demographic features result in a good match? The belief may be that this individual has shared life experiences which would make them more apt to understand the individual’s life experiences.
Often, a person seeking a therapist with a similar racial or ethnic backgrounds as a preferred provider and may delay therapy while waiting for a “match.” But an analysis that looked at individuals matched in terms of background and those who weren’t indicated the treatment outcomes were similar. Therefore, the therapist doesn’t have to share a collective life experience, ethnicity, or other background feature. But AI might skew the results in that direction.
Selection of a therapist is of utmost importance because they are dealing with your life and assisting you to make needed changes. As you would with any significant decision, check carefully, be satisfied, and never hesitate to question. It is your life.