Coercive "therapy"

[teachback]

Psychological coercion is an act of violence.

Excellent point, my dear Watson.

Why thank you, kind sir. But in all honesty, you should thank my parents for raising such a wonderful child. Their phone number is 619-232-0349, ask for Stevey or Jojo and tell them Johanas told you to call. They'll get it.

 :rofl:  :rofl:

[Nihilanthic]

It's not just as DESIRE not to get caught, but an appreciation of the CONSEQUENCES of getting caught.  I think it is an important lesson.
When you are in a regular boarding school, of course you might want to drink in the dorm.  You also might think you can do it without getting caught.  The important thing to learn is that the consequences of getting caught are not worth doing it, even though you want to.  It never mattered to me that my son WANTED to drink, drive the cars without a license or skip school, what mattered to me was that he couldn't appreciate the consequences of these actions.

Yawn?

I've driven without a liscense for over two years, because I had to.

I don't want to, and I appreciate the florida wacky-huts would arrest me for it, but given my situation, I don't care. If I wasn't out busting my ass I wouldn't have a place to live or the ability to help cover for a litany of medical and legal expenses necessary to keep my mother alive.

What dictates what I do is discretion, risk balancing, and morality - not fear of getting caught or fear of being punished if I was caught.

See, thats the thing. Education and direction (PARENTING) make people want to do the right thing, and not do bad things. Motivating purely by coercion doesn't address their actual motviations one iota - and you have to be out on the lookout, observing and punishing for it to work.

I'm sure you've had that thing about coersion the APA released posted to you at least enough times to have read once, right?

But hey, like Maynard James Keenan said:

If consequences dictate
The choice of action I take
It doesn't matter what's right
It's only wrong if you get caught

At any rate, I gladly do what I want to do despite possible 'consequences' because I know how to get away with it.  :wave: including florida sodomy laws!

[Nihilanthic]

Yes, putting a kid into a program is coercion. Once in, the level of coercion is what needs to be examined.  It can be abused- or not.

I'm damn sure glad that the actual professionals in the field of psychology disagree with you, as well as human rights advocates.

Being forced to live captive, incommunicado, under duress of constant anxiety, fear, reprisal, and torment physically or psychologically is inherantly abusive, period.

But oh well, I grew up with "Night" By Eli Wiesel... so I was able to get that from a young age.

[Deborah]

I think there is a difference between "coercive therapy" and "coercion to get someone into therapy." Coercion can take many different forms -- anything from attempts to persuade & peer pressure to actual physical coercion (escorts or kidnapping).
Most people would agree that If the therapy is genuine and the person chooses voluntarily to participate, there's no problem.
But what if he or she doesn't believe there's a problem, doesn't believe he needs therapy, etc.? Is it wrong or immoral for friends, family, or significant others to try to persuade, to try to point out all the things that seem so obvious to them, but to which the 'troubled' person has turned a blind eye? At what point does it cross a line of being "too coercive"? And what do you say to someone who ultimately finds value and relief from genuine therapy, but who was strongly pressured to give it a try in the first place? Should their loved ones have just left them alone and allowed their suffering to continue, because "coercion" is always a bad thing, no matter what the outcome?

Jump on Cafety and ask Dr Huffine

Coercive Treatment of Adolescents - Dr. Huffine        
By Charles Huffine, M.D.

As a psychiatrist I must confess and disavow some bad history for my profession in the area of coercive treatment. At least we are not in the leadership of the residential therapeutic school movement, but in hospitals and older treatment facilities we presided over some horrible examples of treatment where our patients were without rights. In recent years (since the 1970's) involuntary treatment for adults, mainly commitment to psychiatric hospitals, has been governed by a tight set of criteria. These involuntary stays are usually very brief and designed to intervene to save lives in an extreme situation. This has not been so with adolescents. Forced hospitalizations and residential treatment stays lasting for months or years were common from the 1980?s on where psychiatrists were part of the leadership of the facilities. But such facilities were licensed by states; often they were accredited by an independent agency and held to some sort of standards of humane care. But the rights of youth to consent or refuse care were not in place. My profession, like most mental health disciplines has not taken the issue of youth rights seriously.

My style of practice in providing mental health services to youth.

I work primarily with adolescents in an outpatient setting. I have grown very comfortable with the realities of adolescent life; its pitfalls and its glories. I have learned to respect confidentiality, even when I hear of things that youth I work with do that are clearly risky. Almost all youth referred to me have had terrible experiences with other therapists. Mostly prior therapists didn't respect confidentiality, freaked out and disclosed very sensitive things to parents, who subsequently freaked out causing a bigger mess. So most youth don't come to me with automatic trust or positive expectations. As I hear about a new patient?s outrageous activities from parents I do my best to not freak out. I try my hardest to come to understand that kid, know their strengths and potential. If I have done my part in forging a good working relationship with a kid they come to know and trust me while I come to know them as individuals. We then can work together. A working relationship depends on getting beyond the adult ? kid power imbalance where we come to respect and like each other as human beings. In such a relationship youth tell me things about their lives that most adults never hear and I use my influence to help youth who are taking huge risks and are on the edge of self-destructing. I try to cool their jets a bit and offer up some good alternatives and common sense to them. I practice a harm reduction approach to treatment. It is my observation that troubled youth are almost always hungry for such a non-judgmental relationship with an adult who can serve as a mentor. I rarely suggest a kid go to the hospital and I never recommend to a kid or their family that they seek long-term placement in a facility such as many of you have suffered. When I have such a relationship with a youth, I almost always witness their toning down their behavior to a level that is not dangerous. They don?t need to be protected from themselves. They come back for their appointments without being forced. I stay involved in their lives actively for a period of time in their adolescents and many come back for counseling as young adults if they have issues, trusting that they will be respected by me and that I will handle personal information sensitively. I am aware that my perspective and my style of working with youth is somewhat unusual given very mixed standards of care in the mental health treatment of adolescents. But I am confident in my approach. I see my patients respond well to me.

Some of my patients are referred to me with a history of having been in a therapeutic boarding school. Once they have come to trust me they will share with me the kind of tales we find on this web site; horrific details of abusive and grossly inappropriate treatment. I have heard these stories too many times. The stories vary however. Occasionally I have heard some positive stories where a youth has been treated with respect and caring in an appropriately run facility, but even then it is against their will. I see very little evidence that even these kids have been helped. The bad stories prevail. I care deeply for youth I work with. I have a strong bias of positive regard for all youth I meet because I genuinely like adolescents. When I hear of mistreatment in facilities that are supposed to care for youth I feel the betrayal and see the harm it has done to my patient. My reaction has been one of extreme anger. This has mobilized me to be an activist in trying to address the system failings that allow these travesties to continue. How could any adult do differently if they are a decent human being and have normal instincts of care and concern for kids? It horrifies me that in our society we can enter into a mass denial that lets these facilities exist.

Youth rights, a major societal failure.

In treatment facilities that treat kids (including hospitals) in almost all areas of the country except my state, the state of Washington, youth rights are violated when they are forced into care, especially forced to stay in a facility. Why are youth rights not violated in the State of Washington? Let me explain. We have an unusual law, a law that is constantly threatened by regressive elements of our legislature. That law states that youth must consent to their mental health and substance abuse treatment from the day they turn 13! Why 13? The thinking of the legislators who drafted these laws is lost in history, but there are hints. They also gave reproductive health rights to all post pubertal woman in this same time period. All these laws came about in an era of consciousness over reproductive rights in the 1970?s. The drafters of the legislation did not have the advantage of good data, but these laws do make some sense based on more recent research. Puberty happens for almost all youth before 13 and is near completion by that time. Social expectations change when youth are post pubertal. Youth are forced to make many complicated judgments at this time in their lives, as they become more independent players in society. Social choices are foisted on youth whether they are prepared or not. They have to make choices that require judgment, even if their brains are not fully developed to the point that they can exercise adult like judgment. We know that emotional arousal will cause a youth?s social judgment to deteriorate. Adolescents depend on their parents, and sometimes other adults in their lives, to moderate their having more independence in their communities and more complicated social choice making. Mostly this parental guidance works for youth if it is respectful and lovingly delivered. Mostly, once in a calmer state after a conflict with parents over a reprimand or limit setting, youth will come around and see the wisdom in their parents concerns. But what happens when youth are not blessed with parents who are competent to offer such good advice, or don?t have their adolescent child?s interests uppermost in their heart and mind? It is these exceptions where there is need for clarity about youth rights is.

When can youth competently exercise judgment regarding major decisions in their lives?

Some research has found that sometime between 12 and 14 (12 and 15 in another study) individuals make as good a judgment about their health care, including mental health and substance abuse services, as did youth at 18, or even those 25 years old. Suffice it to say, some individuals at all ages make terrible judgments, especially when emotionally charged up, but the research supports youth having a capacity for competent, confidential and self determining decision making on all health care matters at age 13 or 14. The right to consent equals the right to NOT consent. One without the other is meaningless. The right to refuse protects youth in my state from being forced into any coercive care in the same way as adults are protected. So let me explain that when youth are forced into care in my state why their rights are not violated.

When is it all right and necessary to force individuals into protective treatment?

It is important to understand the conditions under which individuals can and should be coerced into care. The commitment laws of most states are designed to address those situations when an individual is in eminent risk of lethally harming themselves or someone else due to a mental disorder, or are so incapable of functioning due to such a disorder that they present an immediate risk of incurring harm. My state is very strict in observing these criteria before they detain such an individual. A trained County Designated Mental Health Professional (CDMHP) must screen each person detained before they can be held for 3 days. At the end of an initial 3-day period a court hearing must occur where an independent attorney represents the individual. If the evidence continues to indicate a high degree of eminent risk of harm the individual must stay for an additional 14 days. At the end of 14 days a rigorous legal process sorts out those few individuals who don't respond to crisis level care in 14 days of hospitalization and must be detained for 90 to 180 days. In the state of Washington all youth 13 and older are subject to this process if they are to be detained for a mental disorder. In Washington State there is an alternative method for detaining youth designed to address outrageous behavior that may not be recognized as due to a mental disorder. This process is called either an ?At Risk Youth? (ARY) or ?Children In Need of Services? (CHINS) petition, both of which can inform the judge that a child is at risk due to emotional problems indicated by their behavior. A judge can detain a youth, ages 13 through 17, for 5 days maximum. A longer stay can be theoretically initiated if a parent physically takes a youth to a hospital and the hospital evaluates and accepts them based on the same criteria. An appeal process involving an attorney is possible if the youth is hospitalized. That process, if completed successfully for the youth would take no more then 30 days. No hospital has ever detained a youth under this provision in our current law for fear of a lawsuit.

So what makes an involuntary commitment for an adult or a youth over 13 not against their rights?

It is that a legal review process with access to an attorney is assured. Such a process is the rule in involuntary treatment, and the ARY and CHINS petitions. Of course, if a youth breaks the law a judge may order them to treatment in lieu of jail, but that is not involuntary treatment, it is just giving a youth an option to not go to jail, even if it feels like a "deal they can't refuse."

Involuntary residential care outside of such a legal process cannot be therapeutic, no mater how humane and well intended the staff, as it undercuts and essential aspect of adolescent development, the achievement of autonomy. It is NOT therapeutic because the loss of rights does damage to a sense of self. It undercuts the formation of a personal identity. As with restraint and seclusion, it may be necessary to save a life, but it has a very large cost. It represents a failure, or an absence, of community-based treatment. In such circumstances, such active coercion needs to be ended in the shortest possible time, preferably only a few days. Individuals detained, even in a state of psychotic thinking, should be offered trauma support and counseling, similar to what is commonly recommended after an episode of restraint, to undo the damage caused by such coercion.

I personally believe that if our laws that protect youth rights in mental health and substance abuse treatment were changed from 13 to 16 or 18, the State of Washington would have a flood of locked residential programs emerge around Seattle just as in Idaho, Utah and Montana. I strongly believe that we will not solve the problem of unsafe, non-therapeutic, inappropriate residential treatment until youth are given rights to consent to care in all 50 states. If Idaho, Montana and Utah and all other states had such laws, and had strong Protection and Advocacy agencies in their states to assure adherence to such laws, we would not have the problems we do today and youth such as most of you would no longer endure the abuse and humiliation you have suffered.

Giving youth legal rights doesn?t take away parental rights.

Assuring that youth under 18 have rights would not cause them to run amok. It is an insult to youth to assume that the much-maligned stereotype of an unruly teenager is the rule. It is a very clear minority of youth who are out of control of their parents and in these cases the breakdown of parental authority and respect most often represents a serious emotional problem for the youth, or within their family. Almost always families have the resources to instill decent values in their kids and kids don't violate such values with their behavior without guilt and shattered self-esteem. We know that caring parents who set limits and intervene on the basis of their love for their kids are successful at influencing their kids and can be assured that their youth's behavior will be reasonably safe and decent. It is also true that if trust between parents and youth has been broken by parents who are abusive themselves, or have neglected their kids, a youth's behavior may very well reflect their upset with such parents. Allowing parents to place such kids in horrible facilities is simply a continuation of that abuse. We also know that youth from decent, ?good enough? families do things, and will continue to do things, with peers that would give parents heartburn if they knew. Incurring some risks; i.e. learning to not be stupid with drugs or alcohol, handling sexuality responsibly, learning to drive a car safely are all not without risks, but are normative challenges for youth in our communities. Youth who are upset due to depression or anxiety or some other mental health problems may act out their pain with gross and inappropriate behavior, (1.e. cutting themselves, abusive drinking, gorging and forced vomiting, shoplifting or getting into fights) but good evaluation and treatment can help youth to no longer need to do these kind of things to express their pain. In these types of situations parents need the support and skill of someone who can work with their son or daughter and have the tools to define and treat the problem. Parents with troubled youth need support and it is the obligation of a mental health therapist to either provide such support or arrange support for such parents. A community based treatment within the context of a mentor like relationship with a therapist is more respectful of a young person who has to find their own way through the complexities of growing up, but it is also more respectful of parents who need a sense of community support if they are to handle the rough edges of parenting a youth with significant emotional problems.

My views on the need to limit coercive care stems from my success in treating youth in their communities, amongst all the so-called bad influences. It is born of my learning the power of strength based care and believing that every young person has talents and capacities that are untapped in their adolescent years and that supporting the growth of maturity and uncovering such capacities is the best form of treatment. My views are also shaped by an appreciation of social and family context. I am very aware that families and communities can fail youth. Families of emotionally troubled youth need ?clued in? therapists to work to correct such difficulties while helping youth cope with often non-optimal growing up conditions. I have seen the power of helping families and building community as an alternative to ripping a kid out of their family and community.

Clearly community based care for troubled youth is preferable. We need to do much more to think through if and when there are medically necessary reasons for forcing youth into hospitals or residential treatment programs. Their may occasionally be such circumstances, but current research is insufficient to forge an informed opinion on this issue. Certainly we know that such interventions, when the result of an involuntary treatment process, should be rare and brief and subject to legal scrutiny. I hope that these thoughts will inspire some discussion, and possibly some debate. I plan to participate on this website in discussions about ?good therapy? and provide some thoughts from the land of sympathetic professionals.
http://cafety.org/index.php?option=com_ ... &Itemid=35

[AtomicAnt]

And, Lactose, you're speaking as one who knows so much about all of it?

Yes, putting a kid into a program is coercion. Once in, the level of coercion is what needs to be examined.  It can be abused- or not.

An paid kidnapping and incarceration without due process is abuse. Rights cannot be 'lost' or taken away. They can only be violated.

[teachback]

Yes, putting a kid into a program is coercion. Once in, the level of coercion is what needs to be examined.  It can be abused- or not.

I'm damn sure glad that the actual professionals in the field of psychology disagree with you, as well as human rights advocates.

Being forced to live captive, incommunicado, under duress of constant anxiety, fear, reprisal, and torment physically or psychologically is inherantly abusive, period.

But oh well, I grew up with "Night" By Eli Wiesel... so I was able to get that from a young age.

:tup:

[Nihilanthic]

"Never shall I forget that night, the first night in camp, which has turned my life int one long night, seven times cursed and seven times sealed. Never shall I forget that smoke. Never shall I forget the little faces of the children, whose bodies I saw turned into wreaths of smoke beneath a silent blue sky. Never shall I forget those flames which cnsumed my faith forever. never shall I forget the nocturnal silence which deprived me, for all eternity, of the desire to live. never shall I forget those moments which murdered my God and my soul and turned my dreams to dust. Never shall I forget these things, even if I am condemned to live as long as God himself. Never."

http://en.wikipedia.org/wiki/Night_%28book%29

[Karass]

Thanks Deborah. I'm interested in this quote you posted from Dr. Huffine:

"We know that caring parents who set limits and intervene on the basis of their love for their kids are successful at influencing their kids and can be assured that their youth's behavior will be reasonably safe and decent."

I'm especially interested in the words "intervene" and "influencing" in that sentence, and in what degree of intervention and influencing is appropriate and effective vs. overly coercive and ineffective.

When someone you love is suffering and/or hurting herself, but stubbornly refuses to recognize there is a problem or to seek treatment, how much intervention & influencing is appropriate? Is it really best to just leave them alone and hope that they someday figure it out and decide to seek help? I fully understand and accept that no one can "make" another person accept therapy, and that coerced therapy is doomed to fail. But I also believe that sometimes if you show someone a path and convince them to give it a try, they might find that it helps -- even if they weren't willing to consider it without persuasion or pressure. And if the path you've led them to doesn't help, maybe they'll at least decide to try other paths.

This doesn't just apply to parents dealing with kids' mental health issues -- it's also an issue for adults dealing with other adult loved ones.

[Nihilanthic]

But I also believe that sometimes if you show someone a path and convince them to give it a try, they might find that it helps -- even if they weren't willing to consider it without persuasion or pressure. And if the path you've led them to doesn't help, maybe they'll at least decide to try other paths.

In my book, that is called "Parenting".

People who do that are doing fine already and don't need any help.

[Anonymous]

But I also believe that sometimes if you show someone a path and convince them to give it a try, they might find that it helps -- even if they weren't willing to consider it without persuasion or pressure. And if the path you've led them to doesn't help, maybe they'll at least decide to try other paths.

In my book, that is called "Parenting".

People who do that are doing fine already and don't need any help.

"Convince" does not equal "force" or "coerce."

"Convince" is a synonym of and carries the assumption of non-coercive persuasion.

Showing someone a path and non-coercively persuading them to try it can be a good idea.

Coerced therapy, which inherently violates therapist/patient confidentiality, is always a bad idea. Obviously, child abuse reporting and duty to warn issues are ethical exceptions to confidentiality.

My daughter, who (like me) has bipolar disorder, has therapy as part of her treatment. Two of my requirements in therapist selection are that she likes her therapist and that the therapist have principles that other than those two exceptions she will not violate confidentiality to me or anyone else.

I would never trust a therapist who would be willingly complicit in violating their child's confidentiality rights.

This is not because I believe children have adult decision making capabilities---they clearly don't.

This is because I believe, with good reason, that therapeutic confidentiality is essential to healthy progress in therapy as opposed to making the problems worse.

While I would probably insist that my child go to therapy with someone, I don't care if she changes her therapist as often as she changes her dress as long as the therapist is ethical and covered by insurance. I don't care if she sits in therapy and refuses to say a word to the therapist. I don't care if she avoids care by making only small talk with the therapist or otherwise refuses to participate.

Go is one thing. Participate is another.

She's eleven. At thirteen, I wouldn't even insist that she go. I'd recommend it. I'd nag to any extent I'd think would not be counter-productive. I'd marshall the best arguments I could.

I've found a kid doesn't mind going to therapy if: the parent is also seeing a therapist--a different one; the kid gets to choose the therapist; and the kid and therapist are clear that the parent is 100% behind confidentiality just as if the kid were adult.

Most screwed up kids have boundary issues. Most screwed up kids got their boundary issues from their parents. In most--probably all--screwed up families, their boundary issues are a huge chunk of what's screwing them up.

You don't fix boundary issues by catering to any family member's, parent or child, desire to violate another family member's healthy boundaries.

Intimate self-revelation is within any other person's own healthy psychological boundaries--regardless of age.

Catering to a screwed up parent's desire to violate their child's psychological boundary makes parent, child, the whole family worse, not better. A therapist has an ethical obligation to "first, do no harm."

Any parent who even contemplates sticking their kid in a Program has demonstrated, right there, their control and boundary issues. You don't heal parent or child by catering to that issue. You don't heal parent or child by "working on" that issue. You begin healing by, once you've identified a behavior where one individual is violating the healthy boundaries of another, stopping that particular behavior cold. Cold turkey, it stops right then. There is absolutely no excuse whatsoever that justifies continuing it.

The first thing a parent contemplating a Program needs to do is acknowledge they have boundary and control issues. The second thing that parent needs to do is treat their own boundary violations of other family members and their own examples of unhealthy control like a bottle of alcohol to an alcoholic--cold turkey. You don't "work on" your "issue" of stopping drinking. You stop drinking, then continue the work that helps you stay stopped.

The third thing a parent with boundary and control issues, and a screwed up kid, needs to do is acknowledge to the kid that the parent has boundary issues and exercised unhealthy control violative of the kid's boundaries in the past, but that stopping those boundary violations does not mean the parent will abdicate healthy, age-appropriate control.

The fourth thing said parent needs to do is apologize to the child for the way the parent's boundary issues have created boundary issues in the child, state that the child needs to learn healthy boundaries too--not knowing where they are because the parents didn't know and have not raised him knowing. The fifth thing the parent needs to do is offer therapy, telling the child that--within the limits of insurance--the kid gets to choose his own therapist, the parent recommends the kid choose one who has a firm policy of not violating patient confidentiality to the parents or anyone else,  that the kid gets to change therapist any time he wants to, and that the kid will have no repercussions for any results or lack of results in therapy because the parent will be relating to the therapist on a don't ask, don't tell basis unless the kid gives explicit permission for a particular conversation because the kid thinks it will help him or the family relationships. The parents needs to give examples, such as, "If there's something you're uncomfortable discussing with me, just us, and you'd like to have your therapist there for support, for example, you can do that. The point is you get to choose--if you're willing to go." The parent needs to make sure the kid understands that it's an open offer, with no time limit.

Program parents will, of course, be appalled at that path and absolutely sure that it will not "work" in any way whatsoever---and they will be appalled precisely because they, themselves, have control and boundary issues. Which is why their kids are screwed up in the first place.

Program parents fail to see that while the kid has the problem, the parents are the problem.

It's convenient to blame the kid, in the form of saying that whatever the parent did, the kid is the problem now. And then they say that they know they have issues and are "working" on them.

Garbage.

They're catering to their own issues and staying in their issues. They're like an alcoholic "working" on his issues by downing a bottle of vodka outside the door of an AA meeting.

The parents' own primary "issue" is unhealthy boundaries. There may possibly be an exception, but I've never met one. You don't "work" your own major issue by wallowing in it.

The parents' issues cause the child's issues. You want to successfully treat the child? Fix his home environment first.

I don't know any kid with problems who, knowing that his parent is going to therapy and said parent is quietly not making a big deal of it, and offered therapy under the healthy-boundaries conditions above, won't take the therapy.

Most troubled kids love to have an opportunity to bitch to another adult, in complete confidentiality and safety, about how awful their parents are. From such a start, successful therapy proceeds.

Developing a healthy sense of responsibility and healthy life skills in someone only comes after you let them get their gripes and complaints--the justified ones and the unjustified ones--off their chest, in confidence and safety.

The Catholic Church has known this for centuries, which is why it's never been their policy to violate the seal of the confessional for a child's parents. It's also why it's never been their policy to force anyone to accept a specific priest as their confessor--although there is often significant pressure. The theology has always been that a confession to any ordained priest, plus an act of contrition, grants anyone--adult or child--absolution.

Hrms---now that I think of it, I can't name a single Program run by the Catholic Church or by devout Catholics. "I took those things up with father so-and-so, and ensured with him that my heart is now right with the Church and God." neatly takes the wind out of the sails of someone who would force therapy.

Hrms. That might be a great tactic for a kid who thinks he's at risk of being shipped off. Convert to Catholic, go to confession, and then respond to any demands for self-revelation with "I'd like to go to mass." or "I'd like to go to confession."  It neatly protects a kid against charges of "manipulation" on a phone call to tell your parents, "Well, I'd like to go to mass and confession. Could you put these folks in touch with the local priest? If I can't leave, perhaps he could visit?"

"Why do you have so much problem with me seeing an ordained Catholic priest? The Church has more than one billion adherents. Islam? Communism? Well, last I heard the Church had quit killing people for heresy."

The Program would still be its own abusive self---but it would make it a lot harder to justify to parents with even the tiniest bit of conscience.

Priests expect to answer to the Church and God if they violate the seal of the confessional.

Julie

[Anonymous]

Many therapists are full of crap and will violate confidentiality as they see fit. I find that most people who become therapists have more problems than the people they are trying to help. Friends are just as good listeners and are much cheaper.

[AtomicAnt]

Many therapists are full of crap and will violate confidentiality as they see fit. I find that most people who become therapists have more problems than the people they are trying to help. Friends are just as good listeners and are much cheaper.

This is exactly the kind of nonsense I would have posted before my marriage crumbled and my ex and I sought ought therapy and marriage counseling.

I have plenty of understanding friends who have heard all my side of the story, but they are not trained therapists and cannot do what a professional does. It is not your friends' job to deal with your personal issues on the therapeutic level and good friends have healthy enough boundaries that they would not let you go that far.

You have to shop around. I went through three idiots before finding someone I could work with.

As a couple, we went through three marriage counselors. Each contributed in their own way, but each was limited and we ended up in a rut and needed a change.

Some would say the divorce shows the counseling did not work. I would point to the friendship and bond my ex and I still have as proof that it worked. Our last marriage counselor was informed up front that we did not want to save the marriage, we wanted to end it rationally. He helped us do that.

Your post only shows your lack of experience and understanding of the process.

[Anonymous]

I read through 3/4 of your post Ant but then your time ran out. We'll pick up next week...

[teachback]

It's cheaper to keep her.

[Anne Bonney]

Pretty simple thread title, huh?  What it is and why it's bad.  Post away, I'll start.

I know it's long, but it's worth the time.

http://www.culthelp.info/index.php?opti ... &Itemid=12

Thought Reform Programs and the Production of Psychiatric Casualties

by Margaret Thaler Singer, Ph. D., and Richard Ofshe, Ph. D.

Psychiatric Annals 20:4

April, 1990

The term Athought reform@ was introduced into the psychiatric literature by Lifton and the term Acoercive persuasion@' by Schein. Both described the organized Aideological remolding@ programs introduced by the Chinese Communists after their 1949 takeover. Thought reform programs were used in the Arevolutionary universities,@ other educational settings, and prison environments. Lifton, Schein, and other authors wrote about psychological effects in military and civilian prisoners. as well as in individuals exposed to thought reform programs in non-prison settings. These authors called attention to the manipulation processes that had been organized into effective psychological and social influence programs aimed at changing the political beliefs of individuals.

As early as 1929, Mao Tse-tung was waging a Athought struggle@ to achieve unity and discipline in the Chinese Communist Party. Following the proclamation of the People's Republic of China in 1949, hundreds or thousands were exposed to thought reform programs to achieve Aideological remolding.@ AGroup struggle sessions@ convinced individuals to denounce their past political views and to adopt the new state-approved political outlook.

Neither mysterious methods nor arcane new techniques were involved; the effectiveness of thought reform programs did not depend on prison settings, physical abuse, or death threats. Programs used the organization and application of intense guilt/shame/anxiety manipulation, combined with the production of strong emotional arousal in settings where people did not leave because of social and psychological pressures or because of enforced confinement. The pressures could be reduced only by participants' accepting the belief system or adopting behaviors promulgated by the purveyors of the thought reform programs.

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Coercive Persuasion and Attitude Change

Coercive persuasion and thought reform are alternate names for programs of social influence capable of producing substantial behavior and attitude change through the use of coercive tactics, persuasion, and/or interpersonal and group-based influence manipulations (Schein 1961; Lifton 1961). Such programs have also been labeled "brainwashing" (Hunter 1951), a term more often used in the media than in scientific literature. However identified, these programs are distinguishable from other elaborate attempts to influence behavior and attitudes, to socialize, and to accomplish social control. Their distinguishing features are their totalistic qualities (Lifton 1961), the types of influence procedures they employ, and the organization of these procedures into three distinctive subphases of the overall process (Schein 1961; Ofshe andSinger 1986). The key factors that distinguish coercive persuasion from other training and socialization schemes are

    * (1) the reliance on intense interpersonal and psychological attack to destabilize an individual's sense of self
    * to promote compliance,
    * (2) the use of an organized peer group,
    * (3)applying interpersonal pressure to promote conformity, and
    * (4) the manipulation of the totality of the person's social environment to stabilize behavior once modified.

Thought-reform programs have been employed in attempts to control and indoctrinate individuals, societal groups (e.g., intellectuals), and even entire populations. Systems intended to accomplish these goals can vary considerably in their construction. Even the first systems studied under the label "thought reform" ranged from those in which confinement and physical assault were employed (Schein 1956; Lifton 1954; Lifton 1961 pp. 19-85) to applications that were carried out under nonconfined conditions, in which nonphysical coercion substituted for assault (Lifton 1961, pp. 242-273; Schein 1961, pp. 290-298). The individuals to whom these influence programs were applied were in some cases unwilling subjects (prisoner populations) and in other cases volunteers who sought to participate in what they believed might be a career-beneficial, educational experience (Lifton 1981, p. 248).

Significant differences existed between the social environments and the control mechanisms employed in the two types of programs initially studied. Their similarities, however, are of more importance in understanding their ability to influence behavior and beliefs than are their differences. They shared the utilization of coercive persuasion's key effective-influence mechanisms: a focused attack on the stability of a person's sense of self; reliance on peer group interaction; the development of interpersonal bonds between targets and their controllers and peers; and an ability to control communication among participants. Edgar Schein captured the essential similarity between the types of programs in his definition of the coercive-persuasion phenomenon. Schein noted that even for prisoners, what happened was a subjection to "unusually intense and prolonged persuasion" that they could not avoid; thus, "they were coerced into allowing themselves to be persuaded" (Schein 1961, p. 18).

Programs of both types (confined/assaultive and nonconfined/nonassaultive) cause a range of cognitive and behavioral responses. The reported cognitive responses vary from apparently rare instances, classifiable as internalized belief change (enduring change), to a frequently observed transient alteration in beliefs that appears to be situationally adaptive and, finally, to reactions of nothing less than firm intellectual resistance and hostility (Lifton 1961, pp. 117-151, 399-415; Schein 1961, pp. 157-166).

The phrase situationally adaptive belief change refers to attitude change that is not stable and is environment dependent. This type of response to the influence pressures of coercive-persuasion programs is perhaps the most surprising of the responses that have been observed. The combination of psychological assault on the self, interpersonal pressure, and the social organization of the environment creates a situation that can only be coped with by adapting and acting so as to present oneself to others in terms of the ideology supported in the environment (see below for discussion). Eliciting the desired verbal and interactive behavior sets up conditions likely to stimulate the development of attitudes consistent with and that function to rationalize new behavior in which the individual is engaging. Models of attitude change, such as the theory of Cognitive Dissonance (Festinger 1957) or Self-Perception Theory (Bern 1972), explain the tendency for consistent attitudes to develop as a consequence of behavior.

The surprising aspect of the situationally adaptive response is that the attitudes that develop are unstable. They tend to change dramatically once the person is removed from an environment that has totalistic properties and is organized to support the adaptive attitudes. Once removed from such an environment, the person is able to interact with others who permit and encourage the expression of criticisms and doubts, which were previously stifled because of the normative rules of the reform environment (Schein 1961, p. 163; Lifton 1961, pp. 87-116, 399-415; Ofshe and Singer 1986). This pattern of change, first in one direction and then the other, dramatically highlights the profound importance of social support in the explanation of attitude change and stability. This relationship has for decades been one of the principal interests in the field of social psychology.

Statements supportive of the proffered ideology that indicate adaptive attitude change during the period of the target's involvement in the reform environment and immediately following separation should not be taken as mere playacting in reaction to necessity. Targets tend to become genuinely involved in the interaction. The reform experience focuses on genuine vulnerabilities as the method for undermining self-concept: manipulating genuine feelings of guilt about past conduct; inducing the target to make public denunciations of his or her prior life as being unworthy; and carrying this forward through interaction with peers for whom the target develops strong bonds. Involvement developed in these ways prevents the target from maintaining both psychological distance or emotional independence from the experience.

The reaction pattern of persons who display adaptive attitude-change responses is not one of an immediate and easy rejection of the proffered ideology. This response would be expected if they had been faking their reactions as a conscious strategy to defend against the pressures to which they were exposed. Rather, they appear to be conflicted about the sentiments they developed and their reevaluation of these sentiments. This response has been observed in persons reformed under both confined/assaultive and nonconfined/ nonassaultive reform conditions (Schein 1962, pp. 163- 165; Lifton 1961, pp. 86-116, 400- 401).

Self-concept and belief-related attitude change in response to closely controlled social environments have been observed in other organizational settings that, like reform programs, can be classified as total institutions (Goffman 1957). Thought-reform reactions also appear to be related to, but are far more extreme than, responses to the typically less-identity-assaultive and less- totalistic socialization programs carried out by organizations with central commitments to specifiable ideologies, and which undertake the training of social roles (e.g., in military academies and religious-indoctrination settings (Dornbush 1955; Hulme 1956).

The relatively rare instances in which belief changes are internalized and endure have been analyzed as attributable to the degree to which the acquired belief system and imposed peer relations function fully to resolve the identity crisis that is routinely precipitated during the first phase of the reform process (Schein 1961, p. 164; Lifton 1961, pp. 131-132, 400). Whatever the explanation for why some persons internalize the proffered ideology in response to the reform procedures, this extreme reaction should be recognized as both atypical and probably attributable to an interaction between long-standing personality traits and the mechanisms of influence utilized during the reform process.

Much of the attention to reform programs was stimulated because it was suspected that a predictable and highly effective method for profoundly changing beliefs had been designed, implemented, and was in operation. These suspicions are not supported by fact. Programs identified as thought reforming are not very effective at actually changing people's beliefs in any fashion that endures apart from an elaborate supporting social context. Evaluated only on the criterion of their ability genuinely to change beliefs, the programs have to be judged abject failures and massive wastes of effort.

The programs are, however, impressive in their ability to prepare targets for integration into and long-term participation in the organizations that operate them. Rather than assuming that individual belief change is the major goal of these programs, it is perhaps more productive to view the programs as elaborate role-training regimes. That is, as resocialization programs in which targets are being prepared to conduct themselves in a fashion appropriate for the social roles they are expected to occupy following conclusion of the training process.

If identified as training programs, it is clear that the goals of such programs are to reshape behavior and that they are organized around issues of social control important to the organizations that operate the programs. Their objectives then appear to be behavioral training of the target, which result in an ability to present self, values, aspirations, and past history in a style appropriate to the ideology of the controlling organization; to train an ability to reason in terms of the ideology; and to train a willingness to accept direction from those in authority with minimum apparent resistance. Belief changes that follow from successfully coercing or inducing the person to behave in the prescribed manner can be thought of as by-products of the training experience. As attitude- change models would predict, they arise "naturally" as a result of efforts to reshape behavior (Festinger 1957; Bem 1972).

The tactical dimension most clearly distinguishing reform processes from other sorts of training programs is the reliance on psychological coercion: procedures that generate pressure to comply as a means of escaping a punishing experience (e.g., public humiliation, sleep deprivation, guilt manipulation, etc.). Coercion differs from other influencing factors also present in thought reform, such as content-based persuasive attempts (e.g., presentation of new information, reference to authorities, etc.) or reliance on influence variables operative in all interaction (status relations, demeanor, normal assertiveness differentials, etc.). Coercion is principally utilized to gain behavioral compliance at key points and to ensure participation in activities likely to have influencing effects; that is, to engage the person in the role training activities and in procedures likely to lead to strong emotional responses, to cognitive confusion, or to attributions to self as the source of beliefs promoted during the process.

Robert Lifton labeled the extraordinarily high degree of social control characteristic of organizations that operate reform programs as their totalistic quality (Lifton 1961). This concept refers to the mobilization of the entirety of the person's social, and often physical, environment in support of the manipulative effort. Lifton identified eight themes or properties of reform environments that contribute to their totalistic quality:

    * (1) control of communication,
    * (2) emotional and behavioral manipulation,
    * (3) demands for absolute conformity to behavior prescriptions derived from the ideology,
    * (4) obsessive demands for confession,
    * (5) agreement that the ideology is faultless,
    * (6) manipulation of language in which cliches substitute for analytic thought,
    * (7) reinterpretation of human experience and emotion in terms of doctrine,and
    * ( classification of those not sharing the ideology as inferior and not worthy of respect (Lifton 1961, pp. 419-437, 1987).

Schein's analysis of the behavioral sequence underlying coercive persuasion separated the process into three subphases: unfreezing, change, and refreezing (Schein 1961, pp. 111-139). Phases differ in their principal goals and their admixtures of persuasive, influencing, and coercive tactics. Although others have described the process differently, their analyses are not inconsistent with Schein's three-phase breakdown (Lifton 1961; Farber, Harlow, and West 1956; Meerloo 1956; Sargent 1957; Ofshe and Singer 1986). Although Schein's terminology is adopted here, the descriptions of phase activities have been broadened to reflect later research.

Unfreezing is the first step in eliciting behavior and developing a belief system that facilitates the long-term management of a person. It consists of attempting to undercut a person's psychological basis for resisting demands for behavioral compliance to the routines and rituals of the reform program. The goals of unfreezing are to destabilize a person's sense of identity (i.e., to precipitate an identity crisis), to diminish confidence in prior social judgments, and to foster a sense of powerlessness,iff not hopelessness. Successful destabilization induces a negative shift in global self evaluations and increases uncertainty about one's values and position in society. It thereby reduces resistance to the new demands for compliance while increasing suggestibility.

Destabilization of identity is accomplished by bringing into play varying sets of manipulative techniques. The first programs to be studied utilized techniques such as repeatedly demonstrating the person's inability to control his or her own fate, the use of degradation ceremonies, attempts to induce reevaluation of the adequacy and/or propriety of prior conduct, and techniques designed to encourage the reemergence of latent feelings of guilt and emotional turmoil (Hinkle and Wolfe 1956; Lifton 1954, 1961; Schein 1956, 1961; Schein, Cooley, and Singer 1960). Contemporary programs have been observed to utilize far more psychologically sophisticated procedures to accomplish destabilization. These techniques are often adapted from the traditions of psychiatry, psychotherapy, hypnotherapy, and the human-potential movement, as well as from religious practice (Ofshe and Singer 1986; Lifton 1987).

The change phase allows the individual an opportunity to escape punishing destabilization procedures by demonstrating that he or she has learned the proffered ideology, can demonstrate an ability to interpret reality in its own terms, and is willing to participate in competition with peers to demonstrate zeal, through displays of commitment. In addition to study and/or formal instruction, the techniques used to facilitate learning and the skill basis that can lead to opinion change include scheduling events that have predictable influencing consequences, rewarding certain conduct, and manipulating emotions to create punishing experiences. Some of the practices designed to promote influence might include requiring the target to assume responsibility for the progress of less- advanced "students," to become the responsibility of those further along in the program, to assume the role of a teacher of the ideology, or to develop ever more refined and detailed confession statements that recast the person's former life in terms of the required ideological position. Group structure is often manipulated by making rewards or punishments for an entire peer group contingent on the performance of the weakest person, requiring the group to utilize a vocabulary appropriate to the ideology, making status and privilege changes commensurate with behavioral compliance, subjecting the target to strong criticism and humiliation from peers for lack of progress, and peer monitoring for expressions of reservations or dissent. If progress is unsatisfactory, the individual can again be subjected to the punishing destabilization procedures used during unfreezing to undermine identity, to humiliate, and to provoke feelings of shame and guilt.

Refreezing denotes an attempt to promote and reinforce behavior acceptable to the controlling organization. Satisfactory performance is rewarded with social approval, status gains, and small privileges. Part of the social structure of the environment is the norm of interpreting the target's display of the desired conduct as demonstrating the person's progress in understanding the errors of his or her former life. The combination of reinforcing approved behavior and interpreting its symbolic meaning as demonstrating the emergence of a new individual fosters the development of an environment-specific, supposedly reborn social identity. The person is encouraged to claim this identity and is rewarded for doing so.

Lengthy participation in an appropriately constructed and managed environment fosters peer relations, an interaction history, and other behavior consistent with a public identity that incorporates approved values and opinions. Promoting the development of an interaction history in which persons engage in cooperative activity with peers that is not blatantly coerced and in which they are encouraged but not forced to make verbal claims to "truly understanding the ideology and having been transformed," will tend to lead them to conclude that they hold beliefs consistent with their actions (i.e., to make attributions to self as the source of their behaviors). These reinforcement procedures can result in a significant degree of cognitive confusion and an alteration in what the person takes to be his or her beliefs and attitudes while involved in the controlled environment (Bem 1972; 0fshe et al. 1974).

Continuous use of refreezing procedures can sustain the expression of what appears to be significant attitude change for long periods of time. Maintaining compliance with a requirement that the person display behavior signifying unreserved acceptance of an imposed ideology and gaining other forms of long-term behavioral control requires continuous effort. The person must be carefully managed, monitored, and manipulated through peer pressure, the threat or use of punishment (material, social, and emotional) and through the normative rules of the community (e.g., expectations prohibiting careers independent of the organization, prohibiting formation of independent nuclear families, prohibiting accumulation of significant personal economic resources, etc.) (Whyte 1976; Ofshe 1980; Ofshe and Singer 1986).

The rate at which a once-attained level of attitude change deteriorates depends on the type of social support the person receives over time (Schein 1961 pp. 158-166; Lifton pp. 399-415). In keeping with the refreezing metaphor, even when the reform process is to some degree successful at shaping behavior and attitudes, the new shape tends to be maintained only as long as temperature is appropriately controlled.

One of the essential components of the reform process in general and of long-term refreezing in particular is monitoring and limiting the content of communication among persons in the managed group (Lifton 1961; Schein 1960; Ofshe et al. ] 974). If successfully accomplished, communication control eliminates a person's ability safely to express criticisms or to share private doubts and reservations. The result is to confer on the community the quality of being a spy system of the whole, upon the whole.

The typically observed complex of communication-controlling rules requires people to self- report critical thoughts to authorities or to make doubts known only in approved and readily managed settings (e.g., small groups or private counseling sessions). Admitting "negativity" leads to punishment or reindoctrination through procedures sometimes euphemistically termed "education" or "therapy." Individual social isolation is furthered by rules requiring peers to "help" colleagues to progress, by reporting their expressions of doubt. If it is discovered, failure to make a report is punishable, because it reflects on the low level of commitment of the person who did not "help" a colleague to make progress.

Controlling communication effectively blocks individuals from testing the appropriateness of privately held critical perceptions against the views of even their families and most-valued associates. Community norms encourage doubters to interpret lingering reservations as signs of a personal failure to comprehend the truth of the ideology; if involved with religious organizations, to interpret doubt as evidence of sinfulness or the result of demonic influences; if involved with an organization delivering a supposed psychological or medical therapy, as evidence of continuing illness and/or failure to progress in treatment.

The significance of communication control is illustrated by the collapse of a large psychotherapy organization in immediate reaction to the leadership's loss of effective control over interpersonal communication. At a meeting of several hundred of the members of this "therapeutic community" clients were allowed openly to voice privately held reservations about their treatment and exploitation. They had been subjected to abusive practices which included assault, sexual and economic exploitation, extremes of public humiliation, and others. When members discovered the extent to which their sentiments about these practices were shared by their peers they rebelled (Ayalla 1985).

Two widespread myths have developed from misreading the early studies of thought-reforming influence systems (Zablocki 1991 ). These studies dealt in part with their use to elicit false confessions in the Soviet Union after the 1917 revolution; from American and United Nations forces held as POWs during the Korean War; and from their application to Western missionaries held in China following Mao's revolution.

The first myth concerns the necessity and effectiveness of physical abuse in the reform process. The myth is that physical abuse is not only necessary but is the prime cause of apparent belief change. Reports about the treatment of POWs and foreign prisoners in China documented that physical abuse was present. Studies of the role of assault in the promotion of attitude change and in eliciting false confessions even from U.S. servicemen revealed, however, that it was ineffective. Belief change and compliance was more likely when physical abuse was minimal or absent (Bider- man 1960). Both Schein (1961) and Lifton (1961) reported that physical abuse was a minor element in the theoretical understanding of even prison reform programs in China.

In the main, efforts at resocializing China's nationals were conducted under nonconfined/ nonassaultive conditions. Millions of China's citizens underwent reform in schools, special-training centers, factories, and neighborhood groups in which physical assault was not used as a coercive technique. One such setting for which many participants actively sought admission, the "Revolutionary University," was classified by Lifton as the "hard core of the entire Chinese thought reform movement" (Lifton 1961,p. 248).

Attribution theories would predict that if there were differences between the power of reform programs to promote belief change in settings that were relatively more or less blatantly coercive and physically threatening, the effect would be greatest in less-coercive programs. Consistent with this expectation, Lifton concluded that reform efforts directed against Chinese citizens were "much more successful" than efforts directed against Westerners (Lifton 1961, p. 400).

A second myth concerns the purported effects of brainwashing. Media reports about thought reform's effects far exceed the findings of scientific studies--which show coercive persuasion's upper limit of impact to be that of inducing personal confusion and significant, but typically transitory, attitude change. Brainwashing was promoted as capable of stripping victims of their capacity to assert their wills, thereby rendering them unable to resist the orders of their controllers. People subjected to "brainwashing" were not merely influenced to adopt new attitudes but, according to the myth, suffered essentially an alteration in their psychiatric status from normal to pathological, while losing their capacity to decide to comply with or resist orders.

This lurid promotion of the power of thought reforming influence techniques to change a person's capacity to resist direction is entirely without basis in fact: No evidence, scientific or otherwise, supports this proposition. No known mental disorder produces the loss of will that is alleged to be the result of brainwashing. Whatever behavior and attitude changes result from exposure to the process, they are most reasonably classified as the responses of normal individuals to a complex program of influence.

The U.S. Central Intelligence Agency seems to have taken seriously the myth about brainwashing's power to destroy the will. Due, perhaps, to concern that an enemy had perfected a method for dependably overcoming will -- or perhaps in hope of being the first to develop such a method --the Agency embarked on a research program, code-named MKULTRA. It became a pathetic and tragic failure. On the one hand, it funded some innocuous and uncontroversial research projects; on the other, it funded or supervised the execution of several far-fetched, unethical, and dangerous experiments that failed completely (Marks 1979; Thomas 1989).

Although no evidence suggests that thought reform is a process capable of stripping a person of the will to resist, a relationship does exist between thought reform and changes in psychiatric status. The stress and pressure of the reform process cause some percentage of psychological casualties. To reduce resistence and to motivate behavior change, thought-reform procedures rely on psychological stressors, induction of high degrees of emotional distress, and on other intrinsically dangerous influence techniques (Heide and Borkovec 1983). The process has a potential to cause psychiatric injury, which is sometimes realized. The major early studies (Hinkle and Wolfe 1961; Lifton 1961; Schein 1961) reported that during the unfreezing phase individuals were intentionally stressed to a point at which some persons displayed symptoms of being on the brink of psychosis. Managers attempted to reduce psychological pressure when this happened, to avoid serious psychological injury to those obviously near the breaking point.

Contemporary programs speed up the reform process through the use of more psychologically sophisticated and dangerous procedures to accomplish destabilization. In contemporary programs the process is sometimes carried forward on a large group basis, which reduces the ability of managers to detect symptoms of impending psychiatric emergencies. In addition, in some of the "therapeutic" ideologies espoused by thought reforming organizations, extreme emotional distress is valued positively, as a sign of progress. Studies of contemporary programs have reported on a variety of psychological injuries related to the reform process. Injuries include psychosis, major depressions, manic episodes, and debilitating anxiety (Glass, Kirsch, and Parris 1977, Haaken and Adams 1983, Heide and Borkovec 1983; Higget and Murray 1983; Kirsch and Glass 1977; Yalom and Lieberman 1971; Lieberman 1987; Singer and Ofshe 1990).