A False Accusation
Recently a colleague called me, “You were so right, Larry!”
“Right about what?”
“Remember that lady I talked to you about a couple years ago when I had some strange feelings about her terminating?”
“Vaguely, bring me up to date.”
“You told me she was a high risk for a complaint and, sure enough, a couple weeks ago I got a complaint from the licensing board. I did what you told me at the time to do if there were problems and called an attorney immediately. The attorney answered the complaint for me and got the details. We’re working on them now but I wanted to keep you filled in because I am going to need your help sorting things out.”
My consultation notes from 22 months before with this therapist revealed a life history for the 42 year-old client of severe, ongoing physical and emotional abuse from a stepfather and older stepbrother throughout early childhood. Mother consistently looked the other way and refused to believe her. The child had been abandoned into the keeping of a distant aunt for six months while mother was in residential drug rehab when the child was only a few months old. Biological father was unknown.
Consultation was sought with me when after several years of good therapy marked by steady life improvement and a positively developing emotional relationship with her therapist, the client had precipitously decided that it was time to terminate. Something didn’t feel right to the therapist but she didn’t know quite what the problem was with the client only willing to come two more sessions.
After a detailed case review it seemed apparent to me that the client had been steadily loosening her defenses and allowing herself to feel ever closer to her warm and caring therapist. The stated reasons for ending therapy were time and money but neither one made much sense to the therapist. The client said she was greatly improved and felt gratitude to the therapist but it was time “to grow up and try it on my own.”
Counterintuitively, I surmised that the developing emotional closeness was too much and therefore, in light of her history of neglect and abuse, terrifying to the client so that she had to flee before she–in transference–experienced devastating emotional abandonment and/or abuse by something the therapist said or did and a consequent emotional breakdown.
We talked about how to empathically let the client go while assuring her of her therapist’s caring and willingness to see her again in the future if she chose.
I surmised that the emotional closeness had become overwhelming such that the client had to immediately close it off and run for dear life. I have learned that when a sudden, seemingly inexplicable turn like this occurs, a deep “psychotic” or “organizing” transference has been mobilized and must be defensively warded off by stopping the therapy, by leaving the therapeutic relationship.
“Why is she filing the complaint now nearly two years after her termination?” “Her live-in partner of nearly 10 years has recently taken up with another woman and abruptly left. In the wake of this abandonment she has massively dissociated and in desperation claimed that it was me who seduced, hurt, and abandoned her.”
The more than 20 minor board complaints all centered around things that the therapist in a caring way had done to help the client through her severe regressions and painful dissociations (e.g., occasionally holding hands or providing requested hugs at the end of sessions). Clearly someone with legal finesse–either an attorney or the board investigator–had assisted in defining these alleged infractions. While there was no reference to explicit sexual touching, the client experienced the therapist’s efforts at support and reassurance as sexually seductive. From the licensing board’s standpoint the therapist’s activities represented “poor and unethical boundaries” and “gross professional negligence”. In my opinion, she had done very solid and empathic work with a deeply traumatized woman experiencing frequent overwhelming dissociative states. As therapists, it is not unusual for us to stretch our personal and professional boundaries to accommodate deeply traumatizing regressions.
Unfortunately, to people who have no knowledge of this kind of deep trauma therapy and the demands that it exerts on therapists, our activities can sometimes be construed as less than bounded and professional. Fortunately, this therapist had good documentation and good consultation which saved her from losing her license–but it was a tough battle against unenlightened administrative personnel.
We Are Vulnerable!
When complaints and accusations against therapists began to escalate in this country during the late 1980s I began teaching classes and writing articles on law and ethics and by the early 1990s, I began consulting on high risk cases and testifying before state licensing boards and federal courts on standards of professional practice, notably on the topic of false accusations against therapists. This was necessary because a number of cases were appearing that featured apparent high credibility of both parties with little previously known formal basis for considering the balance of probabilities. I have since written numerous books and published papers considering the possibility of false accusations. I have served as a consultant and/or expert witness on approximately 500 cases in 19 states, Canada, and the UK. I have actually provided some kind of report or testimony in about 200 of those cases since 1990. Unfortunately, since all of these hearings and judicial proceedings involve confidentiality, no record or research is possible and records are shredded following the close of the case.
In order to speak intelligently about accusations that have a high probability of being false I need to first provide an overview of the concept of transference and to specify what kinds of transference can lead to faulty remembering and thus to false accusations. Other experts may have other methods for determining the probability of an accusation being false but here is the one I use.
The Basis for Considering Accusations Against Therapists as Possibly False
The central feature of all psychotherapies is the transference—by whatever name it is known in different schools of psychotherapy. Transference simply means that over time we tend to transfer into current emotionally intimate relationships established patterns of relating learned in past relationships—especially those from early childhood. The psychotherapy conversation typically involves some form of examining current relational difficulties, understanding their origins in the past, and finding ways to transcend disturbing relational habits in the present. Different schools of psychotherapy have devised varying ways of addressing this task using different theories of mind and change.
Psychodynamic psychotherapies tend to take the process one critical step beyond simply defining, discussing, and working to overcome distressing relational habits. The critical psychodynamic step involves forming over a long period of time an emotionally intimate working relationship so that the relatedness patterns from the past have an opportunity to actually manifest in the present therapeutic relationship itself—thus making themselves known and available for mutual study and transformation in the here and now. That is, transference becomes a viable tool rather than a distortion. Any form of therapy that is long-term and/or intense is subject to similar deep transference formation.
Four Developmentally Determined Forms of Transference
While transfer of emotional relatedness patterns from the past to the present can occur in different ways throughout life, a century of psychotherpeutic study has produced an understanding of four distinctly different kinds of transference patterns that have their origin in early childhood development. I will briefly mention them in order of their historical discovery—which is the reverse of their childhood developmental order. I will be moving to consider level I in the discussion that follows of false accusations.
IV. Independent Personal Relatedness: Sigmund Freud at the turn of the twentieth century first defined triangular transferences as originating in the 4 or 5 year old child’s family relationships. Normally developed children have independent relationships with their important others—mother, father, siblings, etc.—that are emotionally contingent on the child’s other independent relationships. The child experiences conflicts with these competing loyalties that set up enduring emotional relatedness patterns that appear in relationships of later life. Freud used the ancient myth of Oedipus to illustrate how these early conflicts pursue us through life.
III. Unilateral Dependent Relatedness: Heinz Kohut in the late 1960’s clarified forms of transference characteristic of 3 year old children who are intent on demanding recognition and affirmation from their significant others, “selfobjects,” for their budding achievements. The child recognizes others as independent centers of initiative but remains dependent on them for self-fulfillment and self-aggrandizement—“See me! See me!” Kohut understood that these three-year-old relational patterns–ways of seeking affirmation, or conversely, shamefully hiding from recognition–also pursue us throughout life.
II. Mutually Dependent Relatedness: Margaret Mahler, Otto Kernberg and many others have pointed to a developmental era from 4 to 24 months, peaking at around18 months where the child’s emotional experience is “mommy and I are one.” Mahler uses the metaphor of “symbiosis” to characterize the child’s experience of emotional at-oneness or attunement with significant others. While in later development we may largely individuate from our dual relatedness patterns, there remains a life-long search for the safety and security of this earliest merged love relationship.
I. The Search for Relatedness: Harold Searles, Donald Winnicott, and numerous other therapists working with deeply disturbed people have slowly led us to appreciate the earliest relatedness patterns common to all infants dating from approximately four months before to four months after birth after which time the mutual cueing and affect regulation processes lead to the establishment of the emotional symbiosis. This is the period of “organizing” relatedness patterns when infants in innumerable ways search the environment for stimulating connections—for nurturance, soothing, and relief of physical tensions. That is, in utero infants are organizing satisfying channels to mother’s body and after birth to her mind and subsequently to other minds. But we know that many things can and do go wrong during this period for the searching infant—from toxemia in pregnancy, to premature birth, to adoption at birth, to rats in the crib, and family abuse, as well as depression and/or other mental health issues in the family.
We might think of two extremes of relatedness possibilities during this organizing period that lead to the establishment of fixed unfortunate relatedness patterns—overstimulating trauma and understimulating trauma. Either form of intimacy leaves an enduring relatedness response pattern. Overstimulating intrusions cause infants to constrict, inhibit, and/or rage. Understimulating intrusions lead to collapse, withering, and withdrawal. In either case the result of severe intrusive trauma can be grave mental illness. In less marked trauma the child may be able to move forward and establish a “mimical” or “false” self structure that can appear to be normal development based on favorable genetic endowment, good environmental support, and/or good adaptive ego capacity.
I began writing about this “organizing” period and the marks it leaves on later development as early as 1983. By 1992 I was able to state, “People with organizing personalities often develop good intelligence and skills and may be successful and highly placed in business, industry, politics, or the professions. But careful examination of their capacities for intimate interpersonal relatedness places them at below the 4 month level, successful at mimicking human life but knowing they are somehow different, weird, strange, crazy, somehow not quite human” (1992, p. 157). In 1994 I published three books on the subject of psychotherapy with the organizing experience that resulted in the client confusing and fusing the emotional trust relationship of psychotherapy with the perpetrator of intrusive trauma of infancy. I presented my 1995 paper “False Accusations Against Therapists: Where Are They Coming from, Why are They Escalating, and When Will They Stop?” (published in The California Therapist) to numerous professional audiences and have since reprinted it in a number of professional publications. My 1997 paper, “Prevention of False Accusations,” was also published in The California Therapist and presented to numerous state and national professional groups. I have written four further books on the topic (1996, 2000, 2013a, 2013b) and two books on law and ethics (1997, 2000) in which I have treated extensively this phenomenon.
The Bottom Line
While all therapists doing long-term, intensive relational psychotherapy are accustomed to being accused on a daily basis of one thing or another, these transference attitudes can come from any developmental level and can usually become understood and worked through in various ways. But when the accusation of abuse derives from the organizing developmental period the client may be experiencing at that moment an infantile state and truly believes “the therapist is the one who has hurt me”—whatever the nature of that transferred experience of hurt might be. That is, at the moment of the accusation the primitive terror of infancy is guiding the perception and solidifying the trauma as having happened in the present rather than the past trust relationship. Many such therapies abruptly end at this point without resolution. Other times the accuser, much to the amazement of the therapist, blows the whistle and makes an accusation immediately. But often enough some later relational trauma plunges the person back into a state of acute traumatic distress—usually some betrayal and/or abandonment) and it is then that the therapist gets accused.
As An Expert Witness How Do I Build a Case?
In testifying I have first to explain to the judge that we do have a way of considering what might be false accusations when two otherwise credible people are involved. I have to then beg the court’s patience while I explain the various developmentally based transferences as discussed above. I then must explain how in the most “primitive” transference the perpetrator of past intrusive abuse can become (psychotically) momentarily confused and/or fused with the person in the current trust relationship. That having been said, I must then be able to go through the details of the therapy record to establish reported facts that point in the direction of the presence of overwhelming focal or cumulative strain trauma in the client’s early life. Then I must be able to point to the many ways the effects of this trauma are documented in the therapy record. For example, was the person repeatedly subjected to childhood abuse and could never speak or be believed? Or does the case history reveal other accusations that were made in childhood, adolescence or adulthood? Are there accusations in school, employment, or hospital records in the file? Then, and perhaps most importantly, have there been instances of the client being upset with and/or acting out toward and accusing the therapist during the course of therapy? And what was the exact nature of those protests, actions, accusations and/or or reactions? I can assure you that character being what it is—consistent and pervasive—that if there has been significant trauma and anger/revenge feelings and fantasies they will show up repeatedly in life and throughout the therapy process!
But an expert witness cannot work effectively without good documentation!
Why Your Documentation is Important
The “false accusation argument” cannot prove anything in a “he said, she said” situation. However, if properly documented, therapy can provide an alternate way of viewing the situation. Further, if the argument is plausibly given and reasonably documented it can effectively put pressure against the sometime tendency to believe the cry of “rape.” In many such cases the person has not been believed about many things throughout life and he/she extracts a strong demand to “be believed”. This pressured demand to be believed issued toward a person who was not an eye-witness is effectively a boundary violation and further suggests a history of feeling one’s boundaries being (repeatedly?) violated.
Mind you, I am not in any way saying that the person making the false accusation is deliberately lying or scamming in any way. He/she thoroughly believes the truth of the accusation. Rather, we know that in “primitive mental states” people feel traumatized and desperately seek to make sense of overwhelming stimulation—often to the neglect of the reality principle. Then once set, the delusional perception persists into other many normal frames of mind as an adamant belief—as any elementary text on paranoid reactions aptly attests. Further, we now know from widespread studies of PTSD that any and all kinds of stressors in human life can precipitously plummet a survivor into terrifying states of unreality and paranoid reconstitution.
As an expert what do I need from your record? As I sift through documents you have collected—psychology reports, hospital records, employment information and a life history of relational data, I want to be able to see all of the “strange or unusual behavior” manifested and perhaps even in the margins dated comments or questions the documents have raised for you.
Then in your notes I do need to get some sense of who you are and how you work in the first dozen or so sessions,–that is I need a sense of “who is this therapist and how does she work?” For example, “I chose to disclose that I too have several young children so I can understand how terrible it feels to be overwhelmed at times,” Or, “today I mentioned that a close college roommate of mine struggled with alcohol in a similar way so I have some feel for how bad it can be.” That is, appropriate countertransference disclosures can be helpful when the therapeutic intention is clear from the notes. Then, having some sense of your EFT, CBT, or DBT orientation I can see from your notes how you and the client are moving along. Also in this kind of case I need to see frequent peer and expert consultations you have made which corroborate your view.
Of paramount importance in your notes are the “glitches” in the therapeutic process as you note or question them. For example, “when I asked John about…he abruptly changed the subject and when I tried to bring him back later he was reluctant to discuss it.” Or “When I gently suggested that perhaps she was concerned about… a look of horror flashed across her face and she angrily jumped up, ran out and slammed the door behind her.” Or, “My answering machine recorded at 1:32 am message that says ‘I can’t believe what you said today—I am cancelling all future sessions.’ ” When you have no idea what you did or said to upset her. The exact ways these peculiar moments or glitches happen when put together over the entire therapeutic relationship and during the history and in outside relations have an uncanny way of pointing to the specifics of the accusatory situation—again because character is consistent.
There is no fail-safe way for a therapist in an ongoing intimate therapeutic relationship to completely avoid the potential disaster of a false accusation. But using the reasoning espoused here, the danger arises in a relationship—with a person who has experienced focal or cumulative strain trauma—that is overly-trusting, overly-empathic, or in someway overly-good because the original traumas occurred in the context of an intimate trust relationship. When this trust builds again in a later relationship the peril of faulty recall can become triggered.
We work hard as therapists to establish a caring relationship and we pride ourselves on having good empathy. But when deeply traumatized people have a good session or begin to feel good about their progress as a result of our good connecting skills, I say treachery threatens to awaken potential terrifying transferences and to cause an abrupt disconnect of some sort.
Whenever mutually positive feelings are in the atmosphere we need to go on alert and ask our clients to help us look at some of the fear and disconnect that regularly gets triggered when two people experience trust and emotional intimacy with each other. The theme song that I have experienced coming from many accused therapists is “everything was going so well, she was making such wonderful improvement, her life was going better than ever, I thought our relationship was finally on solid ground, and then out of the blue this!” The positive connection in the trust relationship becomes terrifying because it triggers deep memories of traumatic injury and the client must somehow urgently escape. “He hurt me.”
When false accusations occur, so far as I can tell they almost invariably do so in the context of long and emotionally intimate trust relationships that stir up infantile transferences. I have seen this happen with priests, ministers, choir directors, and teachers as well as boy and girl scout leaders, big brothers, and trusted family relations. Since infantile intrusive trauma seems to be at the hidden psychotic core of false accusations some kind of substantial evidence, documentation, or outside observation or corroboration is necessary to establish beyond a doubt that the accusations are true. Documentation and corroboration is crucial in reliably establishing the high probability of the accusation being false based on primitive transference.
Hedges, L. E. (1983). Listening Perspectives in Psychotherapy. Northvale, NJ: Jason Aronson Publishers.
____(1992). Interpreting the Countertransference. Northvale, NJ: Jason Aronson Publishers.
___(1994a). In Search of the Lost Mother of Infancy. Northvale, NJ: Jason Aronson Publishers.
____(1994b). Remembering, Repeating, and Working Through Childhood Trauma. Northvale, NJ: Jason Aronson Publishers.
____(1994c). Working the Organizing Experience. Transforming Psychotic, Schizoid, and Autistic States. Northvale, NJ: Jason Aronson Publishers.
____(1995). “False Accusations Against Therapists: Where Are They Coming From, Why Are They Escalating, When Will They Stop?”published in The California Therapist, March/April issue.
____(1996). Strategic Emotional Involvement. Northvale, NJ: Jason Aronson Publishers.
_____(1997a). “Prevention of False Accusations Against Psychotherapists.” The California Therapist, July/August, issue.
_____(1997b). Therapists at Risk: Perils of the intimacy of the Psychotherapeutic Relationship. (co-authored with Robert Hilton, Virginia Wink Hilton, and O. Brandt Caudill, Jr., Jason Aronson, Northvale, NJ.
____(2000). Terrifying Transferences. Aftershocks of Childhood Trauma. Northvale, NJ: Jason Aronson Publishers.
_____(2000). Facing the Challenge of Liability in Psychotherapy: Practicing Defensively, Jason Aronson, Northvale, NJ.
____(2013a). Relational Interventions, Treating Bipolar, Schizophrenic, Psychotic, Borderline, and Characterological Personality Organizations.The International Psychotherapy Institute. Free download at www.freepsychotherapybooks.org
____(2013b). Facing Our Cumulative Developmental Trauma. The International Psychotherapy Institute, Free download at www.freepsychotherapybooks.org