Abuse of power in psychotherapy

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Of abuse of power in psychotherapy can be spoken when the therapeutic relationship in terms of the needs of the therapist is used or if the actions of the therapist is contrary to the interests of the patient. Mostly it is emotional or narcissistic abuse without a sexual component, but sexual assault can also occur. Abuse of power in psychotherapy usually results in the failure of the therapy and can therefore be viewed as a gross " malpractice ", because the qualifications of trained psychotherapists are also geared towards aligning the therapeutic relationship exclusively with the needs of the patient and thus potential abuse to prevent.

The concept of power

With regard to psychotherapy, the exercise of power is usually understood in the sense of Max Weber : "Power means every chance within a social relationship to enforce one's own will, even against resistance, regardless of what this chance is based on." Usually a rather subtle manipulation that gets by without effective coercion.

With regard to the psychotherapeutic relationship, the role of the patient must also be included, because here “we are dealing with a system that is circular and mutually dependent.” Even if the psychotherapist is responsible for abuse of power, it works It is not uncommon for the patient to participate in the exercise of therapeutic power. Patients usually re-enact early childhood experiences and, as a result, the therapist is treated with excessive idealization, dependence, erotic transference, or disproportionate authority is assigned to him. So there is an interaction between the unconscious relationship pattern that the patient tries to stage and the therapist who abuses this relationship pattern for his own needs.

If such relationship patterns cannot be resolved, the patient remains in the role of the dependent, helpless and powerless person, which can lead in particular to the fact that personal responsibility, independence and self-efficacy cannot be adequately learned.

Power and abuse

The assumption that the therapist is healthy and the patient suffers from a mental disorder leads to a one-sided distribution of roles in the therapeutic relationship. The therapist comes into a powerful position.

This power or the situational superiority of the therapist can be used as a healing therapeutic factor in therapy. Long-cherished desires and feelings that the patient directs to the therapist on behalf of the patient can play an important role in psychotherapy. This enables the patient to deal with it and learn new forms of relationships. The morally upright and knowledgeable psychotherapist is able to forego the patient's fulfillment of his or her own wishes and should resist the temptation to exercise destructive power.

Patients often come to psychotherapy with self-doubt and under great strain. They meet a psychotherapist, to whom they assume competence and mental health, whom they idealize under certain circumstances and bring into the role of savior. Psychotherapy therefore takes place in the context of a permanent "narcissistic temptation", which requires professional treatment by the therapist.

Psychotherapists are at risk of succumbing to this temptation. The psychoanalysts CG Jung and W. Schmidbauer describe psychotherapists as "wounded healers" or "helpless helpers". The psychoanalyst Hans-Jürgen Wirth writes: “Her early developed sensitivity and her pronounced ability to empathize with the emotional state of her fellow human beings predestines her for a helping profession, but at the same time makes her susceptible to either being narcissistically abused by others or vice versa, to functionalize others to stabilize one's self-esteem. "

Forms of abuse

An abuse of power in psychotherapy can develop insidiously. Basically it lies in a border violation. In doing so, the patient's personal integrity is disregarded. Such a limit violation can happen in several ways, e.g. B. as manipulative indoctrination, when the therapist sets his own worldview and his understanding of reality absolute, through recurring defamatory remarks, expressions from adult patients, through excessive illusion, if the patient is considering breaking off the therapy, through black-billed fees, through disregard the rule of abstinence and many other types of emotional (verbal) or structural violence . The abstinence rule states that the patient's relationship fantasies and wishes are to be understood as an expression of the transference process and to be interpreted as such, that the therapist is addressed by these wishes and fantasies not as a person but as a transference figure and that they cannot be converted into concrete action as a result . Freud's postulate “The cure must be carried out during abstinence” is a fundamental orientation of the therapeutic setting and, in addition to abstinence during the treatment hour, excludes private, professional and economic relationships of dependency between client and therapist.

When private and therapeutic relationships mingle, abuse of power becomes evident at different levels of the therapeutic relationship . A typical feature of such misdirected therapeutic processes is a role confusion (English: role trading ), which is characterized by the fact that the therapist takes on the role of the patient and focuses on his needs and wishes. The consequence of this is that the role of the client becomes increasingly unpredictable for them, since in addition to the role of the person seeking help, e.g. B. the role of the listener, the attractive woman etc. is assigned.

The possibility of abuse is increased if treatment methods are used that either do not comply with the generally accepted standards from an ethical point of view or that work with means that significantly increase the susceptibility of patients to be influenced. In the first case, the therapeutic process may be ideologically one-sided, in the second case, for example - as in so-called psycholytic psychotherapy - the use of psychoactive substances, provided that this is not subject to binding, regulated controls and maintains ideological neutrality .

Sexual abuse

According to an estimate by the Institute for Psychotraumatology Freiburg / Cologne, which takes into account the latest national and international research results, at least 300 to 600 attacks per year must be expected in the Federal Republic of Germany. According to this minimal estimate, the statistical risk is less than one percent. In large American studies of 1,000 psychiatrists and the same number of psychologists, however, around 12 percent of those questioned admitted sexual contact with their patients. Even with respect to well-known psychoanalysts or psychotherapists, relationships with patients that cross borders are known. Sexual abuse by teaching therapists is also reported with regard to psychoanalytic training and the power-based organization of the training company is criticized. In 2007, psychoanalysts reacted to their analysis of individual cases and the problem as a whole by publishing an anthology entitled Derailings in Psychoanalysis . Different facets of the problem are presented and prominent cases from the British community are dealt with. In addition, ethical questions are discussed and the code of ethics of the Vienna Psychoanalytical Association and the psychoanalytic professional ethics of the German Psychoanalytic Association are attached.

The consequences of sexual abuse in therapy were described by Pope and Bouhoutsos with the therapist-patient Sex Syndrome . Essential aspects are: feelings of guilt, feelings of emptiness, identity and boundary finding disorders, inability to trust based on conflicts in connection with dependence, control and power; cognitive disorders, especially in the areas of attention and concentration, often in connection with flashbacks, nightmares, intrusive images and thoughts; Mood lability, often accompanied by major depression; suppressed anger and suicide risk. In the context of psychotherapy, women who were sexually abused as children are particularly at risk of experiencing renewed sexual trauma in the form of sexual assault on the part of the therapist. A major reason for this is seen in the client's socialization-related difficulty in distinguishing between intimacy and sexuality. The coupling of closeness and sexuality experienced in childhood is brought into the therapeutic relationship when, induced by therapy, the desire for closeness to the therapist arises. A sexual response to the fact that this is about content to be worked on, as well as the asymmetrical structure of the therapeutic setting with regard to the distribution of power and knowledge. The latter aspect led various authors to draw a parallel between the prohibition of incest and the prohibition of sexual contact in psychotherapy.

Men seeking advice or patients are less often affected. However, it is more difficult for them to see themselves as “victims” of an attack and to get help.

Since 1999, sexual acts in the context of psychotherapy have been considered a criminal offense in Germany in accordance with Section 174c, regardless of the patient's consent, in the sense of sexual abuse taking advantage of a counseling, treatment or care relationship.

Victim protection

Although many victims of border violations by psychotherapists report to the chambers and ethics committees, the large number of complaints is not taken as an opportunity to set up an independent victim protection organization. Psychotherapeutic umbrella, professional and professional associations are primarily committed to their good reputation in the public, produced by the normative pressure for collegial behavior, which can only benefit the protection of offenders. The discovery of therapeutic abuse of power and the punishment of such unworthy of professional behavior is consequently one of the blind spots of psychotherapists, as the Saarbrücken psychologist Klaus Schlagmann, himself a member of an ethics committee, shows in a case study. Victims who hope to be heard and compensated are usually left unaccompanied. Margret Fischer asks in aerzteblatt.de : "Was it possible for those affected to have their say at the symposium 'Ethics in Psychotherapy' [Note: Symposium Ethics, Law and Psychotherapy 2006]?"

literature

  • Adolf Guggenbühl-Craig: Power as a danger to the helper. (= Psychological series. 45). 5th, unchanged edition. Karger, Basel / Munich 1987, ISBN 3-8055-4562-2 .
  • Carolyn M. Bates, Annette M. Brodsky: A fateful affair or Sex in the therapy hour (Original: Sex in the Therapy Hour: A Case of Professional Incest , 1989). Junfermann, Paderborn 1990, ISBN 3-87387-025-8 .
  • Monika Becker-Fischer, Gottfried Fischer: Interim report for the Federal Ministry for Women and Youth on the research project "Sexual assault in psychotherapy and psychiatry". (= Materials on women's policy. 41). Bonn 1994. (New edition and T. Sexual assaults in psychotherapy and psychiatry. Orientation aids for therapist and client. (= Psychotraumatologie, Psychotherapie, Psychoanalysis. 18)). rework., ext. u. actual Edition. Asanger, Kröning 2008, ISBN 978-3-89334-460-4 .
  • Sebastian Krutzenbichler: Sexual abuse as a subject of psychoanalysis from Freud to the present. In: Ulrich Tiber Egle, Sven O. Hoffmann, Peter Joraschky (eds.): Sexual abuse, maltreatment, neglect. Recognition and treatment of psychological and psychosomatic consequences of early trauma. Schattauer, Stuttgart 1997, ISBN 3-7945-1625-7 , pp. 170-179.
  • Sebastian Krutzenbichler, Hans Essers: Does love have to be a sin? About the analyst's desire . Kore Verlag, Freiburg (Breisgau) 1991, ISBN 3-926023-30-9 .
  • Sylvia Zwettler-Otte (Ed.): Derailments in psychoanalysis. Professional ethical problem. Vandenhoeck & Ruprecht, Göttingen 2007, ISBN 978-3-525-49125-6 .
  • Annegret Conrad: A fateful interaction. Failed psychotherapy from the client's point of view. Dissertation . Department of Education and Psychology at the Free University of Berlin, 2009. (PDF online)
  • Bernhard Jakl, Thomas Gutmann: The protection of the patient's fundamental rights as a task of the Chamber of Physicians and Psychotherapists using the example of the monitoring of the abstinence requirement by the Chamber of Psychotherapists. In: Medical Law. 29, 5, 2011, pp. 259-264.
  • Mathias Hirsch: "Goldmine and Minefield". Love and sexual abuse of power in analytical psychotherapy and other addictive relationships. Psychosozial-Verlag, Giessen 2012, ISBN 978-3-8379-2221-9 .
  • Ulrich Tiber Egle, Peter Joraschky, Astrid Lampe, Inge Seiffge-Krenke, Manfred Cierpka (eds.): Sexual abuse, mistreatment, neglect. Recognition, therapy and prevention of the consequences of early stressful experiences. With 70 tables. 4th, revised. u. exp. Edition. Schattauer, Stuttgart 2017, ISBN 978-3-608-96153-9 .
  • Jeffrey Masson : What has been done to you, you poor child? Or: what Freud did not want to admit . Critically revised. Edition. Kore, Freiburg 1995, ISBN 978-3-926023-53-7 .
  • Theodore L. Dorpat: Gaslighting, the Double Whammy, Interrogation and Other Methods of Covert Control in Psychotherapy and Analysis . J. Aronson, Northvale, NJ 1996, ISBN 978-1-4616-2860-6 .

Individual evidence

  1. ↑ a b c d e Theo Piegler: Power, powerlessness and abuse of power in psychotherapeutic relationships. In: Psychotherapy Forum. Volume 11, Issue 3, 2003, pp. 106-112.
  2. ↑ a b Christoph J. Schmidt-Lellek: Narcissistic abuse of power in psychotherapy. In: Christoph J. Schmidt-Lellek, Barbara Heimannsberg (Hrsg.): Power and abuse of power in psychotherapy. Cologne 1995.
  3. ↑ Barbara Heimannsberg: Equality and Difference. The double bottom of the therapeutic relationship. In: Christoph J. Schmidt-Lellek, Barbara Heimannsberg (Hrsg.): Power and abuse of power in psychotherapy. 1995, p. 16.
  4. ↑ a b Christel Hafke: Power, powerlessness and abuse of power in therapeutic relationships. Opladen 1996.
  5. ↑ Wolfgang Schmidbauer: When helpers make mistakes. Reinbek 1997, ISBN 3-498-06319-7 . Reading sample
  6. ↑ Hans-Jürgen Wirth: Narcissism and abuse of power in psychotherapy. In: Psychoanalytic family therapy. 8 (1), No. 14, 2007, pp. 85-98, cit. according to: http://www.psychosozial-verlag.de/29079 (February 10, 2015)
  7. ↑ German Society for Psychoanalysis, Psychotherapy, Psychosomatics and Depth Psychology (DGPT eV): Ethics guidelines of the DGPT . As of September 30, 2016, accessed February 25, 2018
  8. ↑ Mia Schubert: Abuse of power in psychotherapy. My experiences with a "psychotherapist" (HPG). Norderstedt 2009, ISBN 978-3-8391-0965-6 .
  9. ↑ Kenneth S. Pope, Jacqueline C. Bouhoutsos: Sexual intimacy between therapists and patients , Praeger, New York, 1986, page 3 ff.
  10. ↑ Kenneth S. Pope, Jacqueline C. Bouhoutsos: Sexual intimacy between therapists and patients , Praeger, New York 1986, page 6 ff.
  11. ↑ Hansjörg Hemminger: The therapeutic realm of Dr. Ammon. An Inquiry into the Psychology of Totalitarian Cults. Stuttgart 1989, ISBN 3-7918-2341-8 .
  12. ↑ Hans-Peter Waldrich, with the collaboration of Gabriele Markert: Brainwashing or healing methods? Experience with drug-based psychotherapy. Hamburg 2014, ISBN 978-3-8495-7632-5 .
  13. ↑ a b German Institute for Psychotraumatology: Sexual Assaults in Psychotherapy, Psychiatry, and Psychological Counseling. February 10, 2015.
  14. ^ Wolfgang Martynkewicz: Sabina Spielrein and Carl Gustav Jung - a case history. Berlin 1999, ISBN 3-87134-287-4 .
  15. ↑ Helmut Kaiser: Border violation. Power and abuse in my psychoanalytic training. Zurich / Düsseldorf 1996, ISBN 3-530-40024-6 .
  16. ↑ Johannes Cremerius : Training Analysis and Power. The conversion of a teaching-learning method into an instrument of power in institutionalized psychoanalysis. In: Christoph J. Schmidt-Lellek, Barbara Heimannsberg (Hrsg.): Power and abuse of power. 1995, pp. 99-122.
  17. ^ Sylvia Zwettler-Otte (Ed.): Derailments in psychoanalysis. Ethical problems . Vandenhoeck & Ruprecht, Göttingen 2007, ISBN 978-3-647-49125-7 ( gbv.de [PDF; 29 kB ; accessed on October 6, 2019] Table of Contents).
  18. ↑ Kenneth S. Pope, Jacqueline C. Bouhoutsos: Sexual intimacy between therapists and patients , Praeger, New York, 1986, 67 ff.
  19. ↑ Ursula Wirtz: Soul murder - incest and therapy. Kreuz Publishing House. ISBN 978-3-7831-1963-3 , page 245 ff.
  20. ↑ psychiatrie-und-ethik.de
  21. ↑ Margaret Fischer: Psychotherapy: Emotional abuse of power . Letter to the editor in: Deutsches Ärzteblatt, 103 (45), p. A 3018