Interview with Psychotherapist Marina Tonkonogy
Aug 5, 2011
Jaleh Weber (JW): Tell me a little bit about yourself?
Marina Tonkonogy (MT): I am a licensed Marriage and Family Therapist with a Master’s Degree in Psychology from Phillips Graduate Institute and a certification in psychoanalytic psychotherapy from New Center of Psychoanalysis. My interest in the field of psychology has formed over the years after I found out that my sister was suffering from AIDS. She lived in Uzbekistan, one of the former republics of former USSR where there was practically no help available for people with this terrible disease. After I learned about her illness, I started looking for any available treatment options for her in the United States that would alleviate her suffering. Finally, I found an organization in San Francisco that was providing medications for people with AIDS overseas. Unfortunately, the help came in too late and my sister passed away six months later.
This tragic even helped me discover that my heart was in humanitarian activities. After more soul searching and exploring various options, I decided to be in a helping profession and felt that psychotherapy would suit me best given my natural curiosity about all aspects of human behavior and my ability to understand human relationships on a very deep level. I began exploring my newly found profession by facilitating online support groups for survivors of childhood abuse and started my Masters program in Psychology shortly after that.
On my path of becoming a therapist, while studying in graduate school and working with clients during internship, I was also undergoing my own therapy. I have a firm belief that all therapists should undergo their own therapy in order to minimize the interference of their personal issues with their work. My own therapy experience left me with mixed feelings ‘” I had been able to work through a lot of my personal stuff, but, at the same time, I had also been emotionally abused and traumatized.
This firsthand experience of being abused in therapy made me want to educate the public about potential problems that people may face when seeking therapy. Therapy is meant to be a healing experience where patients entrust their emotional well-being to a trained professional. A therapy room is a place where you get vulnerable because this is a part of therapy process. Unfortunately, there are cases when this vulnerability gets exploited and I would like to raise public awareness of this problem.
JW: What are some signs that someone is being abused in psychotherapy?
MT: Before we explore the signs that indicate a possibility of abuse in therapy, let us talk about what could serve as potential reasons for the therapist to emotionally abuse the patient. Abuse in therapy happens when the therapist uses the relationship with the patient to fulfill his or her needs instead of attending to the needs of the patient. Some therapists feel a need to experience a full psychological power over their patients; others want to see themselves as patients’ rescuers, best friends, loving parents or lovers. In most cases, they are not conscious of their true intentions and are confident that they act in their patients’ best interests. At the same time, patients who have a history of being abused, neglected and invalidated get easily seduced by the special treatment they get from an abusive therapist. They misperceive therapist’s inappropriate behavior as loving and caring, only to realize it much later that they were exploited and betrayed.
Even though the ways how patients could get emotionally abused may vary from case to case depending on the victim’s and the perpetrator’s respective profiles, there are some common signs of therapy abuse that I would like to cover:
1. Feeling addicted to your therapy and therapist
You would not stop thinking about your therapist. You feel that he or she has become the most important person in your life. You feel worse when you skip a regular session like an addict who did not take a regular drug dosage. A certain dependency on the therapist is normal. By definition, if we are being helped by someone we become dependent on this person because he or she gives us what we need. However, when normal dependency turns into an addiction, it is a red flag that the person might be abused by the therapist. In any case, it is certainly important to explore what is going on between the therapist and the patient when such addiction becomes obvious.
2. Feeling preoccupied with the therapist
Something goes wrong between you and your therapist during the session and you completely fall apart. You spend all of your next session trying to fix this problem instead of focusing on the areas of your life that you and your therapist really need to work on. This starts happening more often and, at some point, the therapy starts revolting around your relationship with the therapist and your own needs get neglected.
3. Crazy making
Your therapist implies or states directly that any conflict or miscommunication that arises between him/her and you is due to your emotional problems and has nothing to do with what the therapist does thus denying any responsibility for his or her own behavior. Since the therapist denies that he or she might contribute into the problem, you feel invalidated, start doubting yourself, continuously try to justify yourself to your therapist, which in turn contributes into your preoccupation with the therapist and the vicious cycle continues.
4. Feeling isolated and disconnected from family and friends
Usually this sign comes as a direct result of the first two issues. Family and friends are no longer as important to you as they used to be. Your therapist has replaced them all. You start to neglect your family responsibilities, and your relationships with your family members begin to deteriorate. You start avoiding spending time with other people because you feel that others do not understand you as well as your therapist does.
5. Continuously feeling worse
As the next chain reaction, you continuously feel worse. You lose interest in activities that you used to enjoy, feel ashamed of your dependency on the therapist and your helplessness to break this addiction. You feel that your therapy is not working, but you do not find the strength to break away from it. You may feel depressed and even suicidal.
6. Tendency to deny the abuse
Abuse in therapy is hard to recognize because it may not feel bad for a long time. In fact, it may feel very good that the therapist relates to you as a friend, a parent, or even a lover. It could make you feel very special and that is what we all want, isn’t it? Realization that you are being abused by the trusted professional brings a great pain that comes from feeling betrayed and a shame that comes from the erroneous belief that you had the power to prevent this abuse but failed to do so. After all, we were taught that, as adults, we are in control of our lives at all times! Unfortunately, we do not have sufficient education about power imbalanced relationships such as therapist-patient, teacher- student, priest-parishioner, mentor-mentee etc. In those relationships, one person has more psychological power than the other one, but this power comes along with responsibility to maintain the parameters of the relationship. Sadly, many people, including the abused patients, do not see it this way and believe that the patient is equally responsible for breaking therapeutic boundaries. It results in the victim’s tendency to deny that abuse is taking place.
7. Feeling that your case is absolutely unique
This one goes along with the tendency to deny abuse. The truth is that every life experience is unique. That doesn’t mean that there aren’t any common traits between them. Every marriage is unique and yet some marital dynamics could apply to virtually every marriage. As I mentioned, abuse in therapy might not feel bad for a long time. On the contrary, there is a part of this experience that feels like a drug that puts you in an ecstatic state. But, as every drug, it has a stage of withdrawal when you feel horrible until you take your next dosage. The same dynamic exists in inappropriate relationships between therapists and patients. The emotional “high” that patients experience in those relationships makes them feel that their experience is unique, that what is happening between them and their therapist is “real” love, not abuse. The tricky part of this whole issue is that genuine love and abuse may not necessarily be mutually exclusive, which makes this matter even more difficult for many people to understand.
If you have experienced any of the above signs in your therapy, think it through, talk to someone about it to get a fresh perspective and possibly get a second opinion from another professional. The earlier you are able to recognize the abuse the easier it would be for you to get out of it!
JW: What are the potential dangers of abuse in psychotherapy?
MT: Abuse in therapy differs from other kinds of abuse because it is not always easily recognizable. Therapy is meant to be a sacred place where showing vulnerability is not only allowed but is also a necessary part of therapeutic process. Patients often admire and idealize their therapists as they might feel that they are loved, cared for and even rescued by them. These feelings are common and normal and can even help people heal, if the therapist handles them appropriately.
As I mentioned before, therapist-patient relationship is a power-imbalanced one and the imbalance of power in that relationship is sky-scraping. When the therapist responds to the patient’s feelings in the way that serves his or her own needs instead of the patient’s healing process, that constitutes the abuse of power. The therapy setting then becomes toxic and dangerous for the vulnerable patient. In these situations, patients are often not able to identify the therapist’s seductive and inappropriate behavior as abuse. On the contrary, even if they heard about other cases of abuse in therapy before, they are confident that their case is unique and special. With time though, this confidence fades away as more and more signs of abuse are becoming obvious, and patients get overwhelmed by a sense of betrayal and a profound trauma that comes as a result of it.
Even when they understand that they are being abused, they might feel too dependent on the therapist-perpetrator and isolated from everybody else to leave the abusive situation. At this time, finding an outside help and support is essential. Oftentimes though, the victim’s trust and self-confidence are so low that it makes it difficult for them to seek help. They also don’t believe that they will get a lot of support and validation from others.
Unfortunately, their mistrust is often reality based. Our society is not well educated about psychological dynamics of power-imbalanced relationships. Many people still believe that both parties are equal in those relationships and, therefore, share responsibilities equally as long as they are both adults. However, the nature of power-imbalanced relationships implies that one person is much more vulnerable than the other one and, for that reason, is not in a position to exercise a sound judgment. Therefore, the fact that the victim did not object or even encouraged the perpetrator’s ill-behavior is not an indicator that the victim consented to abuse. This, however, is a challenging concept for many people to understand and, as long as it is not fully understood, abuse in therapy and other power-differentiated relationships will continue to occur and the victims will get re-traumatized by being invalidated by the society instead of being helped.
JW: How can someone avoid being abused in psychotherapy?
MT: In order to recognize signs of abuse early enough and avoid being harmed in therapy the best approach is to learn how to trust your gut feelings about your relationship with the therapist.
Very often, our intellectual side would stay on the way of our intuition, telling us that the therapist is an expert and knows better. When we are disconnected from our “gut,” our intellect can be easily manipulated into a defense mechanism that serves our desire to disconnect from painful reality. However, if you are having any reservations about your relationship with your therapist, recognizing any of the signs of potential abuse that were listed above or just feeling that something is not quite right definitely should not be discounted.
As a rule of thumb, I would suggest to get a second opinion whenever you have doubts about your therapy process. Just as you can see another medical doctor to get a second opinion on your health issues, you can also see another therapist to get a second opinion about your work with your current therapist. Your right to get a second opinion is clearly stated in the Patient’s Bill of Rights, an informational and educational guide provided by the Board of Psychology to assist consumers in finding quality professional mental health services.
In addition to seeking a second opinion, take time to educate yourself about what constitutes abuse in therapy and how it happens. The following resources have a wealth of information on the subject; they also provide anonymous support through forums and electronic correspondence: www.therapyabuse.org and www.advocateweb.org.
Please note that even though these resources are created to help those who have suffered any kind of abuse in therapy, the majority of information on these websites is dedicated to sexual abuse by therapists. Abuse in therapy can take various forms, not only sexual. Whether sexual involvement with one’s therapist took place or not, the trauma and the damage occurs on emotional level, not physical. I focus on helping those who have been abused in therapy in ways other than sexual. I do not provide therapy for them at this time, but I can give information and support that many victims of this kind of abuse need desperately.
If something does not feel right to you in your therapy process and you feel lost, confused, or depressed because of that, feel free to contact me at firstname.lastname@example.org for information and support. You can also read more about me and my approach to therapy on my website www.mtmft.com.
JW: Thank you Marina for doing the interview on how to avoid getting abused in psychotherapy.