A Madness in Their Method

By John Leo

Everyone knows that a good deal of psychotherapy does not seem to go well. What everyone does not know, says Psychoanalyst Robert Langs, is that a common factor in failed therapies is the "madness" of the therapists. Skewed treatments, he writes in a new book titled Madness and Cure (Newconcept Press; $36), can bring some measure of relief to the disturbed and often seem to effect a cure, but they can also end in "incalculable harm" to patients.

Langs, 57, the author of 20 books in the field and program director of the Psychotherapy Program at Lenox Hill Hospital in New York City, is a longtime student of various therapies and how they work. His definition of madness is tamer than it sounds. He uses the word to indicate the inner turmoil and contradictions that are present in everyone. But his conclusion is anything but tame: the average consumer of therapy is likely to be influenced, and perhaps overwhelmed, by the emotional problems of therapists. The bad news is that many patients are more damaged by their therapists than they realize, and some actually end up seeking out one disturbed therapist after another. The good news is that patients, on an unconscious level, often tend to be aware of the erratic behavior of those who are treating them. "Mostly what happens is that patients perceive the madness of their therapists and try to correct it," Langs says. "Unconscious attempts by patients to cure the errant therapist are quite common."

For his book, Langs conducted three- to four-hour interviews with 20 volunteers who had been in treatment with a total of 47 different therapists representing a range of schools from Gestalt and group to classical psychoanalysis. "Not one of these experiences," Langs writes, "seems to have been free of self-contradictory, unrealistic, out-of-control behaviors and interventions on the part of the therapist. Using rather gross measures, one might say that in general the therapists were responsible for three times as many incidents of overtly inappropriate behavior as their patients."

Most had been overtly manipulated or even abused by at least one therapist. One male therapist caustically rebuked a female patient for not trying to seduce him. A respected psychoanalyst had an affair with the lover of one of his patients, then lied about it, announcing that the patient was projecting his unresolved Oedipal fantasies upon an innocent therapist. Two female therapists behaved seductively to female patients, and one of them conducted a session while lying in bed in her nightgown. During a Gestalt group-therapy session, a deeply troubled man was goaded into attempting intercourse with a woman, then ordered to stop at the last minute. One analyst dismissed a woman from treatment for refusing to marry the father of her unborn child; another ordered a male patient to refrain from sex for a year as a means of learning self-control.

Many of these patients overlooked or minimized the abuses of therapists and doggedly remained in treatment. The reason, says Langs, is that the evidence of what the therapist is doing is too threatening for the conscious mind to accept. Patients file the information away unconsciously and begin to deal with it in dreams and feedback to their therapists. In a sense, says Langs, the patient and therapist switch roles, with the patient taking on the responsibility of dealing with the therapist's problems. One patient, for example, dreamed that he took his therapist to a restaurant and was not sure who should pick up the tab. "Dreams of this kind are common when patients respond therapeutically to therapist-madness," Langs writes. "The patient wonders whether he should not receive the fee . . ." In another case that Langs studied, the patient of a corrupt psychotherapist improved for a time and married successfully, apparently in an unconscious attempt to show the therapist what a life of integrity would look like. "The patient obtains a great deal of hidden satisfaction in functioning as a therapist to his or her own therapist," says the author.

Such gains, however, are usually short term. They are often based on the patient's feeling of superiority to an unethical therapist or simply a sense of relief that he has been able to avoid confronting his own problems by the therapist's antics. Often, says the author, therapist and patient collude to keep each other's destructive and frightening impulses at bay. Writes Langs: "Patients will often go from one disturbed therapist to another, seeking a form of madness that is more comfortably suited to their own mad needs and defenses." Virtually every patient in Langs' study who left a mad therapist sought out another, and the majority shopped around for a third.

Langs thinks the "overwhelming responsibilities" of therapists push even some of the best-intentioned into imposing their own madness on therapy | sessions. Many, he says, "function well in their own lives, then come into the office and express their own mad concerns." Under the heading of mad therapies, Langs, a strict Freudian, includes all the sunny, upbeat treatments that are based on reassuring patients of their wonderful qualities. Some therapists in Langs' study assured their patients that their husbands or wives were the really crazy people. After a terrifying nightmare, one patient was told by his therapist that his dream was creative and rich and that he need not worry much about it. Bucking up a patient with such banal cheeriness, Langs believes, is a way of denying turmoil and ignoring real problems.

"Psychotherapists are in a position to serve as pleasure merchants with an almost endless assortment of direct satisfactions for their clientele," he writes. "None of these pleasures have anything to do with the sane satisfactions of sound psychotherapy." The right way to do psychotherapy, he says, is to look at the nightmares: "If you look away and pretend they are not there, you will feel better for a while, but you'll pay the price."