Doing Our Homework
Shapiro, Francine, Family Therapy Networker
MICHAEL LERNER'S CALL TO ARMS at last spring's Family Therapy Network Symposium (see page 44) challenged therapists to become a greater moral force in the world and to take more responsibility for the collective good. Lerner stirred an audience of 2,500 therapists with his impassioned appeal for the mental health community to mobilize politically, yet 1 was struck by an important omission in his address there was little mention of our own individual and collective responsibility for the current crises feeing our profession. I don't think therapists can take the moral high ground with anyone when we haven't cleaned up our own house.
I remember hearing about a conversation in which a therapist who said he did family therapy was asked where he was trained. "What's the big deal?' he replied. "I'm a therapist and 1 was born into a family. What more do I need?" I asked the person who told the story, "How did you respond to that?" She shrugged and said, "Nothing. You know how people are. It goes on all the time."
In a field that prides itself on its mavericks and creative innovators, from Freud to Milton Erickson, doing therapy without training is often viewed as an indicator of a willingness to reject stultifying orthodoxies and break with outmoded clinical traditions. But the argument that individual clinicians need the autonomy to work intuitively can often become an excuse for not bothering to become thoroughly prepared and knowledgeable about what has already been developed.
As the originator of a new therapeutic approach called Eye Movement De-sensitization and Reprocessing (EMDR), I have had the opportunity to get a close-up view of how therapists incorporate new clinical methods into their practices. After publishing a controlled study on EMDR in 1989, I decided to teach it to licensed mental health professionals as an experimental procedure. This way, as we awaited further research, clinicians could use EMDR judiciously, careful to employ other procedures if the method did not work. However, I soon began getting reports about clients who appeared to be harmed by EMDR and discovered that they had been treated with improvised versions of the method taught to their therapists by past participants in EMDR trainings. Some participants had even trained lay hypnotists and massage therapists in their version of EMDR. There seemed to be little understanding that you are not qualified to teach something you just learned. My psychiatrist friends laughed at my shock and said, "Why are you surprised? Haven't you heard of 'See one, do one, teach one?" Advertisements for "eye movement therapy" started appearing around the country taught by people who had never been fully trained themselves. Some even started to run workshops based on their reading of the two-page procedure section of my eight-year-old research publication.
The intentions of these therapists may have been benign, but the consequences for their clients were sometimes disastrous. One young woman who had been raped was treated by a therapist who had heard that EMDR was useful for treating trauma. Without any other information, preparation or procedural safeguards, the therapist started using the eye movement component of EMDR, without any real grasp of the method. The young woman appeared to cairn slightly, but when she returned home, she started crying uncontrollably, ended up in a fugue state and had to be hospitalized. When I told the story to another therapist, his response was, "Clients do that all the time. How do you know it wouldn't have happened anyway?" The answer is I don't, but I know that there is much less likelihood of a client being hurt if clinicians are well trained in their methods. As long as we shrug off the use of methods by colleagues who haven't been adequately trained in them, we have to accept part of the responsibility for their results.
We have written in the APA ethics code (and elsewhere) that training and supervision are mandatory before doing therapy, but there is no clarity about what constitutes "training. …