Mental healthcare is still a profession shrouded in mystery. As a psychologist, two questions I get asked a lot are: “Don’t you just listen to people all day?” and “Isn’t therapy only for people who don’t have friends?” For the record: no and no. I do a lot more than listen and I’m not a paid friend (which sounds creepy). But I get it. People don’t understand how counseling works. I don’t blame them because, quite frankly, it’s a complicated process. There’s no one right way to counsel which means that there are many disagreements about the best practices. However, while no one can tell you definitively what you should do, we can certainly tell you what you shouldn’t.
Regardless of philosophical differences, everyone agrees that our primary goal is To Do No Harm. At the end of the day, we’re supposed to be there for our patients, not the other way around. Sadly, not all of us obey this directive. Take Dr. Ike Herschkopf, for example, the psychiatrist familiar to listeners of The Shrink Next Door, one of the top 10 podcasts in the nation. Over seven episodes, journalist Joe Nocera takes listeners on the 30+ year journey of how Ike manipulated Marty Markowitz, one of his patients.
The story is deeply disturbing. Over the years of “treating” Marty, Ike gained considerable influence over his mental health, his relationships and his work. But it wasn’t just Marty. The podcast details at least two other patients (other articles hint at even more) who also fell under Ike’s thrall. Like Marty, these patients isolated themselves from family and friends and made questionable financial decisions, all while paying Ike his large fee. A few even changed their wills to include Ike’s wife and children (in case you didn’t know, this is a HUGE no-no). The podcast notes include a picture of Ike, in a bathing suit at a party in the Hamptons, closely surrounded by three female patients flirtatiously touching him. It looks more like a swinger party than a doctor interacting with vulnerable people under his care.
The damage done to these people while Ike got more money and status is terrible. It’s incomprehensible to me that the state of New York has for years failed to seriously launch an investigation into such troubling allegations. The only explanation I can give is that perhaps the people at the State Board of Health are asking themselves the same question that’s woven throughout the podcast: how did Ike manage to get these smart, capable people to do his bidding? Few were fools, many had power and money and none were physically coerced. Yet this type of manipulation happens. A lot. That’s because the answer to this question speaks not only to the power imbalance inherent in therapy but also to the desperate desire of people to belong.
Over the years, we’ve learned a lot about the ways in which mental health professionals directly influence people and the potential dangers in doing so. That’s why our Professional Code of Ethics that was only a few pages long in the 1980s is now quite lengthy. We realize that people who come to us for help are impressionable, depending upon our years of education, training and experience to help them find the answers they seek. They rely on us to do what’s in their best interests. Those who’ve been deeply hurt or who are at challenging points in their lives are especially prone to search for approval. They badly want someone who sees them at their worst but still values them. When counselors do their jobs, the process can be immensely healing. But when it goes wrong, you get people like Ike, someone his own stepsister thinks went into the field of psychiatry in order to control people.
This desire for control doesn’t stop at the therapy door though. We see it time and again. If you have someone (usually but not always a man) who is charismatic, warm, confident and appears to have answers, people desperate for belonging are attracted to him. They come for the answers, get drawn in by his kindness and charm, and stay for the sense of belonging. These “leaders” all seem to read from the same playbook. Like Ike, they isolate followers not only from friends and family but also from differing perspectives. Many adherents are pushed to give significant financial contributions, not just to enrich the leader but also to ensure commitment. They’re tempted by the high life, whether it be drugs, sex, the reflected glow of a desired leader, or by status and fun (like parties in the Hamptons).
Most of all, participants are given the feeling of being special, of being truly known. Only the leader knows and accepts them fully. Only the leader can give them what they need. The group surrounding them reinforces these beliefs and, without absent any opposing viewpoints, they’re secure in their worth. In return for this wonderful sense of belonging, they end up doing things they wouldn’t ordinarily do. That’s why young people became horrible murderers, families moved across the world and ended up dead, participants killed themselves because of a comet, families holed up in a Texas compound to die from fire or guns, and women allowed themselves to be branded and forced into sexual slavery. Given these examples, should we doubt that people can be manipulated into cutting off ties with those who don’t seem to understand their dependence on their therapist? Is it a surprise that they paid large amounts for what they considered to be good healthcare?
It doesn’t shock me one bit that Ike was able to stage-manage some of his patients into doing what he wanted. Other counselors have done this on a smaller scale. I’ve heard about counselors going on vacation with their patients (on the patient’s dime), having patients “work off” their debts by doing chores, and, one of the most common transgressions, counselors having sex with their patients (like, most recently, FOX contributor, psychiatrist Keith Ablow). None of this is OK. These situations are exactly why our Professional Code of Ethics and regulatory agencies are so necessary. We must police ourselves to ensure that we’re giving the highest level of care. It’s also why counseling should be a Calling and not just a job.
It’s appalling that Ike Herschkopf’s machinations were allowed to go unchecked for so long. Not only did he inflict untold damage on a number of people but stories like his (and Ablow’s) are why the public at large often doesn’t trust us. It’s disheartening. I view my counseling work as an incredible privilege. My patients trust me enough to share their darkest secrets, confident in the knowledge that I’m not there to judge but to help provide the relief from pain they’re seeking. I do my best to ensure that not only do I not do harm but that people leave my office feeling better than when they entered. Shouldn’t that be every counselor’s goal?