Under the Couch

Violence

The violence ripping American society is now permeating its innermost sanctum—the shrink's office. In alarming numbers, therapists in private practice are being threatened with physical harm by the very people they are trying to help.

There are no statistics on how often patients come in brandishing guns or knives, because the topic never gets talked about openly. But New York therapist Franklin Goldberg--who once had a patient train a gun on him-found he hit a raw nerve whenever he brought the subject up among his colleague friends. So he broke the taboo and wound up leading a symposium on the subject at the recent meeting of the American Psychological Association.

"Therapists are very concerned about the increased violence in our society," he says. "And considering we spend our days behind closed doors with sometimes extremely troubled people, it's no wonder therapists can recount incident after incident of threats made by patients."

Female therapists are especially worried. It's not just that we live in a violent society, it's that much of the violence is directed specifically against women, observes Sue Shapiro, who, like Goldberg, practices at the Manhattan Institute for Psychoanalysis, where she also heads a clinic for sexually abused adults.

In a recent study, she identified patients who are most likely to be violent: those being seen at an initial consultation and those in long-term intensive treatment when transference takes place--the point when they direct at the therapist long-inaccessible feelings such as rage, originally felt toward a parent or other authority. "While we as therapists try to use these actions in a way that is helpful to the treatment," she told colleagues, "we must also consider personal safety."

Just what kind of people threaten violence? "You'd think that people who seek treatment for aggressive behaviors would be most prone to violence against therapists," says one. But that's not how it works. "I'd have to say it really could be anyone."

Next time you go for some help, don't be surprised if you find the therapist--under the couch.