Nov 28, 2012

Men Sue Reparative Therapy Center Over Psychological Harm

NOVEMBER 28, 2012

reparative therapy

Four young men have taken the rare step of suing a facility that provides so-called "reparative therapy," and the individuals who run it, claiming that the techniques used to "cure" their homosexuality included ones that inflicted psychological damage. The suit was filed yesterday in Hudson County (N.J.) Superior Court against the organization known as JONAH (Jews Offering New Alternatives for Healing), which is located in Jersey City. The suit charges the organization with falsely claiming to be able to rid the men of their sexual attraction to other men through proven scientific techniques. According to the suit, these techniques were demeaning and emotionally damaging and included having to remove their clothing and beat images of their mothers. One of the defendants, Chaim Levin, now age 23 but 17 when he sought out JONAH's services, told the Jersey Journal, "It was so awful and so degrading and so wrong in so many ways."

Commenting on the suit to Psychiatric News, psychiatrist Jack Drescher, M.D., said, "APA has raised concerns about the potential harm done by trying to change a person's sexual orientation. Anecdotal reports of harm include worsening of depression, anxiety, and even suicidal ideation—not to mention individuals entering into heterosexual marriages with the unrealized hope that these would lead to conversion. Unfortunately, many of the individuals, like the defendants named in this lawsuit, are unlicensed and not subject to professional regulation or censure. Hopefully, if the plaintiffs' suit is successful, it will have a chilling effect on the proliferation of unlicensed individuals offering false hope to unhappy individuals struggling with their sexual identities." Drescher is president of the Group for the Advancement of Psychiatry and editor emeritus of the Journal of Gay and Lesbian Mental Health.

In late September California passed a law banning reparative therapy in youth younger than age 18.

APA position statements on reparative therapy are posted under "Position Statements." For a comprehensive review of mental health issues affecting gay, lesbian, bisexual, and transgender individuals see The LGBT Casebook from American Psychiatric Publishing. (Drescher is a co-editor of the book.)

Nov 25, 2012

Yet Another Look At The Transcendental Meditation Paper

Larry Husten
November 25, 2012

Editor’s note: Below are two responses to Robert Schneider’s defense of his Transcendental Meditation paper, which Schneider wrote in response to my earlier article about the publication of his paper.  In the first part I respond to some of the general issues raised by Schneider. The second part, from Sanjay Kaul, addresses the statistical issues discussed by Schneider.

I’m grateful for Kaul’s highly technical analysis of the statistical issues raised by Schneider, but I don’t think this case really requires a terribly high level of technical expertise. Common sense actually works pretty well in this case. A trial with barely 200 patients cannot be expected to provide broad answers about the health benefits of a novel intervention. As Kaul and others have stated on many other occasions, “extraordinary claims require extraordinary evidence,” and it is quite clear that the evidence in this trial is not extraordinary, at least in any positive sense.

Questions About Trial Reliability And Data– In his response Schneider tries to skate away from the inevitable questions raised about this paper when Archives of Internal Medicine chose to withdraw the paper only 12 minutes before its scheduled publication time. Schneider can pretend that this incident never occurred, but outsider readers can not help but wonder what sparked this extraordinary incident, and will not be satisfied  until the details are fully explained.

There are additional red flags about the trial. Schneider told WebMD that since the Archives incident “the data was re-analyzed. Also, new data was added and the study underwent an independent review.” Said Schneider: “This is the new and improved version.”

This is an extraordinary claim, because a clinical trial cannot be “new and improved” unless there were serious flaws with the earlier version. What exactly does it mean to say that a paper published in 2012 about a trial completed in 2007 is “new and improved”? (According to ClinicalTrials.Gov the study was completed in July 2007, while June 2007 was the “final data collection date” for the primary endpoint.)
The 5-year delay between the 2007 completion date and the publication of the data is highly suspicious.

What exactly caused this delay? The paper hints at one possible source of delay: as Kaul notes below, the investigators refer to the primary endpoint as a “DSMB-approved endpoint.” This suggests that the primary endpoint was changed at some point in the trial. As Kaul points out, it is not the job of the DSMB to either choose or approve primary endpoints. Since the trial was not registered until 2011 with ClinicalTrials.Gov it is impossible to sort this issue out unless the investigators choose to release the initial trial protocol and statistical plan.

Schneider’s response also fails to explain why there is a difference in the number of primary endpoint events between the Archives paper and the Circulation: Cardiovascular Quality & Outcomes paper, since the collection date for the primary outcome measure is listed as June 2007 on ClinicalTrials.Gov. I see no reason why the reason for this discrepancy shouldn’t be explained. Although the difference is only 1 event, it inevitably raises questions about the reliability of the data.

Trial Interpretation– Finally, I am deeply concerned about the way this trial will be used, or misused, to “sell” the brand of Transcendental Meditation in the broadest possible population, ie, everyone. Though the study was limited to African-American with heart disease, here’s what Schneider told the Daily Mail:

‘Transcendental meditation may reduce heart disease risks for both healthy people and those with diagnosed heart conditions. The research on transcendental meditation and cardiovascular disease is established well enough that doctors may safely and routinely prescribe stress reduction for their patients with this easy to implement, standardised and practical programme.’

Meditation may of course be beneficial, but it will never be a cure for heart disease, and it won’t replace other treatments. But here’s what Schneider told WebMD:

“What this is saying is that mind-body interventions can have an effect as big as conventional medications, such as statins,” says Schneider.

It shouldn’t be necessary to say, but the evidence base for statins is several orders of magnitude greater than the evidence base for meditation. Further, there have been no studies comparing meditation to statins. Any claim that meditation is equivalent to statins is preposterous.

To be clear, I have nothing against meditation. Generic meditation is cheap, safe, and even possibly effective. Branded Transcendental Meditation, on the other hand, is a cult, and it is out to get your money. An initial TM program costs $1500, and increases the deeper you get pulled into the cult. Here’s what Schneider told Healthday:

“One of the reasons we did the study is because insurance and Medicare calls for citing evidence for what’s to be reimbursed,” Schneider said. “This study will lead toward reimbursement. That’s the whole idea.”

Here’s the real source of my discomfort with this trial. For true believers like Schneider, fighting heart disease is important only insofar as it can be employed to further the interests of TM. Scientific standards and medical progress are unimportant in the larger scheme of promoting TM.

Read the comments left by Michael Jackson and Chrissy on my earlier post to learn more about the dangers of TM. Or do your own research on the internet.

Here’s Sanjay Kaul’s response:

Power calculation

By convention, the difference that the study is powered to detect (delta) varies inversely with the seriousness of the outcome, i.e., larger delta for ‘softer’ outcomes and smaller delta for ‘harder’ outcomes. This does not appear to be the case in the current study. For the first phase of the trial, the power calculation was based on a 36% risk reduction in death, nonfatal MI, nonfatal stroke, rehospitalization or revascularization (the original primary endpoint). Then, for the 2nd phase of the trial, the power calculation is based on a 50% reduction in a narrower but harder outcome of death, nonfatal MI, nonfatal stroke (the revised primary endpoint). I find it curious that the authors justify their choice of the revised primary endpoint as ‘DSMB-approved endpoint’! Since when is the DSMB charged with choosing or approving trial endpoints?

Incidentally, the Proschan-Hunsberger method refers to conditional, not unconditional, power. To compute conditional power, the investigators had to have looked at data by arm. Thus, some penalty should be paid for the ‘interim look’ in the form of requiring a larger z-score (lower p value) to claim statistical significance. They did not appear to do this.

Strength of evidence

The conventional frequentist approach relies heavily on the p value which tends to overstate the strength of association. Complementary approaches such as the Bayesian inference are available that utilize Bayes factor, a more desirable metric to quantify the strength of evidence compared with p value. For instance, the Bayes factor associated with a p value of 0.03 (observed in the trial) is about 10, which means that at a prior null probability of 50%, there is still a 10% chance of null probability based on the trial results, more than 3-fold higher than that implied by a p value of 0.03. So the evidence falls in the category of at most ‘moderate’ strength against the null.

Another way of assessing the strength of evidence is to quantify the probability of repeating a statistically significant result, the so-called ‘replication probability’. The replication probability associated with a p value of 0.03 is about 58% which is unlikely to pass the muster of any regulatory agency. The FDA regulatory standard for drug approval is ‘substantial evidence’ of effectiveness based on ‘adequate and well-controlled investigations’ which translates into 2 trials, each with a p value of 0.05. At the heart of this standard (or any scientific endeavor) is replication. The replication probability for 1 trial with a p value < 0.05 is only about 50%; replication probability of 2 trials with p value <0.05 is about 90%. In 1997 the rules were changed to base approval on the basis of a statistically persuasive result obtained in 1 trial, i.e., p value <0.001 for a mortality or a serious irreversible morbidity endpoint. The p value of 0.001 is equivalent to 2 trials with 1-sided p value of 0.025 (0.025 x 0.025 = 0.000625 or 0.001). Thus, the current trial results do not comport with ‘substantial’ or ‘robust’ evidence.

Distribution of endpoints

It seems highly unusual that 80% of the primary events were fatal. If true, it means that the subjects were dying either from a non- MI-, non-stroke-related events such as sudden cardiac death or heart-failure death (as in patients with advanced heart failure) or non-cardiovascular events not accounted for by the adjudication process.

Adjusted analyses

Although many have discussed how adjusting for baseline covariates in the analysis of RCTs can improve the power of analyses of treatment effect and account for any imbalances in baseline covariates, the debate on whether this practice should be carried out remains unresolved. Many recommend that the analysis should be undertaken only if the methods of analysis and choice of covariates are pre-specified in the protocol or statistical analysis plan. This is not easily discernible without registration of clinical trials.

Rethinking the Classic Obedience Studies

Pacific Standard
Tom Jacobs

Stanley Milgram’s 1961 obedience experiments and the 1971 Stanford Prison Experiment are legendary. But new research adds new wrinkles to our understanding of allegiance and evil.

November 25, 2012

They are among the most famous of all psychological studies, and together they paint a dark portrait of human nature. Widely disseminated in the media, they spread the belief that people are prone to blindly follow authority figures—and will quickly become cruel and abusive when placed in positions of power.

It’s hard to overstate the impact of Stanley Milgram’s obedience experiments of 1961, or the Stanford Prison Experiment of 1971. Yet in recent years, the conclusions derived from those studies have been, if not debunked, radically reinterpreted.

A new perspective—one that views human nature in a more nuanced light—is offered by psychologists Alex Haslam of the University of Queensland, Australia, and Stephen Reicher of the University of St. Andrews in Scotland.

In an essay published in the open-access journal PLoS Biology, they argue that people will indeed comply with the questionable demands of authority figures—but only if they strongly identify with that person, and buy into the rightness of those beliefs.

In other words, we’re not unthinking automatons. Nor are we monsters waiting for permission for our dark sides to be unleashed. However, we are more susceptible to psychological manipulation than we may realize.

In Milgram’s study, members of the general public were placed in the role of “teacher” and told that a “learner” was in a nearby room. Each time the “learner” failed to correctly recall a word as part of a memory experiment, the “teacher” was told to administer an electrical shock.

As the “learner” kept making mistakes, the “teacher” was ordered to give him stronger and stronger jolts of electricity. If a participant hesitated, the experimenter—an authority figure wearing a white coat—instructed him to continue.

Somewhat amazingly, most people did so: 65 percent of participants continued to give stronger and stronger shocks until the experiment ended with the “learner” apparently unconscious. (The torture was entirely fictional; no actual shocks were administered.)

To a world still reeling from the question of why so many Germans obeyed orders and carried out Nazi atrocities, here was a clear answer: We are predisposed to obey authority figures.

The Stanford Prisoner Experiment, conducted a few years later, was equally unnerving. Students were randomly assigned to assume the role of either prisoner or guard in a “prison” set up in the university’s psychology department. As Haslam and Reicher note, “such was the abuse meted out to the prisoners by the guards that the study had to be terminated after just six days.”

Lead author Philip Zimbardo, who assumed the role of “prison superintendent” with a level of zeal he later found frightening, concluded that brutality was “a natural consequence of being in the uniform of a guard and asserting the power inherent in that role.”

So is all this proof of the “banality of evil,” to use historian Hannah Arendt’s memorable phrase? Not really, argue Haslam and Reicher. They point to their own work on the BBC Prison Study, which mimicked the seminal Stanford study.

They found that participants “did not conform automatically to their assigned role” as prisoner or guard. Rather, there was a period of resistance, which ultimately gave way to a “draconian” new hierarchy. Before becoming brutal, the participants needed time to assume their new identities, and internalize their role in the system.

Once they did so, “the hallmark of the tyrannical regime was not conformity, but creative leadership and engaged followership within a group of true believers,” they write. “This analysis mirrors recent conclusions about the Nazi tyranny.”

It also sounds familiar to anyone who has studied the rise of semi-autonomous terror cells in recent decades. Suicide bombers don’t give up their lives out of unthinking obedience to some religious or political figure; rather, they have gradually melded their identities with that of the group they’re in, and the cause it represents.

Similarly, the researchers argue, a close look at Milgram’s study suggests it really isn’t about blind obedience at all. Transcripts of the sessions show the participants are often torn by the instruction to administer stronger shocks. Direct orders to do so were far less effective than entreaties that they need to continue for the sake of the study.

These reluctant sadists kept “torturing” in response to appeals that they were doing important scientific work—work that would ultimately benefit mankind. Looked at in this way, it wasn’t some inherent evil or conformism that drove them forward, but rather a misplaced sense of idealism.

This interpretation is still quite unsettling, of course. If a person has has fully bought into a certain world view and believes he or she is acting on the side of right, this conviction “makes them work energetically and creatively to ensure its success,” Haslam and Reicher write.

So in the researchers’ view, the lesson of these two still-important studies isn’t about conformity or even cruelty per se. Rather, they reveal a dangerous two-step process, in which authority figures “advocate oppression of others,” and underlings, due in part to their own psychological makeup and personal histories, “identify with those authorities … who promote vicious acts as virtuous.”

So we may not be inherently evil, but it appears many of us can be enticed into believing that a heinous act is, in fact, good and necessary. Perhaps the real lesson of these startling experiments is the importance of learning how to think critically.

The most effective antidote to evil may be rigorous skepticism.

Nov 16, 2012

Relaxation-Induced Anxiety

The Atlantic
NOV 16, 2012

Christina Luberto is a doctoral candidate in psychology at the University of Cincinnati. She is in D.C. today to present research on a concept called relaxation-induced anxiety (RIA). It is precisely what it sounds like: being relaxed, itself, actually triggers anxiety.

"I worry that when I let my body relax, I look unattractive."
RIA has been mentioned sporadically in medical literature since the 1980s, but never as a diagnosis in itself. Luberto looks at it as a disposition; a maladaptive process. She says about 15 percent of people have experienced it, and it's not outside the realm of benefiting from treatment. So she developed an index to identify exactly what part of relaxation is causing a person's anxiety, which should help inform targeted therapy.

RIA is different from just being the sort of person who doesn't find traditionally relaxing things to be relaxing. If those things (doing yoga, playing harp, brunching with Yanni, etc.) actually make you feel anxious -- but you then feel at ease, say, organizing socks -- that's not RIA. Because you are able to relax, albeit by atypical means. In this model, anything that elicits relaxed physiology (slow heart rate, decreased muscle tone, deep breathing) counts as relaxing.

It's also different from being straight-up unable to ever relax, as in severe chronic anxiety.

In RIA, you are able to relax (by whatever does it for you -- cooking, chilling, vacuuming), but it's not long before the relaxation triggers anxiety. You briefly enter a parasympathetic (chill) state, but then your heart rate spikes, and your respiratory rate increases, and you feel anxious.

So why does this happen? It varies, widely, but that's where Luberto's work comes in. She developed a 21-item self-examination that is supposed to help people with RIA identify exactly what part of relaxation triggers their anxiety. She calls it the Relaxation Sensitivity Index.

Luberto tested it on a group of undergrads, and it seemed to work. I asker her if we could publish the full version of the test, but she prefers to wait until her academic article is published, which will also include the dense rubric for interpreting and managing the results. She did release a few examples, though.

The prompts are broken down into three subsections, and each would be rated by the patient on a five point scale.


"I worry that when I let my body relax, I look unattractive."
"I worry that if I relax, other people will think I'm lazy."


"I don't like to relax because I don't like it when my thoughts slow down."
"I don't like to relax because it makes me feel out of control."


"It scares me when my breathing becomes deeper."
"I hate getting massages because of the feeling it creates when my muscles relax."
Treatment could then be tailored based on the responses.

And then, what do you mean by treatment? Luberto made the point that relaxation is often the prescription for anxiety. In this case, it can't be. At least not in the traditional sense.

She believes people with RIA will benefit from exposure procedures ("facing their fears," in a therapeutic context), which, yes, will involve controlled, supervised relaxation sessions. It's like when you take people who are afraid of commitment and force them to get married. Just kidding, that's not a thing. But there is a real TV show called Fear Factor where we make other humans do scary things. A relaxation-themed episode would be mildly interesting.

Nov 15, 2012

Evil, part 4: the social dimension

Clare Carlisle
November 5, 2012

Does contemporary society give rise to conditions more conducive to evil than in the past?

So far in this series I've considered evil as if it were an individual matter – a question of personal virtue, or the lack of it. In emphasising the relationship between sin and freedom, Christian philosophers such as Augustine seem to assume that if we look hard enough at the human condition we will gain insight into evil. This attitude implies that evil has nothing to do with history or culture – as if the fall is the only historical event that matters, at least as far as evil is concerned.

In the 20th century, a series of scientific experiments on the psychology of evil told a very different story. Among the most infamous of these are the experiments at Yale and Stanford universities conducted in the 1970s by Stanley Milgram and Philip Zimbardo. Both Milgram and Zimbardo found that, under certain conditions, well-educated and apparently ordinary university students were capable of immense cruelty. Under the instructions of an authority-figure, Milgram's students were prepared to administer painful electric shocks as a penalty for poor memory: two-thirds of them increased the voltage to lethal levels as their "subjects" cried in agony. These results demonstrated how dangerous and immoral obedience can be. In his experiment, Zimbardo created a prison environment in the psychology department at Stanford, assigning roles of guard and prisoner to his group of undergraduates. Within a few days guards were treating prisoners with such cruelty and contempt that the experiment had to be terminated early.

Reflecting on his Stanford prison experiment in 2004, Zimbardo wrote eloquently about the conditions that make good people do evil things. The prison, he suggested, is an institution set apart from normal society in which brutality can be legitimised. Wearing uniforms and sunglasses, identifying prisoners by numbers and guards by official titles and removing clocks and blocking natural light all helped to dehumanise and deindividualise the participants. In this "totally authoritarian situation", says Zimbardo, most of the guards became sadistic, while many of the prisoners "showed signs of emotional breakdown". Perhaps most interestingly, Zimbardo found that he himself, in the role of prison superintendent, rapidly underwent a transformation: "I began to talk, walk and act like a rigid institutional authority figure more concerned about the security of "my prison" than the needs of the young men entrusted to my care as a psychological researcher."

Although Zimbardo insists that "there were no lasting negative consequences of this powerful experience", his conclusions raise ethical questions about scientific experimentation itself. Does the laboratory, like the prison, provide a special kind of environment in which pain can be inflicted with approval? Do the white coats and the impersonal manner of recording results dehumanise both scientists and their subjects?
These questions point to a larger philosophical issue. Does contemporary society give rise to conditions more conducive to evil than in the past? Do science and technology, in particular, dehumanise us? Modern technology has certainly created forms of communication that allow people to remain more safely anonymous. Take the internet, for example; it's right here. In recent years the malevolent online behaviour of internet trolls and vitriolic commentators, hiding behind their pseudonyms, has become a much-discussed cultural phenomenon. Maybe it's quite natural that we have a delicious taste of freedom and power when given the opportunity to go undercover – like Stevenson's Jekyll-turned-Hyde as he runs gleefully through the night to the wrong side of town, stamping on children as he goes. But in such circumstances are we really in control? Milgram's electrocutors thought they were in control, and so did Philip Zimbardo. It turned out, of course, that they too were part of the experiment.
As usual, Plato has something to contribute to this debate. In the Republic Socrates' pupil Glaucon recounts the story of a shepherd,Gyges, who fell into the earth during an earthquake and found a ring that made him invisible. "Having made this discovery," says Glaucon, "he managed to get himself included in the party that was to report to the king, and when he arrived he seduced the queen and with her help attacked and murdered the king and seized the throne."
Plato uses this story to depict the prevailing immorality within his own Athenian society – a society which had, after all, sentenced to death its wisest and most virtuous citizen. Plato suggests that his contemporaries regard hypocrisy and deceit as the surest route to happiness, since they seek all the benefits of a reputation for virtue, or "justice", while promoting their own interest by vice, or "injustice", wherever possible. In the Republic he argues, through the voice of Socrates, that this view is not only morally wrong but misguided, since true happiness and freedom can only come from living virtuously.
The story of Gyges's ring seems to suggest that evil is a simply a fact of human nature. When anonymity releases us from responsibility for our actions, we will gladly abandon morality and harm anyone who obstructs our pursuit of what we think will make us happy. In this way, we might point to Gyges in arguing that there is nothing particularly modern about evil. On the other hand, though, Plato had to resort to a myth, and a magic ring, to illustrate the conditions under which our tendency to evil manifests itself. In our own time, technology has worked its magic, and the fantasy of invisibility has become an everyday reality.

Nov 13, 2012

Sex Abuse Scandals and Ultra-Orthodox Jews: Is the Internet the Problem?

Ayala Fader
November 13, 2012

On May 22, 2012, forty thousand ultra-Orthodox Jewish men and boys gathered at Citi Fields Stadium in Queens to listen to important rabbis rail against the dangers of the Internet.  (There were separate places where the event was video-streamed for women, prohibited from mingling, at other sites in Brooklyn). The stadium bleachers were packed with bearded men and boys in traditional black and white clothing, many on their cell phones. The scoreboard was silent, but the jumbotron was alive with close ups of the rabbis’ faces, some crying, and English subtitles for Yiddish speeches. The goal of the asifa (gathering) was not to condemn the Internet, which has become indispensable for “business.” Rather, it was to promote the use of “kosher” filters to limit exposure and use. One rabbi claimed the Internet was more dangerous to Judaism than the Holocaust. Another called it “the nisoyan ha-dor (the test of this generation). All agreed that the Internet presented new challenges to Jews in the “Torah community,” threatening their very existence. The event received a tremendous amount of coverage in mainstream and Jewish presses.

Less publicized, though, was a counter-rally across the street from Citi Fields.  Organized by Ari Mandel, an activist with a non-profit organization, Survivors for Justice, this counter-rally sought to bring attention, instead, to sexual abuse scandals in ultra-Orthodox communities and their cover-up, which had been broken in the New York Times just a few weeks earlier. The crowd of a few hundred included many former ultra-Orthodox Jews, those who have “gone OTD”  (off the (path)), holding up signs and chanting, “The Internet is not the problem.” Actually, for many victims of sexual abuse, the Internet has been a literal lifesaver. As Mandel explained it, the Internet made it possible for victims to speak out, first anonymously and then more openly as they found other victims, spurring public activism and greater media attention.

Moral Authority and a Crisis of Leadership

These competing rallies are part of a much larger story, one about the struggle in the digital age over the moral authority of ultra-Orthodox rabbinic leadership to control the gedarim (gates) that keep the secular world at bay. Many in these communities call this “a crisis of emune (faith or trust in God)” and blame the Internet for corrupting Jewish souls. Prior to the early 2000s, an ultra-Orthodox Jew who wanted to explore forbidden ideas or ask questions had to go physically outside the community in search of newspapers, the radio, movies, or even, God forbid, the public library. The smart phone changed this, allowing exploration, questioning and even community building away from ultra-Orthodox surveillance (family, teachers, rebbes, etc.).

This new access to uncontrolled knowledge and people made cracks in the communal wall of silence that rabbinic leadership worked to maintain as the sex abuse allegations came out. The sex abuse scandals and their representation in the media highlight the surprisingly porous boundaries that have existed between nonliberal ultra-Orthodoxy and liberal democracy in the United States, which is based on Enlightenment principles of governance, include pluralism and tolerance, protection of individual rights, and the relegation of religion to the private sphere. Smartphones, though, are adding new challenges for ultra-Orthodox leadership, for as rabbinic leaders have tried to contain the scandals, they have further embroiled themselves with the police, the District Attorney’s office, the ultra-Orthodox victims (now grown up) and investigative journalists.

An Anthropologist’s Confession

When stories about the sexual abuse of children in ultra-Orthodox Jewish communities began tocome out, though, I confess I avoided them. Journalists reported that prominent rabbis molested young male students for years, then were simply transferred to other schools or that proven pedophiles were given light sentences. They documented witness intimidation that included social isolation of victims and their families: the community boycotted businesses owned by accusing families; their children were not allowed to enroll in yeshivas. There were offers of hush money and even threats of violence. Most disturbing, there was evidence that the Brooklyn District Attorney’s office was complicit in the sacrifice of young boys for the protection of ultraOrthodox leadership’s moral authority.

Frankly, the cases upset me. Yet (like the good Jewish girl that I am) I also felt guilty. How could I keep avoiding these stories given that I am an anthropologist who has spent the past fifteen years studying first Hasidic childrearing and now the impact of new media in Brooklyn? Despite many of my own ethical disagreements with the women and children I worked with, I have, in articles and in my book, Mitzvah Girls, a study of alternative religious modernity among Hasidic mothers and daughters, tried my best to offer evenhanded and complex portraits. For example,though I admired so many mothers I met, I have also struggled to represent the unapologetic racism that adults expressed to children in their depictions of Gentiles in contrast to the “chosen people.” Similarly, I have tried to understand the moral reasoning behind how and why Hasidic Jews use the rights of citizenship to reject the values of the liberal state.But the children’s sexual abuse scandals and their cover up felt different. I did not know how to write about or understand them, or even if “understanding” was a form of moral cowardice.

 The Long View, 1990s-present

When I began conducting my research during the mid-nineties, there was not much talk about sexual abuse within the community, nor media coverage of it. In the press the ultra-Orthodox,especially Hasidic Jews, were portrayed in common stereotypes: either as sepia-tinged, quaint,pre-modern throwbacks or (told with secular schadenfreud) as hypocrites who, despite claims to piety, defrauded federal programs. From within the community, I heard a few rumors about the molestation of children, especially boys: the Satmar rebbe installed a shomer (guard) in the men’s mikveh (ritual bath) to prevent men from preying on boys; there were tales about the homoeroticism in boys’ yeshivas (think British public schools). Back then though, the most prominent issues I followed in the community were raising awareness about domestic abuse and providing services to children with disabilities who had previously been hidden away as genetic “problems” (a deal-breaker in arranged marriages).

However, in the early 2000s, the molestation stories began: on anonymous blogs and websites within the communities (e.g.,,, in The Jewish Week, in New York Magazine, The Forward, and finally this spring, in The New York Times. Everywhere I turned there was another outrageous case of community leaders protecting perpetrators–at the expense of victims. Why? Why only now has sexual abuse of ultra-Orthodox children become a focus of investigative reporting in the Jewish and mainstream presses? And how has the media attention impacted the communities?

Sex Abuse Scandals and the Press

Part of the answer is found in recent and prevalent national exposure of child abuse at morally fallible, powerful, sacred institutions. Media coverage of the Catholic Church sexual abuse scandals was a transformative moment in journalism, historian Jonathan Sarna told me, which paved the way for reporting about the ultra-Orthodox Jewish cases. Other cases include the Boy Scouts, the Horace Mann School in New York, and the Penn State football scandal among others. All involve struggles over a great deal of money (potential legal battles, football programs, prestigious institutions), public perception, and the political power of some institutions to reject the authority of the legal system. In all of these cases, children were abused while responsible adults—priests, teachers, rabbis, coaches— looked away because of the high stakes for the institution.

The Catholic Church and the ultra-Orthodox community’s responses to the investigative journalism were similar, trafficking in knee-jerk stereotypes. The Church claimed the Boston Globe, which broke the abuse story, and the media more generally were “anti-Catholic.” UltraOrthodox newspapers like Der Yid lashed out at The Jewish Week and Times reporters, calling them anti-Semitic “Nazis” and “traitors to the Jewish people.” A reporter for a Jewish press who wished to remain anonymous told me that, other than these vituperative attacks on the nonOrthodox media, the ultra-Orthodox presses have been silent on the issue of sexual abuse.

While the majority of child sex abuse crimes–Jewish, Catholic, and other–were committed by older men against young boys in their care, in the ultra-Orthodox communities, there have also been cases of sexual abuse of girls. Due to strict gender segregation in these communities, the abuse occurs more often in homes than in yeshivas, either by male family members or relatives. I have even heard from several anonymous sources that rebellious young girls (and boys)—pathologized as “at risk” youth (at risk for leaving their communities)—are often required by the school to visit a “Torah therapist” from within the community who charges a great deal; there is at least one counselor who has a long history of sexually abusing his female clients and who is currently being prosecuted.

Similarly a fictional account, Hush, of a girl who witnessed the incestuous sexual abuse of her friend who eventually hangs herself, came out in 2010. First published pseudonymously by “Eishes Chayil” (woman of valor), the author recently went public as Judy Brown, speaking out after eight-year-old ultra-Orthodox Leiby Kletsky was murdered in Borough Park, Brooklyn, by an Orthodox Jewish man, Aron Levi, in July 2011. Levi, who had a history of mental illness,approached the little boy, who got lost walking home from day camp for the first time, and was seeking directions. Levi kidnapped the boy then drugged, killed, and dismembered him. Hereceived a forty-year prison sentence this past August. The event stunned the neighborhood because the criminal was one of their own.

The majority of the sexual abuse cases publicized thus far, though, have been of older men preying on younger boys in yeshivas. This has opened the door to familiar liberal critiques of the consequences of “repression” of sexuality in non-liberal religious communities. Like the ultraOrthodox presses’ response, these critiques also invoked stereotypes. For example, some claimed that “insular” or “closed” societies, particularly ones with gender segregation and codes of modesty, are ripe for sexual deviance. As one social services provider told me, “They (ultraOrthodox children) don’t even have names for the body parts. Everything is tushy.” I too have documented that among Hasidic Jews there is very little discussion of the body and sexuality for children or even for young people preparing for marriage. However, there is no evidence of more–or less–abuse in non-liberal religious communities. The Penn State football program and the Horace Mann School had rampant, unchecked cases of sexual predators, yet are secular liberal institutions.

Ultra-Orthodox Power and the State

However, the consequences of the media coverage for ultra-Orthodox Jews have clearly been quite different than for the Catholic Church or many other institutions. It is worth noting that at least some at the New York Times knew about the allegations of sexual abuse as early as 2006, when community insiders offering evidence and contacts approached them. An anonymous source told me that this contact at the Times declined to take on the story because the paper feared being seen as targeting the community; they would only write about the story if an elected official or politician was implicated in covering-up the cases. So it was not until May, 2012, thatThe Times published two articles  (May 9th and 10th) on Brooklyn DA Charles Hynes and his stymied efforts to prosecute sexual abuse among the ultra-Orthodox. The Times coverage made a big splash, impacting the visibility of the cases and putting pressure on Hynes’ office to step up its efforts to prosecute offenders.

More than anything else, The Times’ alleged decision to avoid targeting the community itself highlights the tremendous political influence of the ultra-Orthodox in New York. Politicians court them because community leaders are able to mobilize huge voting blocs: A rebbe or a prominent rabbi simply tells his followers whom to back and thousands in a community will turn out to vote as advised.  Ultra-Orthodox leadership has built powerful alliances with city and state politicians who watch out for their interests, be it zoning laws (e.g., building new yeshivas, school bus lanes), access to state and federal programs (e.g., Headstart, food stamps) or in the sexual abuse cases, using their own rabbinical courts rather than the New York State legal system until 2009.

The power of the ultra-Orthodox communal leadership has led to preferential treatment at the city and state levels that is often framed in a pluralist discourse as abiding the “special cultural needs” of ultra-Orthodox Jews. The ultra-Orthodox leadership has invoked the Jewish concept ofmesira (turning over)– the historical injunction against reporting a fellow Jew to a non-Jewish authority for a crime– to authenticate what amounts to a cover up. Ultra-Orthodox rabbis have claimed that involving the police in sexual abuse charges is mesira; until more recently they preferred their communities use their own rabbinic courts, which have historically handled civil disputes (e.g., divorce, marriage, custody, property), not criminal cases. These courts are not designed to prosecute sexual abuse cases. As The Times reporters Sharon Otterman and Ray Rivera noted (May 10, 2012), rabbinic courts do not have formal power to punish, subpoena or collect evidence.  Some rabbis even refuse to hear testimony from women or children.

Many of the victims and a lot of the media have continued to challenge the validity of rabbinic courts decisions on management of sexual abuse, claiming that they merely bury charges, especially against prominent rabbis. In fact, one of the primary arguments made by victim activists has been that criminal cases must be brought before the New York State legal system and that using the rabbinic court is a violation of state law.

The Politics of Cultural Sensitivity

The DA office’s handling of sexual abuse allegations highlights political favoritism legitimated by “cultural sensitivity,” meaning a sensitivity to the unique beliefs and practices of ultra-Orthodox communities which require special treatment. In theory, this sounds good (especially to me, the anthropologist) but in actuality this has meant that the ultra-Orthodox leadership got to dictate much of the way the sexual abuse cases were handled. Perhaps this explains why, as Paul Berger at The Forward noted, DA Hynes admitted that for the first eighteen years he was in office he did very little to take on allegations of sexual abuse.

It was not until 2009 that the DA created a sexual abuse hotline, Kol Tsedek (Voice of Justice), advised by a “cultural liaison,” a Lubavitcher Hasidic woman who is a social worker. A source who works closely with the DA’s office told me this liaison has opened up lines of communication and made huge inroads in raising community consciousness about sexual abuse. Some others though have told me that too often the liaison has counseled victims to withdraw charges, especially if the accused is an important rabbi.

However, even in setting up the hotline, which has made an impact by increasing the number of yearly prosecutions from zero to between seventy to ninety (the exact number is disputed), the DA’s office has continued to bend to the wishes of Agudath Yisroel, the ultra-Orthodox leadership and policy organization that represents some sectors of the Hasidic world and most of the Yeshiva world.  The Agudath, which is directed by a Counsel of Torah Sages as well as lay advisers, makes political, social and religious rulings for participating communities.  In 2009 Hynes agreed to Agudath’s position that anyone who wishes to press charges must first receive permission from his or her rabbi  or Hasidic rebbe and only then may they contact the police. The DA also agreed not to publish perpetrators’ names publicly, another Agudath position.

Hynes claims that he must continue to work through Agudath because the ultra-Orthodox are “worse than the mafia,” a reference to the community’s common practice of intimidating victims and meting out its own forms of justice. The press, especially Jewish presses like The Jewish Week and The Forward have taken activist roles. Paul Berger in The Forward (May 29, 2012) reported that they, along with other media outlets, filed a request under New York’s Freedom of Information Act for the release of the names of all those accused via the Kol Tzedek program. So far, the DA’s office has denied those requests.
Hynes claims that he can only protect the victims if he works with “cultural sensitivity.” And yet, do other perpetrators who go through the DA’s office get the same kind of culturally sensitive treatment? Are other communities or institutions able to set the terms of prosecution or withhold names of the accused? Clearly not. Only the politically powerful are able to use “culture” and insider “cultural liaisons” in order to protect the authority of communal leadership.

Why Is the Cover Up Tolerated?

How, I have to wonder, can the community stand for this cover up? I spent years in a Hasidic girls’ school and in Hasidic homes, where most children seemed cherished and protected. Indeed, there is much about Hasidic childrearing that is admirable. How and why would community leaders use their political power to put ultra-Orthodox children at risk?

I have a few theories that speak to the shifting relationship between the ultra-Orthodox leadership and the world in which they find themselves today.  First, there are different values at work, values that are in direct conflict with the liberal state’s emphasis on the protection of the individual, especially the child. The good of the community–that is ultra-Orthodox Judaism–may trump individual suffering, especially when the crimes involve the taboo topics of sexuality and sexual deviance. I suspect this is generational as well, with older ultra-Orthodox Jews (those who are most often the community leaders) unfamiliar with and unwilling to engage the language of sexual abuse. One of the stark portraits drawn of Gentiles, especially for children, is of a lack of modesty and explicit sexuality. Such talk about sexuality is thus deemed goyish (Gentile) and not becoming for Jews.

Young Leiby Kletsky’s murder last year is a piece in this puzzle. As writers Shulem Deen, Matthew Shaer of New York Magazine, Judy Brown at Jewish Week and others have noted, the community is so concerned with protecting its children from secular and goyishe popular culture that they often close their eyes to deviance and danger within. Not to mention that, more broadly, the moral universe children are taught includes black and white distinctions between Jews and Gentiles, moral and immoral. Immoral observant Jews rattle this universe.

Even the perception of sexual abuse victims, particularly those ultra-Orthodox who decide to leave their communities, is becoming less black and white. Many have gotten support at Footsteps, an organization founded by Malkie Schwartz in 2003. Footsteps helps those who break with their “insular” communities, offering “educational, vocational, and social” support for its members. This has helped to alter the perception among the ultra-Orthodox that those who leave their communities, especially those who were sexually abused, are what the community often calls “bums.” Seeing some who have left go on to college or become writers or even activists creates a more complex picture of those who choose another life over the “truth” of Orthodoxy.

Second, prosecution at the state level would open the door to potential law suits which would involve large sums of money, not to mention chillul hashem (desecration of God’s name, or besmirching the moral standing of the community before Gentiles). This fear of public exposure or shame can make for strange alliances. Catholic Bishops and ultra-Orthodox rabbis are the only two religious leaderships in Albany who continue to fight the extension of the statute of limitations for prosecution of sexual abuse crimes—from age twenty-four to age thirty. Both groups have a lot to lose.

Finally, a reporter for The Jewish Week who wished to remain anonymous offered me another, more cynical theory for the communal wall of silence, a silence which has failed ultra-Orthodox children. Rampant illegality facilitates much of ultra-Orthodox communal life, particularly the practiced use and misuse of government funding. I have written about ultra-Orthodox competing notions of citizenship in my book, Mitzvah Girls, that include using government resources to build up their own communities.  Legally, many qualify for food stamps and welfare. There are, though, some who misuse government funding or violate tax laws. This is nothing new. When I was doing fieldwork, these kinds of white collar crimes were not unusual. There is little social sanction for those who commit them if they contribute to ultra-Orthodox charities, which most do. As a Hasidic friend once remarked, “That’s golus (diaspora),” meaning that shared space does not mean shared goals for citizenship and community; at the end of the day, ultra-Orthodox Jews are waiting for the messiah, not liberal democracy. However, if sexual abuse victims went directly to the police instead of to their rabbis, there could potentially be a flood of lawsuits, which would require legal investigation and public exposure of practices the community may want to keep quiet. 

New Conversations

The media and victims have played a critical role in forcing the recent conversation that so many were once reluctant to have. Some within the community have begun to respond. There are dissenting voices and recent attempts to train the next generation differently. For example, there are some who do not agree with the prohibition against notifying the police and they speak out, though they often suffer intimidation and censorship for it.

The Orthodox press, Artscroll, published the first book of its kind, Let’s Stay Safe, in 2011. This popular picture book is designed to provide parents with a “tsanua (modest) way to speak to children about a broad range of safety matters.” Safety here goes from wearing helmets when bicycling to warning that “only your parents or a doctor can touch you in a private space that is covered by a bathing suit.” One page is especially poignant, clearly a response to the murder of Leiby Kletsky. If you are lost, the book directs readers, go ask  “a cashier, a mommy or a policeman” for help.  Gone is the assumption that any Orthodox Jew is a safe haven. I have also heard from a social services provider that there is a group of women visiting a bungalow colony in the Catskills this summer to raise awareness among the mothers there.
Maybe these “culturally sensitive” attempts from within the community will help. Ari Mandel, the activist, is cautiously optimistic that attitudes are changing as more and more victims speak up.  And critically, more and more victims who step forward are believed by community members. Ultimately, the sexual abuse scandals and widespread use of the Internet are challenging the moral authority of ultra-Orthodox leadership, which has relied on hierarchy, silence and sometimes secrecy to fortify the gates around their communities. Those gates, never impermeable, have even more openings for the ongoing cultural and political exchanges between ultra-orthodox communities and everyone else. There are clearly changes on the horizon. And I’ve concluded that writing about these changes from a historical and cultural perspective is not, in the end, a form of moral cowardice. I believe it is my moral obligation. 

Ayala Fader is a cultural and linguistic anthropologist who teaches at Fordham University’s Department of Sociology and Anthropology.  She is the author of Mitzvah Girls: Bringing Up the Next Generation of Hasidi Jews in Brooklyn.

Nov 8, 2012

Ethical Standards for Thought Reform Consultants

A group of thought reform consultants, popularly known as exit counselors, propose detailed ethical standards to guide this new profession. In addition to a preamble, these standards include sections on the responsibility of consultants toward professionalism, toward clients, and toward the public. The second section outlines standards pertaining to the consulting relationship, confidentiality and records, and financial matters. The third section is divided into subsections on educational programs and advertising and presentation to the public.

Editor's Preface (Michael D. Langone, Editor of the Cultic Studies Journal)
In the mid-1970s increasing numbers of parents began to consult mental health professionals and clergy about their adult children=s involvements in new religious groups that many called cults. Parents reported that formerly well-adjusted and engaged young adults (many were college students) changed radically, sometimes over a short period of time. These young adults typically dropped out of school, shunned their families and friends, and devoted themselves full time to working for these strange new groups to which they had pledged their total allegiance. Many parents concluded that their children had undergone a type of brainwashing.

Unfortunately for these parents, few helping professionals took their concerns seriously. Most assumed that these parents were overprotective or that their children were merely "going through a phase." But a handful of professionals, including Dr. John Clark on the East Coast and Dr. Margaret Thaler Singer on the West Coast, listened to the parents and began to speak out publicly. Soon, small and loosely organized groups of parents began to form in different parts of the country.

Several of these groups joined to form the Citizens Freedom Foundation (CFF), later renamed the Cult Awareness Network (CAN). CAN became the leading grassroots organization for this movement. One informal group in Massachusetts gave birth, so to speak, to the American Family Foundation (AFF), which has become the leading professional organization concerned with cults and psychological manipulation. Both AFF and CFF/CAN were chartered in 1979.

While these groups were developing, parents were doing what they could to rescue their children and sometimes other family members from what were perceived as dangerous situations. Through trial and error, the controversial process of deprogramming developed. In the 1970s, for many parents, deprogramming became the preferred means of rescuing a cult member. Although initially the term deprogramming encompassed interventions that were voluntary (the cult member was free to leave at any time) and involuntary (restraint was used for at least part of the time), in time the term came to refer primarily to involuntary interventions. Much confusion occurs today when people mistakenly use deprogramming in its original sense because they unintentionally give the impression that they are talking about involuntary interventions when in fact they may be referring to voluntary interventions.

Even though incorrect, the widespread belief among many parents that (involuntary) deprogramming was their best, if not their only option was not as unreasonable at that time as it seems today. This belief was so widely held and so supported by media accounts that several state legislatures considered conservatorship legislation, which would have enabled the parents of a cult member to legally extricate him or her for psychiatric evaluation. Such legislation was tantamount to a legalization of deprogramming. Though arousing passionate opposition, this legislation garnered significant support. In New York state, for example, the legislature twice passed the legislation, only to have it vetoed by the governor. Ultimately, however, the opposition to deprogramming and the growing recognition of the effectiveness of less restrictive alternatives ended all legislative efforts for conservatorship bills.

Deprogramming was controversial because it involved forcing a cult member to listen to people relate information not available in the cults.

Cult members were sometimes abducted from the street; although more commonly they were simply prevented from leaving their homes, a vacation cabin, a motel room, or whatever location was chosen for the deprogramming process. Deprogrammings often succeeded in extricating the family member from the cult; one study found a success rate of 63%. Nevertheless, deprogrammings failed more often than many persons realized; and sometimes lawsuits were filed against parents and deprogrammers.

Deprogrammings were arranged through informal, quasi-underground means. Much secrecy surrounded the process for many years. Mental health professionals were almost always "out of the loop" -- in part because most did not want to become involved for ethical and legal reasons and in part because their expertise was to a large extent irrelevant to the deprogramming itself. The main role of the mental health professional was to help families cope with their alarm about a family member in a cult and to help former cult members and their families cope with the many problems that accompanied reentry into mainstream society. However, sometimes mental health professionals, clergy persons, or former cult members were able to persuade those still in a cult to talk voluntarily about their cult involvements. Sometimes these conversations resulted in a decision to leave the cult.

Because of these successes, the legal risks entailed in deprogramming, and the ethical discomfort many parents and deprogrammers felt, non-coercive means of helping cult members reevaluate their cult affiliations began to get more attention. By the mid-1980s it had become clear to many persons that what had come to be called exit counseling was at least as effective as deprogramming and certainly was much less risky--psychologically as well as legally. A few individuals committed themselves to doing exit counseling and refused to do "involuntaries."

Even within the exit counseling field, further branching off has occurred. Some tend to be technique oriented and/or advance a particular religious perspective. Others are information oriented. They introduce themselves as individuals with important information. Although they may have a preference regarding how the cult member chooses to respond to that information, they take pains to avoid manipulating the cult member.

During the past few years, some exit counselors, who prefer to be known as thought reform consultants, have been trying to professionalize their field by establishing ethical and competency criteria. Although this process of professionalization continues, the following set of ethical standards developed by a group of exit counselors demonstrates how much this field has developed during the past 20 years.

History of cult interventions,deprogramming, exit counseling

Thought reform includes the use of highly manipulative methods and processes such as undue social and psychological influence, behavioral modification techniques, disguised hypnosis and trance induction, and other physiological and psychological influence techniques. These techniques are used in a coordinated and systematic way without the informed consent of an individual. Thought reform is commonly associated with cults, but it can occur in other contexts. For our purposes here, cult refers to groups that tend to be deceptive, psychologically and/or physically abusive, and exploitatively manipulative.

Many different approaches have been applied to the problem of freeing people from the hold of thought reform programs. Early in the history of the problem, some concerned families resorted to methods which we in the 1990’s, consider unethical. Deprogramming was the process of countering the cults’ programming; the process often meant taking adult children off the street or detaining them until they listened to a detailed critique of the cultic group.

Later, as the techniques and process evolved, the term exit counseling was adopted, indicating a voluntary respectful approach. However, there was no universal consensus among those in the field about ethical criteria. This created some problems. First, anyone could declare him- or herself as an exit counselor. Second, the terms exit counseling and deprogramming were often confused and used interchangeably. The labels did not indicate what the individuals were doing or their competency, ethics, or approach. 

The ethical standards here have been developed and subscribed to by approximately twelve consultants. We prefer the term thought reform consultant to describe our profession.


Consultation refers to a voluntary relationship between a professional helper and help-needing individual, family, group, or social unit in which the consultant is providing information that enables client(s) to more clearly define and solve the problem(s) for which they sought consultation.

Thought reform consultation is the presentation of information concerning the principles and practical applications of thought reform. This presentation is done in a manner that is legal and conforms to the following ethical standards.

The consultation involves a respectful dialogue in an open environment, supplemented by educational materials, such as pertinent literature, generic source materials, informational multi-media presentations, and personal testimonies.

A Thought Reform Consultant is an individual who conducts these consultations and voluntarily agrees to abide by these ethical standards.
The existence of ethical standards also stimulates consultants to show greater concern for their own professional functioning and for the conduct of fellow professionals, such as educators, counselors, psychologists, psychiatrists, social workers, clergy, and others in the helping professions.

As an ethical code, this document establishes principles that define the ethical behavior of those who have subscribed to it.



  • Each individual subscribing consultant influences the development of the profession through continuous efforts to improve professional practices, teaching, services, and research. Professional growth continues throughout the consultant’s career and is exemplified by the development of a set of criteria that defines why and how a consultant functions in the helping relationship.
  • To ensure competent service, subscribing consultants recognize the need for continued sharing of information.
  • Subscribing consultants will obtain a minimum amount of continuing education credits agreed upon by the majority of consultants subscribing to these standards.
  • Each subscribing consultant has an obligation to continued professional growth, including active participation in the meetings of fellow consultants as well as participation in research and public education programs.
  • Subscribing consultants are encouraged to devote a portion of their time to related work for which there is little or no financial return.



    This section refers to practices and procedures of individual and/or group consulting relationships.
    The term "client" herein is defined as: the person(s) coming to a consultant for guidance or information in order to help an individual involved in a cultic relationship. If the client decides to pursue an intervention aimed at helping the involved person reevaluate his or her commitment to the group practicing thought reform, the involved person becomes the primary "client" when the intervention begins.

    A. General Standards for the Consulting Relationship

    1. The subscribing consultant’s primary obligation is to respect the integrity and promote the welfare of the client(s), whether the client(s) is (are) assisted individually or in a group relationship.
    2. When working with clients, a subscribing consultant avoids discrimination due to race, religion, sex, political affiliation, social or economic status, or choice of lifestyle.
    3. When a subscribing consultant cannot offer service for any reason, he or she will make appropriate referrals, when possible.
    4. A subscribing consultant will not use his or her consulting relationship for personal needs or to further religious, political, or business interests.
    5. A subscribing consultant will not employ methods or techniques such as neuro-linguistics programming, hypnosis or Ericksonian hypnosis or other techniques similar to those employed by cult groups without fully informed consent of the client.
    6. Subscribing consultants recognize their boundaries of competence and provide only those services for which they are qualified by training or experience. Consultants should only accept those cases for which they are qualified.
    7. The consulting relationship must be one in which client self-direction is encouraged and cultivated. The subscribing consultant must maintain this role consistently and not become a decision-maker for the client or create within the client a future dependency on the consultant.
    8. The Human Services field is becoming increasingly complex and specialized. Few thought reform consultants are able to deal with every cult problem, and many potential clients have difficulty determining the competence of thought reform consultants. Selecting one is difficult because of the lack of knowledge about pertinent qualifications. In some cases, stress itself may impair judgment. Subscribing consultants should help potential clients make informed evaluations of consultants they are considering.
    9. The subscribing consultant must inform the client of the purposes, goals, rules of procedure, and limitations that may affect the relationship at or before the time the consulting relationship is begun.
    10. Before an intervention can be initiated, subscribing consultants and client(s) must agree on the definition of the problem, the goals of the intervention, and the range of possible consequences.
    11. A subscribing consultant must inform the concerned party(ies) that should a client be prevented from leaving the site of the consultation or physically restrained in any manner (unless legally sanctioned permission has been obtained); the consultant will terminate the consultation immediately.
    12. After obtaining the client’s permission (if confidentiality is placed at risk), a subscribing consultant may choose to consult with any other professionally competent person about a client or aspects of the situation. If the client refuses to allow consultant to seek outside consultation when the consultant deems such consultation necessary, the consultant should consider terminating with that client.
    13. When the subscribing consultant is engaged in individual or group consulting (e.g., group sessions with persons who have walked away from cultic relationships with individuals and/or groups), the consultant should be cognizant of mental health resources available.
    14. Ethical behavior among professional associates, including consultants subscribing to these ethical standards and those not subscribing, must be expected at all times. When information is possessed that raises doubt as to the ethical behavior of professional colleagues, whether subscribing consultants or peer consultants, the member should take action to attempt to rectify such a condition. Such action shall use the procedures established by these ethical standards.
    15. The subscribing consultant must have a high degree of self-awareness of his or her own values, knowledge, skills, limitations, and needs in entering a helping relationship that involves decision-making capacity and critical thinking skills, and that the focus of the relationship should be on the issues to be resolved and not on the person(s) presenting the problem.
    16. Dual relationships with clients that might impair the consultant’s objectivity and professional judgment (e.g., with close friends or relatives) should be avoided and/or the consulting relationship terminated through referral to another competent professional.
    17. Subscribing consultants do not condone or engage in sexual harassment, which is defined as deliberate or repeated comments, gestures, or physical contacts of a sexual nature.
    18. The subscribing consultant will avoid any type of sexual contact with clients. Sexual relationships with clients are unethical and are forbidden.
    19. When the subscribing consultant concludes that he or she cannot be of professional assistance to the client, the consultant must terminate the relationship.
    20. A subscribing consultant has an obligation to withdraw from a consulting relationship if it is believed that employment will result in violation of the Ethical Standards.
    21. If subscribing consultants encounter situations in which appropriate ethical behavior is not clear, they should seek the advice of the Ethics Committee. 

    B.  Confidentiality and Record

    1. Records of the consulting relationship, including interview notes, family intake information, correspondence, tape recordings, electronic data storage, and other documents are to be considered confidential information. Revelation to others of such material must occur only upon the expressed written consent of the client.
    2. Use of data derived from a consulting relationship for purposes of consultant training or research shall be confined to content that can be disguised to protect the identity of the subject client unless written permission of the client is obtained.

    C. Financial matters

    1. A subscribing consultant recognizes the importance of clear understandings on financial matters with clients. Arrangements for payments are settled at the beginning of the consultation relationship. Each consultant will provide a written and dated schedule of fees to potential clients.
    2. In establishing fees for professional services, subscribing consultants must consider the financial status of clients and family. In the event that the established fee structure is inappropriate for a client, consultants are encouraged to assist families in finding appropriate and available services at an acceptable cost.
    3. A subscribing consultant will neither offer nor accept payment for referrals, and will actively seek all significant information from the source of referral (with the permission of the client).


    Responsibility Toward the Public

    A. Educational Programs

    1. Products or services provided by the subscribing consultant in interventions, public lectures, demonstrations, written articles, radio or television programs, or other types of media must meet the criteria cited in these standards.
    2. When subscribing consultants provide information to the public or to subordinates, peers, or colleagues, they have a responsibility to ensure that case-related information is sufficiently disguised to protect confidentiality and that other information is as unbiased and factual as possible.

    B. Advertising and Presentation to the Public

    1. A subscribing consultant shall not, on his or her own behalf or on behalf of a partner or associate or any other thought reform consultant subscribing to these ethical standards, use or participate in the use of any form of paid public advertising of services which: a. Inappropriately uses statistical data or other information based on past performance or prediction of future success; b. Contains a testimonial about or endorsement of a thought reform consultant; c. Is intended or is likely to attract clients by use of self-praise.
    2. The subscribing consultant neither claims nor implies professional qualifications exceeding those possessed and is responsible for correcting any misrepresentations of these qualifications by others.
    3. Subscribing consultants may not compensate another person for recommending him or her, or to encourage future recommendations. Advertisements and public communications, whether in directories, announcement cards, newspapers or on radio to television, should be formulated to convey information that is necessary to make an appropriate selection. Self-praising should be avoided.
    4. In advertising services as a private consultant, the subscribing consultant must advertise the services in a manner that accurately informs the public of professional services, expense, and available techniques of consulting.
    5. The subscribing consultant may list the following: highest relevant degree, type and level of certification and/or license, address, telephone number, and type and/or description of services. Such information must not contain false, inaccurate, misleading, partial, out-of-context, or deceptive material or statements.
    6. Subscribing consultants do not present their affiliation with any organization in such a way that would imply inaccurate sponsorship or certification by that organization.
    7. A subscribing consultant shall not knowingly make a representation about his or her ability, background, or experience, or that of a partner or associate, or about the fee or any other aspect of a proposed professional engagement, that is false, fraudulent, misleading, or deceptive, and that might reasonably be expected to induce reliance by a member of the public.
    8. Without limitation, a false, fraudulent, misleading or deceptive statement or claim in this context includes a statement or claim which: 
    a. Contains a material misrepresentation of fact;
    b. Omits any material fact that is necessary to make the statement, in light of all circumstances, from being misleading;
    c. Is intended or is likely to create an unqualified expectation;
    d. Relates to professional fees other than:

    1. a statement of the fee for an initial consultation; a statement of the fee charged for a specific service and any refund policy;
    2. a statement of the range of fees for specifically described services, provided there is a reasonable disclosure of relevant variables and considerations so that the statement is not likely to be misunderstood;
    3. a statement of specified hourly or daily rates provided the statement makes clear that the total charge will vary according to the number of hours or days devoted to the matter.
    From "Ethical Standards for Thought Reform Consultants" by Carol Giambalvo, Joseph Kelly, Patrick Ryan, & Madeleine Landau Tobias, in Cultic Studies Journal, Volume 13, No.1, 1996.

    Ethical Codes or Standards of the following organizations:

    American Association for Marriage; Family Therapy, National Association of Social Workers, Standards for the Private Practice of Clinical Social Work,American Psychiatric Association, National Academy of Certified Clinical Mental Health Counselors.

    Approved 11/94 Revised 11/95  ATRC All rights reserved.