Duped and Recouped

Duped and Recouped

by Nancy Fishman, PhD and Jeffrey Kottler, PhD
Empathy and compassion generally serve us well with our clients, but aren't necessarily the skills we need to navigate the world of running a practice. This story, excerpted from Duped: Lies and Deception in Psychotherapy serves as a cautionary tale.
Filed Under: Humor, Practice Management


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A Business Venture

As a young therapist in a solo practice, I routinely met a colleague for breakfast and peer supervision. I arrived at the neighborhood deli to find my former group therapy instructor waiting for me; his broad, toothy grin and Pacific-blue eyes were electric with anticipation. We had met during my doctoral studies.
I laughed. “What’s up?” “I thought you’d never ask!” blurted a very excited Jeffrey Kottler.

He then proceeded to explain that he had answered an ad for a clinical therapist. When he went to the interview, he convinced the clinic owner to sell him two-thirds of a Blue Cross–approved outpatient psychiatric clinic (OPC). Jeffrey and another therapist/ friend would operate its satellite, located in a busy Detroit suburb. This was a rather significant coup since there was a moratorium on the opening of any new clinics and the only way to own one was to purchase an existing clinic for a great deal of money.

“What?” I screamed. “Why didn’t you ask me to be your partner?” “I thought you were so happy in your little practice that I didn’t think you’d consider...” “Well, I do consider,” I interrupted petulantly. “Your other friend’s out; I’m in!” I declared.

And in that split second, Jeffrey and I committed to each other with complete trust and confidence to be partners in this venture. Were we merely trusting souls by nature, or was there something in our training as therapists that encouraged us to blindly trust people without reservation? Perhaps it was a shared personality trait that drew us into the profession originally and, likewise, into this partnership wherein we simply trusted what others say and how they characterize themselves.

There we were, Jeffrey and I, about 30 years old, masquerading as businesspeople, skipping due diligence, moving the satellite to new digs, signing a lease, buying furniture, hiring support staff, and interviewing dozens of therapists for positions in our new enterprise. We decided to hire only those professionals who seemed to be not only good clinicians but also fun people to hang out with at work.

We each paid a significant amount for our share of the business and began billing Blue Cross and other insurance companies for services rendered. Eventually we hired close to two dozen other therapists to work with us, all of whom met our criteria. In purchasing the clinic, we also inherited a few therapists and Dr. Jolly, our medical director. Dr. Jolly seemed competent enough and awfully amiable. What did we know?

Two months later, Dr. Jolly was caught soliciting sex in an airport men’s room. That was obviously the end of him! But the euphoria of owning our own business carried us through that initial setback. We justified our lack of judgment by claiming that we didn’t actually hire Dr. Jolly. And there were certainly other concerns to distract us.
The most pressing concern was the apparent snag in the money flow from Blue Cross to our third partner and then to us. With each passing week, we became increasingly more anxious about our bottom line.

Our daily calls to the partner, who was handling our billing, were met with sympathy and reassurance that these delays were quite normal in the industry. That seemed logical to us. After three months without payment, we suggested to him that we meet with Blue Cross to try to expedite the cash flow. “No!” he stressed emphatically and cautioned us that contact with Blue Cross would trigger an unwanted audit, which typically resulted in disastrous consequences. He asked us just to remain patient because his bookkeeper was receiving treatments for a brain tumor, immediately eliciting our sympathy.

At the end of the fifth month without payment, Jeffrey and I decided to take decisive action and confront this man who sold us the clinic. Alas, we discovered that all along he had been billing Blue Cross fraudulently. It also turned out that he didn’t actually own the clinic he sold us! It had all been a scam. We poured our hearts out to the executive at Blue Cross who agreed to hear our case, admitting that we had been duped but convincing him that we were honest and trustworthy professionals who were only trying to help people. Much to everyone’s surprise, he rewarded our honesty by assigning the provider number to Jeffrey and me. We were the first recipients of a new authorized clinic in many years.

Trusting souls that we were, we got back on our horses and rode into the sunset believing that enough had happened to us for a lifetime. At last we must be safe from all future peril. And now that we had lost our innocence, we were much better prepared for dealing with unexpected chaos running and operating a clinic. Little did we realize that our innocence and gullibility to deceit had only just begun.

Over the next year, we fired another medical director for inappropriate sexual conduct with his patients. Our part-time book- keeper was caught in a sting operation soliciting sex in a freeway men’s rest stop. One therapist went to jail for fraudulently billing Blue Cross; another therapist went to jail for practicing with a forged license and the malpractice insurance of a dead person; and still another therapist made an out-of-court settlement with a female patient with whom he had been having sex in the clinic after hours.

As therapists, Jeffrey and I erroneously thought that because we were skilled diagnosticians and experienced clinicians, we were inherently good judges of character. Yet time and again, we were duped by people we trusted. In truth, I think we projected onto everyone we encountered our own need to believe that all people are basically good. We refused to imagine that we were actually vulnerable.

It took at least three earth-shattering fiascos before I actually began to consider that I was somewhat responsible for the series of misfortunes that were raining upon us. For a while I became hypersensitive because I no longer trusted myself. I was suspicious of everyone around me, fearing that there were secrets lurking behind the facades of those I thought were loyal friends and colleagues. I was actually paranoid waiting for another shoe to drop. It was like walking through a minefield every day. I hated the feelings and retreated to my office where, ironically, I felt safe in interactions with my patients. After all, I expected them to have secrets under the surface and to be less than authentic with me since they were struggling to be authentic with themselves.

I had a very difficult time accepting that I was unable to fore- see the consequences of my gravitational pull toward people who would eventually fail my litmus test. My rose-colored glasses now had a double edge: While it had been wonderful to always see the good in people, I realized that I had been ignoring signs of trouble to preserve my need for everything to be okay. Challenging my inner belief system shocked me to the core. I had to ask myself, What am I supposed to be learning from these painful and frightening experiences?

To make sense of this episode in my life, I resorted to the only path I thought would yield any answers, self-exploration. And the first question to ask myself was, “What am I getting from this turmoil?” In every fiber of my being, I know that in all of us a self-healing power exists. I just had to figure out why it was so important for me to be telling myself that everything will be okay. After a rather difficult and circuitous route, I realized that the childhood trauma of having a terminally ill mother was the motivation to adopt the mantra everything will be okay. No matter what happened in my life, during childhood or during the years as a clinic owner, I had to believe that everything would eventually be okay. So when each betrayal occurred, I quickly resumed my position as sentinel for my inner belief system and continued to guard the hell out of it.

The personal lesson in all of this is not in the failings of judgment but rather in the repetition of the failings. If I had ruminated on each betrayal and become stuck in the quagmire of details, I would not have heard my inner voice beckoning me to attend to a significant piece of unfinished business. My echoing mantra held the key to the reason for it all. I was duped over and over because I needed to find my own place in the drama.

Once I acknowledged my role, I no longer felt vulnerable or paranoid. My trust in the basic goodness in people returned. I was again unafraid of the goodness of my own heart. In truth, I have made only a very slight change in myself; I am no longer surprised when my expectations for others are dashed. But I consciously refuse to surrender my eagerness to seek the best in people. In the end, I would rather suffer the occasional betrayals than cut out my own heart.

The many episodes of being duped during my ownership of the clinic resulted in an amazing gift to me as a therapist. I learned to help my patients honor their own inner voices. I became better able to observe the ways they guard their inner beliefs and became better skilled at diagnosing why. Ultimately, I learned that, inherent in the repetition of turmoil and struggle, there is always an unfinished piece; when addressed, confronted and honored, calm and balance can be restored.

Jeffrey’s Personal Commentary

Reading Nancy’s story about the trials and tribulations we experienced during our sojourn as clinic directors reminded me of how deeply I buried this chapter in my life. Over the years I’ve talked about the incredible lies, deception, manipulation, intrigue, and immorality that took place under our roof. Like Nancy, I blamed myself for my naïveté and innocence, and for our collective inclination to believe the best in people, even in the face of contradictory evidence. As psychologists, we deluded ourselves into thinking that because of our sensitivity, caring, and clinical acumen, we could tell when people were trying to fool us.

I felt both surprised and moved by Nancy’s confession and acceptance of responsibility for our plight. Nancy describes what she considers “the key to the reason for it all,” as if there was a single mistake or misjudgment on her part that led to the debacle and serial betrayals. Yet in my version of the narrative, or at least my remembrance of what happened, I have also accepted full responsibility for our innocence and misplaced trust in others. Like Nancy, I also found it easy to be forgiving, not only of those who crossed the line, but mostly of ourselves. We were inexperienced in the domain of business. We applied the trusting attitude that serves us well as therapists to another context in which different rules operated—and I see that as our biggest error.

Speaking for myself, I learned some hard lessons about the limits of my ability to read people and uncover so-called truth. Yet these therapists were our friends; they were people we trusted; they were professionals with track records and sterling reputations among their colleagues. Even more disturbing, they were also good therapists and had very successful practices.

Whereas Nancy talks about this repeated deception as a gift, an important lesson learned, it took me many years to come to terms with my lapses in judgment. Eventually, I did rekindle trust, enough so that I still prefer to give people (clients and colleagues) the benefit of the doubt.

As I read over Nancy’s version of the story, and then consider my own narrative, I find it interesting that each of us blames ourselves (instead of the other) for the crazy things that took place under our watch. We mistakenly assumed that because we operate from a position of transparency and honesty, that our colleagues, whom we carefully screened and supervised, would do so as well. That was a huge mistake, one that changed the way I function in some arenas in that I am more cautious and skeptical at times. Yet I think we have both been able to maintain a deep faith in the ability and willingness of most people to do the right thing.

Copyright © 2010 Routledge. Reprinted with permission.
Nancy Fishman, PhD has a solo (no surprise) private psychotherapy practice in Birmingham, Michigan, and specializes in marriage and family counseling and collaborative divorce.

Jeffrey A. Kottler, PhD is Professor of the Department of Counseling at California State University, Fullerton. Dr. Kottler has been a Fulbright Scholar in Iceland and Peru, as well as having lectured extensively around the world. He is also President and Co-Founder of the Empower Nepali Girls Foundation which provides educational scholarships for lower caste girls in rural Nepal who would otherwise be unable to attend school. Dr. Kottler has authored 80 books in psychology, education, and counseling, including On Being a Therapist, The Imperfect Therapist: Learning From Failure in Therapeutic Practice, Compassionate Therapy: Working With Difficult Clients, and The Assassin and the Therapist: An exploration of Truth in Psychotherapy and in Life. He co-edited Duped: Lies and Deception in Psychotherapy, from which this story was excerpted.