(Prepare for the longest book review I have ever written:) I absolutely do not want to take away from the validity of Christie Tate's experiences as she lived them, but I worry that the lack of insight and critical reflection present in her memoir has the potential to lead to really harmful and misleading views of counseling.
At best, some of the treatment methods used by Dr. Rosen were not best practice, but at worst there were major ethical violations. As Christie recounts her experiences, the lack of acknowledgment of the unethical nature of these practices reads like an implicit stamp of approval. Actually, Christie and her fellow group mates seem to have an inflated and warped view of Dr. Rosen such that he is a brilliant man who can do no wrong, and any continued personal struggles they might have are a result of their own failures as clients, not the completely inappropriate treatment their therapist is providing.
To name *just a few* of the major therapeutic red flags in this book:
1. Conflict of Interest - when Christie has her intake appointment with Dr. Rosen, she realizes they were in the same eating disorder recovery group years ago. This is a HUGE conflict of interest, and ethically Dr. Rosen never should have taken her on as a client in the first place.
2. Confidentiality - in all of Dr. Rosen's groups, confidentiality is actively discouraged, and group members are instructed to keep no secrets from the group, and are chastised or isolated when they do. The foundation of a secure therapeutic relationship is confidentiality, and the fact that this was taken away from all group members is completely inappropriate and likely counterintuitive to progress.
3. Limits of Confidentiality/Self Harm - while confidentiality is incredibly important in therapeutic relationships, mental health providers are ethically obligated to intervene if a client shares threat of harm to self or others. At one point in her memoir, Christie sends Dr. Rosen an email that is screaming of suicidal ideation, and he IGNORES IT until she comes back to group therapy days later, to...what? Teach her a lesson? It worked out for Dr. Rosen in this case, but come on. You can literally lose your license for this kind of thing. ALSO, Christie harms herself multiple times during group (like actively bleeds), and Dr. Rosen just passively observes, at most getting some Neosporin to patch her up after one particularly rough session. 100% not okay.
4. Emotional Boundaries - Dr. Rosen crosses so many boundaries with his clients it is honestly cringey. While he may have technically been practicing within the scope of his license, I feel like a majority of the strategies he used completely disregarded best practice or were just super inappropriate. For example, rather than providing medication (which is a valid and research-based form of treatment for some people), he provided "prescriptions" to clients that basically amounted to dares they needed to complete for his approval. It almost seemed as though he was emotionally manipulating vulnerable clients for his own entertainment, just to see how far he could push them. For example, he encouraged Christie to engage in an affair with a married man (who was also in her group, btw), and at one point "prescribed" Christie to tell one of her colleagues something incredibly racy and inappropriate. He created such co-dependent relationships with his clients. A counselor's job is to help you better understand yourself, your actions, your motivations, so that you can learn from them and determine how YOU want to make decisions in the future, not be reliant on your therapist to make every life decision for you. Maybe this is why so many members of Rosen groups have proudly been in therapy with him for 10+ years, which is absolutely not the goal of therapy (also feels like a money grab on Rosen's part?). What methods are really being used here? It is telling that there is no goal setting, no use of a specific therapeutic framework.
5. Physical Boundaries - During one group session, Dr. Rosen literally cradles Christie's entire body in his lap for the entirety of the 90 minutes....Nothing else really to add here.
I love that conversations about mental health are becoming more mainstream, but one of the dangers of pop psychology is accepting everything we are reading at face value without viewing it with the same critical lens we would any other scientific field. Hoping that anyone on the fence about seeking mental health resources doesn't view this book as the standard for ethical and research based counseling.