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Eating Disorders Residential Treatment Facility and Psychologist Sued by Former Patient

December 2, 2011

A Missouri eating disorders treatment center, Castlewood and one of its co-directors, psychologist Mark Schwartz, are being sued for malpractice in the Missouri Circuit Court by former patient Lisa Nasseff, who is reported to have been a patient, off and on for a total of 15 months, at the facility from 2007 through 2009 and also received outpatient therapy through 2010.  Please note that at this point, everything I am about to describe has the status of an allegation, as the case has not yet been heard and tried. Go here to read the full complaint by Lisa Nasseff against Castlewood and Dr. Schwartz.

The charges are very serious and include the allegations that false memories were implanted of sexual abuse, multiple rapes, Satanic ritual abuse, membership in a Satanic cult where serious crimes were committed, as well as convincing the patient that she had 20 multiple personalities. Lisa Nasseff is being represented by attorney Kenneth Vuylsteke. Nasseff alleges that Dr. Schwartz, as her therapist, hypnotized her and implanted false memories. Dr. Schwartz has spoken to the press and is completely denying the charges. Schwartz, who reported as of the date of that article that he had not retained legal counsel responded, “We don’t use hypnosis” although an introductory video on the website by clinical co-director Lori Galperin, when listing the various specialties of the staff, does mention hypnosis and it is also mentioned in a written description of staff specialties (see #5).

One of the main therapies used in the center is Internal Family Systems (IFS) and the website states that all staff are trained this approach. These cannot be said to be some rogue therapists misusing IFS because the creator of IFS, Richard Schwartz (not sure if he and Mark Schwartz are related), is listed as staff at Castlewood and reportedly trained all the staff in IFS.  Internal Family Systems is basically family systems, applied not to actual families, but to internal “parts” within a person. This approach has also been used by Dissociative Identity Disorder (DID) therapists although it does not necessarily have to be only for DID.  The IFS model is described on the Castlewood website. Several strong claims are made about IFS in the treatment of eating disorders, claiming that it helps the client to get to the root of the problem and find “parts” that may be sabotaging treatment success and hence, provides long-lasting results. However, I have been unable to find references to peer reviewed published outcome research that would support such claims.

On a side note, Steve Hassan has reported in a Psychology Today advertisement that he is trained in and utilizes IFS in his treatment of former cult members and this concerns me greatly, since I have not seen any evidence that it is effective and does no harm. This fits with his own theory that there is a “cult self” that has been created by cult indoctrination. Ironically, the description of IFS, the way parts are identified and located according to how they are felt in the body, bears some similarities to Scientology’s secret upper level called OT III, which also somaticizes “parts” that they call “body thetans”. Needless to say, IFS does not have the accompanying sci fi narrative as to how this came about, but I’ve often wondered if it is Scientology’s “parts work” that has damaged some on this level to the point they have had to be hospitalized or worse. Like IFS, Scientology promises, ironically, “return of full self determinism” by completing that level. Here we have a promise of return to an authentic self, free of influence, when the reality is all too often just the opposite. This may be the ultimate form of betrayal.

What I have learned since,  from my study of a large volume of social psychology literature is that no human being is completely free from influence. What we can do is learn about influence techniques and do the best we can to identify them when they occur, learn and practice critical thinking skills and apply them wherever possible, but to think that one is immune and fully self-determined is what makes us most vulnerable. The “authentic self” is an imperfect self and varies from individual to individual. Not all “authentic selves” are likable, charismatic, and good, as the IFS description implies. Although we are all born with the potential to be virtuous, we are not born with virtues, nor do I believe we are we born “evil”. Virtues have to be earned through our actions. My own point of view is that who we are, ultimately is the sum total of all we have done in our lives, some of it chosen and some of it not and subject to change, depending on what we are doing now and will do in the future. Note that I am saying all, not isolated acts or periods in our lives, taken out of context as we have all done things in our lives that we are less than proud of that do not have to be our identity, although smear propagandists would like to portray it that way. When a person admits to mistakes and strives to learn from them, that speaks volumes for who they are. When a person arrogantly refuses to admit mistakes and shows no remorse for causing harm (e.g. Conrad Murray in his most recent documentary) that also speaks volumes and those are the individuals who are indeed a danger to society.

In any case, although it is promoted as being just the opposite, IFS seems to be a convenient way not to take responsibility for ones own actions if someone does something he or she is not proud of (e.g. getting involved in a cult or behaving in a reprehensible manner or simply losing ones temper). According to IFS, it’s the “part” that did it and the real “self” is completely benign, honest, authentic and good. This also bears similarities to Scientology’s conception of the native state of a spiritual being, aka, the thetan. It is highly questionable if IFS is helpful and not harmful for anyone, let alone former cult members. It seems to complicate things unnecessarily. The client originates a feeling connected with a presenting problem and this gets labeled by the therapist as a “part” rather than simply a feeling. I can see how this would be a compelling belief, but the question remains, whether it is helpful or harmful. I raise these concerns, not to make claims, but I raise them as possibilities that need to be investigated. Although it is claimed that the goal is to integrate the parts, labeling and reinforcing them in this manner may result in further fragmentation and since at this point this is clinical lore that hasn’t been subjected to randomized controlled trials, we simply do not know and it should be labeled experimental outlining possible risks to clients, if therapists are determined to use it. There may be people who genuinely befit from such an approach, even if it turns out that others were harmed. No therapy or therapist is 100% harmful all the time for everyone. I point this out because often this becomes a primary form of defense, showing testimonials of people who feel they were helped. Although this may be the case (not necessarily because testimonials are not evidence, even for the individuals who give them since it is possible for a person to believe he or she is better when that actually is not the case and testimonials can easily be faked), it does not in any disprove that others were harmed, as the differences in outcomes are not mutually exclusive and can coexist. The State of California v Conrad Murray in the death of Michael Jackson clearly illustrates this, as I have no doubt that when he practiced standard medicine, he truly did save lives and help the patients who testified for him who appeared to be very honest and credible individuals, yet with Michael Jackson, he was found guilty of egregious violations and he richly deserved every word uttered by Judge Michael Pastor and his ensuing sentence, regardless of who he helped in the past. Whether that is the case with Castlewood, remains to be seen, but thankfully no one has died there, as far as I know but there are allegations of serious damage, at great expense. Since Castlewood uses a wide variety of different modalities (some of them with an evidence-base, such as DBT) and treatment varies by individual, some individuals may well have benefited from their treatment there. Whether some individuals have been harmed, remains to be seen. The evidence presented in this case, if it continues, or if others come forward, will reveal whether this is the case.

Nasseff’s allegations that she was alienated from family members is particularly concerning since family therapy (with an actual family, not an internal “parts” family) is an empirically supported approach to eating disorders. In other words, family support is very important and can be very helpful in recovery. The therapies shown to work for eating disorders are those such as Cognitive-Behavioral therapy that deal with the present and interpersonal therapy is helpful with relationships and systems of support. There is no good evidence that going back into the past and hunting for trauma is helpful, nor is there evidence of a causal relationship between trauma and eating disorders (correlation is not necessarily causation).

Although Mark Schwartz is vigorously denying the allegations in the complaint, according to legal counsel Vuylsteke, there are “several” other former patients who are alleging similar experiences and thus corroborating Nasseff’s allegations and may come forward at some point.

It is also interesting to note that Mark Schwartz has presented at ISST-D conferences, as recently as 2010 and is listed as a therapist in their membership referral database on the ISST-D website. Recently, some other high profile members of ISST-D, such as Dr. Richard Kluft, have maintained that the memories of satanic cults are screen memories for other forms of abuse. However, Nasseff alleges in her complaint that she was threatened by Dr. Schwartz that if she were to come forward and sue him, the crimes she revealed in therapy to have perpetrated as part of the alleged Satanic cult, would have to come out. If this allegation is shown to be true, the it would mean that at least by some therapists, these memories are believed to literally be true. Time will tell as the evidence unfolds, whether or not this is the case. Will ISST-D support and defend Dr. Schwartz, as they have earlier defendants such as Judith Peterson? Again, time will tell.

Although there were a number of very high profile recovered memory lawsuits in the 1990s, this recent lawsuit, if Nasseff’s allegations are proven in a court of law, would show that, as I have long suspected, such therapy has not ceased but has merely gone underground and not publicly discussed and indeed, Dr. Schwartz has denied that he has ever discussed Satanic cults with the plaintiff. It will be interesting to see how this case proceeds and plays out and this is a case I will continue to follow with great interest.

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26 Comments
  1. Adam Rosen permalink

    Monica –
    I appreciate some of the concerns you voice in your post re: the allegations (not proven, we should add) in the Castlewood case. I DO hope that you will find some interest in reading some of the key texts in IFS and perhaps finding your way to speak with some number of therapists and patients. The allegations in that case are in no way typical for IFS treatment.. (Internal Family Systems Therapy 1995 and Introduction to Internal Family Systems Therapy – are good books to start with) If you plan to opine further on the issue, I hope you will invest the effort to obtain a more informed viewpoint on what is generally emerging to be a very valuable treatment, which combines some very useful aspects of many other forms of work – and of course needs to engage in useful and important research as part of its next stages of evolution (the fate of all innovations in any field). Feel free to be in touch with me for some further perspectives and data that is being collected. I don’t speak for the IFS world – just for my own views and concerns on these issues. Best regards, Adam Rosen, J.D., Ph.D, Cambridge, MA

    • Thank you for your comment, Adam. If you reread my very first paragraph, you’ll see that I clearly stated from the outset they were, at this point, allegations and that I am waiting to see how the case unfolds. My comments are not about the case, per se, but rather, about IFS and some of what, in my opinion, are red flags on the website.

      You seem to be implying that IFS as practiced at Castlewood is not representative of genuine IFS or typical. Are you aware that the developer of IFS is listed as “Staff” at Castlewood on their website and it says on their website that all their staff have been personally trained by him? Who better than the Founder of a therapy to represent it? But then again, how would one know what is a “typical” result when as far as I have been able to determine, there is so little research.

      I am actually familiar with other forms of parts work and have seen enough potential drawbacks to it, to be cautious and, as with any form of treatment, expect there to be research evidence, rather than anecdotal success stories from therapists and/or clients. I have learned that I can find rave reviews about just about any treatment from therapists, if I look for them, but that is not enough evidence that a treatment is safe and effective. However, I am always open to evidence that it is safe and effective. Are you aware of any randomized clinical trials published in peer reviewed journals on IFS? If so, I would very much appreciate references to such. If not, are there at least any well-designed pilot studies published in peer reviewed journals?

      You state that research would be a next important step. With all due respect, Adam, I think you have your sequence backwards. Treatments ought to be tested for safety and efficacy before certification trainings are marketed to other therapists and before they are delivered to paying clients, not after. What would you say if a doctor was prescribing a drug to patients, saying — oh, research would be our next step?

      I see you are a JD, so I am sure you have an appreciation for informed consent. What sort of informed consent ought to be provided to clients, given the lack of randomized clinical trials? Are clients informed that they are being given an experimental treatment and informed that while some clients have reported what they consider to be positive effects, others have reported what they consider to be harmful effects? In my opinion, at the very least, clients ought to be made well aware of whether the treatment they’re getting is experimental, before they proceed. Also, when people consent to participate in drug clinical trials, they can do so only after the well established drugs have been tried and failed. If someone has an eating disorder, for example, have CBT and family therapy, done according to the protocols that have evidence, been tried before the experimental ones?

      Whether I have read the major books on IFS really isn’t as relevant here, as is a request and expectation that there be evidence for claims being made. Something can look and sound very good in books, on paper, but when the treatment is tested, the results are not what is claimed, which is why I have learned that the burden of proof is on the one making the claims. What concerns and raises red flags for me is when certification trainings are being held on methods that have not been well tested before they are marketed, but again, if there are randomized clinical trials I may have overlooked, I would appreciate references.

      • Mrs. Stevens permalink

        Dr. Pignotti, you say in this article, “There is no good evidence that going back into the past and hunting for trauma is helpful, nor is there evidence of a causal relationship between trauma and eating disorders (correlation is not necessarily causation).”

        Is it harmful to go back to the past and revisit trauma, or is it helpful? Is there a way for DIDs to recover without revisiting the past? Is it helpful to go back to the past through other parts or personalities as with IFS therapy?

      • Lauren permalink

        Thank you very much, Dr. Pignotti, for voicing all of these concerns publicly. I am a clinical psychology doctoral student, and I am extremely concerned about the fact that patients are paying thousands of dollars to have their loved ones receive a unvalidated treatment. I find it highly unethical that therapists are allowing clients are paying thousands of dollars and investing months of time in it, especially if they are not informing clients that this treatment is experimental before accepting such large monetary and time investments in it. Patients/mental health consumers should be informed if they are receiving experimental treatment. If I found out that i had spent huge sums of money on an experimental treatment without being informed that it was experimental, I would be livid. Better yet, why are insurance companies paying for this?? Are they aware when patients are receiving IFS that they are receiving a treatment that lacks any empirical support?

        I recently came across two therapists that were using IFS work with clients, which is why I became interested in this issue. While some of the aspects of this treatment seem possibly acceptable, some if it is, to be quite honest, bizarre. For example, referring to “little girls” or “little boys” inside of you??? Because of the lack of data, it is totally unknown as to whether IFS is better or worse than generally supportive psychotherapy or other empirically supported interventions for eating disorders (i.e., DBT, CBT).

  2. Patricia L. Papernow permalink

    Dear Monica,
    I certainly understand the concern about a cult mentality. However, you are making a number of accusations about IFS, in a public forum, with apparently little knowledge about the actual methodology. IFS is among the most deeply respectful approaches I have ever encountered in my three decades as a psychologist. I hope you will check out some of your assumptions.
    Yours,
    Patricia Papernow, Ed.D.
    Psychologist
    Clinical Instructor in Psychology, Dept of Psychiatry, Harvard Medical School

    • Patricia,

      I initially wrote a response to your comment, but on second thought, decided that the comments by IFS proponents really deserve a separate blog article in response because it has become clear to me that there are a number of misconceptions about what it means to be engaged in evidence-based practice and why it is important to do actual research before marketing a new therapy to others. I will be responding in a separate article and will post the link when I am done.

      I am not making “accusations”. I am expressing my concerns and I am very thankful that we do have freedom of speech to express our sincerely held concerns and opinions publicly, something I have fought for in court and won, by the way, so this is not a right I take for granted. Whether or not something is respectful is not a statement that is factual in nature (although I did not say it was not respectful, I have concerns about how this could be used by people as an ego saving device, to not take responsibility for their actions, saying they were the victim of a “part” (“hijacked” is the word I heard Schwartz use on a video)). It is a judgment call and hence, would be considered opinion. If I have gotten any actual facts wrong, please do feel free to post factual evidence to refute me if you have any.

      I hope you are not suggesting that I must pay for IFS training in order to criticize IFS because that would create a very closed system and mean that only people with a vested interest in it would be able to criticize it. There is a rather large body of social science research showing that the more someone invests in something, the more adamant they are in defending it so it is a rather chilling thought that critics would be silenced just because they have not bought trianing. If you have any freely available information to refute me, please feel free to post it.

  3. Adam Rosen permalink

    Monica –

    Your statements about the virtues of effective testing are obviously well taken. A few kind of practical / real clinical world questions do arise for me from that, which would be helpful to know your sense of what ideal practice would be in these areas – and then a couple concerns – where I feel that maybe you somewhat concerningly deviate from your own apparent emphasis on empiricism. So a few questions:

    1) What for you is the right trajectory, in your view, for a novel therapy to go from creative spark to weaving together some of its procedural pieces, seeing how it works, etc. What role is there for trying this in development with your patients. Not at all? Some, but with sufficient informed consent? Is it your sense that a series of controlled clinical trials is the only first gateway that must be satisfied before any paying treatment should occur? Are you actually aware of models that have been successfully developed and established in this manner?

    2) Do you have concern that adherence to your framework would work against clinical innovation? If not, what’s your sense of how that would work?

    3) What would you say to a person who has HAD multiple supposedly empircally validated treatments and has had very little movement and still suffers greatly (e.g. perhaps they are wed to their depressogenic cognitions in a motivated way for a motivated reason despite the demonstrated depressogenesis). And what would you say to them if they then had a very positive very healing and self-improving experience in IFS. Would your suggestion to them be that they should stop that treatment and go back to CBT or DBT? I appreciate that your observations are perhaps on a more macro level, but I”m curious what your stance would be on something like this.

    4) Some of your later comments concerned me regarding what would appear to be a degree of abandonment of empiricism (e.g. investment in accuracy). Where you speculate about whether IFS seeks to absolve people of responsibility. That’s a thought that you have that is no more empirical than the conclusions of people who have actually seen the impacts of these therapies. I do appreicate that it’s your right to say what you will – but do you feel that that is fair or consistent with your elevation of “proof” that you put to testing therapies.

    There are a few other points that suggested themselves, but this may help an exchange on these ideas for now.

    I am glad you are concerned about people getting good treatment, but I also worry that a stance of real intolerance towards evolving therapies may have some unfortunate features to it as well. Do you have concerns about that at all?

    Thanks.

    Adam

    • Adam,

      I will respond more fully to your points later, but I wanted to immediately correct a major misunderstanding regarding your perception that I have “abandoned empiricism” in my writings. Where did i say people need to have a controlled study behind each and every statement they make in their writings? I have no such expectation, for myself or for others. I am advocating empiricism in practice with clients. That does not preclude coming to rational, philosophical conclusions about the underlying premises in what one reads. The abandonment of responsibility is a logical, philosophical possibility that may very well come from the philosophical underpinnings of IFS. It appears to be an ego-saving device. When someone does something that contradicts their idealized self-image, it is very attractive to say that it is a “part” that did it, not the real self. In any case, the key point here is about claims that practicing therapists are making about therapies that they are delivering to clients. My point about abandonment of responsibility was a philosophical one, not a claim I am making about an intervention that I am marketing to clients. Just the opposite. If proper research were done on IFS and proponents had accepted their burden of proof (as opposed to attempting to reverse it and put it on the critics), my point about abandonment of responsibility would not need to even be raised. The burden of proof is on the one making the claims for these therapies. My point in bringing that up is that since IFS is untested for safety and efficacy, there are all kinds of possible ways in which it may do harm and the burden of proof is on you, the proponent, to demonstrate that it is safe and efficacious. Critics may legitimately raise concerns about untested therapies and that in no way contradicts the need for empirical testing of a therapy.

      Also it is a very serious misunderstanding is that EBP negates innovation and creativity. It does not in any way need to do that (unless one wants to define “creativity” as doing whatever one pleases without regard for its impact on the client). If you want to see an example of an innovative therapy that is developing in an evidence-based manner, look at Acceptance and Commitment Therapy (ACT). ACT is every bit as innovative and creative as any therapy I have ever seen, but from the very beginning, its developer has very actively encouraged and conducted research and proponents have been very careful not to make it into a proprietary training.

      As for what if there are no empirically supported treatments or the ones that do exist are not working, I have actually covered this in some depth in another article on this blog. That points to a misunderstanding of what EBP is. It does not mean rigidly using empirically supported treatments. It is about informed consent, using the treatments that have the best evidence first, not making unsupported claims about novel unsupported therapies being offered, not marketing expensive, proprietary trainings ahead of evidence, and clearly stating to the client that he or she is participating in an experimental treatment that has possible benefits and risks that may at this point be unknown due to its lack of research. If a client feels he or she has benefited from IFS and failed with CBT/DBT or some empirically supported treatment of course I would not suggest the client go back to what did not work for him or her. My point is, that without evidence, generalizations cannot be made about that positive experience to others and the client should not be used as a testimonial in marketing it to others. Right now, there appear to be both negative and positive anecdotes about IFS and we need research to sort this out. I have read positive testimonials about IFS, but I have also heard from people who did not have a positive experience with it and felt it did them harm.

      I am not “intolerant” of “evolving therapies”. What I do strongly object to is therapies that are marketed to clients and therapist trainings ahead of the evidence and that make claims that are not based in evidence. I object to clients being offered these therapies based on unsupported claims and not being fully informed that the therapy they are being given is experimental with possible benefits and risks. Evolving therapies need to be properly tested before they are disseminated and marketed to clients and other therapists. Again, look at the development of ACT for an example of how this can be done.

  4. Adam Rosen permalink

    What’s in a name..

    Monica –

    You are clearly a strong believer in your point of view – and put forward a pretty cogent articulation of it. But there are things about your stance that I find somewhat troubling – and I think are actually just logically in err.

    I do not dispute the idea that testing therapies can be a valuable thing to do. On the the other hand, isn’t it also true that a “validated” therapy in the hands of an unskilled therapist isn’t worth the paper the validation study is printed on?. I appreciate that that does not erode the idea that validation is mostly upside – but it does perhaps dilute the idea that validation is some kind of guarantee of efficacy – which it could be harmfully taken as – possibly more harmfully so that a positive therapeutic experience from a non-validated therapy

    Have you not seen many people come out of “validated” therapies with little to show for it? I know I have – and I have seen those same people have very positive experiences with IFS. What conclusions should those who have experienced that sort of thing say to us about the primacy of validation compared to clinical experience??

    You can certainly dispute the proveness of that claim, but do you think your dispute of that should move those who have directly experienced the efficacy of these processes? What stance do you suggest one takes where one has seen the positive impact of these processes – seen it – and also heard directly from patients how helpful and positive it has been for them? Should we not believe our eyes and ears and wait till someone can tell us in a journal what we already have seen for ourselves?

    Secondly – where you want a therapy to be validated – are you suggesting that where a therapist may have conceived of a useful iteration or recombination of other therapies – some of which have been shown to be effective – that the new name – new combination always requires new validation studies before implementation is reasonable? Is there no place in your world for clinical extrapolation? If your answer is no, do you know of a world where there is no such thing as clinical extrapolation? And where do you draw the line to say that the new method, where it may combine other methods – needs to have new empirical study before implementing a sensible and observedly useful combination of previously existing methods. If a method has elements of cognitive restructuring and has elements of mindfulness and elements of focusing — some of which have some established support – must the new combination undergo new study before one can believe one’s eyes and ears in how it works? Is it your position to say that a therapist skillfully combining elements of those is in a murky ethical ground in applying clinical judgment and experience in doing so? If your position is that the variance from manualized or established technique calls for that – do you not think that variance in how individual therapists apply the established therapy creates real questions about whether the particular approach of THAT therapist is valid?

    Although I do not wholly dismiss the value of considering validating experiments, I think some of these questions do beg the question about the degree utility of validation and possibly some dis-utility as well.

    I believe that the certitude you put forward about the essentiality of empirical validation just doesn’t match what people know about the complexity of human beings in interpersonal dialogue, including therapy. Do you not hold up a sacred cow that truly cannot wisely guide us as the exclusive compass in situations that may involve useful combinations of other methods?

    My general sense is that your advocacy for validation has merit and value – but your definitiveness about it as the sole gateway to legitimate clinical efficacy connotes that this enterprise is simpler than it is – and that there are not good pathways to clinical efficacy that do not pass through the laboratory – which as you know has some real limitations as well.

    There are other points you make that I think are worthy of response – but that’s all for now.

    Respectfully –

    Adam

    • Once again, you’ve given me a number of additional misconceptions about evidence based practice that I will need to address in a separate posting, but just to cut to bare premises, your arguments seem to be based on upon the philosophical position of naive realism. Can we trust our eyes and ears? For everyday matters, yes, and we can certainly use observations as a starting point for then doing testing. But we cannot just simply take in therapy results we perceive with our senses and draw conclusions from them for a number of reasons. First of all, there is no way we can do that bias free, and as human beings, we all engage in what is known as confirmation bias and as Paul Meehl stated, to believe that the clinician is exempt from that would be unfounded arrogance. Just to give one problem, there is no way to know what happens to the people who don’t come back to therapy and are too polite to tell the therapist it is because they feel they are getting nothing from the treatment. In a well designed clinical trial, dropouts are accounted for and immediate successes are systematically followed up on. Also, failures too often get explained away while successes are often not followed up on or are based on nonstandardized assessments, if any. If a client gets worse, the believing therapist might just rationalize this and tell the client to keep pressing on with the treatment, saying one must get worse before one gets better. In a word, appearances can be deceiving and the scientific method,while not perfect, was designed to correct many human biases. Even though it, too cannot completely escape all biases, meta-analyses by Paul Meehl, David Faust and others have shown that actuarial judgment is superior to clinical judgment. Also, a therapist with years and years of clinical experience does not necessarily achieve superior results to a new therapist, as long as that therapist has had some basic form of training. Clinical skills are, of course, important but they are not a substitute for a well-informed choice of intervention.

      I can show you glowing testimonials for all kinds of ridiculous therapies and self help methods, even ones that have been well documented to cause harm or not work. They are highly misleading, but yet these therapists will argue that they have “seen” the results with their “own eyes” and will not be dissuaded. I can show you a large group of licensed therapists who strongly believe that finger tapping on acupressure points will cure all kinds of mental heath problems and even physical problems within minutes when there is no good evidence to support that claim, although yes, they all claim that they saw it with their own eyes and/or heard it with their own ears. While this method is not directly harmful, it also lacks evidence and there have been controlled studies published that disconfirm that the acupressure points or their sequence play any role in the positive treatment reports.

      As for the argument that Empirically Supported Treatments (ESTs) don’t always work for every client, no one ever claimed they did. That too points to misconceptions about what EBP is. If a treatment is shown to do the kind of damage you allege in your example, it would not be considered a wise treatment choice. Note that there is a certain contingent of trauma therapists using novel unsupported treatments that rationalizes this by spreading myths about exposure therapy doing damage that have been soundly refuted, but if a treatment truly was dangerous, it would not be an EST because the current way we have of determining that takes into account both positive and negative, disconfirmatory studies.

      That being said, yes, of course there are people for whom ESTs do not work. However, this is no excuse to market an unsupported therapy ahead of the evidence and make unsupported claims. What happens to a cancer patient for whom existing supported treatments have failed? Does the doctor, just willy nilly, try some unsupported treatment and make big claims about it, saying he has anecdotes of his clinical success with it? Of course not, such a doctor would immediately lose his or her license for doing so and might even end up like Conrad Murray if harm was done, but in mental health practice, unfortunately there is a different standard and that is, essentially what happens and if harm is done, all too often the therapist gets off scot-free.

      In any case, according to current EBP (see the writings of Sackett and his colleagues and Eileen Gambrill for details) if all empirically supported options have been exhausted, a newer therapy, provided there are not well documented reports of harm, may be offered to a client, but it must be clearly labeled as experimental and the client be provided full informed consent that since the treatment has not been properly tested, it may not do any good or even produce harm. No proprietary, costly certification trainings, no claims of being an “expert”, no testimonials, none of that. Again, I recommend looking at what Acceptance and Commitment Therapy (ACT) proponents, for the most part, are doing as a positive example. Although there are some enthusiasts that have at times gone overboard, its main developer, Steve Hayes, is a very well published researcher as well as clinician (psychologist) and he and his colleagues have made sure that research is done and he has listened to critics and kept claims in line with evidence. ACT has had its share of critics, but none of that can take away from the fact that he is getting a large volume of research done and encouraging his students to do the same.

      As for recombining, it all depends on what is being added to the mix and how well supported each of the elements are. But if it’s more than just a simple eclectic combination of methods with sound support then yes, it needs to be tested. You can’t just take isolated elements, say they are supported and then add in new material that is untested. However, that seems to be a moot point when it comes to parts work, as far as I know. What support is there for earlier forms of parts work? Gestalt, TA, NLP, and the other self help methods I am aware of all have scant evidence.

      Just to give an example unrelated to IFS, there is a certain intervention for internationally adopted children with severe behavior problems I have strongly criticized. Although it does employ well supported behavior management techniques and there may be some genuine successes because of that, it combines those with the use of prone restraint (a method that has been banned in schools and hospitals in several states because it is considered so dangerous and in the states it is used, must be very carefully monitored with life support equipment on hand) and employs highly questionable,”boot camp” style discipline, often keeping the child home from school and isolating the child from all but parents. So here, we have an intervention with some evidence-based elements with others that are clearly not and we have a therapist who is marketing the intervention via numerous media appearances. Obviously, if a child is harmed by prone restraint and/or traumatized by the “boot camp” like methods, it matters not that some of the elements were evidence-based.

      In other words, arsenic with a healthy salad, is still arsenic and the nutritional valid of the salad is beside the point.

  5. First of all, Mark Schwartz and Dick Scwhartz are NOT related. Mark Schwartz and Lori Galperin together founded Castlewood. They had been handed the reins so to speak from Masters and Johnson in 1995 because of their solid, excellent reputations and training. Dick Schwartz developed the IFS model independently, and only in the past couple of years did Dick join the Castlewood group on staff.

    Castlewood began adding that type of therapy to it’s treatments methods because it was hugely apparent that the IFS was extremely valuable in moving ED clients along, who before had been “stuck” in their ED with most other methods that are currently accepted. With IFS it was striking how there were long term success rates had improved. This is something Mark and Lori should have kept data on. Castlewood sponsors an annual visit /reunion for past clients, back as far as a dozen or so years.

    I think that this article should be clear, Mark Schwartz, the therapist, is the one on trial,, it’s his judgement as a clinician that is in question — not hypnosis, drugs, psychotherapy, medical treatments, or IFS. . He uses many methods of treatment, depending on the client. He does not use IFS exclusively by far, nor is it his specialty as a therapist. I don’t really think that IFS should even be on the “main table” here, since it was not the reason this case came up. Who knows as yet, what went on in his mind or hers. Money was the motivation, as some people have postulated. They have a very long waiting list of paying clients that wish to be in treatment there…because of Castlewood’s solid reputation. All of what I say is verifiable.

    I personally know several women whose lives were literally saved by Castlewood — not Mark in particular, but because of the entire program at the treatment center, which, again, as stated he and Lori Galperin founded and directed with huge success for more than a decade.

    This case being brougt to trial indicates this woman’s level of distress, and it is quite a huge surprise to what I have known of the program at Castlewood.

    Sometimes red flags are red herrings. This is about a therapist with a solid reputation and a client who is obviously intelligent and very upset. Now it remains to be seen why he went down this line of “diagnosis.” Is he simply getting “old” and out of touch, or was there an element of truth in reality or in her mind?

  6. In paragraph four, I meant to say, “Money was NOT the motivation to continue seeing this client, as some people have postulated. Castlewood has a very long waiting list of paying clients that wish to be in treatment there….”

  7. Whether the Schwartz’s are brothers does not concern me. What does concern me is that IFS is the main treatment being offered at Castlewood. Sorry, but your testimonial of what is “hugely apparent” does not substitute for actual evidence in the form of well designed, published studies that IFS is safe and effective and what is “hugely apparent” to me is that these are lacking. Given that such studies have not been conducted and IFS does deal with “parts” it seems to me that such evidence relevant to IFS would be highly relevant to the lawsuit, although I noticed that IFS proponents are trying very hard to distance it from the lawsuit. Whatever therapies Mark Schwartz used on this particular client are sure to come up during the case and the role each played will be examined and determined by the evidence, not by the PR tactics of IFS proponents. It appears that other patients are also coming forward, so Lisa Nasseff is not the only one with complaints although whether these become legal complaints remains to be seen. Although I realize that IFS does not necessarily have to be used to treat DID, it frequently has become a tool that has been quite popular among DID therapists. However, that will be for the courts to determine and we’ll just have to wait and see.

    What I would really hope for is that legislation such as the Truth and Responsibility in Mental Health Practices Act which has been proposed by a number of highly esteemed clinical scientists, eventually gets passed. Such an act would prevent reimbursement for untested therapies.

    I really don’t take a position on what his motivations are. Personally, I think money as a motive is highly overrated but am open to whatever evidence comes out in this case. Much damage can come from a mental health professional who means well and sincerely believes in the interventions he offered that nevertheless lack proper testing for safety and efficacy and this can be so, regardless of whether the motivation is money.

    The days of hype and anecdotes need to come to the end, for the good of all mental health consumers, so treatment casualties can be prevented.

  8. To respond, first of all, I agree with you, it is not important if they are brothers or relatives, I just noticed you mentioned in the article the fact that you weren’t sure if they were related, and other other articles actually mentioned it as fact that they were brothers — just decided to take a moment to clarify that very minor point.

    And, I agree with you again, that IFS deserves it’s own blog because it seemed that the issue of whether IFS should be paid diverted from the main point of your very well written article. And what you say is all true, that yes, IFS is one of the main therapeutic techniques used at Castlewood, but Mark Schwartz, himself does not use this method first and foremost. And what I do know is that although he is interested in DID, it is rare at Castlewood.

    I am interested in what you say that perhaps it is not a good method to use for DID. That would be an interesting study. As far as this case and this article, it seems it should be focuses on the article your wrote about being about Lisa Nasseffs suit against Dr. Mark Schwartz.

    As far as motivation, I am glad you agree with me that this is not the case for him or most therapists, But I have noticed that almost 3/4 of the articles I have seen cited this as his reason. And so, I was not directly addressing what you were addressing, it was an additional comment to others who might think that. It seems that that fact begins to make everyone very emotional and angry at those who are in the healing profession.

    And again, I agree with you on so many points, you raise some very important points about methods being used. In fact, myy grown daughter is working towards her PhD in Clinical Psychology. She is very interested in IFS as a therapeutic tool. We have been discussing back and forth, the fact that it really needs to be studied in a lab, and studies conducted. It the best way to determine how and why it works, and to learn how it affects the brain, and for what types of psychological disturbances it is useful in treating. She is excited about doing about being part of this study herself. Dick Schwartz worked along with a Harvard MD/PhD who heads a lab in Rheumatology and they did a study together.

    I would be interested in a blog about the topic of IFS.
    BTW, my email has a typo…but I can’t figure out how to fix it, I wanted to follow your blogs.
    It’s WhitePlate@live.com

    Thank you for raising awareness. It can only help to bring valuable methods into the mainstream if studied correctly.

  9. WEll, I read the entire petition and the allegations.

    I appreciate that you have a link to this — I was very curious what exactly was stated in the petition. There is so much misinformation out there on the net right now. Altogether, it is a blow to the reputation of therapy. I am not for or against Mark Schwartz. I , like you, am trying to understand objectively what happened and will be following this story with great interest.

    That being said,
    And as I read through the petition (just now) Mark Schwartz’s motivations is relevant to this case (and therefore to the original article) as to whether his motivation to treat her the way he did was because of money. Read Count II, paragraph 4 where it states that Dr. Schwartz “singled out and targeted plaintiff for the aforesaid intentional and reckless acts based partly on her ability to pay for long-term continuous inpatient services…” So then indeed his motivation is important to this case. Again, my point is that Castlewood, (Mark Schwartz) does NOT need to keep any one particular patient there because the treatment center needs the money –who is there or for how long is irrelevant to center’s financial concerns. Therefore, that point will likely be thrown out.

    I looked carefully for any part in the petition where the plaintiff specifically mentioned IFS in any way. And I actually didn’t see anything in the allegations about Mark Schwartz using the IFS model at all. And as far as I know of his methods, it is not a tool he himself actually much uses. I know that most other therapists do use it extensively. But her therapist was Mark Schwartz.

    On the other hand, reading the petition it clearly stated that the plaintiff specifically alleges that his use of HYPNOSIS while she was under the influence of psychotropic drugs was the problematic therapeutic method (I don’t know which ones she was using, but examples would include anti-anxiety, anti-depressants, anti-psychotics).

    That is what I got out of the petition, nothing about Mark Schwartz using IFS.

    I appreciate that you have a link to this petition — I have been very curious what exactly was in the petition. There has been so much misinformation out there on the net right now, that it seemed like the lawyers were going crazy. Evidently, the lawyers are fine, it’s the overly enthusiastic journalists that are causing confusion.

    Altogether, it is a tragedy and a blow to the reputation of therapy. I am not for or against Mark Schwartz. I , like you, am trying to understand objectively what happened and will be following this story with great interest.

  10. You are a very clear and concise writer….so please excuse my typing and non-editing, writing is not my strong point. I hope you can see my point through all the errors.

    • Lane, yes, I do see your point. Regarding the petition, it is true that IFS is not explicitly mentioned. What is mentioned, however, is the allegation that multiple personalities were suggested by the therapist. In investigating this claim, a thorough examination of any therapies that were used involving parts work or any other therapies she received would make sense to determine what, if any, role they played in the creation of these personalities.

      I am not a lawyer but one thing I learned having been a defendant myself is that although the plaintiff does ultimately have the burden of proof, for the case to proceed at this stage, what the Plaintiff needs to do is produce a properly stated claim that if, shown to be true would have a reasonable chance of resulting in a judgment. Whether the claim is true is what gets determined during the discovery and ultimately the trial phase either by a jury or a judge. If he filed a motion to dismiss, it would need to be found that the claims were in some way not properly stated or that there was something else improper about the filing, but whether the claims are true would not be examined at this stage. What often happens is that most civil cases get settled prior to going to trial if they are not dismissed in their initial stages. Insurance companies often require following advice to settle or they drop their client. However, it would be up to Lisa Nasseff whether to accept such a settlement offer, should it occur.

  11. I couldn’t agree MORE with you about the DID issue, you hit the nail on the head. I know for fact that he has lectured on dissociative identity disorder. And regarding the Satanic ritual ideas (implanted or not, it seems he allowed it to become way too traumatic and that’s his specialty PTSD), I knew him well several years ago, and this just all seems way out there for him. My personal opinion at this point knowing what I knew of his ability and skills in the past, and knowing that now this sounds bizarre for what he used to be, and taking into account her distress and pain, and this petition? She should be given the money she has asked for, and he should retire.

    As far as other women claiming similar things. I haven’t been able to verify that fact. I have only read about it, and so far I have read many things that are so untrue. The petition is more enlightening and disturbing than anything else thus far.

    It’s all very tragic.

  12. The reason I say she should be awarded the amount she asking, because it seems that today she is left in an untenable psychological state, one that (if I assume correctly) is much worse than when she came in. It appears she has suffered unduly while under his care.

    Let’s say for argument’s sake that these experiences regarding the Satanic cult were all verifiable and true. And let’s say, again for argument’s sake, that she actually always had 20 personalities and Dr Schwartz simply uncovered that fact, let;s make this as bad as it could be for the plaintiff and as easy for the defendant. To continue then, let’s say, he followed all customary therapeutic methods. So everything is as Dr. Schwartz states.

    Even given all of that, don’t you think that a patient who becomes disturbingly worse, to the point of untenable suffering while under a therapist’s, I mean, increasingly distressed to the point of feeling internally traumatized because of the therapy, and actually internally terrified which was caused directly by the direction and the intensity that the therapist was taking the patient, don’t you think that that is the basis of malpractice? As healers the basic tenant is: first do no harm. Even everything she was led to believe, even if every speck of every fact were all true, it was like her mind was in a virtual train wreck, it wasn’t just uncovering a past train wreck, her mind was actually undergoing a fresh new train wreck WHILE uncovering the past train wreck.

    There are therapy models that do not allow the patient to flood and retraumatize. To reiterate a very important point, the tenant of all healers is: first do no harm. I realize when any of us revisit terrifying memories it is an unhinging experience, but I know for fact there are therapists that don’t push, they wait until the patient can handle each step. Therapy should be a very gentle exploration and unburdening, not cause a fresh gaping unhealable wound.

  13. And this is not to say that any patient who gets worse under therapy is justified in a lawsuit. That would be like saying a patient with an old broken finger should bring suit when the doctor rebreaks his finger to fix it, but it doesn’t get any better, and maybe it’s a little worse. What I am saying is that this is an extreme case due to the amount of time the patient was seeing Dr Schwartz, and because of the extreme DEGREE of suffering and anguish that she incurred during that period of time during and due to therapy. IT appears this was not just one rebreaking of a finger, but a rebreaking of it many times over without understanding the extent of the damage being done by the lack of healing.

  14. What are the best therapeutic models used today to treat DID? And (yes, a separate blog), but what are the pitfalls of using a parts model to treat DID?

  15. Russ permalink

    This sounds remarkably similar to my daughter’s situation, which has been a nightmare for our family and that is ongoing. My daughter went to the CA branch of Mercy Ministries, a free residential Christian-based treatment program in CA, back in March of 2010 for treatment of anorexia and was there for one year before “graduating”. After seeing a therapist there, the therapist/counselor called to tell my wife and I not to worry, that this didn’t involve any of my family, but that my daughter had “recovered memories” of being sexually abused by some schoolmates. We were shocked and dismayed, but after reading up on “recovered memory therapy” we were skeptical that this really happened. A couple of months later, my daughter changed therapists and suddenly stopped/refused all contact with us. We came to find out that at her “graduation ceremony” from Mercy Ministries, she said that her dad sexually abused her since she was 4, and that she was the caregiver for her youngest sister since she was 8(both utterly false and without basis). Mercy Ministries has chosen a “new family” for her which she is living with now, and we have since been in contact with several girls from Mercy who say they cut ties to their family because of their repressed memories through the therapy they received…both girls (and some others) now realize that one of it was true and they are now in therapy at a reputable therapist to try to undo the damage from the therapy they received at Mercy Ministries. This kind of therapy destroys families, and I would advise anyone who sends their daughter to a treatment center for eating disorders (or any other kind of therapist for that matter) to make sure before they go what kind of therapy they will undergo. My daughter will be welcomed back with open arms when she does eventually realize that she is a victim of bad therapy. I hope noone else has to go through this, and I want to get the word out about how at least this place (Mercy Ministries) operates.

  16. I have mixed emotions about the whole thing First off, this kind of repressed memories have been manipulated way before this lawsuit ever came to be and yes from the same general area(location) from mental health professionals. I too have been a client at castlewood many times during the times the plaintiffs were there. These girl’s families were torn apart. And, a person dying from a eating disorder will want to continue a treatment that isnt workiing from the fear of dying. And, if you are made to believe your just not doing treatment right and this is why your not recoverying, a person tends to do anything to correct the situation. Perfection is a huge need in a person with a eating disorder.

    I will share with you what i have experienced with this kinda therapy behavior. I am in my late 40’s and have had treatment for my eating disorder since I was 19 years old. I had a great treatment at that time and was recovered for several years. I was seeing a therapist for my anorexia and one for my sexual abuse from a former parish priest (you know one that just got moved to a different parish and cover up) and there was some sadistic abuse that occured. My therapist I was seeing at the time for the abuse asked me if it was cult abuse I sad no and stopped seeing her. Now this was when cult abuse scare was on the rise in the 90’s.

    Now , I needed to see someone for the abuse and by a friends recommendation I saw another sexual abuse therapist. As I saw this therapist, I realized there were other people from my area in which I lived and After 2 months of therapy she had me believing I had DID and was in a cult. So, I thought maybe it was because by this time I was so confused of my truth. However, I know during this time my eating disorder was horrible. And then, my eating disorder therapist was putting me back into treatment. However, I did not tell her I was seeing a different therapist and she had me believeing i was in a cult because once I did she left the scene fast.

    There I was in the treatment hospital no longer having a eating disorder therapist and another therapist messing with me. And the first day i was in the same place where I had been before that I had gotten a good recovery from before was on a kick on treating what they called back in the 1990’s SRA. I felt stuck, alone and dying from the eating disorder. I would of done anything to get back into recovery even if that meant to believe things professionals were telling me to believe. Because when your sick your mind is sick too. So, there I was in a nightmare I couldnt seem to get out of because everyone including the treatment place was on the cult abuse bandwagon. Infact once, I was in the employee lounge and low and behold I saw a flier on the wall about how to treat SRA and who was behind the study Masters and Johnson.

    Once released I had started to lose my family contact and even more alone. I had a sense to me that I needed to get out of this nightmare but didnt know where to go I still had the eating disorder. I went to a treatment in kansas to try to leave this cult madness but nope it didnt stop there ethier. I was more convinced by the professionals that it was cult. But i was done I was tired of this soul searching bullshit and found my own way out of the eating disorder. I went to college and graduated and got married and had a child.

    Now I told you previously I knew of people from my area who saw this same therapist and they had the same situation and sued her for the false memories and they won. She served time as she should of had to do. She too was found that money was a huge factor in the scam. She was found guilty to fraud with the insurance companies.

    Now I saw a great therapist later in my late 30’s to undo the mess the others had put in there and when she passed from cancer my mind and body was taking over by the eating disorder and had to do treatment . I went to castlewood. It’s true I had parts (I did have horrible abuse I had to seperate from for my sanity) However, by this time, I also had a strong sensor to detect crazy help too. I stayed there for 5 days the very first time after fleeing. I was asked after 3 days there if it was cult abuse because it was by a religious figure of my original abuse. This got me a bit suspicious of the set up there( Was it a begiining of conditioning the client?) I dont know. But I knew I was out of there after I saw my therapist at castlewood that I had when I was in Kansas for treatment. Now, I went back to therapist I had been working with at this time and she sent me back and I couldnt tell her what I experienced because I was ashamed of being duped all those times. I went back and just said to myself I need to work on the eating disorder because I’m dying here. Eventually, my brain got so sick from my malnutrition that I was believeing the same shit professionals put in my head years before when the cult craze was popular. But as I got brain healthier my awareness of what was going on did too. Eventually I said no more and broke away from the insanity

    I know that they have a waiting list but that can be deceiving to the normal person. There is many repeat clients that get first serve with slots and there are many clients encouraged extremly encouraged to move to the area (which I found odd) And yes there is a execption for someone who has the funds to get in there quicker and longer I seen it saw it and experienced it. Remember it is a business. So just like objects can be bigger then they appear in a rearview mirror the waiting list can and is manipulated.

    I think what i want people to understand is manipulation of treatmment can happen does happen and will continue to happen if people dont speak up take a stand. And we can argue and share all our judgements on the cases but really no one has been more affected then the ones involved. They lost their families in some of the cases and that is unacceptable in my book. Treatment is to bring closures and new beginnings not create nightmares for people.

    And In closing, I want people to know that there are so many good dedicated people that work at castlewood. It hurts my heart that their reputations are affected. I pray everday that there is some sort of resolution for all involved. And I am not sure if we shouldn’t be looking at the whole picture and look at the trail Master’s and Johnson plays in the mission statements and treament procedures because I know first hand they had a huge hand on the SRA fear epedemic in the early 90’s in this area. As for me, I am in recovery and I am blessed to have my truth back once more and have a great therapist to thank for that. But to the workers that really are there for the client’s at castlewood I am also grateful to you.

  17. Howdy! I just want to offer you a big thumbs up
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  18. I think everything composed made a great deal of sense.
    However, what about this? suppose you wrote a
    catchier title? I mean, I don’t want to tell you how to run your website, but what if you added a post title that makes people desire more? I mean Eating Disorders Residential Treatment Facility and Psychologist Sued by Former Patient Potentially Harmful and Other Questionable Therapies is a little plain. You should glance at Yahoo’s home page and note how they create article titles
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    pic or two to get people excited about everything’ve written. In my opinion, it would make your posts a little bit more interesting.

    • Thanks for the feedback. However, this blog is doing quite well in terms of getting hits from search engines. I am very familiar with the fact that there are many different styles on various blogs on the internet and mine is purposely more understated and professional. I am not in the business of advertising, nor do I have the desire to manipulate others to “want more” by writing “catchy” titles, etc., but nevertheless, people who desire the information I offer here, seem to be finding me. Thanks, anyway for sharing your thoughts!

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