My sister began seeing a therapist after some tension between her and her husband reached a near-breaking point. At first I was happy to hear she was taking steps to address the situation. But she recently explained that her therapist is also a self-described ‘‘spiritual medium,’’ who told my sister she had ‘‘three spirits’’ following her, and that she was carrying unresolved baggage from a past life. The ‘‘therapist/medium’’ also offered to check her home for ghosts and expel any that were found. When I told my sister that this all sounded alarming and inappropriate for a mental-health professional, she responded, ‘‘Well, I like it.’’ She’s considering asking the ‘‘therapist/medium’’ to ‘‘put her in touch’’ with our father, who died almost two decades ago.
I worry that someone who has earned my sister’s trust is now taking advantage of it. Should I do more than casually offer up my concerns? I want to respect my sister’s autonomy and not interfere with her decisions, and I don’t want to dismiss all belief in ghostly matters (I think such things are ultimately unknowable), but I’m afraid that she’s not in a position to exercise good judgment on this, and that something morally objectionable is going on. — Name Withheld
From the Ethicist:
Like you, I’m skeptical of this therapist’s paranormal claims; unlike you, I don’t assume that they must be insincere. I grew up with family members from Ghana and from England, and it wasn’t just the Ghanaians who inhabited a world filled with ancestral spirits. When I was a child, a medium held a seance at my English grandmother’s house and ‘‘put us in touch’’ with my late grandfather — something my grandmother and I both found consoling. I now doubt that my grandfather’s spirit was actually sending messages via a dead Chinese gentleman speaking through the mouth of a small Scottish postman. But I don’t know that the postman was aiming to hoodwink us. Surely, some mediums are genuinely convinced of their abilities, given to experiences they interpret as signals from the dead.
Nor would I rule out the possibility that clients with strong spiritual beliefs could benefit from working with a therapist who shares those beliefs. Over the decades, a body of research has come to suggest that the effectiveness of talk therapy isn’t much affected by the therapist’s school of thought. Some studies do indicate that certain therapies can yield better results for certain conditions, and that certain therapeutic approaches can cause harm. But, in a range of cases, what predicts a patient’s improvement is simply having a good connection with a therapist.
Basically, talking with someone you trust and find sympathetic can be helpful. Notice too how many therapeutic models ask us to imagine the psyche as divided among contending entities. A practitioner of internal-family-systems therapy might teach patients to conceptualize distress in terms of parts or subpersonalities of the self (e.g., ‘‘exiles’’ and ‘‘firefighters’’), while your sister’s therapist relocates the problem to an external set of forces. But is it possible that the experience of healing could be similar if your sister gets better at managing her emotions and finds ways to move forward?
I’m not equating the work done by trained, credentialed therapists with what mediums do. Your sister’s therapist, who’s evidently both, could be breaching ethical codes that mental-health professionals are meant to abide by. Especially if she’s charging extra for her ghost-busting, exploitation may well enter the picture. You might tell your sister honestly that while you’re leery about these spirits, you are open-minded enough that you’d like to stay involved and hear about her experiences. You’ll be the supportive sibling she needs, but also the wary sibling she may one day be grateful for — ready to help her think things through if someone tries to levitate her bank account.
A Note from the Ethicist
Not long ago, I replied to a question from a young gay man who was H.I.V.-positive but whose virus levels, monitored over the course of more than a year, were consistently undetectable. He wanted to know whether he had a duty to inform casual hookups about his status, if he wasn’t asked. A few relevant facts: There’s now a vast amount of empirical evidence in support of the U = U (undetectable = untransmittable) slogan. The virus can be spread by people who wrongly think they’re negative, or who simply don’t know what their status is, and so don’t think they have anything to disclose. If you have a sexual encounter with a stranger, one thing you know about your partner is that this is someone who has sexual encounters with strangers. My judgment was that, because the man was incapable of transmitting the virus, it was on the stranger to ask. (My judgment was also that you had to be honest if you were asked, and transparent with someone with whom you’re entering into a relationship.)
Since I shared these thoughts, people have pointed out that certain jurisdictions have laws that criminalize the failure to disclose — even when there’s no risk of transmission — and that there’s a movement to revise or repeal such laws. Studies indicate these statutes have not reduced H.I.V. transmission; instead, historically, they’ve lent themselves to misuse and abuse, unjustly targeting people living with the virus.
H.I.V. is now far from a death sentence, but the risk of contracting it has to be taken with utmost seriousness; like hepatitis B infection, it remains irreversible. For good reason, PrEP, a “pre-exposure prophylaxis” regimen, is now widely used by gay men who have multiple sex partners. Just around the bend: A twice yearly shot of lenacapavir, a new class of antiretroviral, has proven astonishingly effective at protecting people from H.I.V. transmission in large-scale trials in Africa, and promises to transform the epidemiological landscape around the world. Unfortunately, too many state legislators, very notably those in Ohio and Arkansas, evidently haven’t kept up with the scientific consensus and haven’t grasped that a person can have tested positive for H.I.V. without being capable of transmitting it. I don’t know specifically whether people who have achieved full viral suppression have been charged with violating partner-notification laws since the C.D.C. endorsed U = U in 2019; I do know that what’s on the books in some places hasn’t yet caught up with good sense. And so a statutory fact remains: you may pose no risk of viral exposure, but if you live in the wrong place, you may wish to consider your legal exposure.
Readers Respond
Last week’s question was from a concerned ex-spouse. He wrote: “My former husband is a brilliant and accomplished man who developed a crystal-meth addiction that recently led to the end of our 30-year marriage. Not long ago, he was arrested on drug-possession charges. … I wrote to the judge directly requesting leniency and treatment rather than prison time, highlighting his positive qualities and potential for recovery. When the case was reassigned to a new judge and my ex discovered my letter, he was furious, feeling betrayed. He insists his lawyers’ sole purpose is to clear his name and prevent punishment. I’m now questioning both the ethical duties of his legal team and my own role. I struggle between wanting to help my former husband and respecting his wishes. … How can I help him get rehabilitation without overstepping boundaries? I’m desperate to find a path that leads to his healing, not just his freedom.”
In his response, the Ethicist noted: “Your ex-husband is right about his lawyers. We don’t want legal advocates making their own independent decisions about how their clients should be penalized or processed. … But he is wrong about you. You’re not his lawyer, paid to keep him out of prison, and he shouldn’t treat you like an extension of his legal team. You saw someone you care for struggling with addiction and hoped the system might respond to his situation with treatment rather than punishment. Your letter wasn’t an act of betrayal; it was an act of compassion. This doesn’t mean that you should expect him to be grateful for your intervention. … However commendable your desire to help your ex, it may be time to accept that your role in his life has fundamentally changed. Crystal-meth addiction is notoriously devastating, both to users and to those who care about them. Although I can’t say whether he will be able to move on from meth, I suspect it will be best, at this point, if you moved on from him.” (Reread the full question and answer here.)
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This is the most interesting question — and the best answer — I have seen in a long time. Maybe ever. And I don’t think I have ever said this: I have nothing to add. — Donald
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Often the legal defense to a possession-of-drugs charge is to require the prosecution to prove beyond a reasonable doubt that the defendant had the drugs in his or her possession. Sending the judge a letter advising that the defendant has a drug problem and needs treatment would tend to confirm — at least to the judge in sentencing — that he was guilty. At sentencing, judges do acknowledge letters and input they have received. The ex’s lawyers might have won a motion to dismiss without the letter writer’s interference — and still may. What do I know? I’ve only been a criminal defense attorney for 42 years. — Charles
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Even if well intentioned, the letter writer should stay in his or her own lane. I learned this the hard way when I alerted a former boyfriend’s boss to potential mental-health issues related to his being isolated in a new town with no support network. Instead of helping, as I had hoped, my boyfriend was fired. Ouch. More than 30 years later, I still feel terrible about this. — Mary
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Wanting to help and meaning well are probably the two most common forms of overstepping boundaries in all relationships. Friends do it to friends, parents do it to children and children do it to parents (usually, but not exclusively, later in life). We all need to learn where those boundaries are, as well as recognize that boundaries constantly shift as a result of many factors, including age or the normal changes in relationships. Unwelcome interventions are very easily avoided if people just ask, “What can I do to help?” rather than assume they know what’s best for someone else. — Timothy
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Intervening may be commendable, but the letter writer needs help also. Addiction harms the people around the addict. The letter writer doesn’t don’t have to face it alone. He or she should find an Al-Anon group. Love and support await this person. — Karon
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People in 12-step programs like Alcoholics Anonymous and Al-Anon will tell you that the letter writer is minding the ex-husband’s business instead of his or her own. Minding an addict’s business is a form of disrespect; it deprives the addict of the opportunity to learn from his or her own choices. — Jane
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A quarter century ago I was convicted of participation in a so-called white collar offense. During sentencing my lawyers asked me to ask friends and family to write supportive letters. My daughter urged her mother (my ex-wife) to do one, and she wrote directly to the judge. To this day I have not seen her letter. In all, about 45 letters were submitted, and my sentence of 36 months was better than the 60 that prosecutors wanted. In this case, the spouse understood better than anyone his ex-husband’s condition and the letter, if it were read by the judge, would have been helpful, notwithstanding his lawyers’ strategy. The letter writer did the right thing. — Bill
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As a lawyer with nearly 50 years at the bar, I agree with the Ethicist’s view of the role of the ex-husband’s legal team. His lawyers are obligated, within the bounds of legal ethics, to represent and advocate for their client’s wishes. As an addict who has been in recovery more than 30 years, I agree with the Ethicist’s response as far as it goes. To the letter writer’s question of “How can I help him get rehabilitation without overstepping boundaries?” I would answer that, beyond suggesting that it would be beneficial for him, you can’t. Recovery from addiction is an inside job — until the ex genuinely desires to get sober, no amount of pleading, cajoling or manipulating by outside parties will suffice. The letter writer is certainly entitled to share his or her opinion with the judge (although I agree with the Ethicist that judges shouldn’t be accepting independent submissions), but not to expect either gratitude or a change in attitude. I recommend that the letter writer, as the former spouse, bless hm on his journey, wish him well and get on with life. — Steven
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