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Church's therapy guidelines questioned

By Ralph Ranalli, Globe Staff, 9/28/2003

As promises go, the pledge by the Archdiocese of Boston to offer free therapy for life to victims of clergy sexual abuse was magnanimous, striking just the right tone for a church struggling for reconciliation amid the worst scandal in the history of the Catholic Church in the United States.

Yet just weeks later, it appears the archdiocese may be struggling to provide the promised support while living with the administrative and financial ramifications of its pledge.

Even as the church posted the guidelines for the free therapy program on its website this week, some victims and their advocates said officials at the archdiocese's Office of Pastoral Support and Outreach appear to be taking a harder line on rationing the church's financial support, including limiting the amount of therapy that victims receive.

''People who were seeing a therapist twice a week have been told that they can only go once a week,'' said Ann Hagan Webb, New England cocoordinator of Survivors Network for those Abused by Priests. ''Things also seem more structured now, and it is becoming more difficult to jump through the hoops you need to jump through to get an individual victim what they need.''

Under the new guidelines, the church will pay for one one-hour therapy session per victim per week and consider other requests to reimburse additional therapy, inpatient care, and psychiatric drugs on a ''case-by-case basis,'' the website states.

Carolyn M. Newberger, a Children's Hospital psychologist and expert on childhood sexual trauma, said the victims will probably need access to therapy over years, even decades -- although not necessarily on a weekly basis -- due to the nature of the trauma they suffered.

Studies have shown that trauma changes the psychological, and even physiological, makeup of sexual abuse survivors in a way that makes them more susceptible to future trauma in times of great stress, Newberger said. A survivor might go for years without needing therapy, then suffer a trauma in their life that would make it a life-saving necessity, she said.

''They wouldn't remain symptomatic, but they would need to be able to get back into treatment quickly because their previous experience of abuse has made them more vulnerable,'' she said.

Newberger also said that while there is no ''single formula'' for treating victims of childhood trauma, many professionals now favor counseling that focus on coping in the ''here and now'' over therapies that encourage victims to reexamine and relive their trauma.

While the archdiocese has offered therapy and other support on a case-by-case basis for several years through the Office of Pastoral Support and Outreach, formerly the Office for Healing and Assistance, it is now guaranteed under the recent tentative settlement agreement reached between Archbishop Sean P. O'Malley and lawyers for victims. Some therapy specialists estimate that if half of the more than 500 eligible victims take advantage of the program, the cost to the church could exceed $2 million per year. That would be in addition to the $85 million lump sum the church has agreed to pay victims under the agreement, reached earlier this month.

With that potential cost facing an archdiocese already under serious financial stress, church officials have no choice but to standardize and set limits on the available support so that it is accessible to everyone who is eligible, an archdiocesan spokesman said.

''The treatment being offered is once a week therapy for people who need it,'' said the Rev. Christopher Coyne, a spokesman for the archdiocese. ''We are not going to pay for more than once a week, or for couples therapy and things like that. We can't be committing ourselves to huge amounts of therapy. . . . We just don't have the financial resources to do that.''

Yet not all advocates said they had detected a new era of frugality at the Office of Pastoral Support and Outreach.

Diane Nealon, a social worker who works for Greenberg Traurig, a Boston law firm which represents more than 260 victims, said she believes the firm's clients' counseling needs are still being met ''with a minimum amount of bureaucracy.''

Nealon said she has been told that some victims have been informed that the church would not pay for a therapy of their choice. She added, however, that some of those victims had chosen a therapy that the mental health profession has begun to consider inappropriate for trauma victims, such as regression therapy or intensive Freudian psychoanalysis.

''I know that they are concerned about making sure that everyone is getting good care and, in that sense, they are monitoring what people are doing,'' Nealon said. ''But I have never gotten the sense it is a dollar and cents issue.''

Some victims who spoke with the Globe, however, said they had a different impression.

Arthur Austin, who sued the archdiocese over abuse he allegedly suffered at the hands of the Rev. Paul R. Shanley, said he had a severe emotional crisis and was hospitalized briefly at the psychiatric unit of Newton-Wellesley Hospital.

At first, he said, officials at the Office of Pastoral Support and Outreach said they would pay for his hospitalization. Later, they said they would only pay for any costs that weren't covered by his insurance, coverage Austin said he was hoping to save for an emergency.

The policy statement released by the archdiocese states that victims will be asked to use their insurance for inpatient care and medications before requesting reimbursement from the church.

''I think the archdiocese should have been the payer of first resort, not last resort,'' the 55-year-old Braintree resident said. ''After all, they were the ones who put me there.''

Another victim, who asked that his name not be used, said church officials questioned the appropriateness of his prescription psychiatric medication and said they would not pay for the Motrin and Prilosec pills he takes for the chronic headaches and gastrointestinal distress associated with post-traumatic stress disorder.

''The feeling I came away with was of a security guard at the front gate,'' he said, ''instead of someone there whose job was to help.''