An Expert Weighs In

I’ve mentioned Dr. Paul Appelbaum, a well known forensic psychiatrist. I’ll interrupt the narrative once again to say that he and I spent a few hours talking over what happened and he reviewed recordings, Sam’s notes, and emails and texts we exchanged. Here is (most of) his report, prepared for potential legal action.

I have reviewed materials related ot the case of Matt ____ and evaluated him, to offer my opinion on whether the treatment he received from “Samantha Lymon”, LCSW fell below the standard of care in psychotherapy and whether he was harmed by the experience. I have reviewed the following materials:
Demand letter of 2/28/22
Outpatient treatment records of Ms. Lymon, LCSW, 7/17/18-9/15/21
Handwritten notes of Ms. Lymon, LCSW from various dates
Emails between Mr. ____ and Ms. Lymon during the course of treatment
Outpatient treatment records of [my psychiatrist], 9/27/22-11/28/22
Outpatient treatment records of [my subsequent therapist], LP, MA, NCPsyA, 3/24/22-12/15/22 Treatment summary of [my subsequent therapist], LP, MA, NCPsyA, 10/1/22
[REDACTED], 6/1/22-6/6/22
Notes provided by Mr. _____
Excerpts of recordings of sessions between Ms. Lymon and Mr. _______

In addition to reviewing these materials, I evaluated Mr. _________ via Zoom on February 12, 2023 for two-and-a-half hours. The report that follows is based on these materials and my direct evaluation of Mr. ___________.

Qualifications
I have been a practicing psychiatrist—clinician, educator, and researcher—for approximately the last 43 years. I am board certified in adult psychiatry and forensic psychiatry by the American Board of Psychiatry and Neurology. I serve as the Elizabeth K. Dollard Professor of Psychiatry, Medicine & Law at Columbia University, where I direct the Center for Law, Ethics & Psychiatry, and previously was the A.F. Zeleznik Distinguished Professor of Psychiatry and Chair of the Department of Psychiatry at the University of Massachusetts Medical School. I am past president of both the American Psychiatric Association (APA) and the American Academy of Psychiatry and the Law, and currently I chair the DSM Steering Commitee for the APA. My practice includes patients with a broad range of psychopathology. I am generally recognized as an expert on the ethics of psychiatry, having chaired the Ethics Appeals Board for the APA, the Committee on Ethics of the World Psychiatric Association (of which I remain a member), and the Ethics Committee of the American College of Neuropsychopharmacology. In particular, I have written multiple articles and lectured widely about boundary issues in psychiatry and psychotherapy.

Facts of the Case
Matt _______, now 58 years old, began outpatient psychotherapy with Samantha Lymon, LCSW in July 2018 in response to turmoil in his family over the behavior of his teenage son. Sessions usually occurred weekly, although sometimes more frequently, and until the beginning of the Covid-19 pandemic they took place in person, though they then transitioned in early 2020 to video sessions. Sessions focused on Mr. ________’s relationship with his son, but also included consideration of his dissatisfactions with his work life and issues in his relationship with his wife. He believed that these sessions were helpful.

Beginning in the spring of 2020, however, Mr. ______ perceived a qualitative change in the therapy, with Ms. Lymon turning the sessions increasingly to a discussion of their relationship. By that fall, he admitted to having romantic feelings for her, which are alluded to in her notes and which became an even greater focus of their sessions. Mr. _____ reports that Ms. Lymon became more open about her feelings for him, comparing them to lovers and their exchanges to “pillow talk”; expressing a willingness to entertain erotic ideas with him; encouraging him to have extra-marital sex; and revealing details of her personal history and current life. He concluded that she had romantic feelings for him, as he had for her, and pushed for even greater disclosure on her part. Her response was to pull back at times, leaving him confused about the message that she was sending.

The culmination of this flirtatious behavior by Ms. Lymon came during their session of May 28, 2021, when he reports that she proclaimed that she loved him and was deeply immersed with him, and moreover that they needed to figure out what they would do next. This appeared to Mr. ________ to suggest that a fulfillment of his fantasies was at hand. However, at the following session, she pulled back, responding coldly to him, insisting that they could not have a mutual relationship, and suggesting that he was mistaken if he interpreted anything she said as indicating that she had romantic feelings for him . That session induced a powerful emotional response from Mr. ________, who felt rejected and crushed. He cried for hours and was upset for days afterwards. Although he wanted to terminate therapy, Ms. Lymon urged him to continue with her, a pattern that repeated over the following months. The subsequent sessions over the next three months were marked by further alternations on her part between warmth (“I love you”) and distancing, leaving him bewildered as to the real nature of their relationship.

Verification that Ms. Lymon engaged in the behaviors described by Mr. ________ comes from audiotapes of their meetings during the summer of 2021, provided by Mr. ________, in which Ms. Lymon acknowledges having said that she loves him and talked of them as lovers, that she was deeply immersed with him, and that she had disclosed (and continued to disclose) details of her feelings and emotional life. Mr. ________ continued to feel whipsawed by Ms. Lymon and ultimately, during their session on September 15, 2021, told her that he would not see her again, thus ending their therapeutic relationship.

Opinions

In her treatment of Matt _______, Ms. Lymon markedly deviated from the standard of care expected of psychotherapists. It is universally accepted in the psychotherapeutic professions that it is the responsibility of the therapist to maintain clear boundaries in the relationship. The relationship between a therapist and a patient must remain strictly professional, always focused on the needs of the patient. To the extent that a therapist has personal feelings for a patient, they are enjoined from expressing or acting on those feelings, or gratifying their own desires in any other way. Instead, if the therapist’s feelings are becoming an obstacle to the treatment of the patient, the therapist is directed to seek consultation and supervision with an experienced psychotherapist and, if necessary, refer the patient to another therapist to complete their treatment.

In contrast to this behavior, Ms. Lymon openly expressed her feelings for Mr. ______ and then, apparently concerned that she had violated a boundary (which she had), pulled back and attempted to disavow them. She repeated this cycle multiple times over the last year of their treatment relationship. As a consequence, Mr. ______ felt alternately seduced and rejected, and finally crushed by what he experienced as a profound rejection by someone for whom he had developed intense feelings that he had been led to believe were reciprocated. Note that in Ms. Lymon’s behavior it does not matter whether she genuinely had intimate feelings for Mr. _______ or whether she carelessly used language that would lead any patient to believe that she had such feelings. In either case, it is her overt behavior that fell below the standard of care.

Adding to her mishandling of Mr. ______’s transference and her own countertransference, once it became clear that her behavior was causing him extreme distress—at the latest after the traumatic session in early June 2021—Ms. Lymon should have referred Mr. _______ to another therapist to process the events that had transpired in treatment with her. Instead, she strongly encouraged him to remain in treatment with her and continued to send him conflicting signals about her feelings for him, as illustrated by her reaffirmation of her previous declarations of love and her continued self-disclosure. It was only Mr. ______’s determination to end this torturous situation that led him finally to terminate treatment on September 15, 2021. The lack of trust engendered by this experience led him to put off much needed therapy until the following March, when he began to see [my subsequent therapist]. He did not begin to see his current psychiatrist until September 2022, when he was able to start medication that was helpful. His current regimen includes [redacted].

I have been informed that Mr. ______ filed a complaint with the New York State Office of the Professions alleging that Ms. Lymon had engaged in misconduct during his treatment. That office, I am told, declined to make a finding of professional misconduct based largely on the belief of one screening panel member, a social worker, that Ms. Lymon was merely utilizing a therapy technique. However, when a patient has developed an erotic transference (in this case primarily due to the behavior of the therapist herself), it is never appropriate for the therapist to tell the patient that she loves him, to continue to reveal details of her own personal history (for example, that she was conceived out-of-wedlock by a 17 year-old mother whose love she struggled to attain), and to increase the frequency of their sessions, precisely what Ms. Lymon did here. This mishandling of the transference markedly magnified the patient’s confusion over the nature of their relationship and led to the harms that he has experienced.

Since the end of his treatment with Ms. Lymon and as a direct and proximate result of her failure to abide by the standard of care in her treatment, Mr. _______ has experienced a continuing state of agitation, marked by uncontrollable rumination about their relationship, sleeplessness, excessive alcohol consumption, difficulties in his relationship with his wife, panic attacks, anxiety and depression. He has great trouble not blaming himself for what transpired in therapy and for not leaving treatment with Ms. Lymon sooner. He was unable to concentrate on work for months after leaving treatment and even now limits his free-lance work to existing clients, because he has difficulty connecting with new ones. He tends to avoid social relationships, having become more of a recluse. Overall, in his own words, he “doesn’t have much of a life,” since most of his time is consumed by “wallowing” in the trauma of his experience with Ms. Lymon.

The stress that is a direct and proximate result of Ms. Lymon’s behavior has impacted his physical health, [REDACTED] Even today, over a year-and-a-half after termination of treatment with Ms. Lymon, he continues to be haunted by what he perceives as her seduction and rejection of him, and by his failure to recognize the inappropriateness of her behavior.

[REDACTED]

The opinions described above are all held to a reasonable degree of medical certainty. I would be pleased to review any additional information that becomes available and, if necessary, to modify my opinions on that basis.

Dr. Paul S. Applebaum, MD

What follows this in the original file is Dr. Applebaum’s 92 page long resume of academic credentials, professorships, leadership of professional organizations, awards, grants, publications, and other honors. My attorney does not play around picking experts.

And, to give an update, in the year and a half since I met with Dr. Appelbaum, things have improved considerably. I still have trouble with ruminating from time to time, but not as completely and obsessively as in the past. Subsequent therapists and medication, as well as the end of the legal battling with Ms. Lymon and her squalid little attorney, have helped me to return to about 80% of my former self. I still have trouble trusting others, my wife and I are still working through this episode in couples therapy, and my sense of humor, which was my lifeline, has not returned to its full power, but things are better. Proper therapists who know what they are doing can be a godsend.