The patient was in condition in the chapel, died in a closed ward at a TBS clinic, probably due to drug use. Stef van de Lande, a sociotherapist at the time, wanted to take a look inside the coffin. Simply out of pure curiosity. This man, he knew, had been convicted of the most gruesome rape and murder imaginable.
But when he entered the chapel, three female colleagues were already there, crying around the casket. Van de Lande saw intense grief. And he couldn’t understand it. Didn’t they also know the reports? Surely you knew what this man had been capable of?
In that moment, Van de Lande says now, more than forty years later, the seed was planted to understand more about what remains one of the biggest taboos in TBS: feelings for a patient.
From time to time there is a message about it, from a closed institution in psychiatry, youth care, prisons, TBS. And sometimes it goes beyond just feelings. For example, the Oostvaarderskliniek in Almere has been under increased supervision by the regulator since October after several incidents of sexually abusive behavior came to light. For example, several employees had entered into a relationship with patients. The director left, nine employees have been suspended or dismissed, and Minister Franc Weerwind (Legal Protection, D66) has launched an investigation into the living environment at the clinic.
It is difficult to estimate how often such incidents occur in TBS. Femke den Besten, criminologist and assistant diagnostician at the Groningen Van Mesdag clinic, is one of the few who has researched this phenomenon – she wrote the book It starts before it happens about. In her research, she noticed that it is not easy to get in touch with practitioners who have experienced such a situation themselves. It is sensitive and the willingness to participate in research is low. Harry Beintema, director of the Van Mesdag clinic, who is also a spokesperson for TBS Nederland, does not know any figures either. But if he looks at his own clinic – he has worked there since 2006 – he experiences it approximately once or twice a year. “Sometimes the employees sound the alarm themselves: ‘hey, I’m starting to get caught up in something’. But it also happens that I only know about it afterwards.”
The taboo is great. Entering into a relationship with a person subject to his “authority” is punishable by up to six years in prison for a corrections officer. Abuse of power lurks, and if a relationship occurs, the safety of the entire clinic is at stake. For example, Femke den Besten repeatedly encountered in case law that a general practitioner had given a TBS patient a telephone to keep in touch outside the clinic. “Or other patients who know about the relationship may pressure the employee to smuggle in drugs or other substances.”
A relationship makes the employee blackmailable and, according to director Harry Beintema, almost always leads to a crisis of confidence in the treatment team. “Everyone is asking themselves: how is it possible? What did we miss? How long? Why hasn’t anyone seen it?” Outraged reactions, always. Because such a relationship touches on what he calls ‘tribal loyalty’: a sense of belonging that every treatment team should have, and where the tacit agreement is: you vouch for each other. “If a tribesman develops feelings for someone from the ‘other’ tribe – patients – it can feel like betrayal.”
Sometimes employees sound the alarm themselves: ‘Wow, I’m getting caught up in something’
In such moments, Stef van de Lande’s help is sometimes called upon. Van de Lande, now partially retired, began working as a prison psychologist after his time as a social therapist and also started his own practice as a trauma psychologist. Since that one vision in the chapel, the subject of ‘love in TBS’ has not left him. Why would a general practitioner fall for the charms of someone who has done something so monstrous? Van de Lande began reading about it, providing information to clinics and providing psychological assistance to the team and to the TBS employee who came to it “about twenty times”.
From the patient’s side, it is easy to understand entering into a relationship with an employee. Regardless of the feelings, it can give status if a patient can tell fellow patients that he has seduced a general practitioner. And who wouldn’t want to escape in love and sex after years of confinement in an environment full of rules? Some patients will also see other benefits: collection of contraband, more freedoms, access to schedules. Although these ‘hunters with manipulative characteristics’ are in the minority. Femke den Besten: “Many patients in TBS are lonely and emotionally vulnerable. If they enter into a relationship with a therapist, it is more often because someone is paying attention to them. Some have never experienced it before.”
Even more than in a prison, working in TBS means being close to the patient. A clinic, says Beintema, is actually one large living group. Practitioners look at the patient’s life and correct if necessary, “this is the core of the sociotherapeutic work”. Staff members come to a patient’s room, including to see if he keeps things organized, and they go on leave with them. “Then a general practitioner sometimes drives half the country with a patient, together in a car.”
It is precisely with so much mutual contact that it is important to guard boundaries, and things can go wrong. Featuring inexperienced sociotherapists who fall for the charms of sometimes beautiful, well-trained patients. But just as well with experienced psychologists who have worked in a clinic for years. Man, woman, young, old, single, married, mbo, university educated: Psychologist Stef van de Lande has had all kinds of amorous therapists before her. Because anyone can fall in love. And yes, even a convicted rapist.
“A little bit wrong”, many people find it exciting,” says Van de Lande. “And you also have that among sociotherapists thrill seekers who like to push the boundaries.” Furthermore, the criminal behavior for which someone was placed in a TBS is not constantly visible in daily practice. A rapist committed his crime under special circumstances, but that does not mean that he has sexually threatened all the women he has ever lived with. A sociotherapist sees the patient primarily as a human being, less as a criminal, so the temptation cannot be ruled out. Certainly – and it happens regularly – if a practitioner has a vulnerable background: loneliness, unhappy childhood, divorce. Or if an employee has pathological characteristics that he or she recognizes in the patient.
In addition, says Harry Beintema, TBS also attracts aid workers “who want to protect the rest of the world from the harm that has ever happened to them”. ‘Rescue types’, he calls them. They can be extra vulnerable to temptation, says Stef van de Lande. For example, he once made a home visit to a staff member who had a relationship with a patient who had been convicted of violent rape. She told him he was “a really good person”, at which point the phone rang: “Who are you talking to? The psychologist? Be careful not to give any information!”. Van de Lande shakes his head: “He was completely in his grip.”
But when he talks to such an amorous practitioner, he doesn’t always know himself why he went after the axe. In that case, Van de Lande takes pen and paper and draws the human brain. First the brainstem – “contains our deeper functions: breathing, moving”, around the limbic system – “it contains everything that is tasty: sex, food, addiction” – and then the neocortex as the outermost layer – “it evolutionarily youngest part of the brain with our conscience, our moral boundaries”.
And then he talks about his own ice addiction and that halfway through a long car journey he sometimes thinks “I really want a Magnum”. One of the big, old-fashioned, with dark chocolate. And that at 1,200 meters from the gas station he thinks “I won’t do that” and at 600 meters again, “It’s not going to happen to me”. Van de Lande, meanwhile, draws arrows – Magnum – pointing at the brain: “The limbic system thinks: wonderful, super, super, super. And my neocortex says: ‘No Stef, don’t do it, don’t do it.’ And then I see myself doing it, I take the exit.”
What he means by this: we are all tempting. “And you have to come from a damn good background, also as a psychologist or sociotherapist, to always resist.”
More openness on the subject would help practitioners sound the alarm in time, concludes Femke den Besten in her research. Psychiatric training programs pay attention to ‘distance and closeness’, but she still spoke to many sociotherapists who said the theme is not adequately addressed. And in practice, she noted, it’s still taboo within TBS to talk about positive feelings for patients, “even if it’s not even about romantic feelings”. Practitioners have a fear of being seen as unprofessional or incompetent by colleagues. “Even if it’s only about feelings – you don’t act on them.”
Also read: Director of TBS clinic resigns after the therapist’s discharge
Whether therapists discuss their feelings among themselves primarily depends on the perceived security in the team, says Harry Beintema. “That atmosphere can change depending on the patient group and team composition.” A high workload and a high turnover of employees can be decisive. And it is a challenge in the current labor market with staff shortages and flexible workers. Femke den Besten, for example, spoke to sociotherapists who said that they sometimes have closer contact with a patient they have known for years than with a temporary colleague.
These problems may also play a role at the Oostvaarderskliniek, where, according to the inspectorate, an unsafe working atmosphere has long prevailed, partly due to a lack of staff.
If a relationship comes to light, the employee will invariably be suspended or dismissed. “Go, you rotten apple and move on. It’s the reflex,” says Stef van de Lande. He has seen standards change. 40 years ago, such a relationship was already forbidden, but it often remained with a solid conversation with the director. Now there is a tougher effort: suspension or dismissal follows, and the clinic is obliged to report. While, says Van de Lande: “Why should a TBS inmate be allowed to make mistakes – it’s part of his therapy – and a therapist not?”
“Worthless”, director Harry Beintema usually finds such a statement. “And it makes no sense at all, because the prosecution does not value such a relationship highly from a criminal point of view, so what can be gained from it? Your employee behind bars?” He would rather resolve such an incident in the clinic, in all openness, with each other. So the whole organization can learn from it. “But then we will first have to accept in TBS that these feelings can arise. And sometimes even unavoidable if you work intensively with people.”