The patient, lying in the chapel, died in the closed ward of the TBS clinic, presumably from drug use. Steve Van de Land, a social therapist at the time, wanted to take a look inside the coffin. Simply out of curiosity. He knew that this man had been convicted of the most heinous crime of rape and murder imaginable.
But when he entered the church, there were three female colleagues crying around the coffin. Van de Land saw great grief. And he couldn’t understand it. Didn’t they also know the reports? Surely they knew what this man was capable of?
It was at that moment, says van de Lande now, more than forty years later, that the seed was planted to understand more about what remains one of the biggest taboos in TBS: the patient’s feelings.
Occasionally a message pops up about it, from a closed institution in mental health care, youth care, prisons, and TBS. Sometimes it’s more than just feelings. For example, the Oostvaarderskliniek clinic in Almere has been under increased supervision by the Inspectorate since October after several incidents of transgressive sexual behaviour came to light. For example, many employees have entered into a relationship with patients. The director left, nine staff members were suspended or fired, and Minister Frank Werwind (Legal Protection, D66) launched an investigation into the living environment at the clinic.
It is difficult to estimate how often such incidents occur in TBS. Fimke den Besten, a criminologist and diagnostic assistant at the Clinic Groningen van Misdagh, is one of the few who has researched this phenomenon – she wrote the book It starts before it happens Around. In her research, she notes that it is not easy to communicate with practitioners who have been through such a situation themselves. They are sensitive and willingness to participate in the hunt is low. Harry Bentema, director of the Van Mesdaag clinic and spokesperson for TBS Nederland, doesn’t know any numbers either. But looking at his clinic – he’s been working there since 2006 – he experiences that once or twice a year. “Sometimes the employees themselves sound the alarm:“ Hey, I’m starting to get carried away with something. ”But it also happens that I find out about it only after that.
Taboo is a great thing. Entering into a relationship with a person under his “power” is punishable by up to six years in prison for a criminal officer. Abuse of power lurks, and if a relationship arises, the safety of the entire clinic is at stake. For example, Femke den Besten repeatedly encountered in case law that a practitioner had given a TBS patient a phone to keep in touch outside the clinic. “Or other patients who know about the relationship could pressure the employee into smuggling drugs or other substances.”
The relationship makes the employee vulnerable to blackmail and, according to Principal Harry Bentema, always leads to a crisis of trust within the therapy team. Then everyone wonders: how is this possible? What did we miss? till when? Why didn’t anyone see him? Angry reactions always. Because this relationship touches on what he calls “tribal loyalty”: the sense of belonging that every therapy team should have and in which the tacit agreement is: You guarantee each other. “If a tribesman develops feelings for someone from the tribe.” Others “- patients – might feel betrayed.”
Sometimes the employees themselves sound the alarm: “Wow, I’m starting to get caught up in something.”
At such moments, Stef van de Lande’s help is sometimes called upon. Now partially retired, Van de Lande began working as a prison psychiatrist after serving time as a social therapist, and also started his own private practice as a trauma psychiatrist. Since that scene in the church, the topic of “Love on TBS” hasn’t left him. Why would a practitioner fall in love with the magic of someone who had done something so terrible? Van de Lande began reading about it, providing information to clinics and providing psychiatric assistance to the team and a TBS employee who had happened to him “about twenty times”.
From a patient’s perspective, entering into a relationship with an employee is easy to understand. Regardless of feelings, the patient can tell fellow patients that he has seduced his practitioner. And who doesn’t want to escape in love and sex through years of confinement in an environment full of rules? Some patients will also see other benefits: collecting contraband, more freedoms, and access to schedules. Although these “hunters with manipulative characteristics” are in the minority. Fimke den Besten: “Many patients with TBS feel lonely and emotionally vulnerable. If they enter into a relationship with a therapist, it is often due to the fact that someone cares for them. Some have never experienced that before.”
Even more than working in a prison, working in TBS means being close to the patient. The clinic, Bentima says, is actually a large living group. Practitioners look at the patient’s life and correct if necessary, “this is the essence of social therapy work.” The staff come to the patient’s room, also to see if he is keeping things organized, and go on vacation with them. “Then the practitioner will sometimes drive half the country with a patient together in a car.”
It is precisely with so many mutual contacts that border protection is important, and it can go wrong. With inexperienced social therapists who fall for the charms of handsome, well-trained patients at times. But also with experienced psychologists who have worked in the clinic for years. Man, Woman, Young, Older, Single, Married, Mbo, College Graduate: Psychologist Steve Van de Land had all kinds of amorous therapists before him. Because anyone can fall in love. And yes, even a convicted rapist.
“A little wrong,” says Van de Lande, “many people find this exciting. “You also have it among social therapists Thrill seekers Who like to cross the line.” Moreover, the criminal behavior for which someone was placed in TBS does not appear consistently in everyday practice. A violent rapist committed his crime in certain circumstances, but that does not mean that he sexually threatened all the women he lived with. The social therapist sees the patient primarily as a human being, not as a delinquent, so temptation cannot be ruled out. Certainly – and this happens regularly – if the practitioner had a poor background: loneliness, an unhappy childhood, divorce. Or if the employee had pathological characteristics that he recognized in the patient.
In addition, says Harry Bintema, TBS also attracts aid workers “who want to protect the rest of the world from the harm that’s ever happened to them.” “Savior types,” he calls them. They can be more susceptible to temptation, says Steve Van de Land. For example, he once visited the home of an employee who was having an affair with a patient who had been convicted of violent rape. I told him that he was “a really good person” and at that moment the phone rang: “Who are you talking to? Psychologist? Be careful not to give out any information!”. Van de Lande shakes his head: “It was completely within his grasp.”
But when he talks to such an amorous practitioner, he himself doesn’t always know why he chose the axe. In this case, Van de Lande takes pen and paper and sketches the human mind. First the brainstem – “contains our deeper functions: breathing, moving”, and around it the limbic system – “containing all that is delicious: sex, food, addiction” – then the neocortex as the outermost layer – “the evolutionarily younger part”. From the brain, inside it is our conscience and our moral boundaries.
He then talks about his addiction to ice cream and halfway through a long car ride he sometimes thinks “I really want a magnum”. One of those is big, old fashioned, with dark chocolate in it. And at 1,200 meters from the gas station, he thinks, “I won’t do it,” and at 600 meters again, “It won’t happen to me.” Meanwhile, Van de Lande draws arrows — magnums — pointing to the brain: “The limbic system thinks: wow, wow, super, super. And my neocortex says, ‘No Steve, don’t do it, don’t do it.’” I see myself doing it, and taking the exit.”
What he means by that: We’re all tempted. “And you have to come from a good background, also as a psychologist or social therapist, to always fight back.”
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More openness about the topic will help practitioners sound the alarm at the right time, concluded Fimke den Besten in its research. Mental health education programs are concerned with “distance and proximity,” but still spoke to many social therapists who said the topic was not addressed enough. And in practice, she notes, it’s still a taboo in TBS to talk about patients’ positive feelings, “even if it’s not about romantic feelings.” Practitioners fear that colleagues will see them as unprofessional or incompetent. “As long as it’s only about feelings – don’t act on them.”
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Whether therapists discuss their feelings among themselves depends primarily on the perceived safety in the team, says Harry Bintema. “That atmosphere can change, depending on the group of patients and the composition of the team.” A high workload and high employee turnover can be critical. This is a challenge in the current job market with staff shortages and flexible workers. For example, Femke den Besten spoke to social therapists who said they sometimes come into closer contact with a patient they’ve known for years than with a temporary colleague.
These problems may also play a role at Oostvaarderskliniek, where, according to the Inspectorate, an unsafe working atmosphere has long prevailed, partly due to staff shortages.
If a relationship comes to light, the employee will almost always be suspended or fired. “Go, take out a bad apple and move on. That’s the reaction,” says Steve Van de Lande. He has seen the standards change. Forty years ago, this relationship was already taboo, but it often remained a powerful conversationalist with the director. Now there is a stricter procedure: suspension or dismissal follows and the clinic is obliged to report. While van de Lande says, “Why is a TBS prisoner allowed to make mistakes – that’s part of their treatment – and not a therapist?”
Director Harry Bintema usually finds such a statement “worthless”. And this is absolutely meaningless, because the prosecutor’s office does not consider such a relationship very much from a criminal point of view, what can be gained from it? Is your employee behind bars? He would prefer to resolve such an incident within the clinic, openly, with each other. So that the whole organization can learn from it.” But then we will first have to accept at TBS that these feelings can come up. And sometimes it’s inevitable, if you work intensely with people.”