What she got, she now says, was misery.
Within a year of beginning therapy at Genesis, Carol Ritter had left her husband and young daughter, severed ties with her parents and sister, and been fired from her job.
Today she contends that the therapists at Genesis manipulated her into all that, telling her that her husband and daughter were "toxic" people with whom she had become "enmeshed."
"They had me brainwashed," she said. "They get you so worn out, so confused, you can't think straight."
Reconciled in the fall of 1992, Carol and Martin Ritter have sued Genesis for mental health malpractice, contending that its therapists pushed them to the brink of divorce, battered their psyches and sought to control their lives.
Two other former clients and the father of three children who underwent therapy at Genesis have challenged the group's therapeutic techniques in malpractice lawsuits. In interviews, former clients and some relatives of current clients also have criticized Genesis.
The Exton residents who founded Genesis, psychologist Patricia Mansmann and social worker Patricia Neuhausel, did not respond to telephoned and written requests for interviews. Neither did Kathleen Fitzgerald, a licensed social worker who was a Genesis client and later joined the group as a counselor.
Cornelia Farrell Maggio, a lawyer representing Genesis, said of all four lawsuits, "I feel the allegations are factually incorrect and therefore substantially wrong and untrue."
According to its critics, the Exton practice commonly uses two controversial therapeutic techniques:
* Detachment, in which a client is counseled to sever all ties with family members, sometimes including the spouse.
* Memory recovery, in which a client is encouraged to remember - critics say imagine - a childhood incident of sexual abuse.
Rich Stinger, a former Genesis client who is divorced from Fitzgerald, said Genesis therapy tends to progress this way:
"First, 'You come from a dysfunctional family.' Then, 'You're a survivor of an addictive or abusive environment.' Then, 'You were abused as a child.' And then you suddenly remember that you're the survivor of Satanic ritual abuse."
Genesis has filed objections to the Ritters' suit saying it lacks specifics and that some actions described in it are not cause for suit.
In their answer to a 1991 malpractice suit by Linda Dillingham of Norristown, Mansmann and Neuhausel deny that they counseled Dillingham to sever ties with her family and get divorced.
They say that they acted "reasonably and properly" in treating Dillingham and that "while she remained attentive to her treatment plan (Dillingham) made remarkable progress."
When Dillingham cut off therapy, Genesis' reply says, Pat Neuhausel recommended that she go to a hospital for psychiatric treatment.
In objections to a suit filed last November by Nancy Hunt of West Chester, Genesis says the suit was filed beyond the statute of limitations and lacks specifics.
The therapy group has not yet responded to a suit filed Feb. 9 by a Wallingford man who contends that Genesis therapists planted in his children false memories of being sexually abused by him.
In interviews, five ex-clients and a dozen relatives of clients echo and amplify criticisms of Genesis in the lawsuits. Among the complaints are that Genesis therapists:
* Pressed several women to divorce their husbands and urged one woman to have an abortion.
* Instructed a client not to take medications prescribed for pain and urged others suffering from depression not to go to a hospital or use any anti- depressant drugs.
* Made male clients feel under attack during group therapy sessions.
* Urged clients, even married ones, to go on no-sex "snuggle dates" with other clients - sometimes clients of the same sex.
* Urged clients to limit social contacts to a "network" of other clients. Several ex-clients said alienation from family members made them all the more dependent on the Genesis therapists and network.
* Urged clients to recall instances of childhood abuse, which some clients later said never occurred.
Last year, Jill Bressler, a Delaware County court-appointed psychologist who was looking into the Wallingford custody case that is the subject of one of the lawsuits, described some of that family's involvement with the therapy group as "almost cultlike."
While involved with Genesis, the former clients say, they were paying Genesis hundreds, even thousands of dollars over time for individual sessions, group sessions such as a "rage-reduction marathon," and week-long retreats.
Current Genesis clients whose relatives or spouses are quoted in this article could not be reached for comment.
Carol Bayshore, a state Department of Health field supervisor, said the department had received complaints about Genesis and had referred them to the Pennsylvania Department of State, which licenses psychologists and social workers. That department would not comment. Relatives of clients said they have been contacted by state investigators.
Patricia Mansmann and Patricia Neuhausel met in the early 1980s at a parenting course at West Chester East High School. Mansmann was a prevention specialist in the school system; Neuhausel had children in it.
In a 1987 profile of the two women in the Daily Local News in West Chester, Neuhausel said her family underwent therapy with Mansmann and, over the years, the two became friends and colleagues.
Nicholas Neuhausel, Patricia's ex-husband, declined to discuss specifics of the counseling he and his former wife had with Mansmann. He praised both women: "They're both super people. And they're two of the most honest people I've ever known."
In 1986, Mansmann and Patricia Neuhausel co-authored Life After Survival, a self-published book that describes a therapeutic approach for adult children of alcoholics. The book says that Mansmann received a master's degree in counseling from Duquesne University, is a certified addictions counselor and was a prevention specialist (a counselor who helps students work through serious problems) in several school districts. Neuhausel has a master's degree in social services from Bryn Mawr College. She is a clinical social worker and certified addictions counselor, the book says.
By 1986, the book says, the two women were collaborating on "therapeutic projects." Genesis Associates was registered with the state as a business name in September 1988, and was incorporated in January 1993 with Mansmann as president and Neuhausel as vice president.
A Genesis Associates brochure says it "specializes in adult children of alcoholics (ACOAs) and persons with all forms of addictive diseases."
In their book, Mansmann and Neuhausel outline their therapeutic approach as a six-stage process. An illustration shows a staircase with six steps. On the bottom step, called Survival, a caterpillar is shown starting to climb. On the top step, labeled Genesis, a butterfly sits. The steps in between are labeled Emergent Awareness, Core Issues, Transformation and Integration.
The therapy group takes its name from the final stage where, according to the book, the client creates "a new beginning: evolving from a closed, lifeless period of survival to an open, beautiful creation of a loving being, full of life."
Former clients say that Genesis Associates' hourly fees for individual therapy ran about $70 - on the low side for a metropolitan area, according to the American Psychological Association.
In 1992 Genesis literature, a one-day rage-reduction marathon was advertised for $100; a series of sessions on "healthy sexuality" for $180, and five-day wellness retreats for $650.
Some former clients and relatives of clients who have complained about Genesis acknowledge family histories of alcoholism or other problems. They contend that their involvement with Genesis not only didn't resolve long- standing emotional problems, it created new ones.
"When I came out of therapy, I was more wounded and much more vulnerable than when I went in," said Beth Johnson, who said she spent 2 1/2 years with Genesis. "By following their advice, what it meant was cutting off support anywhere else except at Genesis, and in tough times that gives them great power."
Hunt's lawsuit says that she went to Genesis in 1986 for therapy for depression and that over the next three years the therapists "told (her) that she must divorce her husband, suffer an abortion, and separate from her parents in order to resolve and remedy her mental and emotional problems."
As Hunt's depression worsened and she increasingly had suicidal thoughts, the lawsuit says, she was told by Genesis "that she must not go to a hospital or take any anti-depressant drugs unless she never planned to ever recover."
In her suit, Linda Dillingham says she was "made to sever her ties with her daughter, brother, sisters and parents, all of which aggravated her mental and emotional injuries."
Dillingham's suit said she was told by Genesis therapists to divorce her husband, which she did. It contends that her therapy at Genesis led to ''severe depressions and increased suicidal tendencies and alcoholism."
Hunt and Dillingham declined, through lawyer James Bolden, to be interviewed.
Mansmann and Neuhausel, in court documents responding to Dillingham's lawsuit, say that they never told her to sever ties with her family or divorce her husband, that Dillingham was already separated from him and that she complained of mistreatment by him. Neuhausel's response says she recommended that Dillingham "first work through her problems before confronting her parents" about her recollections that her father molested her.
In a December 1993 deposition, Dillingham said her father, now dead, never
sexually abused her. That idea was planted in her mind during therapy, Bolden contends. "She regrets her involvement in that now," he said.
Stinger said that last year he attended a group therapy session at Genesis with about 20 people, many of whom claimed during the session to have been victims or perpetrators of heinous acts during cult rituals.
Stinger, of Pottstown, and his then-wife, Fitzgerald, became clients of Neuhausel's in 1988. Stinger left therapy with Genesis last year; Fitzgerald, of Gilbertsville, now counsels children for Genesis.
"The things these people revealed were horrific," Stinger said about the 1993 group session. "They talked about sacrificing babies and eating their hearts; Black Masses and having sex on altars. It was like something out of a Stephen King novel. I couldn't sleep for weeks."
Stinger says he checked on his wife's statements of Satanic cult involvement in her childhood and could find no evidence to support them.
"When I did that and confronted her . . . I was accused of being in denial," he said.
Stinger said that, under prodding by Genesis therapists, he recalled being
sexually molested as a child by a family friend.
"It never happened," Stinger said recently. "Having it come out of my own mouth, I actually began to believe it. It sounds sick, and I guess it is."
Carol and Martin Ritter said they attended group "rage" sessions during which people were told to visualize someone who had somehow hurt them. Once, Carol said, a woman became so worked up she displayed seizure-like symptoms for a long time.
"Everyone is shouting and yelling for you to get out whatever you're holding back," she said. "They're asking you, 'Why are you so angry?' 'What are you crying about?' The therapists begin the sentences and you're expected to finish them."
The phenomenon of therapy patients recalling sexual abuse from long ago has mushroomed into one of mental health's most bitter and public controversies.
Increasing numbers of therapy patients are claiming that 20, 30 or 40 years earlier they were sexually abused - often by a parent or other relative - and had buried the memory. Families have been shattered by such accusations.
The issue of recovered memories - or "false memory syndrome," as skeptics label it - has been scrutinized in publications as varied as The New Republic and Playboy, and become a talk-show staple.
In 1988, the state of Washington decided the statute of limitations for civil suits on childhood abuse should begin when an incident is recalled, not when it occurred. About half the states, including New Jersey, have followed suit. In Pennsylvania, the statute of limitations begins on the accuser's 18th birthday.
Since Washington state's decision, says University of Washington psychologist Elizabeth Loftus, aggressive retrieval of such memories has become a growth industry among therapists - in part because of jury awards and out-of-court settlements.
Judie Alpert, a New York psychologist who is co-chair of the American Psychology Association task force examining memories of childhood abuse, said some client recollections of abuse may be false, but she hadn't seen any such cases in her practice.
"I know from dealing with patients that some terrible things that we would consider unimaginable have happened to children who may remember it years later," she said.
Richard Ofshe, a social psychologist at the University of California who has been critical of repressed memory therapy, said its widespread use constitutes a mental health epidemic: "If this were a physical disease, the Centers for Disease Control would be issuing a bulletin every half-hour."
Alpert takes strong exception to such a view.
"In my experience, if anything, psychoanalysts would be more likely to err on the side that what they're hearing is fantasy, and slow to say that it's sexual abuse," she said.
Some feminists and advocates for abused women and children say that mental health professionals who harp on instances of fabricated memories help real perpetrators of abuse get away with crimes. On the other side of the issue, the False Memory Syndrome Foundation, based in Philadelphia, was created to offer support to people who claim to be innocent targets of false memories.
Harold Lief, a Philadelphia psychiatrist who is on the foundation's advisory board, was unable to finish a lecture on repressed memory at McGill University in Montreal last fall when he was drowned out by protesters' catcalls and noise-makers.
"We live in a world where everyone wants yes-and-no answers," Lief said in an interview. "To blame all adult maladies and pathologies on a single childhood trauma makes the world quite simple."
Identify those people, particularly family members, who are "toxic" and ''detach" from them.
That is a hallmark of the Genesis approach, ex-clients and relatives of clients said in lawsuits and interviews.
"We were both told right off, from the beginning, that we were from dysfunctional families and that it was harmful to continue having a relationship with them," Rich Stinger said of the therapy he and Kathleen Fitzgerald underwent at Genesis. "Just about everyone I knew of at Genesis had detached from their families."
Since leaving Genesis, Stinger says, he has reconciled with some siblings but has been unable to re-establish ties with his father:
"I know I hurt him a lot, and I know how he must feel. But I hope I get the chance to tell him how much I care about him before it's too late."
Charlene Reilly of Chester Springs said she was encouraged to detach from her parents shortly after she sought counseling at Genesis.
"I said my parents were elderly and I loved them," she said. "I was told, 'Someday, you'll get to the point where you won't need them.' "
Reilly quit after going to a handful of group sessions. She said she was
put off by the role she felt the therapy group wanted to assume in her life: ''They spend a lot of time trying to convince you that you need them and their network and that's going to replace your parents and everyone else in your life."
Like many Genesis clients, Carol Ritter detached from her parents in a letter. She said she took a draft of the letter to Mansmann, who edited it.
Life after Survival includes sample detachment letters, including one that contains these lines:
Since you made a choice to stay unhealthy and I have not, I'm afraid that total detachment from you is necessary. This simply means that I will not be in touch with you in anyway or you with me, for at least 1 to 2 years.
- From Mary to Mom & Dad
Elizabeth Toebe, a 72-year-old woman who chose to use her maiden name, got a detachment letter on Oct. 5, 1990, from her daughter, a Genesis client. The note card, decorated with butterflies, bore this message:
Dear Mom and Dad,
It's going to be hard but the best way for me to break the cycle of generational addiction and depression for me and my children is to detach from you while I'm going through this therapy. . . . Please don't contact me or (the daughter's husband) by phone, letter or gifts. . . . I will be in touch with you when I'm ready. I'm not sure when that will be.
It's been more than three years, Toebe said, since she has had any meaningful contact with her daughter, son-in-law and two grandchildren.
Jean Fitzgerald, 65, got a detachment letter in August 1988 from her daughter, Kathleen. It was addressed to Kathleen's parents and siblings:
It saddens me to have to say this, but for me to get healthy I need to
physically and emotionally detach myself from our sick family system. This means no socializing, no phone calls, no contact by mail for however long it takes me to feel stronger & healthier.
Said Jean Fitzgerald: "I feel like Kathy died in 1988, or at least started to die."
Several men who attended therapy sessions at the Exton practice said the Genesis approach made them feel as much target as client.
Mansmann "immediately aimed at Martin," Carol Ritter said. "Everything I described about Martin, Pat saw as a bad trait. Martin was an alcoholic, he was addicted to cigarettes, he was addicted to work, he was addicted to me. . . .
"At Martin's first session, Pat said that . . . we had to put our marital relations on hold and that our marriage may not survive the therapy."
The "in-house separation," as it is called in the lawsuit, meant they were not to touch or even converse, except for necessary business.
"I thought, 'This is crazy,' " Martin Ritter said. "But I thought maybe Carol saw something there that I didn't, so I went along with it."
The in-house separation lasted eight to nine months. Then, Martin Ritter said, he was advised by Mansmann to leave their house in Pomeroy. After a month, Carol Ritter said, Mansmann decided Carol should move out, and have her husband return to take care of the couple's toddler daughter.
In the suit, Carol Ritter says that she asked Mansmann for permission to say goodbye to her daughter, and that the therapist refused, telling her that Chrissy was "toxic" and that the child had been corrupted by Martin.
"They put it on me that I loved my daughter too much," Carol Ritter said.
For most of the next two months, Carol Ritter says, she lived with different members of the Genesis network.
Carol Ritter said Genesis therapists urged her to be more assertive at work, particularly with men. Carol said she once manhandled her male boss over a perceived slight and was praised for it at Genesis. Eventually, Ritter said, ''I talked myself out of a job."
She said Mansmann ordered her not to take muscle relaxants a physician had prescribed for a stress-related jaw disorder.
In the fall of 1992, Martin Ritter stopped going to Genesis. Soon after, fearing she would lose her husband and daughter, Carol Ritter quit. By then, the Ritters said, they had spent more than $5,000 in therapy fees.
Martin Ritter said he was castigated many times in individual and group sessions. In the suit, he seeks damages for one such episode.
"Pat Mansmann would blow up in my face and tell me I was a liar, that I'm sick, that she would have Carol divorce me, that I wouldn't have custody of my child," he said.
"It wasn't just Martin," Carol Ritter said. "If anyone seemed not to say the right thing in group sessions, they were attacked for being slick or a liar."
Stinger, too, said he was harangued for resisting therapists' suggestions.
"They used to have a book in the waiting room entitled, What Men Know About Women," he said. "It was full of blank pages. In a therapist's office, that's not very funny."
Larry Byers, of Boyertown, a former Genesis client, said he felt he received criticism in group sessions because he is male.
"The therapists pushed the idea that both men and women had male and female sides, and that men had to have their female side come out more and women should exhibit their male sides more," Byers said. "If you were resistant to some of their suggestions, they'd say, 'Don't be a typical man; be a Genesis man.' "
Dennis Young of Exton, whose wife, Bea, remains a Genesis client and has filed for divorce, said the first time he met with Mansmann, "she wanted to know how I felt about masturbation."
"I thought she meant did I have a religious compunction," he recalled. ''But then she made it clear that I would have to practice abstinence and not have sexual relations with my wife until we worked through our issues, whatever they were."
Some ex-clients, including Stinger, said they were encouraged by Genesis therapists to spend time with fellow clients on "snuggle dates."
The ex-clients said they were supposed to relax on a sofa, hold hands and cuddle, but not have sex.
Two former clients said they heard Genesis therapists suggest clients go on snuggle dates with members of the same sex. The ex-clients said they never
went on such dates.
Jill Bressler was a court-assigned evaluator in a Delaware County domestic case involving a couple - Pete and Kathy - and their three children. (The family's last name is being withheld by The Inquirer to protect the identity of a child who claimed to have been sexually abused; the claim is unproven.)
Kathy and the children have been Genesis clients. The parents are divorced, and Pete, seeking liberal visitation privileges, contends that the therapy group harmed his relationship with his children by inducing false memories of sexual abuse.
After therapy began, the couple's 14-year-old daughter accused Pete of
sexually abusing her when she was younger than 3. According to Bressler, the charge was investigated by the county youth welfare agency and dismissed.
In his recent malpractice suit, Pete says he hasn't seen his daughter in 2 1/2 years and has gone long stretches without seeing his two sons.
Pete's lawyer in the civil suit, Joseph Rizzo, says the notion of repressed memory makes the case challenging: "We are dealing with the debate that
memories may be authentic or fabricated, and that clouds the legal issues in a case like this."
In a report dated June 15, 1993, Bressler concluded that some of the ill feelings the children expressed regarding their father were being coaxed from them at Genesis:
"In order to participate in the (therapeutic) system, (the children) are being subtly and unconsciously encouraged to share what may or may not be actual memories of incest and abuse and other 'dysfunctions.' "
Bressler said Genesis therapists had "taken to calling Pete the 'perpetrator' without any real exploration of what did happen in this family."
Commenting on Genesis' approach regarding Pete, Bressler wrote: "This is not within any standard of established family therapy or family systems theory, nor is it a way to heal the wounds in the family."
Bressler's report said the therapy group had a "central role in the lives of Kathy and the children. . . . A great deal of her and their socializing occurs through what is known as the 'network.' "
She wrote: "What has happened by this almost cultlike involvement is that (the) children are now even more split and conflicted than they were at the beginning of this divorce."
Maggio, who represents the mother in this case and represents several other Genesis clients in divorce actions, said of Bressler's report: "I do not believe that it properly reflects the therapeutic approach (of Genesis Associates). I don't think it's appropriate to go into detail because this is ongoing litigation, but I believe it to be inaccurate and not given in the spirit in which it was requested."
The mother plans to rebut Bressler with a family evaluation by another mental health professional, Maggio said.
Bressler recommended that Kathy and the children sever their relationship with Genesis, and recommended liberal visitation rights for the father. The court has not ruled yet.
In its literature, Genesis Associates says it provides "an innovative ACOA treatment plan coupled with the AA/AL-ANON/ACOA 12-step program."
AL-ANON is a self-help group for relatives of alcoholics that parallels Alcoholics Anonymous in a 12-step approach. The Philadelphia office manager of AL-ANON, Joan W. (AL-ANON members and workers do not use last names) said AL- ANON does not encourage people to estrange themselves from alcoholic loved ones.
"We believe that you should detach yourself from the disease, not from the person," Joan W. said.
Dr. Martin Goldberg, director of the University of Pennsylvania's Marriage Council, said that encouraging divorce or estrangement from family members is ''totally out of line" with the aims of family therapy, except in extreme cases.
"Certainly, you can imagine encouraging someone to make a break with circumstances that are a problem, like quitting a job - say, the patient is an alcoholic and working as a bartender," he said. "However, estrangement from family and friends is not advisable unless there's some compelling, valid, medical, scientific reason. For instance, you might have a patient who is addicted and the whole family is mired in addiction, or criminal activity."
Goldberg said it would be unusual for a therapist to encourage divorce.
"The breakdown of the family and of marriages is recognized as a huge problem in our society," he said, "and the goal of a therapist should be to rehabilitate marriages."
Some ex-clients say they wonder what led them to stick with Genesis therapy despite doubts.
Betty Samuels says she started seeing Neuhausel around 1986. About a year later, she says, the therapy took an unusual turn.
"There was some church-bashing going on, particularly the Catholic Church, and being a converted Catholic that bothered me a little," she said.
Samuels says she resisted when Mansmann and Neuhausel pressed her to detach
from her 78-year-old mother.
"The attitude I got from them was very sarcastic: 'What are you afraid of, that she's going to die?' " Samuels said. "They'd simply tell you that if you didn't do this, you couldn't be helped." Despite her doubts, Samuels continued seeing Genesis therapists off and on. At the end of 1988, Samuels says, her marriage of 25 years was shaky and Neuhausel told her to have her husband attend a session.
"It was Dec. 13, 1988," Samuels said. "When my husband got home, he immediately started packing. He had an urgency, as if he thought he was in danger. He said that Pat Neuhausel said he had to get out of the house that night."
They never lived together again.
Then, when Pat Neuhausel again pressed her to detach from her mother, she did it: "By this time, I was so vulnerable that if Genesis told me to stand on the roof and cock-a-doodle-doo I would have done it."
She sent a detachment letter on her mother's birthday.
Finally, Samuels says, she became fed up with Genesis' demands on her time when Neuhausel insisted that she pass up choir practice, one of her few solaces, to attend a therapy workshop.
After switching therapists, Samuels asked her mother for forgiveness in a letter sent on Mother's Day 1989.
"My mother passed away in 1992 and I was with her as she was dying," Samuels said. "I can't begin to express how glad I was to have reconciled with her."
Former client Beth Johnson says she realizes it may be difficult to understand how anyone could allow therapists to exercise such influence.
"It seems like you'd have to be brainless to let this happen," said Johnson, of Linfield. "It was just the opposite. Most of the clients were bright, intelligent, professional people, but they came in with a wound. They were vulnerable.
"And you spill your guts to these people; you tell them things you've never told anyone else. Eventually, they know exactly what to say, what buttons to push."
At various times, five Genesis clients lived in a rental property Johnson's family owned, forming part of the group's network.
Johnson says members of the network not only attended therapy together but socialized together, frequently avoiding outsiders as "toxic."
The close-knit network was a communications conduit back to the therapists, she says.
"If you expressed some doubts about the therapy or if you said the wrong thing to each other, it immediately got back to the Pats and they'd bring you all in for a group session," Johnson said. "And if you questioned them at all, they'd throw you out."
After 2 1/2 years of therapy, Johnson quit.
Almost as quickly, she said, the Genesis network of support evaporated for her. "When I left, a number of other clients wrote to tell me they didn't want to see me anymore," Johnson said, "because now I was toxic."