My Thoughts

By Ross McDonough M.S.W., L.C.S.W., C.A.P.

I knew Trent Cook.  He was a therapist in a group private practice in the Regency area.  We collaborated on a family together.  I was treating the mother in my practice and he was treating the teenage daughter in the group practice where he worked.  It was not the same person referenced in the article.  We spoke a few times by phone to coordinate our work but never met in person.  He left the group practice abruptly a few months ago and did not terminate with his clients.  I was extremely disappointed in him to say the least and even considered filing a formal complaint on him for abandoning his clients.  I tried to contact him to talk about it but was unable to find him.  He did not leave a forwarding address with his group practice.

It saddens my heart to hear this news this morning.  I feel for the family of this young girl and for what she must be going through.  She is the victim of the ultimate betrayal of our profession.  Where will the victim and her family turn for help in order to start the process of healing?  To the same profession that brought about this suffering?  I feel sick.  The ramifications of this betrayal will likely linger for years.

Licensed Clinical Social Workers are bound by a professional Code of Ethics.  We are also bound by State laws outlined in Chapter 491.  I urge the State Attorneys Office to charge Trent with having sex with a therapy client.  This is a felony in the State of Florida and should be added to his three charges of unlawful sexual activity with a minor.  He should lose his license to practice forever.  He should serve an appropriate prison sentence for these crimes.

I am outraged.  I am angry at Trent for what he did.  I am angry about what happened to this young girl.  The injustices here are multi-layered.  If you look at the blog comments posted on the Times Union web site under this article, you will see that our community is outraged as well.  They are not just outraged with Trent, they are outraged with all of us.  The community blames the profession rather than the individual therapist.

Is that fair?  Do we deserve to share part of this burden?  I certainly haven’t crossed any boundaries with any clients.  There are over 300 Licensed Clinical Social Workers practicing in Northeast Florida.  This is the first time that I remember hearing of a therapist in this area who got into this kind of trouble.  The rest of us are respecting our boundaries with our clients.  The rest of us are working to empower our clients and help them on their journey of healing.  Should we share this burden with Trent?

I think we should.  We failed Trent and we failed his client.  Our profession allowed for Trent to commit the ultimate betrayal of a vulnerable minor.  Hindsight might offer an opportunity to learn from this tragedy.  I hope that we will learn what we could have done differently as a profession in this instance.  I hope that as a profession, we learn something here that will prevent this from ever happening again in Northeast Florida.

When I went through Clinical Supervisor training with Dr. Catherine Waltz in Fort Lauderdale, the discussion of sexual contact with clients came up.  Dr. Waltz wanted to make sure that we equipped those we supervise with the safety nets necessary to prevent this kind of event from happening.  She encouraged us to boldly ask our supervisees about their sexual attraction to their clients.  She encouraged us to make sure that we discussed this important topic and warn our therapists in supervision of the pitfalls that often lead up to boundary violations with clients.

I remember asking Dr. Waltz about the circumstances that lead up to a therapist sleeping with a client.  I proposed that these therapists were probably weirdos that operate on bizarre theoretical and practice orientations that involve touching or other sexual contact as a part of the healing process.  I have heard rumors of these professional deviants and always assumed that these were the people who slept with their clients.  Dr. Waltz’s response startled me.

She told us that these therapists who slept with their clients were people like me and you.  They are people that have allowed themselves to become detached and not self-aware.  They are people that are experiencing personal issues that are not being dealt with.  They are people that have allowed the safety nets of the profession to loosen.  They are people who allowed themselves to take small liberties with clients, one at a time, that grow into the kind of boundary crossing that we see here.

I am sure that Trent did not directly go from being this client’s therapist to being her sexual victimizer.  It is likely that there were a dozen or more progressive boundary violations that led up to this victimization and ultimate boundary violation of sexual victimization.  The safety nets of our profession failed to recognize these progressive boundary violations that led up to a therapy client and her family being betrayed by someone that they likely went to for help in a time of crisis.

Trent was licensed.  He was not required to be in clinical supervision.  I don’t know if he participated in group or individual consultation with colleagues.  I don’t know if he ever participated in his own long-term therapy.  I don’t know what his clinical supervision was like.  I don’t know if he was experiencing a personal crisis that left him clinically vulnerable.  I don’t know if he recognized the significance of the progressive boundary violations that led up to him victimizing a client.  Our profession should be asking all of these questions.

What else should we do?  I believe that we have to be vigilant within our own profession to recognize boundary violations in our colleagues.  I also believe that we should embrace the idea and create a culture of therapists going through their own long-term therapy.  We need to empower therapists to police themselves and we need to figure out how to help each other.  We need to be more transparent in our work.  We need to staff problematic cases.  We need to participate in our own therapy.  We also need to ask difficult questions of each other.  We need to act on our “third ear.”

Trent’s behavior does not just affect him, the victim and the victim’s family.  His behavior undermines our collective credibility.  Our profession was betrayed by Trent.  You are betrayed as well.  Ask yourself, “What will I do to make sure that I never betray my clients or my colleagues?  What will I do to make sure that other therapists never betray their clients?”  The community blames us all for this tragedy.  We all need to act to make sure that this never happens again.

If you would like to reply to this, please email me at or go to my website:

Ross McDonough M.S.W., L.C.S.W., C.A.P.

Dr. Cathy Waltz’s Response:


   Thank you very much for sharing your Blog entry with me and agreeing to allow me to post it on Dr. Cathy Waltz’s Blog as well.  The news article seems so terse and unemotional – “just the facts, m’am” reporting.

   On the other hand, your eloquent response and questions clearly express the pain that many are just beginning to realize.  Some of “us” are not clear about boundaries and cross the line.  Your efforts to contact Mr. Cook after he dropped out of sight are a credit to your personal/professional ethics and, hopefully, a response to all of the training you have had.  You observed something out of bounds and attempted to address your concerns directly.  That is what the Social Work Code of Ethics tells us (social workers) to do.  Remember, too, that our other 491 Licensed colleagues’ Codes of Ethics do not directly instruct them to take the same action. 

   I appreciate your saying what many of us feel and do not express.  You “feel sick” when facing the reality that the boundary violation committed by Mr. Cook has impacted the future help-seeking options for all of the young woman’s family but especially her future contacts with psychotherapists.

   I, too, feel sick. . . because many of our colleagues don’t even know that this abuse of power occurred and those that do might just “duck and cover” because it is really difficult to face the idea that “Mr. Cook is just like me…I could violate boundaries, too.”

   Your express outrage, anger, frustration, and then denial.  I am with you on all those emotional fronts.  Sorry, though, I have to say it Ross, when you assert that the rest of the LCSWs in your area haven’t crossed any boundaries I have to say denial.  Boundary violations occur along a continuum.  I dare say that we and many of our colleagues are likely to have crossed boundaries somewhere on that imaginary line.  I wonder what boundary violations we all would be willing to own publicly on a Blog or even in a consultative-supervision group.  I do share some of my errors when I am providing training, but I am much more comfortable pointing out others’ errors as examples.  Yck, I don’t even like remembering where those conversations have necessarily gone in my past consultative-supervision experiences or considering where they might go now.   I know so much more now than I did before when I was young and “knew everything”.

   Here are some questions for all of us:  How did the profession fail Mr. Cook?  How did our profession allow him to commit the ultimate betrayal?  What solutions do you think could be implemented?  Should licensed therapists be required to continue their own personal therapy?  Stay in formal supervision or consultation?  Should the 491 Board take a more proactive approach to the development of new professionals by clarifying the quality of “qualified” supervision?  Should the law be changed to close the loop hole that keeps the Board focused on the Registered Intern’s responsibility while remaining silent on all those who are un-registered and practicing under the auspices of an agency where someone might eventually sign-off on the worker’s hours?  Whoa, that’s certainly enough thought provoking questions for now.  Ross, you ask some great questions.  I’ve added mine. 

   Readers,  what is your response?