A Durango-based therapist has surrendered her license and right to practice as a Licensed Clinical Social Worker after two complaints that she maintained a romantic relationship with a patient.
Lillian Ramey, the executive director of Riversage Family Counseling and chief executive of Rivers Edge Institute, offered to relinquish her license July 10.
Peers, including several former colleagues, are raising concerns about Ramey’s conduct, which they say is a proscribed abuse of power. Other practitioners are also worried by her continued leadership and ongoing consultation during Eye Movement Desensitization and Reprocessing therapy training.
Riversage, under Ramey’s guidance, is esteemed in Durango’s therapy community. Its clinicians often supervise candidates working toward professional counseling licenses, and Ramey is known in the community as a leading trauma therapist.
Ramey denies that she had a romantic or sexual relationship with the now-former patient, but has admitted she had a platonic dual relationship with the individual, violating state standards.
Emily Campbell filed the first complaint against Ramey with the Colorado Department of Regulatory Agencies Division of Professions and Occupations on Aug. 6, 2020.
Campbell, the former program director at Riversage, reported that she had first been introduced to the patient by Ramey at a social event at her own home during summer 2020, when Ramey introduced the individual as “her partner.” Ramey denies using this term.
However, Campbell was unaware that the person identified as Ramey’s partner was also a patient.
At the time of Campbell’s introduction to the patient, Ramey was in the process of going through a divorce and living at Campbell’s home. The relationship between the two grew fraught and Campbell ultimately resigned her position at Riversage, citing “a number of unethical situations (and a) lack of leadership.”
“Two weeks after ending my employment, I found out that the person Lillian had brought to my house as the person she was dating, was in fact also actively a client,” Campbell said in an interview with The Durango Herald.
In a written response to Campbell’s complaint, Ramey admitted to maintaining a platonic relationship with a patient but denied any romantic involvement.
“I recognize that Social Workers are to refrain from dual relationships,” Ramey wrote. “I also know that not all dual relationships are ‘inappropriate’ per se, but that professional judgment must be used in discerning whether it is appropriate for a dual relationship to occur.”
The complaint prompted an investigation by State Board of Social Work Examiners. In summer 2021, an investigator interviewed Campbell, Ramey, the patient and Ramey’s soon-to-be-ex husband.
The investigator found a number of inconsistencies in the narratives provided, including the timeline of Ramey’s relationship with the patient.
The patient also denied having a romantic relationship with Ramey, telling the investigator, “there was zero intimacy.” Text messages between the two, which Ramey’s spouse sent to investigators, revealed they were spending nights together and engaged romantically.
After completing the investigation, Ramey signed an agency order admitting that she had “engaged in a dual relationship by maintaining a friendship with a client while also engaging in a therapeutic relationship,” and that she “shared personal information that went beyond professional boundaries.”
As a stipulation of the agreement, Ramey completed a continuing education program on ethics and boundaries. The order was signed Dec. 27, 2021.
On July 22, 2022, a second complaint was filed against Ramey. Although the complainant was identified as “a former contractor” to Riversage, DORA redacted their name because the complainant was also a former patient of Ramey’s.
This sort of dual relationship was not uncommon at the practice, according to former employees.
The complainant said they were introduced to the patient by Ramey in May 2021, and that the three began to cycle together regularly. Later that summer, the complainant observed Ramey and the patient kissing and was informed by the patient that the two were secretly a couple.
In an interview with the Herald, Ramey said that she did not have anything but a platonic relationship with this client.
“There are circumstances to that experience that can lend itself to a lot of different interpretations,” Ramey said of the second complaint. “ … I am not denying that I spent a lot of time with the person.”
When pressed on whether the complainant had caught her in an intimate moment with the patient, Ramey declined to comment.
The complainant also noted that they were told by the patient that the romantic relationship began when the patient was an active client.
“I was told by (the patient) the prior DORA investigation was falsified and made to appear only a friendship occurred by both parties,” the complaint says.
In a response to the complaint submitted through her attorney, Ramey “elected to plead the Fifth Amendment and will enter a no-admission stipulation in exchange for a voluntary relinquishment of her license.”
In June 2023, the board “found reasonable cause” that Ramey had violated Colorado law which says LCSWs may not engage in sexual contact with a client during the period of time in which a therapeutic relationship exists or for up to two years after.
The board and Ramey agreed that she would relinquish her license but not admit to the allegations.
“I chose to voluntarily relinquish my license after practicing for 25 years rather than going through this grievance process with the licensure board and feeling very unsupported by my profession,” Ramey said.
The order was signed July 10.
The National Association of Social Workers code of ethics has strict guidelines saying social workers may not have sexual relationships with current or former clients, and that they should not provide clinical services to individuals with whom they have had a previous sexual relationship.
Colorado law also says it is a violation of the licensing statute for clinicians to maintain relationships with clients that are “likely to impair the person's professional judgment or increase the risk of client exploitation, such as treating employees, supervisees, close colleagues, or relatives.”
But Ramey’s peers say they are worried that the incident indicates that Durango’s therapy community is slipping when it comes to ethics.
“There just seems to be a culture in the mental health community of getting by with things that would never fly in a bigger city – maybe that’s just normal for Durango,” said Lynn Rosenberg, a therapist who spent two of her eight years working as a therapist in Durango contracted with Riversage. “It’s been disappointing.”
Riversage is known for training up-and-coming therapists, Rosenberg said. She and Campbell share concerns that clinicians in training might not be getting appropriate supervision.
“There are (a lot) of interns and supervisees working under this person who is not checking her own ethics, and therefor not modeling correct ethics,” Campbell said.
She acknowledged that Ramey has provided useful therapy to clients, and she expressed concern that Ramey’s peers or clients could feel “betrayed, confused, manipulated.”
Although she can no longer see patients, Ramey confirmed that she continued to provide EMDR training to members of the Axis crisis team after July 10.
“People provide consultation all the time for things that are not specific to certification or licensure,” she said.
The EMDR International Association requires that anyone working toward EMDRIA credentials be trained by a certified practitioner, however uncertified people may assist in training. Ramey’s EMDRIA certification was revoked upon surrendering her license.
“Axis was made aware that Lillian Ramey was no longer licensed prior to providing EMDR training in July. As a result, a licensed provider was brought in to lead the training and Ms. Ramey moved into a support role for the training,” said Axis Vice President of Administration Sarada Leavenworth in an email. “Axis does not plan to engage Ms. Ramey for future trainings.”
Rosenberg also raised concerns that Ramey had been less than forthcoming with her colleagues and the public regarding her status as a licensed professional.
To comply with state and EMDRIA regulations, Ramey has changed her credentials on parts of her websites to signify she has a masters in social work, rather than an LCSW.
However, those changes were made over a month after losing her license, and as of writing, the signature on her Riversage biography page still credentials her as an LCSW, as does the calendar of EMDR consultations on the Rivers Edge website.
Ramey’s peers say they fear the impact the incident could have on the community of practitioners, as well as current or future patients. And they hope that accountability may better the community as a whole.
“It’s that lack of transparency that all of us are shaking our heads at,” Rosenberg said.
She recommends that potential patients look up a potential therapist’s license and check for any disciplinary actions by the state.
Ramey said in an email that some changes are afoot at Riversage.
“We have diversified our supervision structure as well as added additional supports for supervisors who can often feel alone in their position of authority,” she said. “We are also in the process of transitioning into more of a Team Leadership structure that offers knowledge, inclusion, and growth at all levels.”
Ramey added that she is not compromising on her commitment to do good in the community.
“I have been challenged to stand strong when all those around me are doubting or confronting my truth,” she wrote. “I have also learned that my identity is not about my role as a therapist but instead about who I am as a person and the good that I can do for others in many ways.”
Affected clinicians and clients seeking support from a professional outside the area should reach out to Rebecca Albright at email@example.com. Albright is aware of the situation and prepared for those impacted to contact her.