Newsday (New York)
The Secret World of Case Beukenkamp
By Jamie Talan and Richard C. Firstman
August 18, 1992

FOR THREE MONTHS in the 1960s, a young woman from Roslyn named Sandy Schlager sat mute in a corner of her Manhattan psychiatrist’s office, outside the circle of her twice-a-week therapy group. The doctor, a pioneer of group therapy, had banished Schlager for talking too much.

One night, as a session was about to begin, the psychiatrist, a charismatic, authoritative man with black-rimmed glasses and a black goatee, turned to Schlager and said there was only one way she could return to the group: She would have to have sex with him, in front of her fellow patients.

“They sat there and watched,” said Schlager, telling the story with amazement at her own submission and the group’s casual acceptance. But she said that wasn’t the first time she had sex with the psychiatrist. And it was not to be the last.

“I was so dependent on him,” said Schlager, who now lives in Washington, D.C., and asked to appear in this story under her maiden name. “He convinced us that if we left, our worlds would fall apart.” And so, says Schlager, who was then a married social worker, twice a week for 15 years she commuted into the city for therapy with a doctor with whom she was sexually involved – a man she now describes as “brutal.”

Shirley Bing says her involvement with the psychiatrist lasted even longer. For 28 years, Bing, a New Yorker who now lives on the West Coast, was what she describes as her psychiatrist’s “patient, lover and private secretary.” The doctor, she said, first convinced her that having sex with him would “feminize” her and later persuaded her to leave her husband and teenage children, who also were his patients. Eventually, she said, she moved overseas with her psychiatrist and gave him most of her assets.

“He used me,” Bing said. “He so easily could have helped me with my problems, but he used them to control me.”

Sandy Schlager and Shirley Bing are among more than a dozen people who have told Newsday they feel they were sexually or emotionally abused by Dr. Cornelius Beukenkamp Jr., a Dutch-born psychiatrist who lived in Great Neck and practiced on Park Avenue for more than 20 years before moving abroad, most recently to the British West Indies.

Some female patients said they had sexual relations with Beukenkamp, ostensibly as part of therapy; in addition, several men and women said they witnessed or knew about sexual acts between the doctor and female patients. If these accounts are accurate, several in the field said, it would make Beukenkamp, who turns 74 next week, an extreme example of professional misconduct by a psychiatrist.

“This is among the worst cases I have ever heard,” said Gary Schoener, a clinical psychologist in Minneapolis who is regarded as the leading authority on the issue of sexual misconduct by doctors. Based on what patients told Newsday, Schoener said, “People were sucked in over a long period of time, and the longer he holds them captive the worse it is, simply because they miss their life . . . He has left a trail of agony.”

Beukenkamp has refused half a dozen requests for an interview – by phone, fax and a reporter’s visit to his oceanfront house on Grand Cayman Island. “I’d rather not comment, please,” has been his most direct response.

For some of Beukenkamp’s former patients, discussing their experiences in public for the first time has meant unlocking a 40-year secret. Several said they joined Beukenkamp when they were young and psychotherapy seemed new and adventurous, that they believed him when he said sexual intimacy between doctor and patient would help them overcome their problems.

Now, years later, they are making their disclosures at a time when sexual abuse by doctors is a growing concern in the psychiatric profession. Sex between therapist and patient is considered highly unethical, and it can be grounds for loss of a medical license in New York and most other states. Still, experts estimate that as many as 10 percent of psychiatrists try to have sex with their patients, and few are ever disciplined. In part this is because patients are often unwilling to come forward, and even when they do, their allegations are usually uncorroborated and difficult to prove.

But beyond the issue of sexual entanglement, many patients said that Case Beukenkamp, as he’s called, became the central figure in their lives, drawing them into the kind of psychological, personal and business relationships that his peers have long held to be highly unethical and unhealthy.

In many cases, the former patients said, Beukenkamp separated them from their families, ridiculed them to gain control and promoted a kind of master-follower relationship. These practices, they say, applied equally to men and women, including three patients who were, and remain, practicing psychiatrists.

Thirty-two of Beukenkamp’s former patients were located, and 19 of them – 11 women and eight men – agreed to be interviewed, although not all would allow their names to be used. Three of the patients said that Beukenkamp helped them and did not abuse them – though all said they either witnessed, participated in or were aware of sex as part of the therapy.

“He taught people how to live,” said one man, a public relations consultant who spent 17 years with Beukenkamp and asked not to be identified. “Things have to happen to shock people, to shake them up.”

The others described abuses that spanned four decades and three countries, with no serious investigation until last year, when authorities in the Cayman Islands refused to renew Beukenkamp’s medical license following reports of erratic behavior. Beukenkamp still holds a federal drug license and a New York State medical license; the latter is inactive because he hasn’t paid the yearly fee.

According to the patients’ accounts, Beukenkamp cultivated a core of patients – perhaps 25 of the 1,000 he may have treated during his career – who became completely devoted to him, true believers who stayed with him 10 or 20 years. Beukenkamp continued to treat some of these patients long-distance at least until 1985, 15 years after he left the United States.

“To my mind, this man was not a therapist,” said Dr. Harold I. Schwartz, chief of psychiatry at Hartford Hospital in Connecticut, who learned of Beukenkamp through a related tax case. “He was a charismatic cult figure who brought a group of people under his influence and took advantage and abused them for his own gratification.”

With some in his own family, however, Beukenkamp has had distant relations. He and his son Robert did not see each other for 20 years after the death at age 46 of Barbara Beukenkamp, the doctor’s first wife and Robert’s mother; her family is still troubled by Beukenkamp’s conduct toward her.

AT NEARLY EVERY STAGE of his career, Beukenkamp’s life was closely intertwined with his patients’. During his New York years, he virtually lived with a patient, Shirley Bing, though he was still married. In 1970, after his wife’s death, he sold his house in Great Neck to another patient, then spent 18 months in Morocco and 11 years in Costa Rica, accompanied for several years by Bing. In 1976, at age 58, he married a 20-year-old woman who had been a patient as a child and whose parents were also patients. In 1983, they moved to the Cayman Islands.

For more than a decade after moving overseas, Beukenkamp maintained close ties to some of his New York patients by exchanging recorded monologues that were flown in pouches between the United States and Costa Rica. Some patients say they went into debt to pay for Beukenkamp’s “cassette therapy” – fees that were deposited into a bank account in Luxembourg, according to tax court records.

The former patients said they also traveled to Costa Rica twice a year for two-week-long therapy sojourns that included hours of manual labor on his large estate, all in the name of therapy and ending only when Beukenkamp said he was leaving them.

“This man ruined my life,” said Meredith Patterson, a 37-year-old Costa Rican woman who said she spent the decade of her 20s locked in psycho-sexual “slavery” with a doctor she says preyed on vulnerable, young women. “I kept this secret for so long.”

Patterson now works in her family’s factory and lives alone in Costa Rica. The former New York patients include a Manhattan art gallery owner, a partner in a well-known family business, a prominent historian, a college professor, a cable television executive, a real estate broker, two magazine editors, two lawyers, a psychologist, two social workers and three psychiatrists.

Three of these patients – Shirley Bing and two psychiatrists, Dr. Kenneth Porter of Manhattan and Dr. Kenneth Terkelsen of Westchester – said they have filed formal complaints against Beukenkamp with the American Psychiatric Association in the past few weeks. Sandy Schlager said she is preparing a complaint as well. These are the first official allegations against Beukenkamp by former patients.

In 1989, Dr. Larry H. Strasburger, a Harvard psychiatrist, filed an ethics complaint against Beukenkamp with the APA. Strasburger had learned that Beukenkamp had married a patient and allegedly was trying to use information from her treatment to gain custody of their two children. It is apparently the only formal complaint ever lodged against Beukenkamp by one of his American peers, though a number of them say they have been aware of allegations of misconduct for some time. The APA, a professional organization, can only reprimand doctors and drop them from its roster. It has yet to act on Strasburger’s complaint.

The U.S. Drug Enforcement Agency is also investigating and will probably ask Beukenkamp to surrender his federal license to write prescriptions, according to Robert Brown, a DEA investigator. If Beukenkamp refuses, Brown said, the agency will go through the legal channels to take it. The agency is concerned, because the psychiatrist renewed his DEA license this year using the Medford address of a family acquaintance on Long Island.

In fact, Beukenkamp resides in a modern house on oceanfront property in the Caribbean. Last month, a reporter visited the house on Grand Cayman Island, where Beukenkamp is widely known as the eccentric American doctor who shaves his head and spends his retirement cruising loud bars frequented by college students and flying in prospective wives who answer his personal ads.

The reporter, who had already had several brief phone conversations with Beukenkamp, knocked on the door and asked if he would come outside for a conversation with her. As she waited for a response, a man could be seen peeking out from between the blinds, but soon he disappeared.

ONE DAY in the fall of 1949, Dr. Cornelius Beukenkamp took a call from a 33-year-old woman of some means and education who lived in Scarsdale. The woman’s closest friend, a patient of Beukenkamp’s, had been prodding her to see the young psychiatrist about her problems: intractable migraine headaches, along with troubled relationships with her husband and her mother. The woman’s name was Shirley Bing, and she would become one of Beukenkamp’s first and most devoted patients.

Beukenkamp, then in his early 30s with a wife and young son, had come out of the Army with a medical degree and had opened a part-time psychiatric practice in an office he shared on the corner of 55th Street and Sixth Avenue while working as a staff psychiatrist at Rockland State Hospital.

In the coming years, Beukenkamp would establish himself as an eminent, if somewhat eccentric, member of the psychiatric community. He would become board-certified in psychiatry and neurology, a pioneer in the group therapy movement, the author of a book on the subject, “Fortunate Strangers.” But to Shirley Bing and many others who would become his patients, Beukenkamp was a more exotic and captivating figure than his curriculum vitae would suggest.

As a young boy, he told some of them, he was raised by relatives in Indonesia, where, at 15, he married a woman who was later killed during the Japanese invasion. He ran the mile for his native Holland in the 1936 Olympic games in Berlin and fought in the Spanish Civil War. Later, he would tell people his son had been killed in Vietnam.

In fact, Beukenkamp came to this country with his parents and brother when he was 4 or 5. He grew up in New Brunswick, N.J. He was a teenager in America the year he claimed to have been married in Indonesia, and while he was an accomplished high school runner, he did not appear in the 1936 Olympics. He did not fight in the Spanish Civil War, or any other war, and his son is now a salesman in New Jersey with a wife and two daughters.

Beukenkamp’s fictional life story, patients say, was part of the way he drew people into his world, how he used “just the right language to cap the seduction,” said one. To this day, many former patients apparently believe the life Beukenkamp invented for himself.

Shirley Bing says she was one who was disarmed by Beukenkamp’s words. During the course of her first few months of therapy, she said, Beukenkamp began to draw her into a psychological odyssey that would last 28 years.

“About a year into my therapy, Case turned to me on the couch and began having sex with me,” Bing, now 75, said during a series of recent interviews at her home on the West Coast. “I was startled, [but] I felt very special, because he would say that he wanted me as his woman. In time, I knew that it was every woman he wanted.”

During the next few years, Bing said, Beukenkamp occasionally engaged in sex with female patients during group sessions she attended, including once with her. There was no discussion, she said, just a tacit understanding that this was part of therapy. She said Beukenkamp photographed her and other women in the nude, saying it would help them feel more comfortable with their femininity.

Often, Bing said, she would stay after hours or return to the office, which was now on Park Avenue, for private sexual encounters with the doctor, who was telling her that he was trying to keep her marriage together.

“My husband and I were both in [separate] therapy with him. And he was paying for me to have sex with my doctor,” she said. “Never during those years did he [Beukenkamp] specify my illness – only that I was distrustful of men.”

Beukenkamp apparently convinced some female patients that they lacked femininity and that his form of therapy, which he said was part of the “experiential” movement in psychotherapy, could cure them. Sex, taking nude pictures – these were acts designed not to gratify him but to help women open up emotionally.

The doctor told his patients that “the real cure did not come from long-term analysis but from the intimacy between patient and doctor, the sex,” according to a former patient who said Beukenkamp claimed many of his colleagues subscribed to this theory, though it apparently applied only to female patients.

Experiential psychotherapists such as Beukenkamp were far outside orthodox Freudian psychiatry. The movement, which started in the late 1940s, grew from the belief that remaining quiet in therapy and letting the patient tell his story didn’t work. Instead, these modern-day therapists made their own experiences part of the therapy.

However, sex was never an acceptable part of the method, particularly because experientialists were supposed to take on the role of surrogate parents during therapy. “It is not only immoral but incestuous,” said Dr. Carl Whitaker, professor emeritus at the University of Wisconsin Medical School and one of the founders of the movement.

According to Shirley Bing, many of Beukenkamp’s early patients were young, upper-middle-class women coming of age at a time when women’s roles were still defined largely by men. And to some Beukenkamp offered the chance to be part of something exciting and avant-garde, a precursor to the liberation movements of the 1960s. But it was also a time when the idea of psychotherapy – especially group therapy – was so new that the line between daring new ways of self-improvement and a doctor’s abuse may have been less clear. Sexual misconduct by doctors was not the public issue it is today; many medical professionals simply did not believe it happened.

In that context, some patients said, sex did not seem wrong – it was part of the liberation process. Others, however, were confused about their relationship with Beukenkamp: Were they his patients or his lovers?

“A few months into therapy I was discussing feelings I had toward him, and he gave me permission to act on it,” recalls Arlene Hall, who was 23 and recently divorced with a toddler daughter when she met Beukenkamp in 1958.

It was the beginning of a sexual relationship that Hall says lasted 10 years. It included some weekends in which she and Shirley Bing engaged in group sex with Beukenkamp at Bing’s apartment, according to both women.

“I remember asking him whether or not the sex should be considered extracurricular,” said Hall, now 57, remarried and selling real estate in Connecticut. “We were broke, and I could not understand why I had to pay for the therapy when it was all sex.” She said Beukenkamp simply smiled and said he was making her feel more comfortable with her body.

It has long been considered natural for some people to develop emotional attachments or even sexual feelings for their psychotherapists, but it has been an equally accepted principle that patients should not be allowed to act on them. In part, this is because these so-called “transference” feelings are part of the therapeutic process and should never be manipulated.

But it wasn’t until 1974 – when cases of sexual misconduct were starting to surface – that the American Psychiatric Association published its first guidelines on the issue, stating for the record that such involvement was unethical and damaging.

Among his patients – and in his field – Beukenkamp was known as a psychiatrist with some bold new ideas about sexuality and personality and about the problems of the modern American woman.

He told colleagues at a conference in 1959 that women had “taken over” in the home, usurping the authority of men, and that this “liberation” was causing angry sons to hover between violence against their parents and homosexuality, according to an account in The New York Times.

Later, in a 1966 journal article titled “Hostility in Female Sexual Identification,” Beukenkamp described a session in which female patients with “masculine-mothers and feminine-fathers” released “great torrents of hostility about males and their sexual demands.”

Beukenkamp wrote in an epilogue: “Some ten months later it can be accurately said that the experience in this incident was the turning point for the emergence of nine females as women.”

BEUKENKAMP’S APPROACH TO men, meanwhile, involved a different sort of confrontation, according to several former patients. Two of the men in Beukenkamp’s circle said they were made to feel inadequate, as less than men.

As part of the experientialist practice of trying to break down the walls their patients put up, Beukenkamp bombarded people with their own weaknesses, pressuring them to change, to take responsibility. And for some men and women, it was effective: Even Arlene Hall credits Beukenkamp with giving her the strength to become a businesswoman.

“I knew him as a brilliant guy, very insightful. I got a hell of a lot from him,” said Sydney Cohen, an experiential psychologist in Manhattan who joined one of Beukenkamp’s groups as part of his training. “He was extremely self-centered, and you were forced to come out of yourself to relate to him. In a new situation, when someone would come in, he was capable of being charming and smart and engage you. Once you were involved and you had some need to be with him, his conditions would insinuate into the relationship.”

For some, the conditions meant separating from their families and ceding much of the control over their lives to their doctor. Sandy Schlager said Beukenkamp caused her to sever connections with her parents and her husband. “He cut me off . . . until I had nobody left but him,” she said.

Shirley Bing said she also was urged to cut off communications with her three children, then teenagers who had also been Beukenkamp’s patients. This was not unusual, she said: In several cases, he tried to break the ties of entire families coming to him for therapy.

In their place, Beukenkamp created new families: his therapy groups. As the father figure, the psychiatrist was authoritative, even loving at times. He began each meeting with a flourish – a silent approach to his chair, then a dramatic “Good Evening.” His patients admired and respected the doctor, as they might a father who knew best. They presented him with expensive gifts – paintings, sweaters, a pair of cuff links.

As years passed and the group dynamics intensified – and as some families under Beukenkamp’s care broke apart – some group members came to regard each other as a real family: a loud, bizarre and what today might be called dysfunctional family from which they had difficulty separating.

Indeed, one patient, who asked not to be named, said she still regards her group as her family and Beukenkamp as the guiding spirit of her life. The woman, now 58, says that Beukenkamp “was extraordinarily kind to me.” She was 21 when she started therapy with the doctor and remained in his care for 27 years, until 1983, when Beukenkamp released many of his patients. “I really loved Case,” she said. “I would be dead or in a mental hospital if it weren’t for him.

“Case is my father.”

Gary Schoener, the Minneapolis psychologist, said he’s not surprised Beukenkamp was able to attract so many educated, successful people and keep them hooked for long periods. “Everyone wants to buy the dream of emotional health, and once you buy into it, it is hard to get out, especially when someone is an expert at deflecting doubts. You are afraid to tell the outside world. You have to admit you have been had, and denial sets in.”

Several patients say that is exactly how they felt. And so, Beukenkamp’s private practices remained secret as his public reputation grew. He spent several years as supervisor of group therapy at Hillside Hospital, which later merged with Long Island Jewish Medical Center. He served a year as treasurer of the highly respected American Group Psychotherapy Association, delivered papers at international conferences and was a contributing editor to Voices, a journal published by the American Academy of Psychotherapists.

His thriving practice came to include several fellow psychiatrists who regarded Beukenkamp not only as a clinician but as a professional mentor. One of them, who would spend 14 years with Beukenkamp and become one of his most loyal followers, was Dr. Kenneth Porter of Manhattan. For Porter, it had started simply, in 1967. A second-year medical student who was looking for a psychiatrist, Porter knew Beukenkamp by reputation and liked what he heard: board-certified, wrote a book, was past president of the American Group Psychoanalyst Association.

And there was one other thing, Porter would testify nearly 20 years later during an obscure tax court case that would shed the first, though largely unnoticed, light on the long, strange life of Dr. Cornelius Beukenkamp.

His doctor’s participation in the 1936 Olympics, Dr. Porter said in 1985, “reflected the caliber of the man.”

Nobody, however, was more devoted than Shirley Bing. By 1960, she had asked for a divorce from her husband and rented a large apartment on East 71st Street. Soon, Beukenkamp was spending his weeknights there, Bing said, though he never severed the doctor-patient relationship. On the weekends, he returned to his wife and the corner house they’d bought in Great Neck in 1951 on Wooleys Lane.

As a way to avoid talking money and the monthly doctor’s bill, Bing says, Beukenkamp suggested that stock shares could take care of her therapy. “At one point, I gave him two hundred shares of AT&T, and that was worth a few years of therapy,” Bing said. When she dropped out of group therapy, he continued taking stocks for everyday advice, she said. Eventually, she says, she would give most of her assets to him.

Bing’s devotion ultimately meant giving up her own family. She rejected her mother, even when her mother was sick and dying. And even today, Bing’s only daughter “is still so angry at me,” she says, and they rarely speak. “I did so many sick things,” Bing said. “I am ashamed.”

She loved Beukenkamp and believed in him, Bing says, though on some level she always had grave doubts. But she said she never gathered the courage to leave on her own – even in the end, 28 years after her first call to Beukenkamp. “Why do battered women stay in a relationship?” she said. “The less love they get, the more they need. Case manipulated me into giving up everybody I loved.”

She wasn’t the only one who still feels loss – and guilt. Sandy Schlager says she spent weekends with Beukenkamp in Great Neck, helping him write “Fortunate Strangers,” a fictionalized account of group therapy published in 1958. “[I would] have sex with him in his study, while his wife was downstairs in the kitchen preparing dinner for us,” Schlager said. “She was such a lovely woman, and I felt totally ashamed.”

In a life populated by many women, Beukenkamp reserved a special place for his wife: the background. Barbara Livingston had married Case Beukenkamp in 1944 while he was a private first class in medical school. Twenty years later, the doctor’s life centered around his patients in New York, and his relationship with his wife was distant. But her friends and family say Barbara Beukenkamp did not speak ill of her husband, and it is still unclear to them how much she knew about his life.

Sometime during her last year, however, she decided she wanted to end their 23-year marriage, according to her sister, Gladys Grossman. Grossman says Barbara asked for a divorce but that Beukenkamp refused. It is unknown if the discussion went any further. To her family it is one of many questions about the last months of Barbara Beukenkamp’s life.

In November, 1967, Mrs. Beukenkamp, 46 and a heavy smoker, had a mini-stroke that partially paralyzed her face and made speech difficult. A neurologist in New Hyde Park, Dr. Martin Green, concluded that hospitalization was “certainly warranted,” he wrote in a letter to her physician, Dr. Gilbert Blum of Great Neck. Green noted cancer as a possible cause but said there was a roadblock to having Mrs. Beukenkamp admitted for tests.

“I spoke with her husband, and he is afraid of upsetting her and does not want to have her admitted to the hospital immediately,” Green wrote to Blum. “As discussed with you, I will wait until you can thrash this out further with him.” (Green died last year, and Blum would not be interviewed.)

In the end, Mrs. Beukenkamp stayed home and seemed to recover by Mother’s Day, 1968, her family said. But on June 20, Blum admitted her to North Shore Hospital with shortness of breath, back pain and general illness.

On July 8, a lymph node biopsy showed she had an aggressive cancer. Doctors who reviewed her medical records for Newsday said the cancer probably started in the lung – and probably would have been detected had she been admitted to the hospital the previous fall. Though it might have been terminal even so, the doctors said, treatment might have extended her life.

“You could make a case of passive neglect, at the least, especially a doctor’s wife,” said Dr. Mark Hoffman, an oncologist at Long Island Jewish Medical Center, one of the five physicians who reviewed the records.

Dr. Kyle Fink was a 26-year-old intern then, and Mrs. Beukenkamp was one of his first patients. Now a cancer specialist in Denver, Fink had little trouble recalling his patient from 24 years ago.

“Every once in a while this case blows through my mind,” he said. What he remembers most, he said, was the patient’s husband: “I remember this paranoid secrecy. He wanted to keep it hush-hush. He said he didn’t want his patients to find out his wife was dying of cancer, because it would disturb them so much and it would ruin his practice. And I was scratching my head; I said, ‘How’s this going to ruin your practice?’

“I felt so sorry for her. I felt she needed help from family or friends, but he wanted to keep everybody away from her. I remember how awful it was that this guy felt like his practice was so important that he had to treat his wife in this ugly way. It was a terrible situation. I thought the guy was crazy.”

Nonetheless, some of her family visited. And at night, Mrs. Beukenkamp was tended by one of her husband’s patients, a registered nurse.

The day after the cancer diagnosis, Mrs. Beukenkamp’s heart began beating irregularly, and an oxygen tent was helping her breathe. The following morning, July 10, at 11:15, she went into respiratory arrest. She was pronounced dead 15 minutes later.

The physicians who reviewed the records said they show she was very ill, that her cancer – or any number of other conditions – could have caused her death. But they said that in the absence of an autopsy, the exact cause of death will never be known.

Within minutes of being notified of his wife’s death, Beukenkamp called the Roslyn Heights Funeral Home and told the owner, John Tucholski, that he wanted his wife’s body cremated immediately. Like Kyle Fink, Tucholski still vividly recalls his encounter with Beukenkamp.

“The woman had died, and he wanted to take her right out of the hospital. There was a lot of pressure to get it done quickly. I told him that I can’t do anything until the death certificate is signed. He said, ‘Hold on.’ When he got back on, he asked me how long it takes to get from Roslyn to North Shore Hospital, and I said about ten minutes. He said, ‘Go now, and it will be there.’ It was.”

Barbara Beukenkamp had told one relative she wished to be cremated and she had told several that she wanted her remains to be buried in her family plot in Flushing Cemetery, under a particular cherry tree. Within a couple of hours of her death, she was cremated at Fresh Pond Crematory in Middle Village, Queens, and a can containing her ashes was left in the basement of the Roslyn Heights Funeral Home.

Late that afternoon, Bob Beukenkamp, the couple’s 22-year-old son, learned of his mother’s death from other family members. In a phone conversation that afternoon, family members said, Beukenkamp told his son it was “a complete cremation” – there were not even any ashes left. There would be neither a burial nor a service.

A few days later, family members said, the locks on the house in Great Neck were changed. Bob had to sneak in through a window to retrieve personal possessions, including his German shepherd, April, his baseball glove and some pictures.

The two men spoke once more a few days later and did not see each other for 20 years, family members said. Until he initiated a reconciliation with his son in the late 1980s, Beukenkamp told many people that his son had been killed in Vietnam.

Three years after his mother died, Bob Beukenkamp went looking for her remains and found John Tucholski at the Roslyn Heights Funeral Home.

Tucholski went down into the basement and came back with a small can of ashes. Bob Beukenkamp and his mother’s family took them to Flushing Cemetery and buried them in the Livingston family plot, near where the cherry tree had once stood.

The gravestone reads, “Barbara,” with the dates of her birth and death. Nowhere does the name Beukenkamp appear.

THIS WAS the letter Beukenkamp sent his patients on Nov. 15, 1970, the day he left the United States. For some, it was a welcome release, but others “were devastated,” said Shirley Bing. “People were so dependent on him for so long, and their therapy was terminated with no warning, just this note.”

Beukenkamp was not terminally ill, as his letter implied. Instead, according to Bing, he had planned for months to leave the country, taking Bing with him to start a new life in Morocco.

Beukenkamp sold his house in Great Neck to a particularly faithful patient, John Bing (no relation to Shirley), for $ 100,000. John Bing declined to be interviewed for this story.

Leaving for Casablanca with great trepidation, Shirley Bing says, she brought along about five dozen turquoise sleeping pills, “enough to kill myself,” if things got bad enough. She still keeps them by her bedside to remind her of what she calls “her escape” in 1977.

But Beukenkamp’s farewell letter was not his last communication with his patients. Pleading poverty or illness, he wrote letters such as this one, which went to the sister of a former patient in the summer of 1971: “In 1968, I lost my wife through cancer; in 1969 my son on Vietnam . . . This is extremely embarrassing what I am about to say – could you materially help me for just this one occasion? In my memory of you, I recall what a generous human being of emotion and spirit you always were.”

Money arrived by mid-July, according to his next correspondence: “How very, very thoughtful and kind!” In August, a birthday card showed up from the same friend, and he wrote back: “Your much appreciated birthday card and sentiments came today, along with its enclosure . . .

At the same time, a numbered account at the Bank of Switzerland in Zurich contained $ 717,285, according to copies of bank statements dated Dec. 31, 1971, and provided by Shirley Bing. Bing says the account was Beukenkamp’s, but that cannot be verified.

Beukenkamp and Bing traveled, shopped and received visits from a few patients, but by the beginning of 1972, Beukenkamp grew unhappy with the climate in Casablanca – cold and damp. He began making plans to move to Costa Rica, where he would conduct a unique new kind of psychotherapy. He called it “cassette therapy.”

He had it all worked out. New York patients would meet in the apartment of one group member and talk into a tape recorder. People in individual therapy would record their talks in private and drop the tapes off during their group sessions. A group member would collect the payments – generally $ 35 a person for a group session, $ 75 for individual therapy, premium prices at the time. The tapes would then be sent in a pouch from Kennedy Airport on a 2,000-mile trip to Costa Rica. A return pouch would deliver Beukenkamp’s responses.

During the next 10 years, Beukenkamp built a prosperous long-distance practice, says Bing, who twice a week would drive to the airport in San Jose and crawl into the belly of an airplane to retrieve the pouches of tapes.

“I think back now how stupid it was,” said Blanca Vasquez, who was a participant. “A group with no therapist leading it?”

Several psychiatrists said they had never heard of such a method of therapy and that it may have been a lucrative method of psychiatry but not a legitimate one.

“My concept of therapy is that you need a patient and a therapist, not a patient and a tape machine. To evaluate therapy by listening to one half of a tape. . . is really not therapy,” said Dr. Stanley L. Portnow, a clinical professor of psychiatry at New York University School of Medicine.

Portnow made this comment during testimony in a 1985 federal tax case in New York brought by Kenneth Porter. Porter, by now a psychiatrist in private practice, was suing the Internal Revenue Service for the right to deduct the cost of his cassette therapy – $ 67,000 in just two years, 1979 and 1980 – as an educational expense.

Beyond the issue of the medium, Portnow testified that the dialogue between Porter and Beukenkamp was decidedly untherapeutic.

“This relationship,” he said, “is one in which Dr. Beukenkamp is constantly berating Dr. Porter on various tapes, calling him all types of names, telling him to be a man, etc. . . . I don’t believe for a moment that what I heard on those tapes even begins to qualify as psychotherapy. It is really the sign of a somewhat sadistic older man, paternalistically inclined, berating a younger colleague without giving him any insight, without giving him any ability to change his psychic functioning other than saying, do it and be a man.”

Of one tape Portnow said, “the entire tape was about the Super Bowl. At the very end, Dr. Beukenkamp berates Dr. Porter for not sending the ten dollars that he owes him and says ‘send it in the pouch and mark it medical convention.’ ”

Porter testified that by 1982 he had borrowed $ 115,000 from his father and a lending company to pay for his cassette therapy. He won a partial deduction when U.S. Tax Court Judge Arthur L. Nims III ruled that since Porter seemed to believe he was benefiting from the therapy – why else would he go into debt to pay for it? – then it was therapy.

The decision was based partly on the testimony of Dr. Harold I. Schwartz, chief of psychiatry at Hartford Hospital, who said he believed that what he heard on the tapes constituted therapy. But in a recent interview, Schwartz said such treatment was “awful therapy. It meets no definition of therapy that any legitimate professional would abide with.” He reconciled the two statements by saying the IRS should not be the judge of whether a given form of therapy is legitimate.

Though Porter declined to be interviewed, he responded earlier this month by letter: “I have filed a formal complaint against Dr. Beukenkamp for ethical misconduct with the American Psychiatric Association and am further pursuing the issue through appropriate professional channels.”

Exchanging tapes was not the only way Porter and his fellow patients maintained contact with their psychiatrist abroad. Throughout the ’70s and ’80s, Beukenkamp made a couple of trips a year to New York to meet with patients and recruit new ones. He would stay in John Bing’s apartment, where patients would sign up to cook him meals.

And twice a year, in August and December, small groups of New York patients would fly to Costa Rica for two-week pilgrimages to the five-acre estate Beukenkamp built in 1973, a compound that included a pool, tennis court and four guest rooms for patients.

HERE, IN A SUBURB of San Jose called Escazu, Beukenkamp’s practice grew more outlandish, according to patients. He grew selectively imperious, said Shirley Bing, who carried out the task of shaving the psychiatrist’s head daily, a ritual begun in Morocco. And “therapy” for the visiting New Yorkers came to include what one ex-patient, now a cable television executive in Manhattan, describes as “slave labor”: gardening, planting trees, scrubbing the tennis court, cleaning the pool, dynamiting a well, digging ditches.

Beukenkamp also would belittle and ostracize some of his visiting patients, several said. Three patients described how one young patient, herself a psychiatrist-in-training, allowed her hair to be cut off for inappropriate behavior – doctor’s orders. “She came into the session looking like a clown, her hair chopped up in different lengths,” remembers Blanca Vasquez.

A native of Costa Rica, Vasquez was one of dozens of local patients Beukenkamp treated, though, according to Dr. Jose Fuchs, treasurer of the country’s medical association, he had no license to practice in Costa Rica. She later moved to New York but continued to be a patient through cassettes and visits to Costa Rica.

Vasquez’ future husband, the cable executive, was a young American hitchhiking in Costa Rica when he became a patient. He says the doctor referred to him as his “golden boy” and once ordered him to “command the troops,” and to berate two female patients taking a break from gardening. “He told me to pretend that I was a drill sergeant and force them to continue the weeding.”

During one group session, the man slapped Vasquez, by then his wife, in the face. “It still makes me sick thinking about it,” the man said. “It was a terrible thing to do.”

Vasquez said Beukenkamp never approached her sexually but told her that she envied male sexual organs because of her underlying hatred of men.

“He constantly left me feeling helpless,” said Vasquez, who is now divorced from her husband. “You did not question him. If you did, you’d be repelled and rejected by the group.”

“Everyone was under his spell,” said Vasquez’ former husband.

“We were on a quest for existence. It was the culture then,” added another woman. “He instilled a great deal of hope that if you followed his prescriptions you’d be fine.”

IN COSTA RICA, Shirley Bing had her own living quarters; her relationship with Beukenkamp was now more businesslike than sexual, she said, but fear kept her from leaving.

Not long after their arrival in Costa Rica, Beukenkamp had met a professor of German literature at the University of San Jose named Maud Curling, and married her eight weeks later. The marriage lasted only another eight weeks, but Curling says that was long enough for her to get Beukenkamp a teaching position at the university.

Soon after Beukenkamp began teaching a course in group dynamics, he started inviting students to his estate to swim nude, according to one of the students, Maria Aeugenia Herrera.

After two semesters and many rumors about the new faculty member, the course was dropped.

In the summer of 1973, a 17-year-old high school student named Monica arrived from New York for a visit to the estate on Guachipelin Road. Both her parents had been patients; after her mother’s death, her father remained a member of Beukenkamp’s inner circle. And she herself had been a patient as a young child. At age 20, Monica became her 58-year-old psychiatrist’s third wife.

Monica, who later divorced Beukenkamp, declined to talk about their 12-year marriage. Now 35, she lives in the United States with the two children she had with him and asked that her last name not be used.

Her experience, however, led to the ethics complaint by Strasburger, the Harvard psychiatrist, who was hired as an expert witness for Monica during her divorce. Strasburger alleged Beukenkamp continued to “treat” Monica after their marriage and used information from the treatment in his failed attempt to obtain custody of the two children. “If the allegations are true, then his behavior was clearly unethical,” Strasburger said in an interview.

Shirley Bing had been at the center of Beukenkamp’s Costa Rica operation, but by the time of his marriage to Monica, her role had been reduced to that of a secretary. As such, she had access to financial records and other papers. “Case had two bonfires, and we were told to burn all of his papers,” she said. But she says she furtively made copies of some documents and left them with a neighbor who would mail them to a friend in Florida. One day, she hoped, they would be of some use.

Meanwhile, in New York, cassette therapy continued to thrive in John Bing’s city apartment. Beukenkamp gave Bing’s address as his own to the U.S. Drug Enforcement Agency so that he could still write prescriptions. And Bing was busy as Beukenkamp’s banker.

Testifying at Kenneth Porter’s tax trial, Bing said that at each session he would hand out tiny slips of white paper with the amount each patient owed. Bing would collect the checks, endorse them with a rubber stamp bearing his and Beukenkamp’s names and deposit them in his own account. Then he would draw a cashier’s check for the total and deposit it into a joint account he had with Beukenkamp at the Bank of Boston. From that account, he would transmit the money to a personal account Beukenkamp maintained in Luxembourg.

American citizens living abroad in those years were required to pay taxes on income over $ 20,000, minus any foreign taxes paid, according to the IRS. It is not known how much Beukenkamp was earning, or reporting.

But in 1986 the courts found that Beukenkamp owed $ 43,478 in taxes for the year 1979, and ordered him to pay, which he did.

Four of his patients – subpoenaed by the IRS in the Kenneth Porter tax-deduction case – testified that in 1979 and 1980 they paid Beukenkamp a total of $ 214,869. That is apart from payments by Beukenkamp’s other long-distance patients, at that time another dozen or so, who were paying $ 125 for individual sessions and $ 75 each for group. Beukenkamp was also conducting his local practice in Costa Rica.

Even so, according to documents furnished by Shirley Bing, at least one medical doctor, a patient, sent a letter to the Social Security Administration in 1973 claiming Beukenkamp was incurably ill, could not work, had to live in Costa Rica and should receive disability payments.

On June 27, 1973, his first check, for $ 2,912.80, was sent to Costa Rica, according to a copy of the award settlement provided by Shirley Bing. Thereafter, it indicated, he would receive $ 174.80 a month. Such payments normally continue until the recipient turns 61 1/2.

In 1976, Beukenkamp told Bing her time to leave was approaching. She says he asked her to compile a list of all the money and stocks she had “invested” with him. On May 21, they signed a “gentleman’s agreement” stipulating that Beukenkamp would “see to it” that Bing “will be able to live at a standard of living deemed reasonably comfortable regardless of where she chooses to live in the world.”

A year later, on June 30, 1977, she boarded a plane for Miami with their beagle, Rutgers, named for Beukenkamp’s favorite football team. “I touched the ground when I arrived in the United States,” she said. “I was free.”

That freedom, she said, gave her the strength to try to take action against Beukenkamp. “I always knew I wanted to do something,” she said. “I knew what he was doing was wrong, and he had to be exposed.” She said she contacted the American Psychiatric Association but was told she needed other patients to come forward before action could be taken. She called a few patients, but no one was willing to speak up.

Bing said she met with IRS agents but never heard back from them. She said she called the Social Security Administration, but again, “nobody seemed to care.” She packed the documents away in a shopping bag in her basement, where they remained until she received a phone call from a reporter 15 years later.

Beukenkamp kept his promise to send monthly checks of $ 416 until October, 1978. The previous May, Bing had informed Beukenkamp and Monica that she had given Rutgers, the beagle, to a friend. She received the following letter: “We are both aghast to hear of your rejection of Rutgers. We are hard pressed to believe that he could be anything but miserable in light of his extreme devotion and utter dependence on you. In view of our upsetness regarding the disposal of Rutgers, we have decided that it is the better part of good judgement not to engage in any further personal news.”

Six months later, this note came: “Self-help, both materially and emotionally, is the best kind of help. Therefore, no more material contributions will be forthcoming. This then concludes all matters between us.” It is signed: “Best wishes, Monica and Kees,” a Dutch name for Case.

Though he would keep some patients until as late as 1985 – the year Porter’s tax trial brought many of them unwelcome attention from the IRS – most apparently stopped therapy in 1982 and 1983 after Beukenkamp said his work with them was done. He was moving on to the Cayman Islands, he said, to spend time writing fiction.

IN THE OUTSKIRTS of the tiny island of Grand Cayman, along a sleepy oceanfront road called Old Prospect, Case Beukenkamp built a large home with a separate office suite, two satellite dishes and a pool. Out front, a wooden post read: Dr. Beukenkamp.

He joined the local medical and dental society, served a year as its president and became affiliated with the local hospital.

But it wasn’t paradise for long. Once the only psychiatrist on the island, Beukenkamp received patients who later complained that he was rude, screamed at them and had a brusque manner, according to Dr. Brian Stevens, who practiced on the island in the mid-1980s. Beukenkamp ultimately resigned as president of the medical society; during his tumultuous term, he screamed at other doctors, ordering them to “shut up unless they are called upon,” said Dr. Steven Tomlinson, who runs a clinic on the island.

Last year, Beukenkamp’s license to practice medicine was not renewed by the Health Practitioners Board, the medical licensing arm of the government, and his relationship with the local hospital, where he was doing volunteer work, was severed. “He is not practicing on the island,” said Dr. Bernard Martin-Smith, head of the government-run George Town Hospital. “He does not have a license to practice here.” The agency gave no official reason for the action, though the record reflects there were complaints from patients. But the licensing board is not the only agency on Grand Cayman that has taken an interest in Beukenkamp.

When Monica and the children left the island in 1986, Beukenkamp was alone, apparently for the first time since he was graduated from high school 50 years earlier. In the late 1980s, he called his son and invited him to visit. And in 1989, when his divorce was finalized, Beukenkamp began placing advertisements in newspapers in the United States, Canada and Costa Rica. He was looking for his fourth wife.

One ad in Costa Rica’s Tico Times read: “I will interview all females for marriage at 9 A.M. Sunday, December 17, 1989 at the Amstel Hotel. Ask for Dr. Case. Age 32 to 38 not more than 135 pounds, college education, no kids.”

Several women who answered the ads and came to visit Beukenkamp ended up filing police reports, complaining he screamed at them, shadowed them or refused to let them leave the compound. One woman told the police she thought the doctor had drugged her food.

Jana Pristach, a Canadian with a doctorate in nursing, said that after she responded to an ad in the Toronto Star in July, 1991, Beukenkamp began phoning several times a day, every day. “Sending flowers, everything.” He wrote letters telling her that he wanted their union “to be a meaningful, serious, long-term committed relationship . . . Yes, this doctor needs you as not only his nurse, but simply put, his partner.” He Federal Expressed pictures of his house and of himself, looking vigorous in a microscopic bathing suit.

When she went to Grand Cayman at his invitation, she said, he opened the door and told her to go away. Then he called the police.

Cynthia Pozzi of Fredericksburg, Va., met Beukenkamp through an ad in the May, 1989, issue of the Washingtonian magazine. Beukenkamp’s children were visiting from the United States, and Pozzi reported in a police affidavit that while driving to a day of fishing, “the children and I pleaded for him to slow down but he refused . . . and hit a man on a bicycle and drove on without stopping. At this stage, the children were absolutely terrified as I was.” She also said Beukenkamp was verbally abusive to his children.

In an attempt to determine if Beukenkamp was no longer fit to practice medicine, the licensing board last year hired a Jamaican psychiatrist, Dr. Frank Knight, to examine him. Knight found Beukenkamp “showed no active or residual features of functional or organic mental disorder.” In his summary, Knight said, “Dr. Beukenkamp came to Cayman with a past history of colourful activities and achievements . . . He is capable of deliberately misrepresenting and has done so to project a particular professional image . . . His present mood is one of overconfidence.”

“In the Caribbean, there are no insane asylums. People can be quite bizarre and accepted as they are,” said Dr. Robert Efford, an internist on Grand Cayman, commenting on Beukenkamp’s behavior.

Still, late last year, immigration officials wrote a letter to Beukenkamp warning him that if his public behavior continued, he would be asked to leave the island. “We advised him that we don’t want to keep hearing complaints from the police department,” said chief immigration officer Jon Bostock. “We haven’t heard anything about him for months.”

Presumably Bostock doesn’t frequent bars such as the Lone Star, a smoky joint where kids come nightly to eat and drink. On many nights Beukenkamp can be seen sitting at the bar, a small, elderly man with a shaved head and straw hat, chatting with young women, using his credentials as a psychiatrist to “read our minds,” according to a local student.

MEANWHILE, back in the United States and in Costa Rica, some of Dr. Beukenkamp’s former patients are still sorting through their entanglements with him, though they say they are coming to terms with that chapter of their lives.

Meredith Patterson, the Costa Rican woman who says Beukenkamp took “the best years of my life,” from age 19 to 30, says she is “doing well, under the circumstances. I can talk about it now.” She works in her family’s factory, remains single and hasn’t forgotten her last session with Beukenkamp seven years ago: “He said, ‘I can’t be there for you for the rest of your life.’ ”

Sandy Schlager moved to Washington and now, at 60, works as a health-care administrator for the federal government. She is divorced and says she has traveled to more than 100 countries since she last saw Beukenkamp. “I am not the person I was thirty years ago. I have been all over the world, and very much enjoy living alone,” she said.

Shirley Bing sought help from a female therapist. She tried reuniting with her family, but only one of her three children is in communication with her, she said. She was in a long relationship with a man, “a wonderful man,” who died a few years ago. Now, she spends her time volunteering at a hospital, sight-seeing and visiting friends. “I am really doing well,” she said.