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Can Therapy Do Me Harm?

Can Therapy Do Me Harm?

More people are recognizing the importance of mental health treatment and working to remove the stigma it used to have. Public figures from podcast hosts to movie stars talk about their experiences in therapy and rave about how much it helps them. Friends and family who wouldn't have dared to confess it even a decade ago now casually mention that they're in therapy.

As a growing number of people identify therapy as an essential part of their self-care toolkit, it can start to seem like everyone should be in therapy and that you should sign up with the first therapist you can find. But like most things in life, it's a little more complicated than that.

Yes, most people can benefit from the right kind of therapy at the right time in their lives. Yes, it's more likely that therapy will do good than do harm. But the dark secret in the mental health world is that therapy can cause harm. People who've been to a bad therapist can tell you: bad therapy is worse than no therapy at all.

Sometimes "bad therapy" is simply ineffective. Even worse is when a therapist shuts down your healing process instead of helping it along. The worst case is when therapy is actively destructive, either re-traumatizing you or causing new psychological harm.

The bad news is that something as well-intentioned as seeking healing by going to therapy can backfire. The good news is that being aware of the dangers of bad therapy can empower you to recognize when something isn't right and to know when to walk away.

What Harm Can an Unethical Therapist Cause?

The greatest harm a therapist can do is take advantage of a client for personal gain. Even though most therapists are drawn to the field because they are caring people who want to empower and help those who are hurting, therapy is no safer from the worst human motives than any other profession. Predators are sometimes drawn to the mental health field because of the power their position gives them over vulnerable people.

We've written about the warning signs of unethical counselors before, but in general, here are a few red flags to watch out for:

  • Your therapist touches you inappropriately or makes sexual advances.
  • Your therapist asks you to meet with them outside of the office for a social or sexual encounter.
  • Your therapist ignores what you tell them and continues doing something after you've said it makes you uncomfortable and have asked them to stop doing it.
  • Your therapist tries to enlist you to support their personal, political, social, or business interests, such as trying to get you to pay to see them give a talk or to donate or vote for a political candidate they support.
  • Your therapist tries to control your behavior outside of the office, such as pushing you to go on a certain diet or to break off contact with family members.

Keep in mind that there are some gray areas when it comes to navigating the delicate and subtle boundaries of the therapeutic relationship. You don't necessarily have an unethical therapist if they forget that you told them that you don't like to shake hands or if one day they offer a more spirited critique of your partner than usual. Even good therapists have bad days.

And good therapists can also be misunderstood. Most modern therapists offer feedback and suggestions that can be misinterpreted as commands or directives, so be careful and clarify with your therapist, then ask for a second opinion, if you're worried your therapist is trying to control you. One way to avoid predators in any field is to tell your loved ones what's going on. It's a major red flag when anyone, especially a therapist, tells you to keep something that they did a secret.

However, there are no gray areas if your therapist is trying to get you to have a sexual relationship with them. Not only should you never go back to a therapist who pursues sexual contact, you should consider reporting them to the board that licenses them. It's not unethical for a therapist to find a client attractive, but to act on that attraction means that they've forgotten or cast aside their most important professional duties to honor their clients' needs and not abuse their power.

What Harm Can a Bad Therapist Cause?

Most "bad therapists" aren't bad people. They're just not as good as they need to be at their jobs to not inadvertently do harm. Being a therapist might seem simple and natural, but to do it well, therapists have to do many things that don't come easy. They have to refrain from bringing any of their own baggage into the room, from judging their clients according to their own personal beliefs, from chatting too much about themselves, and from giving too much direct advice.

To do their jobs well, therapists have to figure out how to guide you toward your own innate wisdom so that your insights come from within. When a therapist has the patience to allow you to come to your own realizations, it allows what you realize to have a deep and lasting healing effect. It's so easy to get any part of this process wrong.

The most important skill a therapist can have is empathy. Therapists avoid sitting in judgment of clients by putting themselves in another person's position and understanding how it feels to be where they are. Many therapists are drawn to the field because they're naturally empathetic and are able to pick up on others' feelings from subtle, intuitive cues. A therapist can never have perfect understanding of your experience, but a good therapist can do more than theorize about how something might have affected you.

Some therapists who weren't particularly sensitive when they were younger can learn how to hone their empathy, but some never quite develop their empathy enough to respond to clients in an effective way. Failures of empathy are triggering and can be re-traumatizing when repeated, especially when they come from someone you trust. A therapist who can't attune to you empathetically is less likely to be able to help you heal.

Another kind of bad therapist can waste your time with interventions that have no effect by using you as a guinea pig to test their pet theories. While there are some predators who intentionally manipulate others without regard for their feelings, more bad therapists do this because they don't know better. They overestimate their own insights and truly believe they are helping you.

How Can I Tell When I've Got a Bad Therapist?

It can be tricky to identify a bad therapist because even good therapy can make you feel worse before you start to feel better. For example, if you're depressed because you haven't fully grieved a loss, or if you know you need to change some habits you've become attached to, it can feel pretty bad the first weeks you start to process those feelings or let go of those habits.

Sometimes your sudden bad feelings are part of the therapeutic process and are a sign that it's working. An important element of therapy is projection, when your reactions to your therapist have more to do with the way they remind you of other people than with them. A classic example is when you react to a therapist as if they were your mother or father. When this starts happening it can actually be a sign that therapy is starting to work.

The important thing is to trust your instincts and to talk to other people about your experience. People who've had good or bad experiences in therapy can help you understand how the process works, but be careful—other people have their own filters, prejudices, and blind spots. At the end of the day, if therapy has been making you feel worse for a long time and you don't feel like you're healing, it may be time to walk away.

What Happens If I Choose the Wrong Therapist?

Sometimes therapy goes wrong even if a you're seeing a therapist who's successfully treated and helped other clients. This can happen when a therapist isn't a good match for you or when the style or method a therapist uses isn't what you need.

Having a therapist who doesn't understand your cultural background is one of the factors that can lead to therapy causing harm instead of doing good. The sad truth is that therapists can be racist, sexist, homophobic, or otherwise prejudiced against particular groups. Even when they're not, failures to study and learn from history can translate into failures of empathy. Though many therapists are taught the histories of oppressed groups and the social injustices they have faced, not all listen or understand. Far too many people judge and blame people on a personal level for struggles that reflect our failures as a society, some therapists included.

Therapists can project, too. For example, if they have unprocessed pain or trauma related to a family member who had an addiction, they may project that experience into the therapy room and harshly judge or react poorly to clients with substance use disorders. In general, if a therapist you've had a good relationship with suddenly starts making you feel judged, it can be a sign that they are reacting to something they haven't dealt with in themselves. When therapists aren't aware or haven't dealt with their own issues, they can inadvertently harm their clients.

Subtler problems can arise when a therapist is trained in a technique that isn't right for your needs. While cognitive behavioral therapy (CBT) is a widely effective therapeutic technique, it's not universally effective. Sometimes CBT only goes as far as symptom control and not to healing the deeper wounds underneath the symptoms. If you have a history of trauma and your therapist isn't trained in a trauma-informed approach, your work with them might never touch it. This is why many people labor unsuccessfully in therapy for years until they finally try a technique like eye movement desensitization and reprocessing (EMDR) that starts to unlock their trauma.

Keep in mind, though, that the reverse is true—if you don't have unprocessed trauma, techniques like EMDR might not help as much as other techniques more suited to your therapeutic needs.

What If I Get Therapy When I Don't Really Need It?

Perhaps the most confusing issue of all is figuring out exactly when or whether you need therapy. While therapy can help with everything from everyday relationship conflicts to severe psychiatric disorders, it's not a cure-all.

The biggest risk of getting therapy when you don't need it is blaming yourself for an issue that isn't really yours. A widely shared quote that many people misattribute to Freud advises, "Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, surrounded by assholes." Even though Freud didn't say it, it's still a good point. If someone is abusing you, whether at home or at a toxic job, therapy will at best help you cope in the short-term but can be dangerous if it keeps you from walking away from the abuse.

Depression and anxiety are not always triggered by brain chemistry, past trauma, or personal hurts. Sometimes they're a natural reaction to external circumstances. We live in anxious times, and therapy isn't going to do as much for your anxiety about social and political issues as taking action to make a difference. The danger with any effective healing or self-care technique is that by giving you tools to endure difficulty, it can actually make it easier not to deal with a dangerous or toxic situation that will keep harming you as long as you keep enduring it.

Of course, this doesn’t mean you shouldn't take care of yourself if you're having to endure stressful circumstances that are out of your control, and that therapy or therapeutic techniques can't be a boon in such situations. It just means that sometimes your pain is pointing you to something outside of yourself that you need to fix and that nothing will get better until you fix it.

It's good to make the decision to start therapy carefully, but if you've come to OpenCounseling, you've probably given the topic of signing up for therapy some thought and know it's what you need. If that's the case, don't let the fact that therapy can go wrong stop you. Give it a shot by using the tools on OpenCounseling to find an affordable local therapist or by trying low-cost online therapy at BetterHelp (a sponsor). Just trust yourself and be willing to walk away if things don't go well. It's not your job not to hurt a therapist's feelings. A good therapist will understand and respect your efforts to find the right match, and a bad therapist isn't worth your time!

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Stephanie Hairston, MSW
Posted on 09/30/2019 by Stephanie Hairston, MSW

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a masters-level clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments. She has also worked as a technical writer for a medical software company and as an editor for a company that appeals denials of insurance coverage for behavioral health treatment. As a writer, she is motivated by the same desire to help others that brought her into the field of social work and believes that knowledge is one of the most essential recovery tools. She strongly believes in the mission of OpenCounseling and in making therapy accessible for everyone.