EthicsThere is a mantra in the mental health field, a code of ethics that we all live by: “first do no harm.” This seems like an obvious idea but, in truth, the definition of “doing harm” may not be universally understood and agreed upon. The relationship that is forged between a client and his or her therapist is an extraordinarily emotionally intimate and vulnerable one. There is an inherent expectation that the client will, in time, disclose deeply personal thoughts and feelings, as well as allow us to bear witness to past and current behaviors that may be quite shame-based for them. It is our ethical responsibility to create and maintain an environment of emotional and physical safety for clients so they are able to reveal, process, and transcend their most difficult memories and experiences in ways that feel reparative and never re-traumatizing.

In the earliest stages of treatment the onus is on the therapist to appropriately establish boundaries and clearly articulate the parameters of the relationship. In this day and age that includes whether or not e-mails, texting, after hour phone calls, doing sessions by Skype, meeting you outside of the office, or connecting with you on Facebook are going to be an allowable part of the therapeutic alliance. When it comes to these issues, we shouldn’t assume clients understand what is and is not appropriate. Our job is to model what is appropriate, and then maintain consistency. Blurring or crossing boundaries, engaging in a dual relationship or continuing to work with clients when there is a conflict of interest, repeatedly going over the allotted session time, making the agenda for therapy ours and not the clients, or fostering co-dependency, are often therapy missteps that have their roots in the clinician’s own unresolved issues.

Quote for When Terapists Do HarmIt is also essential for us to keep in mind the potential feelings of inadequacy, shame, confusion, and incompetence that clients struggle with when they enter treatment. They often don’t understand why they have their symptoms or untenable thoughts and feelings, and mistakenly believe that their struggles represent “evidence” of being crazy, damaged, broken, or bad. The extent to which we, inadvertently, reinforce these ideas by pathologizing, blaming, or shaming our clients, goes a long way towards either helping them to heal or solidifying and deepening their trauma. Even when we simply suggest possible theories about why clients have somatic complaints, engage in a certain behavior, remain in an unfulfilling relationship or job, we must remember that our theories and suggestions carry tremendous weight and are often taken as gospel, especially by young or vulnerable clients. It is far better to invite the client to be curious about their issues and struggles, in a non-judgmental and compassionate way, and to help re-frame the cognitive distortions they propose in a therapy session, so our silence is not mistaken for agreement.

Some therapists believe that maintaining total neutrality and an almost disengaged or highly intellectualized stance is a good way to “do no harm.” This can actually backfire when clients experience it as a lack of attunement, warmth, or concern for their feelings and their circumstances. Conversely, the therapist who cries alongside their clients and becomes overtly distressed, angry, dissociative, or overwhelmed, is operating from a place of emotional disequilibrium that can lead to role reversal or the client’s fear that they are “too much to handle” and irreparably “broken.” The challenge for us as clinicians is the balancing act of dual awareness. It’s being “present” enough to simultaneously ask ourselves during the session, “what’s going on for my client AND what’s going on for me?” When we lose sight of the client’s process or we lose sight of our own counter-transference, there is the potential for deviations in the standard of care, a loss of safety in the room, a breach of trust, a rupture in attachment, blaming the victim, missing critical information that is being communicated verbally or non-verbally by the client, an abrupt termination, or therapist burn-out. The notion of “doing no harm” is an important concept. However, we should operate from a much higher credo that pushes and encourages us to be supremely sensitive to the emotional vulnerabilities of our clients, and to make the therapeutic relationship and environment conducive to ego-strengthening, personal growth, and true healing.

Have you found yourself caught up in this type of experience? Share your experience and solutions to the problem in a comment.

 

 

41 thoughts on "When Therapists Do Harm"

  1. Terry Chapman LICSW says:

    Sometimes we are too close to a problematic relationship to see our part in it without the assistance of another professional. I have found peer groups, supervision and consultation to be invaluable resources in helping me become aware of counter transference issues as well as pointing out times when I have begun interpreting or speaking for a client. Hopefully all who engage in the practice of therapy also have peer support and trusted advisers to help them avoid/manage potential pitfalls.

    1. lisaferentz says:

      Hi Terry, this is really well said! Thank you for weighing in and sharing your wisdom!

  2. M. Smith says:

    I’m a client who suffered through an impasse in therapy last year that eventually led to a rupture and termination. It was devastating emotionally and psychologically. Shortly afterward, I contacted the therapist and asked for more support.

    Thus began a new phase of therapy, even more harmful and distressing than before. We were locked in a stalemate, both triggered into vulnerabilities and defenses, and as I pushed harder and more desperately to reconnect the bond and work through the rupture, she became increasingly hostile and resistant. I brought up 3rd party consultation, to no avail. Feels like I will never recover from this, a year later still crushed.

    I appreciate the tone of your article. Says it like it is. Therapy can do real harm and it must be discussed more openly. How many people are walking away wounded or re-traumatized, silently and invisibly?

    1. lisaferentz says:

      I appreciate your courage in sharing such a traumatic therapy experience. Sadly, there are bad therapists out there who are certainly capable of doing harm. My concern is that you don’t generalize this experience and assume that all therapy would play out the same way. When the therapist is able to be compassionate, humble, kind, creative, and willing to check in on his or her efficacy with the client, then the relationship can be incredibly reparative and there are countless tools as well as life changing insights that one can take from the process.

      1. M. Smith says:

        Therapists I have interviewed or tried since have not been very helpful. Some made things worse. Problem is I am coming to see them with a bias against therapy and with a story that therapy has done harm. Some do not like to acknowledge this. Others subtly deflected blame toward me, in a sort of reflex fashion. When in doubt, blame the client. ANd to be honest, with past therapists I was mostly ambivalent, nothing much happened.

        I’m sure there are good therapists out there, but finding one who is also a good fit seems to be no small feat.

        And I still am not clear precisely how therapy would be of benefit, in part because it seems very difficult to get therapists to talk about the details of the process, rather than the theory behind it. Lot of mystery and concealment, or perhaps many are just improvising. And the client is going larlgey on blind faith, and attempting to trust someone who cannot really be known and who is heavily filtered.

        1. lisaferentz says:

          You raise valid concerns about therapists and the therapy process. Certainly therapists need to address clients’ concerns, be transparent about the process and take ownership for the role they play when therapy is ineffective. And I still hold strongly to the belief that when there is a good fit and a well trained, compassionate therapist who can provide true guidance and hope, therapy is life changing!

          1. Nathan says:

            I wouldn’t assume only clients with “bad” therapists experience such issues. It is the therapy experience that comes with risk. Perhaps a better therapist might be shown to mitigate this risk better, but it is inherent to the nature of therapy. That’s ok, as anything potent should have possible negative risks. What’s not ok is that this is rarely communicated to clients before treatment starts, and that process of therapy is often obfuscated even if asked (and often not asked because clients assume it is the responsibility of the therapist to share this).

            Writing off harmful therapy experiences to bad therapists lets Therapy off the hook, and is kind of a non-started, considering that no therapist considers themselves a “bad” therapist (https://www.psychotherapy.net/blog/title/the-lake-wobegon-effect). Recognizing that deteriotation/harm is a potential part of the therapy process and hence a required component of adequate informed consent is vital. It’s up to clients to decide if the risk of worth it to them, and having a conversation about that risk up front might help mitigate issues and give a language to talk about problems in therapy if they do arise.

        2. Nathan says:

          Still recovering from my own, similar experience.

    2. Anne hedelius says:

      I have been through the same experience. Recovery a year later still seems impossible. I disclosed sexual abuse to a female for the first time, a therapist who claims to specialize in trauma and sexual abuse. Treatment was abusive and recreated my original trauma. I left feeling irreparably damaged, filed insurance and board complaints. She threw me under the bus and I’ve been left without answers or a way to work this through. I can think of nothing worse than a therapist who refuses consultation and the working through with a client. She refused to provide medical records or professional consultation when I found another therapist. She terminated me in crisis and left me without referrals or support. I am working hard to move through the profound grief and failure I have felt over this.

      1. lisaferentz says:

        I am so sorry for all that you have been through. I still find it horrifying that therapists can be so re-traumatizing, although I know it is a very real phenomenon. The most important thing I want to tell you is that nothing about what transpired is your “failure.” It’s never a failure to take a leap of faith and open your heart and mind to another person whom you believe to be trusting and safe. The only failure here is the therapist’s for not appreciating the courage it took for you to open up and for her inability to support you in all the ways that you deserve.

      2. REL says:

        I just got out of a similarly damaging experience with a therapist. It’s awful when the therapist blames you for unresolved issues of her own. How did you go about filing a complaint and was it useful to do so?

    3. Ioana says:

      Dear M. Smith, you are not alone. I experienced severe re-traumatization in my therapy. My therapist played the “guru” part extremely well and, while she was the narcissist, I complied, according to my life scenario, as fhe victim. It’s heartwrenching to acknowledge that the person you confided in does not have your best interest at heart. It’s the same feeling of betrayel we had when we were children and our parents failed to provide us with a safe environment, sometimes giving us the exact opposite. There is hope. I terminated my therapy abruptely, and, although I had the same tendency, to run back and “fix” the relationship on my own time and money, these were the words that kept running in my mind: Never, EVER go back to the person that broke you! I get the need to be seen, to be validated and loved by a person in which you’ve invested tremendously, emotionally maybe more than financially. But, M. Smith, we are adults now. We have power to validate ourselves. Invest in your own personal development. I took up yoga and boxing classes, I started meditating daily and journaling, so that I can monitor my own emotions and become my own therapist. I started finding things I love doing and going out to do them. Mindfulness is key in the process. Soon, if you find your own passion, if you put it into practice, when you go out into the world and trust your own heart and truth, you will find in your soul a power you never knew existed. A power that will set you free, not only from your therapist, but from every single toxic and disfunctional person and circumstance in your life. You see, freedom is finding our own inner voice, the voice we use to validate ourselves. Freedom is being your own parent, guru, therapist. Freedom is trusting in you, and the power of choice – in any given circumstance, good or bad, you get to CHOOSE what your response is – make it so that your response alignes with your higher purpose. Freedom is everything. And love is all the rest. So, M. Smith, I wish you freedom, with all my heart. Break the chanes and know that you are wonderful, that you deserve all the love and appreciation you’ve ever envisioned for yourself and much more than that. Have the courage to leave that which no longer suits you, grows you, or makes you happy. Children who have been abused mistake love for fear. Set your inner compass on “feeling good mode” and know that whenever you are not happy, it’s a sign from your higher self, telling you to run! All the best to you!

  3. Anonymous says:

    I don’t know if you’ll see this M.Smith but I read your posts with interest. I have had the same happen to me, and I agree it is devastating. It is trauma solidified and re-visited, and it’s actually horrific to play it all out with the same outcome.
    Your points about the therapist – I shared these feelings too. I don’t know about you, but I actually felt my therapist was a good enough one. I don’t think I fell into bad hands, and yet the therapy ended up as traumatising (I suspect actually for us both).
    Then I read the responses too, which I know were honest and heartfelt.

    But HONESTLY I don’t think therapy is the answer to therapy not having been the answer! If you’re looking for a relationship to heal relationship wounds – I suspect the therapy relationship isn’t the place to go. Too much power dynamic, too much withholding, too much that feels like game-playing, too much appearing to want a relationship whilst all the time making clear that intimacy is going to be a one way street, which isn’t intimacy at all. I don’t think this is necessarily true for everyone, but I think it was true for me.

    I think perhaps the thing is not to keep returning hoping for a different outcome! That’s like not learning! Perhaps it’s to accept that the limits of therapy are too limited, and to draw a line under it. To move out into the world knowing more than you did, and to find other ways to heal yourself. Otherwise we’re just returning, reenacting and looking for something that is better up accepted as lost. I think that, perhaps, is the mourning process, which is better done by gardening, talking to friends, reading, looking after yourself, trying different relationships with more understanding of what can and can’t be found, healed, changed or transformed.

    In this sense – despite the terribleness of how I feel, I can understand my therapy to have worked. By not working. And I’d rather accept the truth of that than go off in search of yet more therapy thinking ‘this time, I’ll change my life!’

    1. Lynn says:

      Dear M. Smith and anonymous,
      Thank you so much for detailing the harm of your therapy experiences. I would like to believe that my offending therapist was a caring a good person but she coldly and unilaterally terminated our sessions which was very disorienting and hurtful. I couldn’t believe that this person whom i had trusted and valued could turn so completely into a harming and vengeful person wielding the power of her seat without care for the pain she inflicted. I am distraught because a part of me misses her and desperately wants to return and yet i know that any interaction with her is likely to be more damaging than the last. She became emotionally reactive which is totally unsafe for any client.

  4. Don says:

    In the past one year I have also gone through a rupture and termination, which amounted to a terrible reenactment for me. The descriptions and thoughts given by M. Smith and Anonymous were very similar to mine; M. Smith’s almost exactly. I returned after one rupture, things became worse, and I left again. The therapist (a woman) had very strong reactions and emotions to me, couldn’t control herself, was angry at times, cursing at me, calling me pathological names in the middle of her outbursts. I am not newcomer to therapy; I’m an older man who has worked on anxiety and panic attacks during my life. I’m a stable person: jobwise, family – one wife, children, grandchildren.
    M. Smith says that with past therapists he was ambivalent, implying he did not create as much of an emotionally charged atmosphere. I was similar in that my previous therapies were focused on issues more external to the therapist. In the case I am discussing, we did enter into more of a transference-countertransference situation. I have read much professional-oriented literature over the years and was somewhat aware of what should have happened. Theory and empathy and acceptance are one thing to write about, but another to execute. I think it is the exceptional therapist who can actually do it. I didn’t expect her to be perfect, but I did expect that she would and could discuss the problems between us. But to her, the “problems” were all my transference, she took little responsibility, and engaged in silence or vague responses to my questions.
    “It is trauma solidified and re-visited, and it’s actually horrific to play it all out with the same outcome . . . Too much power dynamic, too much withholding, too much that feels like game-playing, too much appearing to want a relationship whilst all the time making clear that intimacy is going to be a one way street, which isn’t intimacy at all”. Very well said by Anonymous. And also that “therapy is not the answer to therapy not having been the answer”.
    It has been said that therapy has some necessary illusions, that the analytic situation is an encounter between two people brought together with complementary if not identical aims: for the analyst, to permit the eventual disappointment that must follow; for the patient, to delay this disappointment for as long as possible. For those of us who have been through harmful therapies, the illusion is gone. We know that the artificial relationship of therapy is never going to replace what we didn’t receive in childhood. And a second artificial relationship is not going to help us get over the first failed artificial relationship. When I have read about the success stories with abused/neglected people in the texts, I think they were helped because the therapist stepped a little outside the bounds of the artificial relationship.
    Even though I said what I did above, I have gone to therapy after the failed therapy. But it hasn’t been that helpful. The follow-up therapists are reluctant to discuss the present day reality of the failed therapy; there’s a rush to tie even that to the past. They will treat anything as real that happened tens of years ago, but they won’t treat as real something that happened just recently with your previous therapist.

    1. lisaferentz says:

      Thank you for taking the time to write such an eloquent response Don. I think your words, and the words of others who have weighed in, make the strong and incontrovertible case that BAD therapy doesn’t work, and dysfunctional or incompetent therapists absolutely are capable of doing harm. But it would be a tragic mistake to say that ALL therapy and therapeutic relationships are destined to fail or cause harm. The relationship can and must feel authentic, not “artificial.” Therapists must always start where the client is, and use the therapeutic process as an opportunity to help clients access their own inner wisdom, resilience, and healing properties. Treatment should never evoke feelings of shame in clients. I stand by my belief that when the therapeutic alliance is safe, trusting, non-judgmental, and supportive, therapy can be life changing and healing for clients. I’ve been privileged to witness that transformation countless times in my practice.

      1. Nathan says:

        Therapy can also be life-changing negatively for patients, and the risk cannot be cordoned off to just “bad” therapists. I don’t think anyone here actually made claims that therapy is inherently bad for everyone and I don’t know why you are providing such a vigorous defense as if that claim was made.

        Enough people have had and continue to have traumatizing experiences in therapy due to all sorts of therapy factors, but it remains that it happens in therapy. I would propose that it is ok, and that even the best therapists are going to have therapies where I client becomes irrevocably hurt. The big issue is that clients are often not aware of this possibility (and many therapists deny it), and when it happens, clients feel blamed and pathologized for the experience. This makes seeking help again more difficult and less likely to be successful, as belief in treatment success (hope, placebo, whatever you want to call it) is tied to success. Having real experiences of deep hurt really cuts into that hope.

      2. Ioana says:

        Dear Lisa, the trouble with my therapy was that it really felt “authentic”. It felt like I found the mother I never had. My therapist would call me, we would do volunteering sessions together, she would buy me gifts, our sessions went minimum half an hour past the time frame. She would tell me that I am “a crystal child”, “special”, ” dear to her” etc. She gave me books and told me about her life. It went beyond authentic. My childhood need was being met, at my iwn expense, because not only was I not being empowered, the exact opposite happened, I layed my personal power into her arms and opened my heart fully. She fostered severe dependancy. But the moment came when I wanted to become my own person and leave therapy. She used to tell me storied about all her former patients with whom she became friends, so I thought that would naturally happen. I was 1 year in therapy, her former “patients” had done a minimum of 3. Well, guess what? She felt like she lost control, and, from all the deep connection and understanding, I suddenly became a problematic “patient”. She used withdrawal of affection, blaming and shaming for five sessions, until I wrote a message to therapy abuse network, and they offered me the support I needed to abruptly terminate therapy. Afterwards, I went through severe PTSD and depression, dissociation and loss of an identity sense. I had been severely re-traumatized by a charlatan. Being “authentic” in that way, for me, is utter bullshit. I didn’t pay almost 7000€ for someone to pretend they were my caring mommy. I thought I was paying for evolution and empowerment. It took 10000 € more to recover from the damage with no pills. For me, being an “authentic” therapist means getting in the business mindset and having a practical approach to the process, no emotions involved. I wish for all people to know their own criteria of “an efficient therapist” before they enter therapy, and having an objective way of assessing their therapeutical process, because, if misused, the therapeutical power can cause extreme damage, sometimes worse than the initial damage.

      3. ellen says:

        my ex therapist used to walk around me looking at my legs n breasts, it was really quite terrible for me , i felt i couldn’t say anything as i was going through a lot of transference that i figured out afterwards .. I should have read the signs in the beginning as when i 1st brought something up to discuss he just fobbed me off n said give me something better than that to deal with , excuse me ….#badtherapyindeed

        1. lisaferentz says:

          I’m sorry your therapist behaved so inappropriately and insensitively. It seems that we need to do more in our field to empower clients to speak up when they experience something uncomfortable or inappropriate in session- and to find the courage to fire a therapist who makes them feel invalidated or objectified.

  5. Don says:

    Thank you for your response. I have had good therapy as I mentioned. The recent therapy was harmful because of some general conditions which always exist within therapy (for good or for bad) and because of the particular behavior of the therapist. The potentially negative general conditions are made worse by a therapist who is dysfunctional. These include being alone with the therapist; having the therapist behave later as if nothing happened and that the relationship should just go on as usual; that the client shouldn’t complain; complaints and requests for responses and clarification of the therapist’s behavior are met with silence and/or vague/circular responses (in the name of therapy); and if the client “tells” later they are only marginally believed or urged to put it behind them. These aspects are very similar to what actually occurred in childhood.
    I spoke to a few therapists after my experience. Frequently I told them I gave them permission to preface their responses to me by saying – “If what you are telling me is true, then………”. I needed and still need them to react sufficiently and demonstrate their genuine outrage. I’ve never received it.

  6. Anonymous says:

    I came back and read your response Don, and I agree with what you’re saying. Maybe therapist’s embrace what we’re calling the “artificial” to defend themselves against their patients. It might be impossible to operate without it – to be truly able to be authentic and talk about what’s happening with them? I experienced similar frustrations to you in terms of vagueness and an inability to talk about what was happening – particularly if what had occurred was something the therapist felt uncomfortable or uneasy about. He just shut up or said blaming things or excusing things about his own background, which was fine, except it was said to close the conversation down not to open it up.
    I think I expected too much but it’s odd because you feel that what you’re expecting are v human normal things – like honesty and openness.. I do know that the effects of it are dreadful, and terminations without sufficient explanations are awful and devastating. And that there is no redress. I also get the feeling when this happens that the therapist’s blame the patient. Which adds insult to injury – and really it ought not be a blame-filled situation on either side. It does make me wonder how often this happens though, and Don and Martin I do want to say that it has been good and helpful to read what you’ve said , it’s reassuring to know I’m not the only one even though I wish none of this had happened to any of us – so thank you. It’s comforting to read and understand what you’re saying so entirely.

    Lisa is right too when she says that nobody ought to dismiss the whole of therapy because of a bad experience. That’s true, though as Don says – there may just be given things in the nature of therapy which don’t work for some patients. When we say authentic, I suspect we mean it – warts and all – and perhaps that’s too much to ask. Therapist’s seem to idealise therapy so it’s hard to have that conversation – they’re more inclined to see it as information about you rather than allow that this difficulty has been your reality.

  7. JetiLuke says:

    Similar to others who replied, I have been wounded by my therapist. I had been seeing my therapist for many years and she was quite a remarkable therapist and human being for that matter-until something shifted and her own wounds were triggered. I recognize that therapists can sometimes give too much of themselves and then feel resentful of their patients and I believe that is partially what happened with me. Things were changing in her workplace and it was quite a difficult time for her. Add to this, a client who is feeling panicked and fearful much of the time and I can understand why she would feel stressed. That said, something shifted and my therapist began accusing me of things that were not true and saying hurtful and quite wounding comments to me at times. I didn’t understand where all the distrust and anger was coming from and she wouldn’t listen to me when I tried to speak openly with her about it. She was just certain that I was manipulating her and making things up, when I wasn’t. It was incredibly painful for me as I cared deeply for this person and trusted her with my life and my vulnerability. I began to question my reality because I trusted her so much. I felt twisted inside and sad. I felt emotionally abandoned. What made things more difficult is that we didn’t have a traditional therapeutic relationship and we were quite close in some ways. She would treat me like a friend at times but then tell me we weren’t friends. She would behave as a friend in some ways but then deny it. I really began to question myself and my reality. It just felt like come here, go away, a lot of the time and that along with the distrust and negative feelings towards me just triggered my abandonment issues. It was a nightmare.

    I spent years trying to get through to my therapist. I wanted to repair so badly but I couldn’t because she wasn’t truly present with her own stuff to see what was going on. She, at times, seemed to hear me when I mentioned to her that I thought she was triggered and that her unkind responses reflected that but then she would go back to distrusting me and resenting me again and she just was emotionally distant.
    It’s quite painful as I saw this person as a mentor, therapist, friend etc in some ways so it’s a huge loss. She has left her practice and I can no longer see her to complete the repair which leaves me feeling terribly pained. She left me emotionally some time ago and that abandonment was painful in and of itself. Now she is gone physically, too, so there is no resolution. Just feeling terribly pained and abandoned and not quite sure why or what I did wrong. I find it hard to not blame myself at times because, as a patient I went in there so vulnerable with all my flaws and I think that it must of been me that caused this. Then I think of some of the unkind things she has said and how she constantly pulled me in and pushed me away emotionally and I realize that she is just wounded herself. It’s going to take me quite some time to get over this loss and wound as I cared for her deeply. I have never lost a person in this way or had anyone push me out of their life emotionally so I’m unsure how to handle this. Even my ex’s and I stay in touch because I tend to leave relationships amicably, but with this therapist, it just feels like I have hole filled with confusion and I feel completely disposed of.It’s so painful. Thank you for listening.

    1. lisaferentz says:

      I am so sorry that you experienced a therapeutic relationship that was made to be so complicated by your therapist. This is truly not what good therapy is supposed to feel like. There is no question that it takes great courage on the part of a client to open up, trust, feel vulnerable and share intimate thoughts and emotions with a therapist. Therapy is supposed to be emotionally safe, supportive, educational, and growth producing. There are many wonderful clinicians out there – I know, I have trained hundreds of them. They are compassionate and nonjudgmental. They have excellent boundaries and enough self-awareness to be mindful of the difference between their clients issues and their own stuff. And they take ownership and rectify things when the dynamics of therapy are inadvertently driven by them and not their clients. Like in every other profession, there is a percentage of therapists who are awful and have no business being in the field. Or they pursue it for all the wrong reasons. But for you and everyone reading this, don’t throw the baby out with the bath water. A safe, appropriate, supportive, and well boundaried therapeutic relationship with a well qualified therapist is a gift and is well worth pursuing.

    2. Ioana says:

      My dear, dear, Jeti, know that you are not alone. “You are a manipulative victim”, “I have no interest in you”, “patient X (who was also my friend) is so much better than you” – these are some of the last words I heard from my therapist, my therapist who, until that point, used to call me, to tell me I am “special” and a ” crystal child”, the same therapist who would say she is fond of me, buy me gifts, share her life with me, call me, “mentor” me, the same therapist who would run our sessions a minimum of half an hour over our time frame just because she was fond of spending time with me. I came to a point of complete trust, honesty, and, unfortunately, complete dependancy on her. I had been severly abused my my mother in the past, physically and emotionally. My father was an alcohoolic. I grew up as the small victim, craving to be seen, acknowledged, validated. My therapist provided just that and way more. My therapist was, concomitantly, doing the same thing with a whole lot of people, one of them was my childhood dear friend, with whom I’ve become completely alienated. She still attends the same therapy, it’s her fifth year. You see, some therapists want to be gurus, rockstars, they want to play “God” with people’s lives, they are charlatans and narcissists with unresolved issues of their own. My therapist didn’t want me to thrive, to be free and beautiful and powerful, she wanted me to be dependant on her because my dependancy validated her own sense of self-worth. So, the moment she noticed I was getting better and confident and strong, she started putting me down in a horendous way. The climax was using confidentially disclosed information about my childhood abuse with my friend (resident in psychiatry on antidepressants, after five years in therapy), who also attended her sessions. I felt utterly shamed, problematic, I felt less than a human being, I felt that I was doomed and black and irrecuperable. I felt betrayed, the same way I had felt when my mother, instead of protecting me, used to leave purple spots on my skin. But worse of all, I felt like I deserved it, that “people like me” are disgraceful, ugly, they deserve to be punished and shamed. Horror followed. I wrote a message to the therapy abuse network. They advised me to break all contact immediately. It took me five more sessions of utter disbelief to do so. When I did break contact it felt like complete groundlessness. Here I was, a confused 26 year old, with only one website as a safe place in this world. I had been abused 20 years, have been in an abusive relationship 5 more and, when seeking professional help, I had been abused once again. My only utter luck, which I am deeply grateful for, is my financial inherited status, which helped me overcome what I had gone through without being immersed in a psychiatric ward. Which ment other means of personal development – yoga, meditation, NLP. PTSD, dissociation, severe depression and identity loss can be, indeed, healed with mindfulness. You can’t control your dreams, though, and, sometimes, I still have nightmares, wake up sweaty and scared, I still wake up screaming. At the same time, I am grateful to be in this world as my own person, knowing and feeling deeply that I am not dependant on my circumstances, knowing that I can choose, moment by moment, my own response. Knowing that I can breathe freely- what a reief! Knowing that I can validate myself. This is freedom. And my freedom was worth 26 years of pain, pain that I had inflicted on myself by clinging to what was familiar, by craving validation from others and being seen as a human being – because I just didn’t know how to do it for myself.
      My dear Jeti, you are worthy! Your birth right is freedom, your birth right is love! Assume your own sense of worth and know that simply because you are walking on this earth you are utterly beautiful, utterly complete, utterly loveable. People who cannot see that in you cannot see that in themselves. Define yourself and have the courage to live your own beauty! Let go completely of all that which no longer grows you. Fear is a sign that you’re getting out of your comfort zone and moving towards your higher, authentic self. I wish for you peace of heart and mind, and above all, love and validation for the wonder that you are.

  8. for now I'm anonymous says:

    As a therapist who has also experienced this rupture as a client, it is a painful complicated grief. Since the injuries are both transference and the actual therapeutic relationship, it makes it much more difficult to re-enter the therapeutic process with someone new. The therapeutic relationship itself is a trigger for the trauma which then makes it more difficult and much more delicate to work with. One day I will publish (or co-publish) on this topic, for there very little out there that talks about the clinical implications for the clients when impasses and ruptures are left unresolved.

    1. lisaferentz says:

      Thanks for your feedback. I believe that would be an important topic for you to write about. This is an issue that obviously impacts many people. Wishing you all the best in your healing journey.

  9. Kelly LCSW-C says:

    I agree SOOO much with Anonymous! Well said! Also can relate to other posts here too. I found that a decade or two, and having some INFORMAL (but educated and experienced) reparative therapeutic relationship/s helps the pain get better — seriously. Traditional MH therapy by definition just doesn’t include a “real” relationship. It’s one that is professional, formal, limited, and clinical. And that may be great for some – think medical doctor, professors, trainers…. I wonder if it’s so great for others.

    1. lisaferentz says:

      Thanks for your comment Kelly. I appreciate your thoughts on this subject. I am not sure what an “informal” therapeutic relationship looks like. It’s critically important that the relationship is non-judgmental, genuinely supportive, and emotionally safe. But it also has inherent limits, needs very clear boundaries, and can’t cross into a dual relationship as that is a deviation in our ethical standards. A “real” therapeutic relationship is not a friendship but is “real” in the sense that clients feel authentically validated, guided, and empowered.

  10. Eve B says:

    I often wonder how a helpful, authentic relationship can develop from a secretive, artificial environment. The consulting room itself is closed, and yet, clients are expected to risk opening up their vulnerabilities to a stranger who could turn out to be a bad therapist or not good enough despite all their credentials. I believe that the most effective therapists know how to modify and/or extend the boundaries to fit their clients’ needs without compromising professional ethics. Unfortunately, this type of skill comes from the heart and head and can’t be taught in school. I think the stigma of therapy is as much about therapists promoting and protecting their profession instead of equally acknowledging the reality of harm in bad therapy to clients who are there because of their suffering and could leave suffering with even more emotional (and financial) baggage. Who usually ends up suffering the most when therapy fails? Many of the top tier psych professionals appear to be too afraid to talk about their own mistakes for fear of blemishing their own reputations. The clients can easily be blamed and labeled as ‘crazy’ and resistant while the therapist can just move on to their next case and try again. It’s little wonder that the public remains skeptical about the sincerity and motivations of a science as subjective as psychology that dually functions as a self-serving business. It’s not so easy to find a good therapist as a bad or at best, ineffective one, especially when expense and locale are primary factors.

  11. Mary S says:

    Lisa,

    You say “It’s critically important that the relationship is non-judgmental, genuinely supportive, and emotionally safe.” That sounds great to me — and is what I expected when I first tried therapy. But, having tried several therapists, I never found all of those things.

    Indeed, most therapists I tried seemed judgmental — although sometimes I would guess that what came across as judgmental was intended to show me that they understood me (when they didn’t understand me). Differences in values and worldview also undoubtedly came into play.

    As for “emotionally safe”: In my first session with the first therapist I tried, I asked “What is therapy?” She replied, “A safe place to work on your problems.” That sounded great — and I assumed that “safe” meant “emotionally safe.” But therapy with her and with every other therapist I tried was not emotionally safe for me. And when I told a later therapist what this first therapist had said and what I assumed it meant, he said no, and gave a description that sounded like what I would call “confidential” — that what went on in therapy wouldn’t get back to where you worked, etc.

    But I think “genuinely supportive” is where a lot of the problem lies: A therapist may believe they are being supportive when that does not seem to be the case to the client. Sometimes this is because the therapist does not see the client as a real person, but makes one-size-fits-all assumptions that don’t fit the particular client. Also, since different clients have different strengths and weaknesses (and different combinations of strengths and weaknesses), what is supportive will necessarily differ from client to client. For example, one of my weaknesses is coping with personal attention. I went to therapy in large part to learn to be better at coping with personal attention. But the therapists didn’t see this as something to help me with — they seemed to expect personal attention to be supportive, not part of the problem. Differences in values and sub-cultures can also make a difference in what is or is not supportive.

    Bottom line: The therapy professions need to give much more attention to seeing clients as individuals rather than making one-size-fits-all assumptions. Soliciting and facilitating client feedback — and taking that feedback seriously — needs more attention. And, since no one is perfect, there needs to be more thought to helping the client get a suitable “fit”. For example, I tend to see the world in complex terms. I have found that most therapists see the world in simpler terms than I do. This leads to frequent frustration for both of us: I say something complex, they repeat back an oversimplified version, showing me that they haven’t heard me. And they, presumably, get frustrated that I don’t see things in their simple terms.

    1. gerrib18 says:

      Thank you for taking the time to express your concerns about therapy and the therapeutic relationship. I certainly agree with your point that every client is unique and a ” one size fits all approach” is destined to fail. You are right- It’s so important for therapists to get ongoing feedback from every client regarding the efficacy and, yes, the emotional safety of treatment. All the best to you! – Lisa

  12. Sue says:

    I am twenty months out of a very damaging, painful, chaotic therapy that lasted two years. And I’m still recovering.

    I am making my story and process for recovery public. http://www.thesandbox.life

    1. lisaferentz says:

      I am so sorry that therapy had such a lasting and traumatic impact. Keep trusting in your ability to heal and know that when you share your story with others you can receive the compassionate support that you deserve.

      1. MA says:

        JetiLuke & all who have shared,
        There are so so many similarities with our stories — brought tears to my eyes. It helps to know that I am not alone. Thank you.

        One thing that has helped me —
        I found a trauma specialist trained in the SE (somatic experiencing) model, and she agreed to do SE work with me directly related to unresolved traumatic events in my previous therapy work that had left me shut down/overwhelmed and for a number of months unable after sessions to drive away from her office for hours (sometimes well after midnight) because I was a flooded mess. It all began when ex-therapist had a very angry outburst (came halfway out of her seat towards me telling me to hush..that I had said plenty, etc etc while I was trying to explain something to her). She then blamed her anger somehow on me…said that I had provoked her and she couldn’t help reacting as she did. (Though I didn’t learn that until years later because she refused to process what had happened when it first happened. Had told me that she had something “personal” going on that had left her “checked out” at the time.) Overnight after years of amazing work related to various childhood traumas, I began getting treated as an angry ungrateful client who had turned on the caring respected longtime therapist. I’m pretty sure she shared that with another professional connected to my treatment at the time because that one began suddenly treating me differently as well. It was a painful painful heartbreaking confusing mess on so many levels — triggered up all sorts of stuff…re-traumatizing me in the process. Or as a friend of mine said (who happens to be a psychotherapist), it was a real clusterf#%$. Nothing quite like hearing a therapist mutter about you under her breath “it’ll never be enough”…
        With trauma specialist I later found & in her private office, I actually was able to get a meeting with ex-therapist. She ended up telling me, among other things, that she viewed it as a “public shaming” and requested no further correspondence.
        Anyway, the SE didn’t heal my broken heart, but it did help a lot…seems to have made the worst more bearable and settled down within me.

        Again, thank you everyone for what you have shared. And “for now I’m anonymous”, I sincerely hope you do publish something on the clinical implications for the clients when impasses and ruptures are left unresolved. It is desperately needed.

  13. Robert says:

    My spouse began therapy some time ago with a therapist that I recommended. My recommendation was premature because I did not know at the time that my spouse had begun a cascade of decline into despair and dysfunction as a result of childhood trauma. Had I known what we were dealing with I would have searched for someone who had the experience and training necessary to understand the subtleties of trauma. Long story short, the therapist took my spouse down a path that went too deep, too fast, and we lost her to many of the common symptoms that are present when one experiences a resurgence of trauma. There’s no reaching her now. My spouse has surrounded herself with people, including her therapist, who are easy to manipulate. She’s running from everyone she has ever loved and admired. I’m concerned for her safety as her risky behavior mounts and have no idea how to reach her. If I attempt to contact the therapist, the therapist ramps up with protective behavior for my spouse. The therapist has even shared my spouses story among mutual friends which tells me there is a gross lack of training and experience. I believe this therapist is keeping my spouse from getting the help needed. How does a spouse help when that spouse is alienated from the situation. I understand how feelings for abusers are projected onto those closest to the survivor… why doesn’t the therapist know this and respond by bringing in someone qualified to help.

    1. lisaferentz says:

      I’m so sorry for your experience Robert. Clearly this is an example of a breach of ethics and clinical boundaries. In order for me to model appropriate boundaries, I’m unable to give clinical advise via the internet. I hope that you are able to find a clinician who you can trust and will meet your needs.

  14. Anonymous says:

    This article outlines my experience. I’ve gone for years without any symptoms of PTSD. Went for treatment for depression and ended up with PTSD. Did not realize at the time of my therapy that it was an reenactment? Not sure if there was malevolent intent involved or it was just not enough experience with trauma. Took me a few times to try and get away and break the attachment. I was able to find a wonderful therapist and within 10 months I was back at my job full-time and had filed a licensing body complaint. And everything is going really well for me right now so much so that I no longer need therapy. Unfortunately, it has left such a bad taste in my mouth that I wasn’t able to stay in therapy long enough to the point of working on myself and self-esteem. I know the past therapy (3yrs) was just too damaging for me to continue the therapy once I was well even though I had a spectacular therapist. One year later complaint is still under investigation. I’m very thankful for the second therapist. I finally had the experience of understanding what therapy in a safe environment is, too bad it didn’t happen the first time. Thanks for the great article very validating.

    1. lisaferentz says:

      I appreciate your sharing your experiences and I’m so glad you were able to at least have a second therapeutic relationship that sounds safe, appropriate, and helpful. There are definitely bad therapists out there- and there are also wonderful, compassionate ones who do amazing work and genuinely help their clients to heal. It’s important to remind prospective clients that great therapists exist, too!

  15. Theresa says:

    I found this article tonight while in a deep, deep pit of despair over my therapist, who I saw twice a week for just about two years, abruptly terminating therapy with hardly any explanation. I remember texting him later that day, begging for a reason, something to help me understand something that I now know is not understandable. His response was that my “final bill was in the mail” and that I please respect his wishes and not contact him further. That was nine months ago and I am still absolutely devastated and desperately seeking answers to what happened.

    I’m not going to write anything too long (it’s not been a good night), but I just wanted to express my gratitude for this post and for all the comments. I do feel less alone, less desperate, less afraid, after reading all of them.

    Thank you all so much,
    Theresa

    1. Lisa Ferentz says:

      Glad to know that you found some value in this post. All the best to you.

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