During therapy

Signs of harm – when to say you feel worse

Based on our current understanding of clients’ experiences, therapy can sometimes lead to a number of unintended, unhelpful, negative and harmful consequences. Fortunately, these events do seem to be rare, and we aren’t yet clear on the range of factors that create or influence these consequences. However, if you think that your therapy is harming you, or has harmed you, or notice any of these experiences (or others not listed here) during or after your therapy you should certainly discuss this with your therapist, GP, or other healthcare professional (or of these aren’t available consult ‘Who can help me if I have concerns?)

Here we have listed the main experiences that clients who have described being harmed by therapy have reported. This is not to say that these are the only experiences. As a general guide, if you’re finding the process of therapy more difficult than expected, creating new problems, traumatic or upsetting or your therapist is behaving in an unacceptable way then you should seek support and guidance from your GP, other health or social professionals you are involved with. 

Worse symptoms or problems

One response to this is that therapy can involve a short-term increase in the intensity of symptoms and emotions, and so feeling worse is to be expected. This may be true, but should not be taken as a rule. Indeed, it should be possible to distinguish the helpful forms of increases in the intensity of symptoms (for a short while and related to your problem area), from new symptoms or problems that are unrelated to your original concern, or feeling worse that goes on for a significant period of time (perhaps longer than two weeks). So whilst it may sometimes be true that ‘it has to get worse before it gets better’, this is by no means true for everyone, the experience of it ‘getting worse’ is usually limited, and is in the context of feeling you are developing new understanding of your problems. 

It is important to raise your concerns with your therapist and look at the ideas in How will I know my therapy is working as it should?’ to help you decide whether your therapy is helping or not.

Anger, frustration or other intense negative emotions

If therapy isn’t working, or hasn’t worked, you may experience some intense emotions at the time, or at the end of therapy. Some of these can relate to therapy events that you were dissatisfied with, or because therapy hasn’t worked out as hoped for, whilst others may relate to specific things your therapist said or did in therapy that aroused strong or intense feelings and weren’t addressed in a helpful way, or weren’t addressed at all. 

Based on our current understanding of when things go wrong in therapy, as a consequence you may notice a range of feelings and thoughts – anger, frustration, sadness, despair, loss of hope, worrying – quite intensely in ways that were not there before therapy. These emotions may start some time after your therapy has finished, particularly if you have discussed your experience with others, received more information about what should and should not happen in therapy, or begun a new therapy process.

A particularly difficult set of intense emotions, which may last for some time, can be associated with the consequences of therapist malpractice or unethical behaviour

The presence of these in your life, distressing enough in themselves, can lead to additional consequences, which we will look at next. 

Other areas of my life, such as relationships with others, have got worse

As further consequence of the thoughts and feelings that can result from harmful therapy can be changes in other areas of life, such as increased difficulties relationships with others, or at work. These can range from increased irritability with partners as a consequence of the intense feelings described above, to a lasting mistrust of others and an avoidance of developing close relationships. 

It is important to say that we are not talking about the times when other people in your life notice that you have changed as a result of therapy in ways that they find difficult (such as becoming more assertive, or making more time for yourself), as these, whilst unintended, are a natural consequence of the positive aspects of therapy. Rather, the experience we are focusing on refers to the times when you and others notice that you have changed as a result of therapy in ways that you find difficult.

Self-blame for things going wrong in therapy

Therapy is a complex process, and although much more is now known about how and why it works, there is still a lot that is unknown.  If things have gone wrong in therapy you may notice that you blame yourself for things that happened, or for things going wrong. Should this happen, it would be worth spending time with your therapist to explore some of the factors that led to therapy not working, or created problems as part of the ending process. (Note: It isn’t helpful if the therapist uses jargon, like ‘resistance’ or ‘transference’, without explaining it.  A skilled and competent therapist should be able to help you explore these in ways that help you understand them without feeling like you are being blamed).  

The most important situation to address here is if you are blaming yourself for specific actions of your therapist that are unethical and harmful. In the rare circumstance of inappropriate relationships developing between therapist and client it is entirely the therapist’s responsibility and fault that this has developed. Unfortunately, the nature of abusive relationships (even though they may not feel abusive at the time) is that the power imbalance, and other issues, can lead to coercion, and a shift of blame and responsibility onto the victim by the perpetrator.

Guilt and Shame

Some of the emotions associated with blaming oneself for negative events are guilt, shame, worthlessness, powerlessness and vulnerability and maybe fear that you will never be helped or you will be rejected by your therapist. These can be particularly burdensome and may lead to difficulties talking or thinking about your difficult therapy experiences, and be reluctant to disclose them to anyone who may be able to help. There are specific organisations around whom you can contact to discuss these issues if you find disclosing them to others difficult.

Like it’s all been a waste of time, effort and money.
Clearly, attending therapy and making changes in life as part of this involves a significant investment of time, effort and money. A clear consequence of spending all of these resources on something that doesn’t work out can be disappointing and lead to some negative feelings, as there has been no helpful outcome 

In the case of harmful therapy, the time, effort and money have been spent and there have been negative consequences in return. In this context, several emotions may arise, many of them outlined above. Perhaps most notably is that this may make you less likely to seek out further help for the original problem (as well as the additional ones). 

Questions to ask yourself 

  • Am I feeling worse as a result of therapy?
  • Are there any unintended, unhelpful, negative, or harmful results of therapy?
  • Am I noticing any thoughts and feelings described above?
  • Are there any others?
  • Can I talk to my therapist about this?
  • If my therapy is ended, or my therapist is creating these difficulties, can I contact one of the organisations suggested?
  • Do I know who I can talk to about this?