I think those differences are fairly apparent to anyone (though I would argue that it is a 'real' relationship, albeit a very particular one).
Also, I agree with you that the pain of harm in therapy is all too often downplayed, especially in the profession (the further into the therapy world I step the more aghast I become at some of the attitudes I find) and should be highlighted a lot more. Due to the intensity of the relationship and the manner in which it can reopen old wounds, there is real potential for harm, and this needs to be openly acknowledged.