A Former (Hurt) Client Thinking of Becoming a Therapist...

To me a Slavic proverb comes to mind which in direct translation sounds like: "He who does not risk does not drink champagne".

Therapy, if done properly, is an endeavour of high risk with possible high gains because it is dependent on people attending to people. I don't see any way of eliminating the risk completely. One can try to do that but then therapy probably becomes an automatic, robotic, manualized process that, as the OP's case shows, is still not harm-free at all. This is the goal of evidence-based therapies - to manualize the process - but my belief is that this approach is misinformed. Psychotherapy works and can be very powerful but it is probably nevertheless still more art than science and I don't believe that this will change any time soon.

Some therapists are generally more effective than others, some therapists are more effective with certain problems and some therapists just fit better with certain patients. Bad fit can also cause harm even if there was no malpractice or malignant intent present.

How to avoid causing harm? Of course malpractice and malignant intent should be officially forbidden, not tolerated and punished. Education system could be more restrictive. In my country it is officially impossible to start calling oneself psychotherapist just after finishing masters (which seems to be the standard route in US). After masters one has to go through additional studies in a particular psychotherapy modality, which takes at least 3-4 extra years. That again doesn't guarantee anything if the institutions that train therapists (after master's level studies) will not choose their trainees carefully. Even if they do choose carefully, there is no (and can not be) any objective criteria because those who are choosing are doing that from the position of their own flawed humanity. The psychotherapy trainees should be required to go through a more rigorous psychotherapy themselves - a person cannot take into account what they are not aware of themselves. Again, this minimizes risks but definitely doesn't eliminate it completely. Total working through of all blind spots will take a life time and is probably even then not enough.

So, if something goes wrong and harm happens then who is responsible? In case of malpractice it is clearly the therapist but what if there was no malpractice and both the therapist and the patient did the best they could, without any malicious intent? I suppose the answer is highly culture dependent. I've understood that in US where civil lawsuits are common, it is standard to blame the other person and if possible, sue them. To me, as an European, this cultural practice is foreign and appalling. As children, we are dependent on our caretakers but the unpleasant reality is that as adults, we and only we are responsible for ourselves. If the therapy I am engaging n is harmful (assuming that there is no malignant intent from the part of the therapist) then it is my responsibility as an adult to walk away and if I cannot do that for whatever reason then this does not give me any right or justification to roll the responsibility for my life and decisions to another person. It just doesn't work that way in adult life.

As for OP, many useful and good things have been said already. I would perhaps add that if you're afraid of making mistakes then you probably cannot do this work. Psychotherapy will be risky and there will be always risk of harm. If you try to get rid of all risks then you also probably get rid of the potential of drinking any champagne. You were helped by EMDR, there are other people who have been harmed by it. Some people have been tremendously helped by CBT, I, for instance, have been helped great deal by psychoanalysis. No matter how good EMDR therapist or CBT therapist in the best case would probably just provide useless or annoying service to me, in the worst case they would inadvertently harm me. So it's not clear cut. The responsibility lies on both sides. The responsibility not to abuse the patient relies on the therapist, the responsibility to walk away from an incompatible service relies on the adult client. Also, no one owes the adult patient anything, the responsibility to live their life, as good or bad as they can, is fully theirs. So, follow your heart, work with your problems and do your best without fear and I'm sure you'll be able to help many people.

Excellent post feliecan.

Yes US is largely a very very litigious society and it effects how people conduct their lives. Even though I’ve been living in the US for awhile and consider myself American, practices of filing grievances and suing before assuming personal responsibility remains a foreign practice for me. That’s why I often disagree with people on this subforum in regards to accepting personal responsibility. So yes some of it is cultural

Excellent quote: “If the therapy I am engaging n is harmful (assuming that there is no malignant intent from the part of the therapist) then it is my responsibility as an adult to walk away and if I cannot do that for whatever reason then this does not give me any right or justification to roll the responsibility for my life and decisions to another person. It just doesn't work that way in adult life.” I can’t agree more

Any career choice has certain amount of risk in it. Especially careers that deal with helping others. There is always a chance that one will make a mistake. Yes there is a risk as in every job. But as long as you don’t intend to harm anyone, you should do well. At the same time if in doubt, then don’t. I firmly believe in following one’s calling. If it’s a calling, there is usually no doubt.

I agree. It is not the license or the training that authorizes providers to harm others. It is the disturbed individual that has gone through the training and therefore happens to be carrying the license. It is just like allowing the wrong person to carry a concealed weapon. In both of these cases, the problem isn't the task, it is the disturbed individual that shouldn't be afforded the chance to do either. But, unfortunately, disturbed people fall through the cracks.

OP if you are seeing a therapist, it might be a good idea to see what he/she thinks.

Perhaps the therapy context is more harmful, or potentially harmful, to some folks than others. Unfortunately, when people are hooked or in what turns out to be an unhealthy relationship, especially with someone or an institution that society grants authority to, they may not recognize it for a long time. And it's because society does grant some authority to psychotherapy for "helping" people with their internal stuff that I think it is a problem beyond my own, personal one. I like the contrast between the terms "responsibility" and "response-ability". If you haven't had that experience, then you haven't had it. If someone wants to discount the experiences of those who have, or lay it at the door of cultural difference, that is certainly their individual prerogative and point of view. I disagree, though I likely might not have years ago.

For myself, I would say that I have been hurt by 2 therapists that shouldn't have been allowed to enter their fields; thus they wouldn't be doing therapy. They were very disturbed. I guess that is why I used the analogy of a disturbed gun owner.

Yes, this approach certainly is not for me. While I do believe it wasn’t the only factor at play in my traumatization, the coldness, rigidity, sterility, and roboticness of manualized treatment felt incredibly invalidating and dehumanizing to me. Truly it made me feel like nothing more than a defective robot that needed to be fixed, more for society’s benefit than my own.

If I have followed well enough, I agree. Here today, I believe you read and responded to my big long post about my personal story of being harmed by psychotherapy. I’m not sure if I made it very clear in that post, but like you mentioned, I did not recognize the kind of harmful situation I was in for a long time. After a while (close to a year with that therapist), I did start to think to myself that it simply wasn’t worth it... I knew that I had been leaving sessions frequently feeling frustrated with my therapist and I certainly didn’t feel like I was benefiting from seeing her at that point... so I left. One day I walked into our session and just told her that this was our last. I felt confident in that decision. I had talked it over with a friend and my dietitian, and I was excited at the prospect of saving money. But then I left that session and was in such an enormous amount of distress that I just couldn’t have seen coming. I didn’t understand it at all at the time. No one saw it coming actually... not me, not my therapist, not my friend and dietitian whom I had consulted with before making this decision. So by the time I had come to the decision to leave, enough damage had been done. Long story short, I ended up going back to that therapist for several months (I think of it now, but not back then, like a dangerous, addictive drug... something about going to therapy with her felt addicting when I look back at it, and leaving was like quitting cold turkey from that drug. It felt like withdrawals painful beyond belief). I still knew that I didn’t exactly “click” with that therapist (which now just seems like some lame therapist-y jargon that they feed you), but I stayed with her because I was so terrified of feeling those ‘withdrawals’ again. When she finally terminated me on her own terms, the feeling hit again and I was officially traumatized. Because this time I couldn’t go back. I felt stuck with so many dangerous thought processes and feelings about myself that I hadn’t even realized she had instilled in me until I was out on my own and free from her. So no, I (and I’m sure many other people) didn’t realize how harmful this therapy was for me until it was too late. And I generally regard myself as a bright, insightful person, or at least others have described me that way, but still I didn’t and couldn’t have realized what was happening to me at the time. At times I did blame myself though — I kicked myself over and over for staying with her as long as I did (or for ever going to her in the first place), thinking I should’ve known better... but truthfully I couldn’t have. I’m wiser now and hope that I could recognize warning signs if I were to start back up in therapy, but I had no way of knowing back then. Therapy rarely comes with any warnings or “side effect” labels — even prescription drugs do a better job of warning consumers about potential adverse reactions. But this therapist and the clinic she practiced at loved to feed consumers the cliche adage of “it gets worse before it gets better.” That therapist even told me after I came back after I first left her that “therapy is supposed to be hard and not always feel good.” While I believe this is sometimes true, I think therapists need to be very careful about saying things like this, as it could be just an excuse for harming clients and getting away with it.

I’m really not the type of person to sue a restaurant because I spilled their hot coffee on me. I think that’s ridiculous and I don’t believe in doing that when something like that happens. But I believe most of these harmful therapy situations are not like that. Consumers go because they need help. Many of us find ourselves desperate for help and are even willing to pay out of pocket for professional help. Many of us do a fair amount of research into the therapists available in our area and try to make the most informed decision we can. Not gonna lie, the way that clinic that I went to sold “evidence-based practice” on their website made it sound pretty convincing. They went on and on about all the supervision that their trainees received and how every session was video-recorded. It all sounded great in theory, but in practice it really harmed me. How was I supposed to know that therapy could do such harm in the first place? Unless a person of the general public happens to come across these forums or some of the few other resources available online that talk about therapy harm, they’re likely not going to even see it as a possibility unless the therapist is engaging in outright explicit misconduct (such as sexual abuse) that would be considered unethical in just about any field. I just don’t think people even consider that this kind of thing can happen, but obviously it does. As I’m writing this, it makes me realize that perhaps a good place to start (and perhaps we have started) in creating social change here would be to educate the public (and the therapists... I’m not sure how much this kind of thing is talked about in their training). Maybe we need more warning labels. Maybe it should be a requirement to list possible adverse side effects of therapy on waivers. Maybe it should be openly discussed in the first session. Because truly I think many people just don’t even consider that it can and does happen... which seems totally understandable and fair because it’s just so rarely talked about. So many people out there are advocating for people to “just go to therapy” in an effort to decrease stigma around it, but I wonder if this is doing more harm than good. It’s almost as if going to therapy is ‘trendy’ now... but then what happens to the people that did “just go to therapy” and didn’t experience much help from it or were even harmed by it? I think if something is going to be so popularized by social media, we must also be open about the potential risks, or we are just doing more harm than good.

You should probably read up more on that whole McDonalds hot coffee thing. Total smear campaign. The coffee was so hot it gave the victim burns that were severe enough that she required skin grafting and was hospitalized for more than a week.

I think studying therapy failure or harm is a great idea.

Therapists need to be held responsible for failures. They can't just take credit for successes. But most of them do not even recognize all the ways they harm people. Many of them are emotionally immature or have grandiosity delusions, and cannot or will not see clearly. Therapy is their fantasy world.

Governing bodies should be held responsible too, since they turn these people loose on the public, and let them go crazy with little or no oversight.

Also, malpractice can be about negligence not just malicious intent.

I couldn't agree more. You took the words out of my mouth! There maybe some individuals whom may not know when a therapeutic relationship has become unhealthy. This can easily happen to someone who is entering therapy for the first time and/or someone who is very young. So, they stay until it is too late.

Even if you realize something is amiss, doesn't mean it's easy to just walk. In some cases, "emotions have been severely manipulated and unconscious deals done", as someone said.

I'm wondering what do you mean by saying that therapists need to be held responsible for failures? Like how exactly should they be held responsible? What is a failure?

Or what do you mean by saying that they take credit for successes? How do they take credit for successes+ Also, what do you mean by negligence in this particular context?

I don't know anything about governing bodies because, as I've said, I'm from Europe and here things really work differently from US.

Although I'm long term therapy patient myself in an exploratory therapy, this is something I agree with very much.

I believe that open-ended therapy should not be free because it basically puts the patient only in the receiving end and that's not good. I strongly believe that it helps to give out money for these services, which helps to decide whether these services are actually beneficial to the person. It forces the person to take responsibility and initiative to advance their treatment and if the provider is not suitable, to end the treatment.

Also, I think it's not fair to other tax payers to pay for such open-ended services that are so poorly defined. It's not that I think it is not helpful - it has been very helpful for me for instance - but obviously there are no guarantees.

Sure everyone should be held accountable for their work but this is just so vague and general .

How does one define failure and success in therapy? It’s so very subjective and differs from a person to a person.

For one client failure in therapy means that therapist refused to reciprocate and take on a client as a lover (and yes there have been instances of people being furious with therapists not accepting romantic advances from clients or not accepting friendships) or a failure is that a client doesn’t become functional adult even though therapist promised to help with that? Or a failure is that addict relapsed and therapist is now to blame? Or is it instance of violent harm which actually enters category of crime rather than just failure?

And what’s success and who defines it and it what way therapists take credit for it? It would be a violation of HIPPA for a therapist to make public announcement that divine is successfully completed her bereavement therapy and is now accepted death of a loved one.

Where is she taking credit for it? Talking with colleagues, on the street, talking about it in her home? In what way therapist take credit? Credit for what? And what do I care (unless t shares my name publicly which then I’d care about violation of privacy not her taking credit for something)

These statements about failure, successes and accountability are just so general. What specific instances are being discussed here?

The topic does need more research, that's for sure. But you can still find a pretty good list from a search engine using terms like "harmful therapy", "therapy failure", etc.

Here's one that was on the top of the list of the search on "harmful therapy" that I just did..

When therapy causes harm | The Psychologist

But that’s exactly what I am saying. It’s not conclusive because it’s not exact science. This is from the article you posted:

“Banning treatment approaches that the evidence shows cause harm may sound like common sense. But the issue is a methodological minefield. Firstly, one has to decide what counts as psychological harm. Some cases will be obvious. But then there are cases where, even if a client shows improvement after starting psychotherapy, it is possible they would have recovered more quickly if they had participated in a different, more effective, treatment approach. In that sense, their current therapy has been harmful because it has slowed down their progress. Moreover, many trials that find negative effects are never published – what’s known as the ‘file-drawer’ effect. On the other hand, psychological harm can be overestimated. A client who deteriorates after starting psychotherapy might well have deteriorated anyway. In fact, undertaking psychotherapy could have slowed down their deterioration.”

It’s not that simple

I don't think we can call people irresponsible for not walking away from therapy when it becomes unhealthy. If the patient is entering therapy for the first time and or the individual is very young, she/he may not know what an unhealthy therapeutic relationship is. There could also be other reasons the individual stays with a bad provider through no fault of his/her own. But, I just don't agree that the patient is being irresponsible by staying.

In my post, I was explaining WHY it is not easy to just walk.

No, it's not simple.

OP, I think it would be good to speak with your therapist about your wanting to become one.

I'm not sure what you are referring to. As far as I know, I did not call anyone irresponsible, nor did I ever plan to do that. Saying, that paying for one's own therapy forces the person to take more responsibility does not imply that all who do not pay, are somehow automatically irresponsible.

If you don't agree that paying out of pocket helps to consider more carefully if the treatment is useful and appropriate (generally, not necessarily in every particular instance as there are always exceptions) then we can discuss that. But what you said above is not really related to what I wrote.

Oh I am sorry. I responded to the wrong post. I agree with what you are saying. Sorry about that.

In my experience, paying out of pocket has helped me to consider when therapy is really “worth it” for me at any given time. I think it is very important to check in with yourself and ask yourself if you are really getting what you want/need out of therapy, and being the one who pays for it can certainly help spark that kind of reflection. Still, it wasn’t enough to keep me from being harmed by T#8/therapy with T#8. That was a situation where I believe unconscious damage had been done to me that I wasn’t aware of until it was brought to the surface right after termination. But I have had other therapy situations that I decided to walk away from simply because I felt they weren’t worth the money that I was paying. They didn’t harm me; just didn’t really help me so I left. And perhaps they could’ve/would’ve done harm had I stayed longer. Hard to say.