New Study Investigates Negative Side Effects of Therapy

Researchers find that nearly half of cognitive behavioral therapy (CBT) patients experience treatment side effects.

Rebecca Troeger
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A study led by Dr. Schermuly-Haupt of the Psychosomatic Rehabilitation Research Group at Charité University Medicine Berlin examines the prevalence of side effects for Cognitive-Behavioral Therapy (CBT). The researchers, whose results were published in Cognitive Therapy and Research, found that 43% of CBT patients in their sample experienced side effects, which they define as “negative reactions to an appropriately delivered treatment.”

“Knowledge about the side effect profile [of psychotherapy] can improve early recognition of side effects, safeguard patients, and enhance therapy outcome,” the researchers write.

Photo Credit: Pixabay

Researchers have long recognized that psychotherapy has positive as well as negative consequences. Estimates of side effect (SE) rates for psychotherapy vary from 5% to 20% of cases. One such side effect — deterioration of symptoms due to therapy — has been found to occur in 3 to 10% of patients. Psychological distress and marital/family conflict are two common side effects of treatment; others include the appearance of new symptoms, suicidality, stigmatization, and tension or changes in a patient’s social relationships.

Despite historical recognition of psychotherapy’s side effects, there is currently little data on their features and rate of occurrence. Dr. Schermuly-Haupt and colleagues sought to address this gap. They interviewed one hundred CBT therapists, asking them to describe “unwanted events” (UEs) experienced by a recent patient who had undergone 10 or more sessions of CBT.

Therapists were prompted to distinguish between unwanted events (i.e., any unwanted event that occurs during therapy, which may or may not be related to the therapy), adverse treatment reactions (i.e., an unwanted event related to treatment), and side effects (i.e. an unwanted event related to treatment that met “professional standards”) through the use of an Unwanted Events-Adverse Treatment Reactions Checklist, which differentiates between these treatment reaction categories.

The researchers found a curious discrepancy between the percentages of side effects identified by psychotherapists who were first asked for a “spontaneous report,” versus the percentage later identified during interviews when the various categories of unwanted events were “systematically evoke[d]” through use of the checklist. Initially, 74% of therapists stated that they didn’t know of any UEs or SEs that had occurred during treatment.

After the structured interview, however, therapists reported that 43% of patients experienced one or more SE (Average .57, SD = .81). This difference in reported side effects may point to a blind spot on the part of psychotherapists, which perhaps owes to difficulty recognizing one’s ability to harm, as well as a lack of training and awareness about psychotherapy’s adverse side effects.

The most commonly reported side effects included “negative well-being/distress,” “deterioration of symptoms,” and “strains in family relations.” According to qualitative data, examples of “negative well-being/distress” included crying uncontrollably in session, discomfort, and fear when engaging in interventions in session (e.g., exposure activities, role plays), difficulty discussing specific topics, and strong feelings experienced in response to the therapist (e.g. anger, tension, stress, and anxiety).

Examples of family strain that emerged as a result of treatment included a spouse who was distressed after his wife became less attentive and took more time for herself after being in therapy and a client who felt guilt and sadness after choosing to distance herself from a parent.

The authors note that there is some debate regarding whether “ordinary reactions” to CBT, such as the distress reactions and changes in patients’ social relationships described above, should be characterized as side effects, particularly since they may be essential to successful treatment outcomes. They argue that even though these responses “may be unavoidable, justified, or even needed or intended,” they should nevertheless be categorized as side effects. These side effects, although “unavoidable” and even “intended,” should be studied and should serve as motivation to develop treatments that “are better tolerated,” they write.

The authors also note that although the majority of the side effects identified in their study were rated as mild to moderate (59.6%) and not lasting (89.6%), over 40% of side effects were classified as severe or very severe, and 8.8% were persistent. Reflecting on these findings, they conclude, “Psychotherapy is not harmless.”

The study has several limitations. As psychotherapists reported side effects, reports may have been influenced by therapist bias; the authors suggest that future studies use a blend of stories from patients, therapists, and outside interviewers. The study’s sample was composed of patients with various diagnoses, and as such, results would likely be different in a more homogenous sample, or with a different form of therapy. Additionally, as approximately half of the patients whose cases were reported on in the study were taking psychotropic drugs, and it is thus impossible to rule out the effect of medication on the observed side effects.

The authors hope that the results of their study will increase psychotherapists’ awareness of treatment side effects and that this will contribute to improved care. In alignment with the recent call for an enhanced psychotherapy informed consent process, the authors also state that their data can be used to strengthen informed consent in psychotherapy, as well as to support “risk monitoring” throughout treatment.

 

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Schermuly-Haupt, M. L., Linden, M., & Rush, A. J. (2018). Unwanted Events and Side Effects in Cognitive Behavior Therapy. Cognitive Therapy and Research42(3), 219-229. (Link)

68 COMMENTS

  1. One negative side effect of counseling is when the counselor is not trying to help his client. This happened to me over and over. It involves gas-lighting and brain-washing. The client must stop going to see the counselor, which I did. I also questioned the first counselor I saw, asking “who do you work for?” when it became apparent that he wasn’t working for me.

    It was just the beginning of a 36 year Public Relations campaign against me. I was sixteen.

    Instead of restorative justice–which would have worked (and still can work)– I was subjected to all kinds of insults…yet no one was going to tell me why…it was because of bad behavior that I had forgotten about…no one was confronting me about it directly… as a brain-injury survivor, I needed to be confronted directly…but it was not happening.

  2. What is wrong with this situation? A person was/ is seeking help; and yet the counselor has information about the client that he is not willing to discuss.

    The client needs the counselor to confront him (that is why he is going to see the counselor); and yet the necessary confrontation doesn’t happen.

    The powers that be have told to the counselor not to confront the client. That is what is wrong.

    We need that confrontation to happen. We need restorative justice.

    • In 1966 I was run over in the driveway and brain-injured. My mom was there; and she was negligent.

      Later, she blamed me for getting run over. This was gas-lighting. She was the person who was negligent.
      She even made sure that I wrote it was my own fault in my fifth grade autobiography. I was so confused
      (and trying to finish my assignment) that I just wrote what she told me.

      That was GAS-LIGHTING and I wish I had said to her, “Mom, wasn’t that Your fault?” Because, of course it was. I was only 18 months old at that time.

      Her friend Mrs. Moore was backing out of the driveway. Mom mom should have been protecting me from the moving vehicle. I don’t know what she was doing but she was not protecting me.

      I still can feel the large indentations in my skull. I was a slow learner; and I was very gullible and naive throughout childhood.

      People who have been run over (and brain-injured) in the driveway should not be conspired against.

        • This is a common phenomenon, and one of the reasons I really despise the DSM. It provides cover for the adults who are not doing their jobs, or are outright abusive. If the kid protests his/her treatment, s/he is “ADHD” or “Oppositional Defiant” or “bioplar.” Saves anyone having to ask the difficult question of why the child is protesting and what is going on in his/her life?

          • I’m very sorry about what your mother did, and/or didn’t do. In other words, I’m sorry she didn’t protect you, then blamed you for her mistake, johnchristine. I agree with Steve, “the DSM … provides cover for the adults who are not doing their jobs, or are outright abusive.” Especially since the primary function of our DSM believers today is, according to their own medical literature, covering up child abuse. Which is illegal, since they are mandatory reporters, by the way.

  3. 40% of 43% of people experiment severe or very severe side effects, ie: 17.2%. It still remains a lot.

    A more accurate way to measure the benefit and the harm of psychotherapy would be … to make satisfaction surveys.

    Simple. Effective. Specific. Of course, the surveys of the therapists themselves are not reliable…

  4. I, too, dealt with a therapist who misdiagnosed me with a DSM stigmatization, based upon lies from child rapists, according to her medical records and my child’s medical records, I eventually learned. Then she gas lighted me and had me massively poisoned by psychiatrists.

    I’d say what happened to me was atypical, but misdiagnosing, gas lighting and poisoning child abuse survivors is the number one actual function of today’s “mental health professionals,” according to their own medical literature.

    Today, over 80% of those stigmatized with the “psychotic and affective disorders,” (depression, anxiety, bipolar, and schizophrenia) are misdiagnosed child abuse survivors. Over 90% of those stigmatized as “borderline” are misdiagnosed child abuse survivors.

    https://www.madinamerica.com/2016/04/heal-for-life/

    All this misdiagnosis of child abuse survivors by the “mental health professions” is by design. Child abuse is listed in the DSM as a “V Code,” and the “V Codes” are NOT billable DSM disorders. Which means no “mental health professional” may ever bill any insurance company for ever helping any child abuse survivor ever, unless they first misdiagnose and stigmatize the child abuse survivor with one of the billable DSM disorders.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    Since today’s “mental health professionals” cannot even bill insurance companies to help legitimately distressed child abuse victims, they should stop false advertising that their industries are the experts in such.

    We need an alternative to today’s “mental health professionals.” We need people who will actually help, rather than merely defame and torture, child abuse and trauma survivors. Since I do not believe “professionals,” that have been profiteering off of covering up child abuse for decades, will all of a sudden start actually helping child abuse survivors.

    • Therapy which focuses on the family system has a better chance of success. If a child is blamed as “the problem”, this is almost always a fallacy because the kiddo is responding the adult world. Child therapy can be very successful when it helps kids to process their traumas without pathologizing them.

  5. Everything we do (and not do) in life has side effects! And we may eventually view these so called ‘side effects’ as a wonderful thing that happened to us! This is the same for CBT.

    We also need to remember that this situation is very different from the terrible side effects a person may experience as a result of taking psychiatric medicines – including the potential for these medications to make one drug dependent for life. There isn’t anything good about that.

  6. I understood CBT to say basically that since feelings are derived from the consequences of beliefs, and the beliefs you have were almost certainly arrived at through faulty reasoning, it must follow that they are not necessarily true, and therefore questionable, and when seen correctly, must be false. So, if you buy all that, logically, you give up those beliefs, and feel better, find yourself able to do that which is validating, satisfies your needs, conquers your fears, and improves life. It sounded good, except for the feeling that beliefs were somehow so basically ingrained that to challenge them with reason wasn’t going to budge them because they were learned emotionally, and it takes an emotional approach to influence them. To me it was that I was going to have to feel something to change something, and CBT was just missing that. Their solution is exposure therapy, and I had enough exposure to bad situations already, I thought it was bad experiences that created the problem, so why just keep doing that over again. I suppose my beliefs had to change first, but then how does that work? It all seemed to rely on you being over awed by the authority of the therapist. IMO it takes some good experience to overcome some bad experience, but with CBT they seem to like to throw you to the wolves.

    • I agree with you ‘dfk.’ This is why I think mindfulness interventions make so much more sense because instead of the need to challenge one’s ingrained beliefs and emotions, one can simply observe how thoughts and emotions come and go in the present moment (and also notice how they are influenced by one’s past conditioning).
      Some aspects of CBT maybe useful for people however in order to solve various practical problems, and to gain hope and support for recovery. I too totally disagree with explore therapy and think it is quite unnecessary.

    • CBT is superficial. That is the real problem with it. The larger truth is that for any treatment to be helpful, it probably needs to address the person’s trauma history. Mental health treatment isn’t necessarily the problem. The system this treatment is provided is more likely the issue. Community mental health centers are set up to focus on quantity rather than quality treatment. A good therapist will do almost nothing more than listen and validate. Some modalities like EMDR also have promise because they are nonpathologizing.

    • “The larger truth is that -all- of mental health, inc. is often (usually) damaging, sometimes to the point of death.”

      Yes, I agree that this is the larger truth. The mh industry has proven to be extremely dangerous and even fatal for way too many people for it to have any credibility as “well-being support services.” I perceive it to be a colossal failure, and sabotaging to individuals and society on the whole. And we’re paying for it big time.

      There are many paths to true and authentic healing available in the world already that have absolutely nothing to do with the academic study of “psychology,” which, in the end, is merely a thinly veiled exercise in creating nothing more than holograms and illusions to serve a few unenlightened greedy and power-drunk self-proclaimed so-called “elite” groups, at the extreme expense of everyone else.

      • I agree with you, Alex, that there are many paths to healing.

        There are thousands of social workers and counselors who don’t subscribe to the medical model, however, and I think many of them do good work with their clients. The issue is the medically-dominated systems. These systems view the person treated as “ill” and needing “treatment” with “psych drugs.” This is the core of the problem. We need a paradigm shift away from seeing individuals as fragile, incompetent, and sick. People are resilient, strong, and survivors. That is the message people need to hear. We all have fragile parts of ourselves, and these fragile parts need to be recognized and validated, not drugged up.

        • “We need a paradigm shift…”

          Yes, we do. And I believe it is a much broader and core shift than what you are describing.

          I agree that we are all fragile and vulnerable, and at the same time, we are all resilient and powerful. That is what I call “being abundantly human.” This is how we grow and integrate as we go along in life, exercising all sides of ourselves, hiding from nothing about who we really are. That is the exploration of our spirit, the journey of life, as I see it.

          And I also believe that what we manifest for ourselves along the way is the precise reflection of how we are doing in this regard, where we can validate ourselves and where we can learn and grow. This is how life mirrors us, and we can use that mirroring as our most powerful guidance and tool for growth. Or, we can simply blame life or others for our plight, and see what manifests from that. It is a choice we all make from moment to moment, involving trial and error. Again, that’s life.

          Personally, however, I’d stay far away from any of these systems–mh system, social services, the entire mh industrial complex–for the purpose of achieving healing, personal growth and spirit/body/mind integration, and I know you already know I feel this way. But I’m happy to reiterate it.

          From my experience in the system and also working with social workers in a teaching capacity (I’ve given workshops to social workers et al), I believe wholeheartedly and with certainty that they lack the training and perspective necessary for holding a safe space for growth and healing. Being loyal to the system will simply not allow it, so it is stressful to all concerned.

          I believe the agenda in the system and all that world is entirely different, at the core, has nothing to do with healing and rehabilitation, and it is of course virtually always denied that this is the case. Of course it would, that is the essence of “corruption.” I see it as blatant criminal fraud.

          Again, it’s why I call it “toxic,” most accurate word I can think of to describe such a system so stuck in its own self-aggrandized delusions, and claiming it can help others in their quest for clarity and well-being.

          You are certainly free to disagree with me, based on YOUR experience, if that is what you feel. And from your posts and our previous dialogues, it seems that we are simply not in agreement here, because you seem to insist that the system/field can be reformed, and I’m saying it is beyond repair and doing way more harm than good, in any respect, way beyond the issues of DSM and psych drugs. I believe it is philosophically misguided and vampiring society at large.

          If we are not in agreement here, and I imagine we are not, then we’d just have to agree to disagree, and I’m ok with that.

          • Hi Alex,

            Yes, certainly we see this from different perspectives, although we agree in many respects, too!

            “because you seem to insist that the system/field can be reformed, and I’m saying it is beyond repair and doing way more harm than good, in any respect, way beyond the issues of DSM and psych drugs.”

            I’ll just point out that if the DSM and drugs weren’t in the picture, there is no way we’d be in this mess with iatrogenic effects, dehumanization, and pathologizing human suffering.

            The system in some ways is changing for the better. At my center 30-40 therapists have been trained to provide EDMR over the last few years. EMDR trainers have explicitly told us that the whole point of this treatment is to end treatment as quickly as possible, including titrating pills as appropriate. This is a paradigm shift from the idea of “lifelong patients” in community MH centers. This is a good thing.

          • “I’ll just point out that if the DSM and drugs weren’t in the picture, there is no way we’d be in this mess with iatrogenic effects, dehumanization, and pathologizing human suffering.”

            But they are in the picture at present, and you are talking to someone who experienced all of this first hand. This is from where I am getting my truth about it. That, and having been on your side of things, too. I am familiar with both perspectives, from a first person point of view, and my truth comes from having integrated both perspectives of my experience. I feel this gives me a very broad perspective.

            Not only has this been my direct experience, all that you mention here re DSM and psych drugs, but I got out of all this a while back and have been processing through it for clarity and very deep information for years, and with others, and I call the result of this “my truth.” You can assess it as you wish, and hopefully not project anything further onto my experience, although I have no control over that. Although I do inherently have the power to not take it on. That is my choice, and I am not in any way dependent on you, not even on your opinion. That is simply the truth of the matter.

            I hear you that you feel EMDR is a viable healing tool, and I’m not arguing with that. I’ve said this twice, already, and very clearly and directly. But I seriously doubt it’s going to save the system. Still, if it helps clients, then go for it, is all else I’ll say about that.

            The framework of the DSM and the systemic dependence on psych drugs as a tool for anything are SYMPTOMS of a much deeper issue at hand, a societal issue amounting to oppression and control, and it is not only misleading, it is also downright fraudulent to call this “healing” or “support” of any kind. I believe this begins with specific personalities who are drawn to this field.

            Yes, people want to help others, and that’s fine. But I think they discover something about themselves when they come face to face with clients, and that’s when the denial, projections, and dysfunctional power-imbalanced relationship dynamic begins. The abuse can be subtle and insidious on this level, and it can go on for a while before a client realizes they are being gaslighted and manipulated, to line the pocket book and feed the ego needs of the clinician. That is so common in this field!

            Thousands and thousands of testimonials have corroborated this. Are you going to dismiss them all as merely “subjective?” They still have the power of truth and experience behind them. Put them all together and you get a very clear picture of something terribly amiss here that goes beyond DSM and psych drugs.

            And THAT is where therapy can be extremely dangerous and most harmful to unsuspecting clients.

            “The system in some ways is changing for the better.”

            I totally disagree with this, I believe it is getting worse. I’ve seen “changes” happen that, in reality, amount to more of the same. These are illusions to appease funders. And funding groups change their mind and focus all the time, arbitrarily, and no one is going to stand up to funders and go against their bread & butter. This is why, in reality and despite the pretense of change, nothing ever gets done.

            There are increasingly more and more and more and more socially, financially, and professionally disenfranchised people every day, just look around. I believe this is the product of your “system,” which you defend on some level.

            Again, I guess we’ll have to agree to disagree, and wait until history tells the story in hindsight. But, at this time, I do wholeheartedly and in my gut completely believe the reality I am putting forth about this. I’m fine with being wrong about it, and I would applaud anyone who actually FIXES this system.

            However, I do believe I am right and speaking truth here, and I honestly do not believe that the system can be fixed, in any way shape or form, because it is already a black hole. It is sabotaging itself bit by bit, day by day, as is the case with toxic systems. They eventually self-destruct, their own shadow turning against them because it is never owned. We’ll see how this unfolds…

          • So Alex you seriously think that changes like offering EMDR is a sign that the system is getting worse? Please, I don’t get that logic at all. It makes me think you don’t understand EMDR or it’s philosophy. EMDR won’t “save the system”, but again I think it’s a step in the right direction towards nonpathologizing and compassionate care which doesn’t require drugs. It will actually mean that more people will quickly move through treatment and move on with their lives.

            There are also thousands of testimonials of people who say the system has helped them immensely. Everyone has opinions about whether it has been good, bad, indifferent, etc. I tend to fall on the side that we’ve done some good but also a lot of harm. This is why I believe we should abolish the DSM and stop over drugging the population. This is quite a radial perspective for someone who is currently in the system. It isn’t “my” system but the system a lot of people have influenced over decades. I do not like many aspects of the current state of affairs, which is why I’m changing my practices in a lot of ways, starting with informed consent. I am also advocating with my colleagues to do the same and be more transparent about the downsides of treatment with their clients.

          • ” It makes me think you don’t understand EMDR or it’s philosophy.”

            Ok, first of all, let me tag that as a projection. I certainly do understand Eye Movement Desensitization and Reprocessing, and I also know it’s been around for a long time. I know people who have benefitted from it, starting in the late 90s.

            “you seriously think that changes like offering EMDR is a sign that the system is getting worse? Please, I don’t get that logic at all.”

            What I find illogical here is yet another projection you make. I never said that the EMDR is a sign that the system is getting worse; those “signs” are in society and the overwhelming negative feedback the system gets. EMDR is separate from this issue. Your harping on it the way you do does not equal the power of change.

            “I tend to fall on the side that we’ve done some good but also a lot of harm.”

            If people feel the system has done them good, more power to them. The fact that it’s done “a lot of harm” is the dominant perspective here. So, I’d say “enter at your own risk” would be an appropriate phrase.

            We’d also need official warnings posted in every therapist’s office, too, if we are to offer informed consent: “psychotherapy may cause suicidal feelings and post traumatic stress.” Because that is absolutely true. Maybe not in all cases, but in a lot of cases this has already proven to be accurate, and people have the right to know this.

            Shaun, I sincerely and with my heart applaud your efforts to bring relief and clarity to your clients. Perhaps in your community, you are progressive and conscientious, and so therefore you can help bring about change for the good of everyone concerned. I can’t say one way or another. But I’d cheer you on in that process, while honestly reflecting back where I feel you are missing information. That would be up to you to either take to heart what I say or dismiss it. Your choice, your reality.

            Right now, I’d say keep going and keep an open mind. You’ll discover interesting and perhaps eye-opening things on a daily basis. Life will teach you what you are meant to learn, as it does with us all. I’m sure of it.

          • Alex,
            I should be have been clearer. What it seems you are saying is that the system is getting worse. I am giving you an example of how the system is offering a non-pathologizing treatment option, which seems like an improvement. Do you not think this is an improvement from psych drugs? My point is the system itself is making EMDR even an option for clients, which is a massive improvement over psych drugs and CBT. People much higher than me support using EMDR, as they do with DBT because they believe it helps people empower themselves.

            What information am I missing? You imply that I’m ignorant of something. It seems to me you might feel this way because I haven’t concluded like you have that the system needs to be abolished. I will say I find this goal to be completely unrealistic. I don’t see big pharma and psychiatry giving up their profits or influence. I do hope that over time more people will be exposed to what MIA is talking about. We all should be critical of everything. Once the masses are on the same page, we will see substantial change. Until then, I will do my best to advocate for change that I believe in, as I know you’ll do the same. We should all speak our truth. I know mine is constantly evolving these days. Take care and thanks for the spirited conversation.

          • “Seems to me you might feel this way because I haven’t concluded like you have that the system needs to be abolished” is yet another projection because I’m not trying to convince you of anything, but more so, to hear what I am saying in the moment and to treat my perspective and information with respect rather than saying things like “you obviously don’t understand…” yadayada, which implies I don’t know what I’m talking about, when in fact, I most certainly do! Otherwise, my journey was completely meaningless and useless, which is neither truth, nor acceptable to me. In this venue of all venues, the voice of experience should most definitely be respected, and not dismissed. This is exactly what we’re trying to reverse, right here.

            Yes, I am saying the system is getting worse, because it is increasingly apparent that it cannot take the feedback it needs to hear. It has been a failure for a long time, people have been saying this and with plenty of evidence and powerful testimonials, and it keeps trying to chug along, draining us all along the way.

            Money for this research and that research and all this stuff that we already know, all for grant money. I think it’s a bad investment because it does not serve those who it needs to serve–the clients. It only serves to make academics richer, which is what drives the system.

            ALL about money, at everyone else’s expense. Because most of this research is meaningless and trickles down to nowhere. Fat cats getting fatter.

            So yes, you read me correctly here: it is abysmal, from my perspective, and failing society terribly, on the whole.

            What we are talking about here is so, so, so much bigger than merely introducing a new “treatment option” or “healing modality.” We’re talking about systemic abuse, marginalizing perspectives and practices, and the head-scratching and maddening legality of it all. This involves other entities (all part of the “bigger system,” so to speak), all of which collude against the human heart and spirit, for their own gain and profit.

            I believe by now, this is evident to most people on the planet. Certainly outside of the very small bubble of the mh industry, this is common knowledge.

            Are you aware of how the mh industry is not in the slightest representative of how most people perceive reality? It is in a world unto itself, and most people whom I know realize this already! Even before I tell them my story. They’re not terribly surprised when I express my disdain for the mh and social services systems, and at that same time, they are aghast when they hear my story, go figure.

            And that is a reasonable response, it is a ghastly experience to be subjected to this kind of inhuman treatment!

            The mh industry is, to such a large degree, “horror stories from the mh industrial crypt,” and that can be truly mind-boggling to the everyday person, to hear the details of how this occurs. So we all know to avoid it at all cost.

            As you and I have agreed, healing is available in many forms and fashions. There are myriad ways to *tap* into the unconscious in order to unearth trauma and shift the energy of it, for relief and clarity. But in the context of “the system,” any modality of healing is sorely compromised by the bigger picture of systemic corruption.

            “What information am I missing? You imply that I’m ignorant of something. It seems to me you might feel this way because I haven’t concluded like you have that the system needs to be abolished.”

            You are drawing a false conclusion here, and that is the third blatant projection I am seeing in this dialogue, which is exactly what I’m talking about when I criticize psychotherapy and suggest it needs to be accompanied by a warning–it’s just way too easy and second nature to do this, until we make it a point to see it in ourselves before we unwittingly project it onto others. That can confuse and disorient a client faster and more profoundly than anything, leading to all sorts of chronic rumination and post traumatic stress.

            I do believe, however, that you are missing information, and from my experience, you don’t want to hear that. Ok, go forth, and tomorrow you might see that today, you were, indeed, missing information!

            We’re all ignorant about that which we have yet to learn, you’re not alone. Same applies to me. I do think I have a much broader perspective than you do around these issues. Again, maybe I’m wrong, but that is my feeling, based on these dialogues. You’ve never been on the inside of it, to my knowledge, so you would indeed be missing that information. The information of truth comes from experience, not outside observation.

            No reason to be “offended” if you feel ignorant, that is a neutral quality we all share, until we learn that about which we’ve been ignorant. To me, that is the essence of humility.

            And thank you, as well, I feel complete here, and at peace with it all. Keep going!

          • Alex,
            I am more than happy to hear new information and perspectives that differ from mine, which is why I’m on MIA to begin with. If I just wanted to hear more of what I’ve heard for 15 years, I’d go to the APA and FDA for all of my information.

            You keep saying I’m projecting. What I am saying is that the fact that the MH system is starting to embrace non-pathologizing treatments for trauma is a step in the right direction. I agree with many of your criticisms about the MH system. The truth is that all large systems seek to keep themselves in power. We are all self-interested, and some of us are particularly greedy and short-sighted.

            Regarding psychotherapy, I also agree with you that it has the potential to harm clients. It also has the potential to make the client very uncomfortable because it’s asking them to challenge their beliefs, feel their emotions, consider changing the status quo if it isn’t working for them, and so on. All of these challenges are threatening and difficult to most individuals, as change is stressful. The other side is that some clients have become dependent on the system because they haven’t developed a strong internal locus of control. They believe they need others to take care of them, and no doubt the MH system has played a role in creating this dependency. One thing that has changed in the MH world is the idea of an “episode of care”. In other words, we don’t tell clients we expect them to be in treatment for life. Instead, we tell them we expect it to be temporary. Again, I think this is an improvement from the past where people were “stuck” in the system forever.

            I will also point out that clients keep demanding our services. If there wasn’t a demand, there would be no supply. We have people waiting 1-2 months to get into our center, so we aren’t dragging people kicking and screaming into treatment. They can also leave at any time, and we’ve made that clear in the informed consent. We also tell them that they do not have to see a doctor if they don’t want to. Personal choice is emphasized. This I find is respectful of the person.

            Take care.

          • Alex,
            I also should mention that I’ve been on psych drugs before. I was put on them after my dad died when I was 24. I was grieving and my doctor suggested meds to help with anxiety (I was doing checking behaviors with locks and the oven). Looking back on it, I was not myself because I was upset and grieving. The problem as I see it is the medical model immediately thinks to medicate understandable human responses to life circumstances. I took myself off the pills after about 9 months because I felt I had processed much of my grief, but as a result I had heart palpitations for a couple days which freaked me out and was very uncomfortable. This is just a drop in the bucket to what people on psych drugs experience with TD, akathisia, and metabolic syndrome.

            I don’t recall my doc telling me about such things to worry about. I’m glad I didn’t get stuck on pills because from what I know about longterm risks and talking with my clients, it can be terrible trying to get off these pills. One of the main interventions docs are trained to provide is pills, and because of this they keep doing what they know, despite the harms to their patients. I think med schools need major reform, but you know until big pharma isn’t so influential, this is unlikely to change, which is highly upsetting.

            I have experienced social anxiety much of my life (12-35), ever since I was bullied as a kid (and my parents had what I perceive is a loveless marriage, which I got to see first hand, and my father was addicted to alcohol from when I was about 12 until he died), and in my twenties it was particularly uncomfortable, as I would get anxious and feel the need to escape the situation. This luckily has mostly resolved in my 30s, but for a period I was highly avoidant of anything which caused me extreme comfort socially. It was terrible. I can see why pills or other drugs would be an escape for people who feel so uncomfortable in their own skin. I still struggle with self-confidence issues and feeling ok being me. When clients tell me they appreciate my kindness and tell me I’ve helped them, my immediate (internal) response is to not believe them! I know from personal experience that trauma is at the heart of human suffering, which is why I don’t support pathologizing people simply because they have feelings or behaviors which are perceived to be “abnormal”. What the hell is normal anyway?

            One final note I’ll make is that the reason I still believe in my work is because so many of my clients feel judged, alone, with nobody else they can talk to about how they feel in their day to day lives; I hear it often from my clients that they look forward to talking to me because I listen, don’t judge, and validate their pain. I don’t try to change them, convince them that they are “ill”, or any of that BS. I normalize their pain and point out that it would be unhealthy not to have the responses they have to dysfunction and trauma. I deeply care about those folks who I work with; they are truly amazing, and I hope for all of them that they will feel that way about themselves one day. I feel it is a privilege, as they tell me things they haven’t told anyone else. This is why I think therapy can be very helpful, if done carefully and thoughtfully. I think we all deserve such treatment. I hate to see my clients drugged up, because more often than not they say they don’t feel very human when in this state. While I think a small minority of people do get better with psychiatry, the majority don’t.

          • Thanks for sharing your story, Shaun. Indeed, we are all having our journeys. I’m going to once again cut to the chase here.

            I don’t know if any of this will resonate with you at this point, but it’s the best I can do right now, as far as offering you what I feel might be new information. If it’s not, then I apologize ahead of time for wasting your time. Hopefully, this will be something new for you to chew on, and also hopefully it will ripple to your clients.

            There’s always more, but for starters, this is the core of what I learned in my healing journey–

            I don’t know if you are familiar with the idea of light vs. density, as energy concepts. Light is free flowing and a spectrum of colors, like the rainbow; whereas density is thick and dark, like tar. These are contrasting frequencies of energy, and can even be measured in Hz.

            On a feeling level, it is quite apparent the difference. Light feels good, buoyant, and clear in the body. It is expansive and creative, and translates into feelings of joy and optimism, and our bodies and minds feel unburdened in the light, and our energy flows freely and unencumbered.

            Whereas density feels like worry, fear, doubt, shame, guilt, and intense anxiety in the body. It is constrictive, inhibiting and even undermining to energy flow. The only thing created by this is frustration, chaos, conflict, and self-sabotage.

            There’s really no gray area here, when speaking of energy, it is either one or the other. There is a continuum of frequency, the way there is a continuum of emotion, but it is either in one category or another: light or dense.

            When we talk about healing either individuals or society on the whole (one individual at a time), we are talking about healing density, of transforming it into light. That’s the idea—transformation. This is accomplished by transmuting energy, which is how frequency is raised, and this is what brings relief to our minds and bodies.

            Emotionally speaking, we look to transmute despair into hope, the relief of which is where we feel healing (change) occurring. This is exactly how we alleviate suffering. That is a process, taken one step at a time. Quantum leaps are possible, but they can be rugged. Best to find ease in the flow of healing, which would mean radical self-care and practicing great patience and trust. That, alone, is healing.

            Truth-speaking sheds light on the dark, because truth is light energy. Deception, duplicity, fraud, and corruption are pure density. And think about it—wouldn’t anyone lying, somewhere in their consciousness, feel ‘worried’ about being caught? And wouldn’t their fear be that they would feel shame and humiliation? That is why density is now on the run, people are no longer taking on these projections. The entire country is truth-speaking at this point. Everyone who is aware of it now (and that’s a lot of people during this time of mass awakening) is sick and tired of the lies, deceit and corruption–the density which has been running our world.

            Awakening is not a one-time event. We awaken repeatedly, in layers and over time, because what we’ve absorbed from living and operating in such density as our society has become, is in our cells, and that can take a while to work its way out, depending on one’s healing process.

            Density is what blocks healing (energy flow), so there is paradox here to ascend, which is wonderful consciousness expansion. Not always easy, but highly invaluable to our personal growth and evolution.

            But to feel our own light, aka self-healing power, it is vital we walk our talk. That is synchronicity in the body, and that is what ripples most powerfully and clearly, like a stream of light. Integrity is pure light, in human form.

            Ok, that’s the best I’ve got right now. I hope at least some of it rings true. Take good care of yourself, and all the best to you. And I sincerely mean that.

          • P.S. This is all I can offer on a limited venue like this. If you really want to learn more in depth about energy and how to apply these principles to healing, either post your contact info (do you have a website?) or feel free to contact me through Steve. He can forward your email to me and I’ll write you back. I do have Skype, if you want to talk face to face. I imagine that would cut through the static we experience in online written communication.

          • Alex,

            Thank you for taking the time to read my posts and for sharing your perspectives. I do greatly appreciate it. Your comments around awakening to me is similar to mindfulness/meditation practice. It’s a journey not a destination! There are so many opposing forces in the world and nature, and without one, we would not appreciate the other.

            I would certainly be up for communicating more. I don’t have a website since I’m not in private practice (yet). I’ll reach out to you through Steve. Have a great Sunday!

  7. This study strikes me as more or less bogus, for a number of reasons mentioned above. It is as though it was fabricated to put a dent in the armor of those who move away from psychiatric drug use, by showing “side-effects” to be ubiquitous in therapeutic endeavors and not necessarily a bad thing at all.

    • True. It was perhaps funded by big pharma. I have seen some mindfulness studies that seem to be designed for negative outcomes (for example providing only one very short meditation session as the intervention, and then elaborating on the ineffectiveness of the outcome in media articles), that appear to be funded by big pharma.

      • It’s great if people find benefit in mindfulness, meditation or any form of psychotherapy. But suggesting that reports of harm or lack of benefit must be untrue and the result of big pharma intervening strikes me as the same knee jerk reaction as that which those who try to talk about harm from psychiatry – silencing.

        It strikes me that it would be odd if there was anything anywhere that was universally beneficial, outside of generalisations like food, fluids, etc.

        People find their way to freedom by many different paths. There is no one path.

        • Hello ‘out’:
          Numerous studies have consistently shown that ‘rumination’ (regretting the past and worrying about the future, proliferating anger, etc.), is a transdiagnostic risk factor (i.e., having the same underlying mechanism) for the development of “psychiatric disorders” – check out the following reviews for example:

          Kaplan, D. M., et al. (2018). Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review. Journal of Clinical Psychology.

          Watkins, E. (2015). Psychological treatment of depressive rumination. Current Opinion in Psychology, 4, 32-36.

          When considering this, mindfulness interventions can be especially valuable, as they appear to significantly reduce rumination – see the following reviews:

          Tomlinson, E. R., Yousaf, O., Vittersø, A. D., & Jones, L. (2017). Dispositional mindfulness and psychological health: a systematic review. Mindfulness, 1-21.

          Querstret, D., & Cropley, M. (2013). Assessing treatments used to reduce rumination and/or worry: A systematic review. Clinical Psychology Review, 33, 996-1009.

          Everyone may not be READY however, to engage in mindfulness practices right away – so other interventions (e.g., to address various practical problems a person may have, engaging in physical activity or yoga) might prepare one for mindfulness practice. There are other benefits of mindfulness practice as well that I have talked about in several previous comments – if you like, you can check them out by clicking my username here.

          • Thank you Nancy99! On a personal note irrelevant to the article, I have only recently discovered that the medication I have taken for well over 2 decades has not made me well or whole or in any way improved my life. Now that I have successfully weened myself from psychiatry altogether, I am faced with finding a new definition for my malady and addressing it in a more productive way than taking pills and reporting monthly for further humiliation. I’m finding rumination to be a major obstacle to daily life. The act of ruminating, which occupies the vast majority of my waking hours and many hours I would rather be aleep, consists of replaying the past and suspected future in search of…I don’t even know what. It’s like I’ve lost my keys and can’t leave the house until i find them (and then when I do occasionally find them I set about looking for a way to avoid losing them again, starting with a full accounting for how I lost them last time.)

            All of this is just to say, I think you may be on to something here. I appreciate you sharing it.

          • Thank you for your comment ‘twentyseven.’

            The following (relatively old) article gives some techniques that can be used to build mindfulness into your life. You may find it useful:

            Reference: The clinical use of” mindfulness” meditation techniques in short-term psychotherapy (1975). Gary Deatherage, Journal of Transpersonal Psychology, 7.

            It can be downloaded for free online.

            All the best to you!

          • How does this answer my comment, Nancy99?
            And just to be clear, I have many years of personal experience of mindfulness/meditation.
            There is no one perfect path

          • Sorry, missed the snarky “everyone may not be ready….”
            What other reason could there possibly be if the perfect answer doesn’t show always demonstrate it’s divine perfection as the answer to everything?

          • Hi ‘Out’: I see that you are clinging to the idea that people need to find their own path to happiness, and there simply cannot be any principals/ideas that could be common to everyone. That is not true at all.

            For example, there is compelling evidence regarding rumination and mental illness (I provided a few references but there is a very large body of strong evidence). So, any interventions that can reduce rumination can be of great help to anyone.

            Also, meditation it is not merely about watching your breath. There is so much depth to it than that – for example, meditation enables you to get to know your own mind (i.e., to develop self-knowledge), and to cultivate wisdom. Also, when we practice meditation, we are able to understand how we are attempting to find happiness through mere autopilot striving and reacting to stimuli, as well as the difference between hedonic happiness (which involves short term happiness that come from fulfilling sensory pleasures) and eudemonic happiness (which is about cultivating contentment and wisdom).
            Also, in contrast to what you say, meditation is not about ‘instant nirvana’ – it is a slow process of gradually cultivating understanding.

            I can provide references for all what I have said above.

          • Nancy99
            Can you see the parallels to psychiatry in the arrogance of the assumptions you are making here? In the patronising manner with which you assume the right to put your misguided perceptions of who I am, and of what I have experienced onto me?

            I practised Buddhism, including daily meditation practice under the guidance of a sensei and a Roshi for many years.

            Do you not understand that psychiatry can reference hundreds of thousands of studies to silence critical research?

          • @ ‘out’:
            “Arrogance of the assumptions”? I am sorry if you felt that way, however I would like to know what I said for you to conclude that please. Psychiatry (especially the type we are criticizing here) assumes that all mental issues are ‘brain disorders’ that can be managed with the right medicine. This is a belief system as there is no evidence for that (I won’t go into details as you would know enough about this, considering that you are commenting here at MIA).

            Regarding meditation, most people who teach meditation to people interested in Buddhism simply teach how to focus the mind (although there are a very few teachers who go deeper into wisdom teachings).
            Buddhist teachings comprehensively analyze and describe the mind (consciousness) – it is NOT a belief system. I suggest that you very carefully read the following peer-reviewed academic article:

            Karunamuni, N., and Weerasekera, R. (2017). Theoretical Foundations to Guide Mindfulness Meditation: A Path to Wisdom. Current Psychology.

          • Sigh.
            Nancy99 you assumed a lot of things about me and about what I believe in the comment I responded to. One of the main assumptions was that my disagreement meant I hadn’t practised ‘true’ meditation, that i must have been doing it wrong, or I’d agree with you, and also that I wasn’t aware of the precepts you mentioned.

            The comparison with the religion of psychiatry in this is; if the patient doesn’t improve via its methods, and/or wholeheartedly endorse the ‘truth’ of the psychiatry’s beliefs about themselves, the patient is faulty and needs further correction until they do.

            Of course it is a belief system. Our little ape brains aren’t capable of comprehending ‘reality’, in my opinion, Also, there is, and always has been huge debate between and within the different Buddhist traditions, and the different points of view can’t all be objectively ‘true’.

          • @ out
            These discussions are not about you, or me making assumptions about you. My aim of making comments here is to seek/indicate different ways of addressing psychiatric issues. I hope you will read the article very carefully sometime – then you will understand what I am talking about. All the issues you have raised are addressed within that article as well.

          • Nancy99
            Reading back through our discussion, I regret that I was so aggressive in the way I responded. I do feel sensitive and easily angered when I feel I am being gaslighted.

            I am glad that you are finding peace and freedom.

          • Thank you ‘out’! It is very nice (and sweet) of you to say that. To be able to say ‘sorry’ shows you have tremendous mental strength.
            I wish you the very best!

          • Nancy, I really love your exploration about the diverse advantages and applications of meditation. I’ve had a daily meditation practice for over 15 years now, and it is what helped me most to heal from the various injuries I incurred from the mh system, including temporary brain damage (and other organs) after I withdrew from psych drugs after 20 years. Not to mention, the chronic ruminations caused by too much psychotherapy. I could not shut off my brain, and that is an energy drainer.

            I’ve learned different kinds of meditation over the years, and am trained in chakra meditation, which I learned in a psychic healing program years ago, to see our own energy and work with it in a way that is supportive to our holistic well-being. I believe we are our own healers.

            I have also found it valuable in the process of creating and manifesting. Learning to quiet the mind allows us to hear our higher self/inner guidance/inner healer, so we are not dependent on others and we know our resources at all times.

            I find that daily meditation aligns me in such a way that what I need manifests on my path when I need it. No more feelings of lack or deprivation, but only abundance when we integrate with our spirit energy and higher self awareness. It is a robust feeling like no other I know, and with practice, it can become a constant, no matter what is occurring around us. True serenity, the calm in the storm.

            Although, of course, being human and all, I still most definitely feel and express my emotions, which I value highly, it is the core of our truth. But thanks to meditation, I’ve learned to enjoy my emotions, as creative and guiding tools, rather than to feel overwhelmed by them or self-conscious for expressing them. Much in opposition to what I feel the system doles out, there is absolutely no shame in having emotions! In fact, we would not be human without them.

            Thank you for your beautiful testimonial, which I’ll repost here because I believe it bears repeating–

            “Meditation it is not merely about watching your breath. There is so much depth to it than that – for example, meditation enables you to get to know your own mind (i.e., to develop self-knowledge), and to cultivate wisdom. Also, when we practice meditation, we are able to understand how we are attempting to find happiness through mere autopilot striving and reacting to stimuli, as well as the difference between hedonic happiness (which involves short term happiness that come from fulfilling sensory pleasures) and eudemonic happiness (which is about cultivating contentment and wisdom).
            Also, in contrast to what you say, meditation is not about ‘instant nirvana’ – it is a slow process of gradually cultivating understanding.”

        • FWIW I did not intend to suggest that CBT or any other therapy is universally beneficial or that “reports of harm…must be untrue”. I merely find this particular study to have used questionable means to arrive a gripping headline. All the study really seems to show is that recovery often includes some unpleasant processes. So I guess if there are people out there struggling with symptoms of “mental illness” and they find their way to a therapist believing “once I walk through that door my troubles will magically vanish and I will be wonderfully happy and deeply fulfilled for the rest of my life,” then perhaps it would be good for someone to tell them it’s not so simple—which this study accomplishes. But for anyone trying to weigh the various costs and benefits of different approaches to solving a mental health crisis, this study comes awfully close to falsifying evidence. The fact that it includes some “intended events” as “side-effects” is a major red-flag. They’ve actually changed the definition of side-effects for the purposes of boosting numbers.

          • ……And the back-up of assumptions about unrealistic patient expectations of instant nirvana……
            There is something disturbing about seeing the same tactics psychiatry uses, ie blame the patient, so glibly trotted out to silence any feedback that disconfirms cherished beliefs. Why can’t you just feel good that you benefited? Why does this have to be ‘enforced’ as a universal panacea?

        • I think this gets at the most basic fallacy of the psychiatric system – that people’s “disorders” can be identified and categorized and that one “treatment” can be implemented for one particular category. This is observably untrue and extremely destructive. Different people travel very different pathways to get where they are, and each of them needs different things at different times. Anything that promotes healing has to humbly invite participation and be humble and open to being totally ignorant of what is really helpful to this particular person. The only person who knows what is helping is the person being helped. They may not consciously be able to tell us what they need, but if something’s not helpful, they will know it. It is arrogant for any of us to assume we know what will be helpful to another.

      • Thank you ‘out’! It is very nice (and sweet) of you to say that.
        To be able to say ‘sorry’ shows that you have tremendous mental strength…
        I wish you the very best!
        (sorry I have posted this in the wrong location – I am unable to delete it!)

  8. We may be giving way too much credit to CBT as something that can cause adverse effects. It is those psycho technicians and psycho educators (I find it hard to call this lot therapists) that cause the damage. A small percentage of people sees a psychologist for “symptom relief” and unfortunately the majority of “CBT therapists” are not equipped to meet other needs clients might have.

    • I think these results come from believing that a particular “school” of therapy is more important than who is delivering it. Rigidly adhering to a “CBT” or any other particular school of therapy is likely to be damaging to a certain percentage of people even if delivered “perfectly,” because it is likely not what some people need. Additionally, therapists who haven’t dealt with their issues are likely to mess up anyone they see, regardless of what approach they take. The researchers act as if someone doing “CBT” is the same as someone else doing “CBT.” In my observation, humility and flexibility are the keys to success in helping another person. Deciding ahead of time what is going to “work” leads to blaming the client when it doesn’t, as well as other damaging interactions.

  9. This article is pretty useless. Correlation also doesn’t equate to causation.

    “Examples of family strain that emerged as a result of treatment included a spouse who was distressed after his wife became less attentive and took more time for herself after being in therapy and a client who felt guilt and sadness after choosing to distance herself from a parent.”

    Um, this sounds like people making healthy choices for themselves. I’m assuming that in both cases there might have been good reasons for these individuals to make these choices to focus on their own needs and well being.

    Therapy isn’t some panacea for human suffering. It is one way some people can find relief from suffering but by no means is it a perfect solution. CBT in particular is very limited and doesn’t help people feel understood or validated. We all experience “cognitive distortions”, and to me this isn’t the root cause of most human suffering (trauma, especially in early childhood).

  10. I’m vexed that mental health practitioners call harm in therapy “side effects,” a metaphor that implies the treatment essentially worked, but with some undesired, less important detriment. That fails to reflect a treatment that is mostly or fully harmful.

    But I’m more vexed how mental health clinicians seem so curled up in theory that they neglect the business of how we exist together as human beings. Therapy interventions generally install one person as the authority figure and the other as the disordered supplicant, there to receive wisdom in eyedropper doses. The client exposes her most private aspect, her irrational thought stream, to be invaded, evaluated and corrected by the towering master. She is instructed on how to think and function as if she has regressed to infancy. In childhood, our thought stream might be the only precious possession not subject to inspection. Is there any wonder that some people might find this harmful?

    In my blogging life I’ve found that professionals mostly discount the harmed consumer, condescendingly discounting that we might have any insight into the service we have received. Consumers who’ve been harmed speak quite differently than the professionals who ventriloquize for us.
    https://disequilibrium1.wordpress.com/2010/10/10/a-disgruntled-ex-psychotherapy-client-speaks-her-piece/

    • This is a superb article, rings true in every way to me. Thank you for posting this, disequilibrium1. A couple of passages that especially stood out for me:

      “The worst, most damaging bout was group therapy led by a disdainful psychologist and a syrupy psychiatric nurse. Clients were encouraged to bring-your-own-whine, though often answered with bruising dismissals. The nurse announced ‘something about you makes me want to kick you.'”

      So similar to my experience in a group once, many years ago, where a psychotherapist said to a 60-year-old-man (a gentle and wise old soul who identified as “disabled”) complaining about bully abuse and rampant theft in his public housing situation, “Take your meds and don’t make waves.”

      And this–

      “So I’m left to untangle this large knot left by so-called treatments. I feel hoodwinked. I combed professional literature and was dismayed by the denigration of unsuccessful clients and the limited discussion about harmful therapy. We’re labeled resistant, and our dissatisfaction is labeled as transference. Or we’re conflating our internal pain with an external relationship. Or we’re difficult cases who don’t want to change or too unstable to be redeemed. There’s scarce conjecture I reacted sanely to my therapists’ distortions. As I read how therapists are trained to think, attitudes toward difficult cases, and the defensiveness toward official complaints, it’s clear why therapy left me feeling worse.”

      Absolutely correct.

  11. Psychotherapy with an incompetent and misguided psychotherapist can lead to suicide ideation and post-traumatic stress from chronic rumination. It’s a form of emotional abuse, and it is insidious. I have a friend who specializes in helping people to heal from “therapy brain.”