Psychotherapy can be harmful to patients. That’s the focus of another blog I stumbled upon and, as a psychotherapist myself, I couldn’t agree more. Like any professional service one might seek out, there are highly competent practitioners, there are those who are mediocre and those who are simply bad apples. So, how does someone in need of mental health treatment know if they are in the right hands? The blogger does such a thorough job of describing “bad therapy”, that I thought it would be useful to share this with your readers for help with evaluating therapists and their treatments. My colleagues in the field might want to check this out as well… Paradoxical Asymmetrical Structure of Therapy Relationships (from [trytherapyfree.wordpress.com] The structure of therapy is antithetical to and models the opposite of goals one would hope to achieve in real life/relationships: 1) Goal: mutuality and natural give-and-take reciprocity e.g., mutual trust, mutual respect, mutual sharing, mutual dependence, mutual vulnerability, mutual love, etc. Therapy: asymmetrical dynamics of exposed and hidden, wounded and healer, needy and needed, subordinate and authority, payer and payee, etc. 2) Goal: authenticity, e.g., connection based on both people revealing their true selves and developing mutual love and respect Therapy: artificial relationships based on payment, theories, labels/assessment/judgment, contrived boundaries, and one-way intimacy 3) Goal: independence or healthy mutual dependence Therapy: one-sided dependence or co-dependence 4) Goal: happiness and a generous spirit Therapy: self-focus/self-absorption, which is correlated with depression 5) Goal: trust that is earned based on mutual sharing and commitment Therapy: “trust” that is demanded based on status and paternalism 6) Goal: peaceful terms with one’s past and personal relationships Therapy: fishing for problems with one’s past or personal relationships; possibly misleading interpretations/false memories prompted by “innocent” inquiries that damage outside relationships and create incentives to continue the therapy relationship 7) Goal: honesty, openness, transparency Therapy: closed-door shrouding in secrecy, hiding information about perceived mechanism of action and outcome data, subtle manipulation, transference, uneven exposure/voyeurism dynamics 8) Goal: “Always act in such a way that you treat humanity, whether in your own person or in the person of another, at the same time as an end-in-itself and never merely as a means.” — Immanuel Kant Therapy: Dehumanizing instrumental relationship in which the therapist uses the client as a means to profit and gratification by withholding information needed for a client’s true informed consent. Therapist belief that she knows best and that the end justifies the manipulative means. 9) Goal: ability to acknowledge, take responsibility for, and learn from one’s mistakes Therapy: therapist is always right and blames the victim/client when anything goes wrong (and often uses unfalsifiable jargon to cover it up, e.g., “resistance,” “denial,” “defensiveness,” “projection,” “not ready for change,” etc.) 10) And the list of antitheses between our goals and what therapy models goes on . . . If you are considering or currently in therapy, I encourage you to be on the look out for any of these “warning signs” and either inquire initially or address them with the therapist. Being open and direct with your therapist can act as a proving ground for interpersonal interactions outside the therapist’s office. Even initiating termination with your therapist can be therapeutic. Therapy can result in profound personal transformation when it is practiced with intelligence and compassion. I agree with the blogger, that the patient and the therapist must see eye to eye on the therapeutic goal, be open and honest with one another, respectful and willing to fess up to failings and to celebrate victories. I check in regularly with my patients on how we are progressing (or not) towards their goals. The patient is in the driver’s seat and I am always on the lookout for signs of when they might be overly compliant, dependent or too willing to give up their own stake in our relationship. So, let’s not abandon hope for getting help. With the right therapist, one can receive relief from emotional suffering. Admittedly, my profession does a poor job of oversight. In part, confidentiality and privacy prevent scrutiny of therapists. The onus then is on the therapist to keep up with current best practices. My own, self-imposed oversight include regularly attending trainings, consulting with mentors and peers and ongoing supervision. Video taping my sessions (with patient consent) allows me to review sessions and get feedback about my work from colleagues. Perhaps the initial question a prospective patient might ask: “What measures do you take to insure accountability of your methods?” With the right therapist, psychotherapy can be helpful not harmful.