For many decades, psychotherapy has been the go-to treatment for many mental health disorders and for people who wish to change a behavior, such as quitting smoking.
However, most are unaware that psychotherapy has its dark side, where it does more harm than good.
This article will focus on the pros and cons of psychotherapy and how it can be both helpful and harmful.
What is Psychotherapy?
According to the American Psychiatric Association, psychotherapy, aka talk therapy, is a method to help people face and recover from various mental health issues and emotional difficulties.
Psychotherapy helps people cope with mental health disorders such as those listed below.
Handling daily life
Cope with the impact of trauma
Facing medical issues
Coping with the loss of a loved one
Coping with depression or anxiety
There are many types of psychotherapy, such as cognitive-behavioral or behavioral therapy, and many theories about why it works. After all, all one does in therapy is talk to a stranger about what is going wrong in one’s life.
However, psychotherapy has been proven to help many people who experience it.
The Psycho-therapeutic Bond
The therapeutic relationship is perhaps the most important aspect of psychotherapy. Therapeutic bond describes the relationship between the clinician (therapist) and the client. The bond between therapist and client helps the therapist and client engage with each other and helps the client find their way from confusion and illness to recovery.
The depth and quality of the therapeutic alliance have been linked to the success of the treatment across many types of patients, presenting problems, and which type of psychotherapy is used. It is believed that the therapeutic bond can be defined in three themes: how collaborative the relationship is, the affective bond between therapist and client, and the patient’s and therapist’s ability to agree on treatment goals and tasks. 1-2
It can safely be said that no recovery can occur without the bond between a therapist and their client. If the connection is not made between the therapist and the client, it is time for either the therapist or the client to end the relationship.
Transference and Countertransference
Simply put, transference is the projection of feelings and emotions onto the therapist, and countertransference is the redirection of a therapist’s emotions onto the client.
An excellent example of transference might be as follows.
A patient loses a parent in childhood, and therapy looks to the therapist for the unconditional acceptance and love they did not receive when a child. However, because therapists are only human, they will inevitably fall short. This failure makes the patient feel hurt, angry, and deeply disappointed.
Countertransference, on the other hand, is the redirection of a therapist’s feelings onto their client, such as the therapist may respond to the client above by feeling coerced by their client.
Transference and countertransference are the fundamental aspects of the treatment relationship, and as long as the therapist is aware of them, it is a crucial part of successful work. With these two vital parts of psychotherapy, the therapist can offer interpretations to their patient and see the articulation of their patient’s patterns in their interactions with them. Understanding these patterns is critical to the therapist’s and client’s work together.
Can Therapy Be Harmful?
The simple answer is yes; therapy can harm if not employed correctly. A lousy therapist may shut down your healing journey instead of helping you on your travels. Therapy can be destructive by either re-traumatizing you or causing further psychological harm.
The therapeutic alliance is a strong bond; when wielded by a lousy therapist, it can become a weapon of destruction.
One way a bad therapist can do this is to take advantage of their client for their personal gain.
Therapists are in a position of power, and there are many rules therapists must follow to ensure that they have no social or sexual relationships with their clients. However, the power imbalance will be attractive to a therapist who does not respect the rules and takes advantage of their clients.
There are some signs that a therapist is unethical.
The therapist touches their client inappropriately or makes sexual advances.
The therapist ignores their client’s discomfort and does things the client has stated makes them uncomfortable.
The therapist asks their client to meet them outside the office for a sexual or social encounter.
The therapist attempts to control their client’s behavior, such as insisting their client break contact with significant people in their lives.
If you encounter a therapist doing the above things, it is vital to stop seeing them immediately and report them to their supervisor or their licensing entity.
Encountering a rotten therapist can turn people away from therapy who can genuinely benefit from therapy.
Bad Therapy Experiences
It takes guts to seek a therapist as it is a vulnerable act because people entrust strangers with their feelings and emotions. All of this makes the fact that a therapist misbehaves difficult and taints people’s views on the entire process.
There are other reasons that therapy might be a terrible experience.
Lack of ethics. There will be rotten eggs in every profession, including therapists. Clinicians who behave unethically deeply harm their clients.
Unrealistic expectations of therapy. Believing wrong things about therapists and therapy often leads to an unpleasant experience. More often than not, clients enter therapy believing the therapist will ‘fix’ them and tell them what to do. However, that is not the job of the therapist, or the way therapy works. The therapist’s job is to help clients find the truth and power that is already within them but lies undiscovered. Also, clients sometimes believe their therapist will be a friend, but that defeats the distance one must maintain to understand the client’s problems better.
The type of therapy being used. As stated, there is a variety of therapies available. If clients don’t respond well to one type of therapy, they are free and encouraged to seek a different type.
Overwhelm. The purpose of therapy is to seek the client’s truth, and in doing so, they will encounter powerful emotions and feel overwhelmed, causing them to leave therapy before it is recommended.
The Cost of Psychotherapy is Prohibitive
The cost of therapy is expensive, and this often puts a strain on those who experience it or are out of reach for some. As of 2019, the average cost of therapy ranges from $100-$200 per session in the United States. However, because of inflation in 2023, that estimate may be low. Clients who see a therapist in person or virtually are most likely billed per session.
Even if a client has insurance, it likely will require a copay, and if your therapist is considered out of network, you must pay out of pocket, paying the entire amount yourself.
It is easy to see why therapy costs are daunting to many who need it, as people living with a mental health challenge are either on a fixed income or are underemployed.
Some therapists offer a sliding scale method to pay for their services, which can help enormously. Another method to getting therapy paid for is to reach out to a county mental health facility, which often charges payment on a sliding scale.
Ending Our Time Together
Therapy is a personal experience; the last thing one needs is to get into a therapeutic relationship with a bad therapist or a wrong fit. Sometimes clients dislike their therapist, which is to be expected because clients and therapists are strangers with different tastes and backgrounds.
In my personal life, I have had several therapists, some good and some not so good. I’ve had therapists leave just as our alliance formed, causing me great harm. I’ve also had an unethical therapist, making me cynical about future encounters with a new therapist.
Therapy is not for everyone; however, it is necessary for healing if you have dissociative identity disorder. You cannot deal with the deep nuances of DID without someone by your side.
The key to finding a good therapist is to go in with eyes wide open and watch for signs it is a good or bad fit. If you don’t feel comfortable with your therapist, you may leave. However, it is vital to remember that we all feel uncomfortable when encountering a new therapist. Use good judgment when deciding if your therapist is a good fit for you.
I have found two great therapists who have helped me climb the mountain to heal and reach the other side of health. No, I’m not a single person, that is impossible, but I am doing well and have a happy life. It took me many years to reach this point and hundreds of hours in a therapist’s office, but it was worth the hard work and tears.
“Our wounds are often the openings into the best and most beautiful parts of us.”
“Positive psychology is not remotely intended to replace therapy or pharmacology. So, when depressed, anxious, or in panic or post-traumatic stress disorder, I’m all for therapies that will work. Positive psychology is another arrow in the quiver of public policy and psychology through which we can raise wellbeing above zero.”
Flückiger C, Del Re AC, Wampold BE, et al.: How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. J Couns Psychol2012; 59:10–17
Martin DJ, Garske JP, Davis MK: Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol2000; 68:438–450