Can therapy cause harm?

What does "harm" mean?

There is no question: psychotherapy can also be harmful. There are a whole series of people who tell regrettable stories about poor therapy, insults, assaults, lost time and disappointed hopes.

Psychotherapy is not infallible. Especially, two people interact with each other, and many unpredictable things can happen in this kind of process. There are not only the feelings that the patient has towards the therapist, but also the feelings, attitudes or prejudices that the therapist has towards the patient. In psychoanalysis, this (counter-) transference is regarded as vital for the successful therapy. In cognitive behavioral therapy, it is assumed that psychotherapy could be planned so precisely that the personality of the therapist takes a back seat.

Damage in psychotherapy can mean a lot:

  • Feelings can be hurt
  • Expectations can not be met
  • Trust can be abused
  • Valuable (life) time can be lost
  • Private relationships can be affected
  • Self-payers may suffer financial damage
  • Helpful therapies are not applied or are applied too late
  • Mental dependencies are exploited
  • (Sexual) assault can happen

There can be no doubt that emotional insults are very painful and can severely impair the quality of life. This can also be the case with physical harm.

Emotional versus Physical Harm

When considering the question of harm in psychotherapy, one is inclined to compare this question with the question of harm, for example through medical treatment, such as surgery. It may be necessary to remember that there is always danger and potential harm in life. There can be no doubt that emotional offenses (which are what is usually considered to happen through therapy) are very painful and can severely affect the quality of life. This can also be the case with physical damage.

But how do we compare the two? Every human being has to overcome grievance and disappointment in his or her life. But sexual abuse, for example, can have extremely serious consequences for those affected and can even destroy their entire lives. How can you weigh that against fates that tie people to a wheelchair as a result of an accident (or an operation that went wrong), for example, or cause chronic pain for years?

Benefits of Illness and Indirect Effects

When people begin psychotherapy and express their problems, one would think that these people want to overcome their difficulties as quickly as possible.

Yet, people in a problematic situation also a certain degree of benefit, a "gain/profit through illness". A therapist cannot simply "take away" a problem from someone without giving them a new perspective.

Ultimately, however, psychotherapy always aims at a concrete change in the patient's experience and behaviour, a change that the patient himself wishes and has thus agreed on in advance with the therapist.

Psychiatric Drugs and Psychiatry

Psychotherapy, practiced by psychological psychotherapists, is always based on the effect of the special interaction between therapist and patient. This means above all that psychiatric medications are never prescribed. There are ongoing debates as to whether psychotherapists should be allowed to prescribe psychiatric medications (following an additional qualification), as is also possible in other countries. But if you look at the incredible quantities of these drugs that are already being prescribed and taken, you may ask yourself whether this is the right path.

In no other question do beliefs clash as violently as in this one. For some, psychiatric drugs are a blessing, for others a fatal mistake. There are many arguments for both sides that could fill books. That is why this subject can only be mentioned here, because I would like to point out that all too often a patient who contacts his family doctor with an emotional problem may receive a recommendation for psychotherapy, but certainly also an offer or even a prescription for medications such as benzodiazepines. Yet, these can cause serious damage very quickly, which is certainly more serious than any possible damage caused by psychotherapy.

Duration and Cost of Psychotherapy

A common complaint that is heard in connection with the topic of "harm through psychotherapy" is that of wasted money and time.

In addition it should be noted here that the psychotherapy by psychological psychotherapists and child and adolescent psychotherapists in Germany is usually paid directly by private and statutory/public health insurance companies. The so-called reimbursement of costs is also a form of payment by insurance. As is explained in the guide to psychotherapy, it is unfortunately the case that not everything that is helpfulis paid for. But this is equally the case in the medical field.

In any case, Germany has one of the world's most modern and generous systems of providing psychotherapy.

If someone wants a certain form of therapy, whether it is well established and renowned, such as gestalt therapy, or a form that is currently under discussion and in fashion, such as family constellations, then this is to be paid for privately and every person must weigh up the costs and benefits for themselves.

Psychotherapy usually lasts between a few weeks and two years, or even longer in the case of certain serious disorders. An initial relief, a certain clarification of the state of mind, should occur relatively immediately. In psychotherapy it is clearly discussed at the beginning of treatment what the goals of treatment are, what should needs to change and which behavioral problems must be addressed. Over the course of the sessions, both the therapist and the patient should keep coming back to whether treatment is still focussed on achieving these goals.

Psychotherapy always aims at a concrete change in the experience and behaviour of the patient, a change that the patient himself wishes and has thus agreed with the therapist in advance.

What Should I Look Out For?

A professional psychotherapist gives comprehensible information about her training and methods. Especially at the beginning of treatment, goals are clearly discussed, sometimes even fixed in writing. During treatment, progress is discussed again and again.

If you are dissatisfied, your psychotherapist must deal constructively with this criticism. If you are unsure how to judge a situation, you can ask other therapists. You can use the four trial lessons to which every insured person is entitled at any time, as many times as you desire.

Your health insurance company will advise you on all questions regarding coverage and formalities.

Use your common sense, gather information, read on the subject and pay attention to your emotional state. Keeping a diary can be very helpful.

Lastly, you can also consult the the psychotherapists chambers of your state or region: and