Recognising Unhelpful or Harmful Therapy
Research indicates approximately one in twenty people undertaking therapy with well-trained accredited therapists in the UK, experience long-lasting harm (which also means 95% of people undertaking therapy do not!).
The majority of harm is unintentional i.e. it occurs despite the therapist’s best efforts & good intentions.
If we feel therapy is not being maximally helpful, it is important to discuss this with our therapist & explore & mitigate this together if possible.
Sometimes our therapist is not a good fit (or our problems lie outside their area of expertise) & it may be that both sides need to acknowledge this so we can then find someone more suitable. Research has shown that if we have not established a good working relationship with our therapist by the end of the third session we are unlikely to subsequently, so this might be a good time to review!
There are instances. although uncommon, where therapists behave unethically & exploit clients to meet their own needs (e.g. sex, money, admiration or control). Exploitation typically occurs after boundaries are gradually eroded over time (called the "slippery slope"). It can be flattering for us to be apparently singled out for, "special treatment" by our therapist, but these behaviours are "red flags" indicating therapy is not safe.
If we have knowledge of these warning signs in advance, it can empower us to take appropriate action (e.g. terminating therapy) when things are not as they should be!
"Red Flag" Warning Signs Therapy May Not Be Safe
*NB* There may occasionally be circumstances in which a small number of the behaviours listed below may be considered to be okay.
These are only a selection of possible warning signs of questionable therapy.
1. Poor boundaries
-Shares lots of personal information about themselves/family/friends/other clients.
-Allows sessions to go on much longer than scheduled.
-Schedules sessions for when no-one else is around e.g. end of the day or mid-morning if working from home (alone during day)
-Regularly phones/texts/contacts us via social media between sessions (& requests we delete these exchanges).
-Discusses their problems in our sessions.
-Touches us (okay if a standard part of that type of therapy & fully explained/agreed at contracting).
-Behaves in a "creepy" manner or make odd comments that don't seem relevant to a current topic of conversation.
-Socialises with us/introduces family/friends/other clients outside of our therapy sessions.
-Gives us presents.
-Discusses going into business with us or offers employment.
-Suggests they/their family members babysit our children.
-Tells us we are "special" or their “favourite” client.
-Flirts, discusses problems in their current/previous relationships or expresses regret we did not meet years ago!
-Discusses their sex life/fantasies and/or asks about ours. Lends or gives us sexually explicit material.
-Asks us to sit on their knee or lie down together.
-Hugs, kisses or engages us in other sexual behaviour.
-Lends/gives us their belongings or buys us clothes/jewellery etc.
-Comments on our appearance or asks us to change it (lose weight/wear specific clothing).
-Advises us not to discuss our therapy/what happens in the therapy room with anyone.
-Negatively influences our opinion of loved ones (e.g. partner, family or friends) or encourages us to terminate contact (except in cases of abuse).
-Increases the number of sessions/week.
-Sees us for free or at reduced cost as a favour.
-Insists they are the only person capable of &/or interested in helping us.
-Suggests we cannot survive without them.
-Fails to refer us appropriately when our needs are beyond their capabilities or we have markedly deteriorated.
3. Discriminatory Practice
-Fails to respect social difference including: culture, sexuality, gender, SES, neuro-diversity, religion, physical diversity, class or ethnicity.
4. Failing To Gain Consent Or Ignoring Our Stated Preferences
-Undertakes hypnosis or other techniques without consent.
-Breaks confidentiality without consent or good reason.
-Lies or engages in gaslighting.
-Is unable to collaboratively engage with constructive feedback.
7. Undermines Our Well-being
-Ridicules/shouts/threatens/is contemptuous/expresses disgust/suggests or implies we have no positive qualities/engenders helplessness & despair/encourages risk taking or other unwise actions/endangers life or suggests suicide.
It is worth noting that when asked this question:
"Compared to other mental health professionals within your field (with similar credentials), how would you rate your overall clinical skills and performance in terms of a percentile (out of 0–100% : e.g., 25% = below average, 50% = average, 75% = above average)?"
Of a sample of 129 mental health professionals (a mix of psychotherapists, psychologists, psychiatrists & social workers), just 8% rated themselves as below the 75th percentile (!) & NONE rated themselves below average (50th percentile). It is statistically impossible that this can be true! So there is substantial bias in mental health professionals' perception of their own relative competencies & almost all think they are well above average or awesome at their job! This is an interesting finding & I am curious what impact these self-perceptions have on therapists' willingness to engage with the possibility of iatrogenic (caused by treatment) harm, especially given many currently refuse to even acknowledge it as a possibility.
If ~16 million people in the UK have ever been to therapy & of these at least 5% (as studies have found) suffer enduring harm, that is approximately 800,000 people in this country alone!
Any efforts we can make to increase awareness (on both sides of the couch) of therapeutic harm & abuse & consider way to reduce their likelihood, has the potential to positively impact the lives of people in distress seeking help in the future.