The risks of therapy

Dr. Melissa Shepard Smiling in white lab coat

By Dr. Melissa Shepard

In general, therapy (no matter what form it takes) can be incredibly helpful and even life-changing. However, we forget that just because it is “mostly talking” doesn’t mean that it is a benign form of treatment. Just like medications and surgical procedures, therapy is not without risk. Therapists must train extensively to become skilled in their art and avoid and minimize these risks (and respond to the inevitable adverse effects). Here are some of the potential pitfalls of therapy and how we prevent and manage them:


Risk: If misused, used at the wrong time, or used with the wrong person, therapy can make symptoms worse.

Solution: A well-trained therapist knows that all forms of therapy are not right for all people at all times. Many widely used forms of psychotherapy utilize evidence-based techniques proven through research studies. However, this only tells us that these forms of therapy are effective for the general population or the specific population studied. When it comes to the individual, certain forms of therapy can be harmful when used at the wrong time. For example, if someone is in the midst of a severe major depressive episode and cannot concentrate, insisting upon traditional cognitive behavioral therapy (CBT) might do more harm than good. CBT may be too intense, causing the depressed individual to internalize their struggles as further evidence of their inadequacy, guilt, or hopelessness. Likewise, if a therapist forces someone to confront their trauma too soon, they may be re-traumatized. A skilled therapist can recognize when someone cannot tolerate a particular form of therapy and switch to an alternative approach when needed.


Risk: Therapists inevitably make mistakes, and issues always arise in the therapeutic relationship.


Solution: In any relationship between two humans, problems are bound to happen. These issues may be from therapist error (it happens to the best of us), a mismatch between the therapist and the client’s goals/values, or a simple misinterpretation. We try to avoid these problems as much as we can, but they happen. Ultimately, the therapist’s way of addressing the issue can be just as important as the problem itself and can even improve the relationship. A skilled therapist must be able to identify and navigate these issues with empathy when they arise.


Risk: People can become overly-dependent upon therapy.


Solution: Part of successful therapy sometimes involves learning how to manage your emotions, build your social network, and become your own best therapist. When this doesn’t happen, it can cause people to rely too much on therapy. For example, they may start to hesitate to take action until they can talk to their therapist, or they may contact their therapist between sessions for frequent reassurance. To avoid this, a skilled therapist will set boundaries, build your social network, and think through problems rather than just offering solutions.


The bottom line is that therapy is not one-size-fits-all, and it is not without potential adverse effects. If you feel that you aren’t getting what you need from therapy, talk to your therapist so that they have a chance to examine what is going on and how to address it. If you aren’t able to bring it up or feel that your concerns aren’t taken seriously or addressed, consider looking for a new therapist. Just because your first (or second, or third) therapist isn’t a good fit doesn’t mean that therapy isn’t for you!

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