Image by Dillon Mangum
Around 10% of clients report that they experience harm in counselling and psychotherapy, and this statistic rises significantly for clients in minority groups, as well as for clients who are therapists themselves.
These statistics may seem shocking and disheartening for those of us who work within the counselling and psychotherapy profession. After all, most therapists enter the profession with a view to making a positive contribution.
'If it is our ethical duty as individual therapists to mitigate harm, then it must also be our collective duty as a profession'
While much has been written on overt ethical transgressions and knowingly abusive therapy, the impact of unintended harm which occurs in psychotherapy is less often a part of the debate. Dr Philip Cox and Dr Phil Mollon have recently done important work towards raising this area to our awareness and it is my feeling that a more open discussion of harm in therapy can only be a good thing. If it is our ethical duty as individual therapists to mitigate harm, then it must also be our collective duty as a profession.
Researching and acknowledging elements of therapy which clients experience as harmful and working to avoid harm is a crucial part of this process, but it is only one part. The above statistics suggest that many clients have already experienced harm in therapy and it is likely that harm will continue to occur. For those clients who choose to return to therapy, it seems vital that we become aware of the needs of this unique client group, as well as the fears and uncertainties which could possibly be lurking in our own shadows.
It feels important to say that I count myself among those who consider themselves to have experienced harmful therapy, and I feel very lucky to have had an excellent and healing experience in therapy subsequently.
'It was a meticulous process, but my therapist’s skill and intuitive understanding of my needs helped me to move forward, and develop a deeper understanding of myself as a result'
When I sought therapy again, I felt protective towards my previous therapist, to whom I was still attached, confused about what had occurred and desperately seeking validation of my experiences.
I appreciate the tightrope my new therapist had to walk in those early days, of validating and empathising with my pain, while avoiding alienating me by commenting on my previous therapist’s actions. I came with a complex set of feelings, on top of which, none of the issues which had initially brought me to therapy had been resolved. It was a meticulous process, but my therapist’s skill and intuitive understanding of my needs helped me to move forward, and develop a deeper understanding of myself as a result.
Like any presenting issue, each client who returns to therapy after a harmful experience will have different feelings and needs; my example is illustrative but by no means universal. I think it is likely, however, that a client returning to therapy after a harmful experience may experience a particularly strong sense of trepidation about forming a new therapeutic alliance, and allowing themselves to again become vulnerable in the relationship. Equally, a therapist might also be wary, for example, a client who has filed a complaint in the past may do so again, and tread more carefully in the work, or even fear such a client.
'My hope is that a new generation of counsellors entering the profession, as well as those with established practices, can continue to embrace the challenges of working with harm in therapy..'
Of course, all these feelings are okay, and must be acknowledged and dealt with in the appropriate forum (I would suggest supervision is the appropriate place for the therapist to explore such fears). I would love to see core training address working with therapeutic harm and iatrogenic trauma so that from the very beginning of their career, therapists are used to the idea of harm being something we tackle and discuss, and not something we shy away from.
The constructive and positive work being done by Dr Cox and Dr Mollon is very encouraging and it is wonderful that these conversations are taking place within the profession. My hope is that a new generation of counsellors entering the profession, as well as those with established practices, can continue to embrace the challenges of working with harm in therapy and that we honour our profession’s integrity with transparent and non-defensive discourse.
Erin is a therapy blogger and student counsellor due to complete her training in summer 2018. With a passion for ethics and client rights, Erin greatly values her therapeutic work with clients as well as co-facilitating anger management workshops in association with York Mind.
Outside of counselling, Erin is a keen writer of rhyming verse, avid reader and occasional ukulele player.
Erin’s blog can be found at aclientfirst.com and she is on Twitter @aclientfirst
Cox P & Wilson J (2017). Exploring Unintended Harm in Psychotherapy. [ONLINE] Available at: onlinevents [Last Accessed 03/12/2017].