asymmetrical relationships, bad therapist, bad therapy, bias, blaming the victim, Brene Brown, consumer protection, consumer rights, dehumanizing, emotional rape, ethics, harmful therapy, harmful treatment, health, human rights, humanity, iatrogenesis, identity, Immanuel Kant, labels, mental health, mutual, mutual being seen, mutual give-and-take, mutual vulnerability, paternalism, psychoanalysis, psychology, psychotherapy, survivor, talk therapy, termination, therapist, therapist abuse, therapist bullying, therapy abuse, therapy survivor, transparency, unethical, unethical therapy, victim, vulnerability, wounded healer
Psychotherapy or “talk therapy” is an unethical, damaging practice with conflicts of interest and perverse incentives at its foundation. The problems with therapy can be put into roughly the following categories: paradoxical and dehumanizing structure of therapy relationships, lack of scientific validity, lack of transparency and consumer protections, and harmful outcomes.
Paradoxical Asymmetrical Structure of Therapy Relationships
The structure of therapy is antithetical to and models the opposite of goals one would hope to achieve in real life/relationships:
1) Goal: mutuality and natural give-and-take reciprocity e.g., mutual trust, mutual respect, mutual sharing, mutual dependence, mutual vulnerability, mutual love, etc.
Therapy: asymmetrical dynamics of exposed and hidden, wounded and healer, needy and needed, subordinate and authority, payer and payee, etc.
2) Goal: authenticity, e.g., connection based on both people revealing their true selves and developing mutual love and respect
Therapy: artificial relationships based on payment, theories, labels/assessment/judgement, contrived boundaries, and one-way intimacy
3) Goal: independence or healthy mutual dependence
Therapy: one-sided dependence or co-dependence
4) Goal: happiness and a generous spirit
Therapy: self-focus/self-absorption, which is correlated with depression
5) Goal: trust that is earned based on mutual sharing and commitment
Therapy: “trust” that is demanded based on status and paternalism
6) Goal: peaceful terms with one’s past and personal relationships
Therapy: fishing for problems with one’s past or personal relationships; possibly misleading interpretations/false memories prompted by “innocent” inquiries that damage outside relationships and create incentives to continue the therapy relationship
7) Goal: honesty, openness, transparency
Therapy: closed-door shrouding in secrecy, hiding information about perceived mechanism of action and outcome data, subtle manipulation, transference, uneven exposure/voyeurism dynamics
8) Goal: “Always act in such a way that you treat humanity, whether in your own person or in the person of another, at the same time as an end-in-itself and never merely as a means.” — Immanuel Kant
Therapy: Dehumanizing instrumental relationship in which the therapist uses the client as a means to profit and gratification by withholding information needed for a client’s true informed consent. Therapist belief that she knows best and that the end justifies the manipulative means.
9) Goal: ability to acknowledge, take responsibility for, and learn from one’s mistakes
Therapy: therapist is always right and blames the victim/client when anything goes wrong (and often uses unfalsifiable jargon to cover it up, e.g., “resistance,” “denial,” “defensiveness,” “projection,” “not ready for change,” etc.)
10) And the list of antitheses between our goals and what therapy models goes on . . .
We create patterns, habits, and ways of being — we create our worlds — through our actions and interactions with others. To the extent that therapy creates a world of artificial imbalanced relationships, inequality, non-mutuality, one-way intimacy, one-way exposure and concealment/voyeurism, “patient” status/distancing labels/disempowering identities/assessments, paternalism, authority, subordination, and co-dependence, it may be far more harmful than the original worldview that a client was trying to get a new perspective on in the first place. Many clients end up feeling violated, exploited and used, and much worse off than they were before therapy.
The therapist-client relationship is equally harmful to therapists. While the feelings of power, control, and superiority may temporarily alleviate a therapist’s narcissistic wounds and fears, the unbalanced dynamics actually perpetuate and reinforce the painful condition (lack of capacity for mutuality, trust, equal vulnerability, being seen, etc.) that often motivates a therapist to become a therapist in the first place.
Lack of Scientific Validity and Justification
In addition to the dehumanizing structure of therapy, there’s the validity problem. There are no scientifically valid, replicated, controlled clinical trials showing that psychotherapy is any more efficacious than talking to friends or life coaches, motivational speakers, gurus, psychics/palm readers, cult leaders, mystics, and other snake-oil vendors that prey on vulnerable clients — and have a following of enthusiasts with anecdotes who extol their benefits.
Moreover, for the anecdotes/cases in which therapists claim that they have helped, they are unable to articulate why or how what they did altered the brain or helped. Until therapists can clearly articulate what processes/methodologies and what types of client/therapist relationship matches cause benefits and which cause harm, and why, they are not in a position to navigate away from harming clients. Without understanding why or how they help in some cases and hurt in other cases, they are not in a position to adhere to scientific and ethical principles, including “first do no harm.” And until they have that sorted out, it is irresponsible and unethical for them to experiment on clients — collecting lots of money and spending lots of time, figuring that it may work or may harm them some of the time. “Treatments” need to be tested, understood, and validated *before* being tried out on the public.
In accordance with basic principles of reason, the fact that there exist (unfalsifiable) anecdotes/cases in which there are perceived benefits resulting from therapy does little to justify the practice in light of the fact there are also anecdotes/cases in which there are perceived harms resulting from therapy. The burden of proof lies with she who asserts a positive. In this case the burden of proof lies with she who asserts that therapy is justified, not with its critics. It is not the critics’ job to prove the null hypothesis. The burden is to show that the practice of therapy is justified in spite of the fact that there will be collateral damage and some people will be harmed. Until this burden can be met by means of scientific demonstration and ethical argument (it’s not merely a utilitarian numbers game; the end doesn’t justify the means), the practice cannot be viewed as justified. The number of anecdotes about people who claim to have benefited from a practice is irrelevant in the face of dehumanizing or unethical means to that “benefit.” (Analogy: lots of people may “benefit” from the food and shelter provided by slavery, but that does not make slavery a justified means of providing that benefit. An unequal, power-imbalanced slave-slave-owner relationship without fully informed informed consent is an unethical way of relating to our fellow humans regardless of the number who may “benefit.”)
Lack of Transparency and Consumer Protections
Therapists often fail to acknowledge or warn clients about the potential harm that may result from therapy. The practice is currently so shrouded in secrecy, and the limited data behind it is riddled with so many shady research practices (e.g., using statistical methods that generate false positives, hiding data that didn’t show the desired outcome, the file-drawer effect, publication bias, selection bias, confirmation bias, allegiance effects, demand characteristics, Hawthorne effects, failure to use active controls that control for expectations, etc.), that many therapists themselves aren’t even aware of the potential side-effects and risks. They are notoriously blind to their own weaknesses and failures, and subject to the “Lake Wobegon Effect” when it comes to their own practice — playing up anecdotes of treatments that worked and blindly disregarding the clients that they hurt.
This needs to change. Consumers deserve better. In order for consumers to have the opportunity to give true informed consent, therapists have to disclose their efficacy/failure rates and Important Safety Information up front, including proposed methodologies, perceived mechanism of action, clinical trial results (or lack thereof), rates of adverse events and side effects, etc. And there should be an independent regulatory board, like the FDA, to which consumers can report adverse events and side effects of therapy so that the most harmful therapists can be pulled from the market, or at least reported in a database available to consumers wishing to make informed decisions. With the current lack of clinical standards, consumers bear the burden of evaluating their therapists, which can be extremely time-consuming and expensive. Those in crisis without the luxury of time and money stand a strong chance of suffering from a poorly matched therapist.
Many clients are harmed, emotionally abused, emotionally raped, retraumatized, or mistreated in therapy, and end up much worse off than they were before therapy. Despite the possibly good intentions of the therapist, the paradoxical asymmetrical structure of the relationship discussed above is a dehumanizing framework that creates a situation ripe for exploitation and harm. Additionally, there is no such thing as a human being (or therapist) who can adopt a purely unbiased, value-free, neutral position. Many, if not all, therapists enter the therapy relationship with their own baggage lurking in their subconscious, which infects the nature of the inquiries, interpretations, and “insights” that are discussed. Since it is very easy and natural for a client in a vulnerable and naively trusting position to be influenced or to acquire false memories based on even subtle suggestions/inquiries from a therapist who is assuming the role of “expert” or “professional,” this creates a potentially dangerous situation for clients. Add to this the fact that, whether conscious or not, the incentives of the therapist (keep clients/job security/feel important) are not aligned with the incentives of the clients (become healthy/happy/therapy-free), and that diminishing the strength of the client’s outside personal relationships increases the client’s relative reliance on the therapist, and the potential danger for the client may be inescapable. In fact, history has shown that therapy has destroyed many family relationships, marriages, and friendships.
Therapy should not be the mysterious hit-or-miss endeavor that it is. The costs in terms of time, money, and potential emotional damage are too high. Again, dismissing emotionally harmed clients as collateral damage for the sake of some who believe it’s helpful is unethical and unacceptable.
The unethical nature of psychotherapy has been discussed above in terms of the harmful paradoxical asymmetrical structure of the relationship, the unauthorized human experiments involved in practicing therapies that have not been previously validated in replicated scientific trials, the failure of therapists to provide the full disclosures required for true informed consent, and the unjustified risk of harmful outcomes. Given these features of the practice, psychotherapy belongs in the dust bins of history along with lobotomies, slavery, eugenics, Nazism, gay conversion therapy, Native American genocide, repressed memory therapies, colonization of indigenous people, female genital mutilation, critical incident stress debriefing, Stalinism, holding attachment therapy, Chinese foot-binding, Salem witch trials, apartheid, APA-endorsed Guantanamo torture, and other horrors that large populations once bought into.
After seeking the help of a medical doctor for biological/neurological concerns, the best thing people who need help can do is to stop wasting their precious time and money on psychotherapy, and seek out healthier, safer, and cheaper alternatives that foster genuine two-way relationships, generosity, self-esteem, wholeheartedness, and growth, such as: joining a support group founded in *mutual* give-and-take relationships with equal openness/equal emotional exposure, talking with friends/family/significant others (and listening in return), cultivating new friends through hobbies or meet-up groups based on common interests/causes/needs, participating in peer-run support services, getting a puppy, doing volunteer work, meditating, exercising, dancing, reading self-help books, reading literature, connecting with people who have earned your trust, writing your feelings down in a journal, getting massages, talking to a pet or volunteering at an animal shelter for 45 minutes per week (the length of a therapy session), listening to music, going to concerts, going to comedy shows, creating or contemplating art, doing yoga, jogging, hugging, taking nature walks, creating a ritual of having tea at your favorite cafe for 45 minutes per week, reaching out to help other people, engaging in random acts of kindness, and more.
We *all* have the ability to do our part to make this world a more compassionate and sane place to be. When we try to relegate humane support to paid workers (such as the psychotherapy industrial complex with labels and incentive structures that conflict with lasting health and flourishing), we chip away at the humanity of us all. We are all in this together, and we can do better.
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Inspiration and thanks are owed to the thoughtful, intelligent discussion on Disequilibrium1′s blog: Bad Therapy? A disgruntled ex-psychotherapy client speaks her piece