Harm in Therapy Revisited – What’s it Like for a Client Seeking a New Therapeutic Relationship?

Last week I went to the first meeting of the small group undertaking a research master’s in psychotherapy at Leeds Beckett this year. My research idea is still in the planning stage, but I am essentially interested in what happens for therapists when a client comes to them wishing to talk about a previous distressing, harmful or traumatic experience of therapy. One reason I am interested in researching this topic is that it appears to me to be a common presenting issue in therapy, yet I cannot find a single thing written for therapists who work with therapeutic harm (I live in hope that this will change as my research deepens!).

In terms of my research, I don’t want to say anything more until the wheels are in motion, but I do want to talk broadly about what it can be like to experience harm in therapy, because among those who have never experienced it, I imagine it could be difficult for some to appreciate the nuances of this particular issue.

I have touched on the definition of harm in therapy before in this blog, so I won’t dwell on it here, except to say that as an integrative, person-centred practitioner, I believe the phenomenological perspective of the client is of paramount importance, therefore, if a client comes to me saying they have been harmed in therapy, then, as far as I am concerned, they have been harmed in therapy.

Here are some of the themes I have been aware of when in conversation with people who have returned to therapy after a previous harmful experience:

Grief: If a client comes to therapy to discuss harm in therapy, more often than not, this client will have been through a painful termination with their previous therapist. I have heard people in this position speak of carrying the great pain of this disenfranchised grief, and feeling as though those around them see the loss as little different to changing dentist or optician. Carrying this grief alone can be a weighty burden, even accompanied by a sense of shame and ‘unworthiness’ as a result of invalidation from a society that rarely acknowledges the depth and significance of the therapeutic relationship from the perspective of the client. While, of course, the therapeutic relationship does not hold tremendous significance to every client, for many, the relationship is not only central to the work, but also holds a significant, often reparative role in the client’s wider relational landscape. In my experience, it is often (though not always) clients for whom the relationship itself holds greatest significance, who are most vulnerable to experiencing harm in therapy.

Vulnerability: At the root of harm in therapy, as all iatrogenic harm (harm which occurs via contact with the helping professions – therapist, doctor, dentist, surgeon etc)  is vulnerability. When we go into surgery, when we see a doctor, when we meet with a psychotherapist, we inevitably make ourselves vulnerable to some degree. We must trust that the person in front of us wishes to do us good, not harm, and that they will do us good, not harm. When we experience harm in this vulnerable state, whether intentional or, as in most instances, purely accidental, it is shocking and very scary. I can only liken it to the reliance a child has on their caregivers – children are necessarily vulnerable; they rely on those around them to ensure their safety and security. To be in this situation as an adult and for it to backfire is an acute pain indeed.

Fear of a repeat performance: Clients are likely to return to therapy with their defences fortified. I certainly spent the first year or so telling my therapist that I didn’t have any feelings towards him one way or the other and that if I never saw him again, that would be fine by me. I look back on that wondering who I was trying to convince – myself, I am sure. I suspect it was my way of ensuring I was the guardian of my own vulnerability.  As I reflect on what was happening outside of my awareness, I actually praise the wisdom of my unconscious, and I am grateful to my inner world for the way in which it worked to protect me. When this particular defence realised it was safe to step down, it did, and the next phase of therapy could begin, but I learnt much about myself from its presence and the love I showed myself at this time.

I think, when a client returns to therapy after a harmful experience, it’s important that every feeling, even the kind I describe above, which might appear to be a barrier to relating, are recognised and treated as part of the process. In my view, defences are not a barrier to relating, they are a means of relating. As my supervisor says, the unconscious just does it’s thing, and it knows what it’s doing. It shifts as it receives new information, and in my view, there is no more healing a new experience than an unconditionally accepting, patient and trusting relationship.

* If you are a UK-based therapist who has worked with clients who have been harmed in counselling or psychotherapy and you would like to express an interest in participating in my research, please drop me an email at erinstevenscounselling@gmail.com . The research is likely to involve exploring your experiences and responses to working with clients who have been harmed in therapy. The focus of the research will be on your experiences and feelings, and not details of your client’s experience of harm in therapy, and will be anonymised. At the moment, the research is in the early stages of planning and I will not be officially recruiting participants until after Christmas. At this stage you would be expressing interest only. Thanks!