Beyond Good Intentions: Examining the Potential Harms of Talk Therapy

In our journey toward mental wellness, we often place immense trust in the therapeutic process. As someone deeply committed to a biopsychosocial approach to healing, I’ve witnessed firsthand how professional support can transform lives. Yet, there’s a lesser-discussed phenomenon worth examining—iatrogenesis in therapy, or the potential harm that can occur through the very process designed to heal.

Understanding Iatrogenesis in the Therapeutic Context

Iatrogenesis, derived from Greek meaning “brought forth by the healer,” traditionally refers to adverse effects caused by medical treatment. In the context of psychotherapy, it encompasses negative outcomes directly resulting from therapeutic interventions.

Research suggests this isn’t merely theoretical. Studies indicate that approximately 5-8% of therapy clients experience worse mental health after treatment than before beginning. More concerning still, about 5% of individuals report “lasting bad effects” from their therapeutic experiences.

And the bigger issue is that your therapist may not be discussing potential negative outcomes/side effects of treatment with you or may not be asking and recording symptoms and side effects through the treatment process.

The Shadow Side of the Healing Process: Potential Harms of Talk Therapy

We hate to admit that something so helpful could have side effects or negative effects. But we can't forget that client autonomy and consent requires that we let them know what side effects may be possible. So what exactly constitutes these negative effects? Research has identified several common experiences:

• Unpleasant memories and feelings: Nearly 58% of clients report experiencing disturbing memories during therapy, with about 30% describing unpleasant feelings

• Misunderstanding and disconnection: Approximately 19% of clients report a lack of understanding of their treatment, while 18% feel misunderstood by their therapist

• Practical life impacts: Some clients experience deterioration in their physical well-being (13%), ability to work (13%), and overall vitality (11%)

• Boundary violations: Alarmingly, nearly 17% of clients report feeling violated by statements made by their therapist

As a wellness professional dedicated to reducing suffering, these statistics give me pause. They invite us to consider a more nuanced view of the therapeutic landscape.

Moreover, the very structure of therapy sessions can sometimes inadvertently reinforce negative patterns. By focusing primarily on problems, issues, or negative experiences during sessions, therapy may unintentionally create or strengthen a victim narrative rather than a liberating one. Clients may find themselves dwelling on difficulties, potentially overshadowing their resilience and capacity for growth.

This problem-centric approach can lead to a phenomenon where clients feel compelled to “collect” their hurts throughout the week, saving them for their therapy session. They may worry about having “enough” to discuss, inadvertently giving more weight to negative experiences. This practice can have several implications:

1. It may cause clients to over-focus on negative aspects of their lives, potentially distorting their overall perspective.

2. It could create a dependency on therapy as the primary outlet for processing emotions, potentially weakening natural coping mechanisms and support systems.

3. The anticipation of needing to report problems in therapy might lead to heightened anxiety or hypervigilance in daily life.

4. It may reinforce a belief that one’s identity is primarily defined by their struggles or traumas.

These considerations underscore the importance of a balanced therapeutic approach that not only addresses challenges but also actively cultivates resilience, celebrates progress, encourages healthy community and empowers clients to recognize and build upon their strengths. We have to remember that there are potential harms of talk therapy.

Is Modern Therapy Helping or Hurting?

The prevalence of therapy in contemporary society has grown exponentially. Mental health awareness campaigns encourage seeking professional help, and therapy has become increasingly normalized. This shift represents important progress in destigmatizing mental health care.

Yet we must ask: In our rush to professionalize emotional support, have we inadvertently pathologized normal human suffering? Have we created dependencies where resilience might otherwise develop? Moreover, we need to consider whether therapy sometimes reinforces a victim mentality, potentially hindering personal growth and agency.

The research presents a complex picture. While many clients report significant improvements—with positive changes in depressed mood reported by nearly 68% of clients—we cannot ignore those for whom therapy either fails to help or actively harms. Additionally, there’s a growing concern that therapy may over-pathologize parts of the human experience, labeling normal reactions to life’s challenges as disorders requiring professional intervention.

Therapists must be mindful of these potential pitfalls. It’s crucial to strike a balance between validating clients’ experiences and encouraging personal responsibility and resilience. This involves:

1. Carefully distinguishing between normal human struggles and clinical issues requiring intervention.

2. Empowering clients to develop their own coping strategies rather than fostering dependence on the therapeutic relationship.

3. Acknowledging the role of societal and environmental factors in mental health, rather than solely focusing on individual pathology.

4. Encouraging clients to maintain and strengthen their natural support systems alongside professional help.

By addressing these considerations, therapy can evolve to better serve individuals while respecting the full spectrum of human experiences and emotions.

The Erosion of Community Support Networks

Perhaps the most profound iatrogenic effect of therapy’s cultural dominance has been its impact on traditional support systems. As we’ve elevated professional helpers, we’ve simultaneously devalued the healing potential within communities, families, and friendships. This shift has had profound implications for how we approach emotional support and mental health. Traditional support systems like close-knit neighborhoods, religious communities, and extended family networks once played a crucial role in providing emotional sustenance and practical help during difficult times. These informal support structures offered a sense of belonging, shared wisdom, and collective resilience that professional therapy often struggles to replicate. By increasingly turning to professional therapists as the primary source of emotional support, we risk overlooking the powerful healing potential that exists within our immediate social circles and communities. This overreliance on professional help may inadvertently weaken our natural support systems and diminish our collective capacity for mutual aid and emotional reciprocity.

Consider how often we now hear phrases like “you should talk to someone” when a friend shares emotional difficulties. While well-intentioned, this suggestion subtly communicates that emotional support requires professional credentials rather than human connection. Just like when we use "trigger-warnings" we are subconsciously letting the person know they could be unable to deal with the content coming, sometimes it may be helpful but then it may have moments where it is harmful.

Traditional gathering spaces—religious communities, neighborhood associations, extended family networks—once provided containers for shared suffering and collective wisdom. These spaces, while imperfect, offered something therapy often cannot: belonging without pathology, support without a time limit, and wisdom derived from shared lived experience. This is exemplified in coming-of-age ceremonies found in many cultures. For instance, the Jewish Bar and Bat Mitzvah, Native American vision quests, or African tribal initiation rites serve as powerful community rituals. These ceremonies not only mark an individual’s transition to adulthood but also reinforce community bonds and shared values. They provide a sense of belonging and identity, offering psychological benefits that extend beyond the individual to the entire community. Such rituals create circles of shared experience and support, where elders pass down wisdom, peers celebrate milestones together, and younger members anticipate their own future roles. This intergenerational exchange fosters resilience, provides a sense of continuity, and offers emotional sustenance that professional therapy alone may struggle to replicate.

Finding Balance: Professional Help and Human Connection

The solution isn’t abandoning therapy—many dedicated therapists provide invaluable support using evidence-based methods. Instead, we might consider a more integrated approach that honors both professional expertise and community wisdom.

Some questions worth reflecting upon:

• How might we reclaim the wisdom of community support while maintaining access to professional help when needed?

• Can therapists work more collaboratively with clients’ existing support networks rather than positioning themselves as exclusive healing agents?

• How can we better identify which individuals might be vulnerable to iatrogenic effects in therapy?

• What role might other healing modalities—movement practices, creative expression, nature connection—play in supporting mental health alongside or instead of traditional talk therapy?

A Personal Invitation to Reflection

As someone committed to facilitating healing in others, I invite you to consider your own experiences with therapy and support systems:

• Has therapy enhanced or diminished your sense of resiliency?

• Do you feel more connected to your community since beginning therapy, or more isolated?

• Have you ever experienced negative effects from therapy that weren’t acknowledged or addressed? Did anyone ever discuss the risks or potential negative effects of therapy?

• What non-professional relationships and practices support your emotional wellbeing?

• Did you ever find yourself mentally "banking" emotional experiences to bring up at therapy? Was this helpful? How or how not?

• Have you ever tried group therapy? Why or why not?

There’s profound wisdom in your lived experience, regardless of whether therapy has been helpful, harmful, or somewhere in between. By sharing our stories and questioning our assumptions, we contribute to a more nuanced understanding of what true healing entails.

Moving Forward with Mindfulness

The conversation about iatrogenesis in therapy isn’t about dismissing professional help but rather enriching our understanding of healing. By acknowledging potential harms alongside benefits, we create space for more personalized, integrated approaches to emotional wellbeing. It’s crucial to recognize that not all therapists are created equal, and the quality of care can vary significantly based on a therapist’s training, experience, and personal approach. Moreover, the structure and approach to therapeutic appointments play a vital role in determining outcomes. Some therapists may employ a more directive, solution-focused approach, while others might use a non-directive, exploratory method. The frequency, duration, and format of sessions (e.g., individual vs. group therapy, in-person vs. teletherapy) can also impact the therapeutic process. By understanding these variables, we can better tailor therapeutic interventions to individual needs, potentially minimizing iatrogenic effects and maximizing positive outcomes.

In my practice, I remain committed to continuous learning about both the healing and potentially harmful aspects of the support I offer. I believe that by holding this tension with compassion and curiosity, we can collectively move toward more holistic models of care that honor the full complexity of human suffering and resilience.

What has your journey with therapy and community support taught you? I welcome your reflections and experiences as we navigate this terrain together.