Are there any risks from engaging in psychotherapy?
Psychotherapy
Psychotherapy
appears, on the surface, to be one of the most benign forms of medical
therapies. There is (usually) no physical contact. No medications are
prescribed. Only words are exchanged between people, and nothing more.
However, never underestimate the power of words. There is a parable that
may be recalled from childhood: "Sticks and stones may break my bones but
names will never hurt me." Such a parable was created to provide comfort
from the emotional wounds received from being called names. One would not
need to recite such a parable if words did not hurt! Words carry power.
Just as psychotherapy has the power to heal, it also has the power to
harm. The harms vary from lack of progress to outright abuse. Most harm
from psychotherapy comes from what are known as boundary violations
between the therapist and the patient. The most obvious boundary
violation stems from sexual or physical relationships that can develop
between the therapist and patient. In many states, this boundary
violation is considered a criminal offense because the power differential
between the patient and therapist is so great as to put the patient in a
particularly vulnerable position.
Other Boundary Violations
Other boundary
violations are not as obvious. Simple exchanges of personal information
between the patient and therapist are often considered to be boundary
violations and may or may not lead to more serious offenses on the part
of the therapist. The potential dangers are that they may lead to
friendly meetings that move beyond the office, and friendly meetings may
turn more intimate. Although many patients may experience their
therapists as friends, such feelings generated are known in therapy as
transference. Transference is an artificial relationship that the patient
projects onto the therapist. In insight-oriented or dynamic (Freudian)
psychotherapy, a transference relationship is intentionally created to
allow the therapist to understand a patient's outside relationships
better. This in turn allows the therapist to help a patient develop
insight or greater understanding into the unconscious motives behind his
or her relationships so that healthy interactions can be learned.
Therapists also develop transference relationships to their patients
known as counter-transference. If the therapist is unaware of his or her
counter-transference, behavior toward patients reflects the therapist's
own outside relationships. If such relationships are problematic, a
patient may be made to feel that he or she is experiencing problems that
are really the problems of the therapist. Patients often idolize their
therapist, which makes patients particularly vulnerable to the influence
of their therapist's words.
A notable example of the vulnerability patients can have in therapy occurred
a few years ago when some cases were made public of patients believing
through their therapists' suggestions that their parents sexually abused
them. The process by which this occurred came about through the
implantation of false memories on the part of their therapists. The
therapists did not do this intentionally. However, in their zeal to
associate certain symptoms that their patients presented with to a
history of sexual abuse, they began to gradually convince their patients
that they had repressed memories of abuse. Once they had convinced their
patients of past abuse, false memories could easily be constructed by
asking them to imagine being abused or by implanting false memories
through hypnosis. "False memory syndrome" was coined, and several
high-profile legal cases occurred in which patients sued their therapists
for psychological damages as a result of the patients taking legal action
against their parents based on their false memories.
Avoiding the Risk of Psychotherapy
How can one
avoid such risks? One must rely primarily on referrals and word of mouth
from friends as well as other professionals. Generally, one's primary
care doctor has developed relationships with various therapists over the
years and knows their work. Success in therapy is not dependent on the
academic degree of the therapist as much as it is on the therapist's
training and experience in treating patients. Secondarily, one needs to
maintain an open mind to make changes if uncomfortable with a particular
therapist, no matter how skilled he or she may be. Chemistry between
patient and therapist is needed, and no amount of training provides that
for any particular patient. Success in therapy depends on how one feels
about the therapy sessions as well as the motivation from the therapist
to "do the work" outside of therapy in order to make the changes needed.
