I've been thinking about therapeutic harm a lot because it's so sadly common. Here's some thoughts on what it is, how it shows up, and why an anti-oppressive person-centred approach can mitigate some of the harms therapist's perpetuate in more rigid therapeutic approaches.
Okay, what is therapeutic harm?
Therapy is meant to be a safe and supportive space for healing, but it’s important to acknowledge that it can also cause harm. Therapeutic harm happens when a therapist inadvertently causes emotional, psychological, or relational damage to the person they’re supposed to help. This is a type of iatrogenic harm, which refers to harm caused by interactions with care professionals—whether they are therapists, social workers, nurses, doctors, or other healthcare providers.
When therapeutic harm happens, it can leave a lasting impact, often creating a deep sense of distrust in therapists and the counselling process. Opening up to someone when you’re feeling vulnerable is already a difficult and courageous act. So when that trust is broken through harmful practices, it can damage not only your relationship with the therapist but also understandably your willingness to seek help in the future.
What Does Harm in Therapy Look Like?
Therapeutic harm can take many forms. It’s not always obvious, and it can even happen without the therapist realising. From my experience working with folk, below are nine common examples of how harm can manifest in therapy, particularly when the therapist doesn’t take an anti-oppressive, person-centred approach:
Individualising stress and distress as your fault: when therapists fail to recognise systemic social, cultural, political, or economic factors that influence your wellbeing, they may blame you for your experience of stress and distress. This harm is especially damaging when you hold marginalised or minoritised identities.
Pathologising natural ways of being: viewing aspects of your identity—such as neurodivergence or queerness—as 'abnormal' or 'disordered' can be profoundly harmful. This pathologising approach can make you feel as though your real, congruent self needs to be 'fixed', 'healed' or changed in some way.
Judging you for not ‘getting better’ within a set timeframe: healing is not linear, and it doesn't fit neatly into externally imposed timelines. When a therapist judges your progress against rigid expectations, it can make you feel as though you’re failing, which can deepen feelings of shame and frustration.
Criticising you for not ‘complying’ with therapy methods: if a therapist focuses solely on manualised techniques and blames you for not responding in a certain way, it invalidates your individuality, expertise and personal healing journey. Therapy is not one-size-fits-all.
Pressuring you to recount traumatic experiences in detail: forcing or encouraging you to relive trauma without ensuring you’re ready can cause emotional distress and retraumatisation. This can leave you feeling exposed, overwhelmed, and worse off than before.
Acting as if the therapist is the expert on your experience: while therapists bring professional knowledge, you are the expert on your own life and experiences. When a therapist positions themselves as knowing better than you, it disempowers you and may make you feel unheard. This can also harm your ability to develop a sense of self-trust (or, your internal locus of evaluation).
Not asking for your consent to incorporate body-focused work: somatic (body) approaches can be powerful, particularly when it comes to understanding the role of your nervous system. For a variety of valid reasons however, they aren’t safe for everyone. Introducing these without your consent or without explaining the approach can feel intrusive or violating.
Imposing limits on what you ‘should’ or ‘shouldn’t’ talk about: therapy should be a space where you feel free to explore what’s important to you. It's a place for you to exercise your right to self-determination. If your therapist sets expectations on what is 'appropriate' to explore, it can stifle your healing process and leave you feeling silenced.
Pushing you to explore painful memories too quickly: revisiting difficult or traumatic memories can be overwhelming if done too soon or too often. If this is done without your full consent, it can cause unnecessary distress and risk retraumatisation. There is as much value in exploring pleasure, joy and meaning in therapy as there is in exploring traumatic experiences.
The Importance of an Anti-Oppressive Approach in Therapy
As therapists, it's non-negotiable that we must do our best to be aware of the power dynamics at play in the therapeutic relationship and to adopt an anti-oppressive approach. This means recognising and addressing systemic inequalities, validating the lived experiences of people we work with, and working collaboratively rather than imposing rigid frameworks or interpretations.
When therapists fail to consider the broader social, cultural, and political contexts of a person’s life, we risk perpetuating harm, even unintentionally. The goal should always be to create a safe, empowering, and respectful space for healing—one that values your identity, autonomy, and unique path to well-being.
We must also recognise that therapy cannot 'fix' or 'solve' oppression. Our role is to help you find meaning, connection and a sense of inner self-trust despite oppressive conditions.
So if you've experienced harm in therapy, know that it is not your fault. It’s okay to advocate for yourself, ask for a different approach, or find a new therapist who better aligns with who you are as a person. Therapy should be a space for growth and healing, not for harm.
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